Undergraduate and Graduate Student
Coping with Stressful Experiences:
The Continuum of Distress,
Suicidal Experiences and Outcomes
Chris Brownson, PhD
cbrownson@austin.utexas.edu
Elaine Hess, MA
ehess@utexas.edu
The University of Texas at Austin
Jennifer Kyle, PhD
jkyle3@gmail.com
Queens College
1
Founded in 1991 at UT Austin
 6 completed studies to date

◦ Will discuss data from our two most recent studies
and campus-level data
Membership is determined study-by-study
 Research is an essential ingredient for defining
a subspecialty of college mental health (Penn
State’s CSCMH, NCHA, Director’s Surveys,
etc.)

2
National Suicide Statistics
2nd leading cause of death on college campuses
 National suicide rates for college students range
from 6.5 to 7.5 per 100,000

◦ Compared to 16 per 100,000 in age-matched peers

Roughly 25% of campus suicides are counseling
center clients, nationally
◦ Suicides in CC clients are 3.3 times greater than nonclients
◦ When taking into consideration the 4 most significant
risk factors (previous attempts, psychiatric illness,
gender, and firearms), you would expect clients of CCs
to commit suicide 20 times more than non-clients.
Schwartz, 2006, 2011
3
Overview of Presentation
Overview problem of college student suicide
1.
◦
◦
◦
Consortium 2006 & 2011 structure/demographics
Problem of college student suicide
Key findings from Consortium studies
College Student Coping
2.
◦
◦
◦
◦
Distal and proximal risk factors
Presentation of study details
Proximal risk factors
Protective factor: Coping
Help-seeking
1.
◦
◦
◦
Help-seeking patterns
Help-avoidance patterns
Implications of help-seeking/avoidance data
4
Overview of Current
Study Characteristics


Web-based survey, anonymous, intervention
Over 26,000 undergraduate and graduate
student responses (~101,000 surveys sent)
~ 26% response rate



74 colleges and universities participated
Random sample at each school
Goal: Useful info for IHEs/CCs; both research
and “screening”
Demographics comparable to most recent
NCHA survey
5
Structure of Survey



Demographics
History of help-seeking, risk and protective
factors
Focus in on recent stressful period
◦
◦
◦
◦

Characteristics of stressor
Level of distress during worst point
Coping approaches
Outcomes (e.g., suicidal ideation)
Resolution
◦ Resilience and factors impacted ability to cope
6
Demographics
◦ N = 26,430
◦ Mean Age of 25.5 years
(Range: 18 – 95 years)
◦ 63% Female
◦ 92% Heterosexual
7
Race/Ethnicity
2011
Undergrad
N = 14,080
2011
Grad
N = 12,094
African American, of African descent, African, of
Caribbean descent, or Black
4.1%
4.5%
Asian or Asian American
8.1%
12.6%
Caucasian,White, of European descent, or
European
71.4%
67.9%
Hispanic, Latino, or Latina
6.5%
4.9%
Middle Eastern or East Indian
1.5%
3.0%
Native American or Alaskan Native
0.3%
0.3%
Native Hawaiian or other Pacific Islander
0.2%
0.2%
Other
1.4%
2.0%
Multiracial
6.3%
4.4%
8
Mental Health History
Ever received MH services from:
Undergrad
N=14,113
Grad
N=12,131
Counselor
37.4%
44.4%
Psychiatrist
12.0%
14.1%
Clergy
6.1%
10.4%
Other medical provider
10.2%
10.2%
Alternative medical provider
4.2%
4.9%
Other
1.4%
1.7%
Never
53.7%
46.8%
Ever received counseling from college
counseling center:
17.1%
22.6%
Taken medication for mental health
concern:
16.1%
22.8%
Been hospitalized for mental health
concern:
3.2%
3.0%
9
Lifetime Suicidal Ideation
for College Students

Approximately half endorsed some form
of suicidal thoughts in lifetime (Drum,
Brownson, Burton Denmark & Smith, 2009)

Approximately 20% endorsed seriously
considering suicide in lifetime (Drum et al.,
2009)

Female students more likely to report
lifetime ideation and attempts (Brownson,
Drum, Smith & Burton Denmark, 2011)
10
First Considered Suicide
When did you first
seriously consider
attempting suicide?
Undergrad
N = 3,088
Grad
N = 2,182
Before or while in
middle school
28.7%
23.2%
While in high
school
46.1%
33.9%
After high school
but before college
3.9%
3.9%
While in college
18.3%
18.7%
After college but
before graduate
school
.30%
8.4%
While in graduate
school
.10%
7.9%
Other
2.6%
4.4%
* Of those who have considered suicide at some point in their life
11
Recent Suicidal Ideation

5 to 6% seriously considered suicide in past 12

Episodes of ideation in past year
described as brief, recurrent and intense
months (Drum et al., 2009; ACHA-NCHA II,
2011)
◦ ~1% actually attempted in past year
(Drum et al., 2009)

Female students appear to be at greater
risk for recent suicidal ideation and
attempts (Brownson et al., 2011)
12
Prevalence of Lifetime &
Recent Suicide Attempts
2006
Undergrad
N = 15,010
2006
Grad
N = 11,441
2011
Undergrad
N = 14,080
2011
Grad
N = 12,094
Lifetime
7.6%
5.4%
7.2%
5.2%
Past 12
Months
0.85%
0.30%
0.81%*
0.22%*
1.1%
.40%
During
Stressful
Time
Period
*NOTE: 2011 Past 12 Months item asked of those who endorsed one or
more lifetime attempts; rates adjusted to reflect entire sample
13
Intentions at Time of Attempt
For those who said “Yes” to having attempted suicide during their most stressful period.
Which of these
statements describe
your intentions at the
time of the attempt(s)?
Undergra
d
N = 152
Grad
N = 43
I made a serious attempt to kill
myself and intended to die
24.3%
11.6%
I tried to kill myself but knew I
might survive
25.0%
20.9%
Was ambivalent and partly
wanted to live
35.5%
46.5%
Mostly wanted to live but small
part wanted to die
11.2%
11.6%
I did not intend to die
3.9%
9.3%
14
Role of Drugs & Alcohol in Attempt
For those who said “Yes” to having attempted suicide during their most stressful period.
How would you
describe the role
of drugs or
alcohol in your
most recent
suicide attempt?
Undergrad
N = 155
Grad
N = 43
I was not using alcohol or drugs
before or during my attempt
44.5%
53.5%
I intended to overdose with
alcohol or drugs
30.3%
27.9%
I intended to use alcohol or drugs
to reduce my inhibitions or fears
about attempting suicide
11.6%
9.3%
My attempt was not planned in
advance and may have happened
because I was using alcohol or
drugs
12.9%
14.0%
I was using alcohol or drugs but
they were not related to my
attempt
16.1%
11.6%
Addiction to alcohol or drugs was
a reason for my attempt
5.8%
2.3%
15
Thoughts During Stressful Period
During the
stressful period,
did you have any
thoughts similar
to the following?
(Select all that
apply)
Undergrad
N = 14,080
Grad
N = 12,094
This is all just to much
51.2%
44.5%
I wish this would all end
33.3%
27.5%
I have to escape
20.1%
17.1%
I wish I was dead
9.4%
7.3%
I want to kill myself
5.7%
3.6%
I might kill myself
3.1%
1.9%
I will kill myself
1.0%
.50%
I did not have any thoughts like
these
37.5%
42.8%
16
During the stressful period, did you have any
thoughts similar to the following?
30000
25000
20000
15000
10000
Those endorsing "yes" to
these thoughts
First
experience Most students
STRESS who experience
DISTRESS
5000
0
Entire
sample
This is
all just
too
much
I wish
this
would
all end
I have I wish I
to
was
escape dead
I want
to kill
myself
I might I will kill
kill
myself
myself
Adapted from a presentation prepared by
Arizona State University’s Wellness & Health Promotion Center
17
During the stressful period, did you have any
thoughts similar to the following?
30000
25000
20000
15000
The idea is to
reach students
here…
10000
Those endorsing "yes" to
these thoughts
…so fewer end
up here
5000
0
Entire This is
sample all just
too
much
I wish
this
would
all end
I have I wish I I want
to
was
to kill
escape dead myself
I might I will kill
kill
myself
myself
Adapted from a presentation prepared by
Arizona State University’s Wellness & Health Promotion Center
18
Discussion Questions
What are your campuses doing to try to shift the
curve (i.e., prevention & fostering well-being of
entire population)?
 What are some of the challenges with tying
suicide prevention to broader prevention
initiatives on campus?
 Counseling Centers and Health Education
Centers can’t be solely responsible for this

◦ What successes and challenges have you had in
collaborating with cross-campus partners?
19
Overview of Presentation
Overview problem of college student suicide
1.
◦
◦
◦
Consortium 2006 & 2011 structure/demographics
Problem of college student suicide
Key findings from Consortium studies
College Student Protective Factors and Coping
2.
◦
◦
◦
◦
Distal and proximal risk factors
Presentation of study details
Proximal risk factors
Protective factor: Coping
Help-seeking
1.
◦
◦
◦
Help-seeking patterns
Help-avoidance patterns
Implications of help-seeking/avoidance data
20
Distal vs. Proximal Risk Factors
◦ Suicide results from a complex interaction of
distal and proximal risk factors
 While having a lack of protective factors such as
coping skills, family cohesion, adequate social
support and access to mental health services
 Proximal Risk factors: Stressful life events,
Intoxication, Hopelessness
Moscicki, 2001
21
Distal vs. Proximal Risk
Distal Risk
Factors
e.g., vulnerability
Proximal Risk
Factors
e.g., Stressful Life
Events
Suicide Crisis
Protective Factors such
as coping, spiritual faith
influence the
progression
22
Queens College
Part of the City University of New
York, the nation's largest urban public
university.
 Established in 1937 to offer a liberal
arts education.
 Enrollment of 20,000 students,
including 16,000 undergraduate
students.
 Students come from nearly 170
different countries and speak over 110
different languages.
 One of the “Best Public UniversitiesMaster’s” institutions in U.S. News and
World Report’s America’s Best
Colleges.
Historically, a commuter school, however,
in 2011, Queens College opened the
first residential facility.
•
23
National vs. Campus Level Data
National
Queens College
Sample Size
26,430
78
Age
M = 25.5
Range: 18 - 95
M = 29.82
Range: 18 - 64
Gender
Female = 63%
Female = 70.5%
Sexual Orientation
Heterosexual = 92%
Heterosexual = 87.2%
Housing
Parents or family =
51.3%
Partner or spouse =
16.7%
Alone = 15.4%
24
Demographics: Race/Ethnicity
African American, of African descent, African,
of Caribbean descent, or Black
5.2%
14%
Asian or Asian American
11.6%
10.3%
Caucasian,White, of European descent, or
European
74.2%
41%
Hispanic, Latino, or Latina
7.8%
20.5%
Middle Eastern or East Indian
2.9%
2.6%
Native American or Alaskan Native
1.5%
--
Native Hawaiian or other Pacific Islander
.5%
--
Other
2.3%
5.1%
25
Religious Preference







Christian = 46.2%
Catholic = 29.5%
How important are your
Jewish = 16.7%
beliefs?
Buddhist = 3.8%
• Very important = 37.2%
Hindu = 3.8%
• Moderately important =
Agnostic = 10.3%
35.9%
Atheist = 5.1%
• Not at all = 25.6%
26
Connection with Friends & Family
Do you consider your
relationship with people you
spend most of your time with
to be:
Overall Sample
N = 26,297
M = 4.09
Queens College
N = 78
M = 4.00
1 - 2 (Not at all close)
4.7%
7.7%
3 (Moderately close)
23%
47.4%
4 - 5 (Very close)
71.8%
44.9%
On average, how close is your
relationship with your family?
N = 26,304
M = 4.16
N = 78
M = 3.96
1 – 2 (Not at all close)
6.5%
3.8%
3 (Moderately close)
18.7%
30.8%
4 - 5 (Very close)
74.3%
65.4%
27
Past History of Suicide

Ever consider attempting suicide:
◦ Yes = 19 (24%)
◦ No = 59 (75.6%)

When did you first consider suicide?
◦ Prior to college = 16 (20.5%)
◦ While in College/Other = 3 (3.9%)

Therefore, 84% of those having ever
thought about suicide had done so prior
to attending college.
28
Proximal Risk: Stress
What sources
of stress did
students
report?
Academics
Financial problems
Family problems
Emotional health
problems
Problems at work
Friendship problems
And during that time, what
was their level of distress?
64.1%
moderately to very much
(56.4%)
35.9%
moderately to very much
(33.3%)
32.1%
moderately to very much
(26.9%)
23.1%
moderately to very much
(21.8%)
21.8%
moderately to very much
(20.5%)
16.7%
moderately to very much
(12.8%)
29
Comparison of Students with History
of SI: Stress Management
When approaching
the challenges of
daily life:
History of
Suicide
Ideation Yes
(n = 19)
History of
Suicide
Ideation
No (n = 59)
..how critical are you of
yourself?
M = 3.58
M = 3.46
NS
…how capable are you
of managing your daily
challenges?
M = 3.89
M = 4.08
NS
t (23.506) = -2.630,
p < .05
…how motivated are
you to manage your
daily challenges?
M = 3.11
M = 4.02
…how meaningful do
you view your life to
be?
M = 3.00
M = 4.10
t (24.382) = -2.984,
p < .01
30
Proximal Risk: Stress & Its Impact on
Social Connectedness and Belongingness
Baseline
How much do you
feel you are a
burden on others?
How understood
by others do you
feel?
How cared for by
others do you feel?
How much do you
feel that you can
count on others?
How comfortable
do you feel making
new connections
Stressful
Period
t (73) = 2.680,
p < .01
M = 2.24
M = 2.59
M = 3.03
M = 2.94
NS
M = 3.77
M = 3.31
t (73) =
3.676,
p < .01
M = 3.01
M = 3.01
NS
M = 2.71
t (72) =
4.275,
M = 3.33
Increase in feeling a
burden
Decrease in feeling
cared for
Decrease in feeling
comfortable in
making new 31
Protective Factor: Coping
During the
stressful
period…
Methods
of
Student
Coping
How helpful
was this
method of
coping?
Type of Coping
Acknowledging
emotions
44.9%
moderately to very Emotion-focused
much (34.6 %)
Coping
Creating a plan
41.0%
moderately to very Problem-focused
much (32%)
Coping
Distracting
myself
38.5%
moderately to very
Avoidance Coping
much (32%)
Prayer
21.8%
moderately to very
Faith-based Coping
much (19.3%)
32
Coping: It’s Impact on Stress
How the following impacted your ability
to cope?
Improved
my ability to cope
Connection with your friends
59.0%
Connection with your family
51.3%
Having experienced a similar situation before
47.4%
Connection to religion, spirituality or a higher
power
32.0%
Connection with a mental health professional
14.1%
The strength of faith-based coping is its ability to find
meaning that allows one to overcome adversity and
maintain greater psychological and physical well being
(Wachholtz & Sambamoorthi, 2011)
33
Protective Factor:
Coping & Spiritual Faith

Faith-based coping
faith-
1) Helps develop personal meaning around a
particular stressful event, and regulate the
associated affective experience
2) facilitates the use of social support, e.g.,
based gatherings.
Youth with spiritual beliefs were more likely to
use and favorably evaluate social support
received
from a variety of sources, e.g., parents,
siblings,
friends and church groups and were less
at
risk.
34
Proximal Risk: Stress to Distress
And for some students, their distress
manifested as overwhelming thoughts:







This is all just too much = 36 (46.2%)
I wish this all would end = 29 (37.2%)
I have to escape = 15 (19.2%)
I wish I was dead = 6 (7.7%)
I want to kill myself = 6 (7.7%)
I might kill myself = 2 (2.6%)
I will kill myself = 1 (1.3%)
35
Stress – Distress Continuum

Key finding on suicide crisis in college
students reported that suicidal thoughts
are common but most importantly that
crises are often brief, intense and can be
recurrent (Drum, Brownson, Burton Denmark & Smith, 2009).
◦ Therefore understanding the role that individual and
environmental protective factors play in the students
progression from just being merely stressed to
distressed and contemplating suicide becomes
paramount.
36
Protective Factors
Protective factors are varied and can include
an individual's attitudinal and behavioral
characteristics, as well as attributes of the
environment and culture.
Examples:
 Strong connections to family and community support
 Skills in problem solving and coping
 Easy access to a variety of clinical interventions and
support for help-seeking
 Cultural and religious beliefs that discourage suicide
37
Protective Factors Study


◦
◦
Examining protective factors in a sample of
diverse college youth as a means of predicting
passive ideation
Instruments
Suicide (Outcome Variable):
1. Harkavy Asnis Suicide Scale (HASS)
Protective Factors (Predictor Variables) :
1. College Student-Reasons for Living Inventory
(RFL-CS)
2. Young Adult Social Support Inventory (YA-SSI)
3. Spiritual Well- Being Scale (SWBS)
38
Dependent Variable: Suicide
Data
Harkavy Asnis Suicide
Scale (HASS Demo)
History of Suicide Ideation
N (%)
Beginning at age 8
78
Mode: 14 years old
(32.1%)
16 (21%) reported having a plan
History of Suicide Attempts
6
(3%)
Most reporting only one attempt; 2
subjects reported 5 or more
Beginning at age 8
Mode: 13 years old
Current Suicide Ideation
(Past 2 weeks)
1.6%
(4)
3 subjects denied plan or intent
1 was brought to Counseling Center
Better off dead
(Within Past 2 weeks)
95
(39%)
Once: 82 (33.7%)
2 – 4 times/week: 13 (5.3%)
39
Student Distress: Passive Ideation
HASS I: Passive Ideation
Low
29%
Moderate
High
38%
33%
40
Protective Factors as Predictors of Passive Ideation
Summary of Hierarchical Regression Analysis Predicting Passive Ideation
Using Social Support, Spiritual Well-Being, Reasons For Living, Gender And
Religious Affiliation Variables (N = 243)
Variable
B
SE B
β
Gender
.470
.438
.085
Religious Affiliation
.144
.083
.137
Gender
.686
.423
.123
Religious Affiliation
.109
.079
.104
YA-SSI
-.935
.243
-.326***
CS-RFLI
-.265
.241
-.091
SWBS
-.617
.260
-.192*
Step 1
Step 2
Note: * p < .05; ** p < .01; ***p < .000 R2 = .137, F (5,163) = 5.034, p <.000, R squared change = .115, F change (3, 158) =
7.013, p <.000
41
Discussion Questions





Do we need to target students differently based on
distal versus proximal risk factors?
How can we foster better coping skills among students,
such as using freshman seminars?
How has your campus used existing programs or
outreach efforts to foster better coping among
students?
How can we increase social connectedness on college
campuses? And would we need differential strategies for
commuter versus residential universities?
As college counselors, how can we support students’
faith-based coping?
42
Overview of Presentation
Overview problem of college student suicide
1.
◦
◦
◦
Consortium 2006 & 2011 structure/demographics
Problem of college student suicide
Key findings from Consortium studies
College Student Coping
2.
◦
◦
◦
◦
Distal and proximal risk factors
Presentation of study details
Proximal risk factors
Protective factor: Coping
Help-seeking
1.
◦
◦
◦
Help-seeking patterns
Help-avoidance patterns
Implications of help-seeking/avoidance data
43
Methods Used to Connect to Others
How important is the following?
Baseline
(Mean)
During
Stressful
Period
(Mean)
Attempters
(Mean)
In person contact
4.41
4.20
3.71
Phone
3.77
3.46
2.91
Video chat
2.16
1.60
1.53
Email
3.61
1.96
1.68
Social networking (e.g., Facebook)
3.35
2.10
2.04
Text message
3.71
2.70
2.79
Gaming connections
1.48
1.19
1.31
Blogging
1.40
1.17
1.33
Other
1.39
1.20
1.22
Likert Scale
1 Not at all important – 5 Very important
44
Disclosing Suicidal Thoughts
2006 study: Asked of those who had seriously considered attempting suicide
(N=1,321)

54% told one or more people
First person
told:
16%
14%
3%
Romantic partner
Peer
Family
33%
Professional
34%

Other (e.g. clergy,
professor, RA)
46% told no one
45
Racial / Ethnic Identity Help-Seeking
Students Advised Seek
Professional Help
N = 596
Students Advised Seek
Help Who Did
N = 331
Caucasian
61%
72%
Multi-Ethnic
52%
36%
Latino/a
45%
50%
Asian American
40%
80%
Alaska Native /
American Indian
40%
50%
International Student
29%
50%
African American
27%
43%
Average
56%
69%
Racial/Ethnic
Identity
Help-Seeking Disparities for Racial and
Ethnic Minority Students
Alaska Native / American Indian, Asian American,
and Multiethnic students had more distressed
thinking or suicidal ideation than others
 Caucasian students more likely to be advised to
seek professional help from confidant
 Asian American students utilize professional help
at lower rates than other students

◦ Of those disclosing suicidal ideation, not frequently
encouraged to seek help from confidants
◦ In contrast, large proportion of those advised to
seek help do follow through
Brownson, Swanbrow Becker, Shadick, & Smith, in press
47
Help Seeking During a Stressful Period
2011 study: Comparison of sources of support sought by students who did and did
not seriously consider suicide during the stressful period
No one
Resident adviser
Alternative medical provider
Coach
Psychiatrist
Considered Suicide (N=1,167)
Clergy
Medical provider
Did Not Consider Suicide
(N=25,030)
Instructor (e.g. professor, TA)
Academic adviser
Psychologist, counselor or SW
Romantic partner
Family member
Friend, peer or roommate
0
10
20
30
40
50
60
70
48
Reasons for Choosing Help Sources
2011 Study: Asked of those who turned to someone for help during stressful period
Referred to them
Didn't know where else to turn
They had expertise
They had gone through experience before
Considered Suicide (N=959)
Appeared safe to confide in
Did Not Consider Suicide
(N=21,892)
They were easily accessible
Had received help from them before
Thought they would empathize
0
10
20
30
40
50
60
70
80
49
Reasons for Concealment
2006 study: Asked of those who seriously considered suicide and did not tell anyone
(N=769)
Concealment Category
Percentage
Example of Category
Low Risk
18%
“The chances of me going through with it wasn’t
extremely unlikely…even though I wanted to”
Solicitude
16%
“I didn’t want to bother anyone with my problems”
Privacy
15%
“Because it’s something I don’t feel comfortable sharing
with others”
Pointless
13%
“Didn’t think anyone would care, or that they wouldn’t
take me seriously”
Stigma
13%
“Didn’t want to appear weak, out of control, crazy”
Shame
7%
“I was ashamed to admit that I had these thoughts”
Repercussions
7%
“Because they would make me go to the doctor or tell
on me”
Interference
7%
“I didn’t want anyone to talk me out of doing it”
Perceived Lack of Confidants
3%
“There wasn’t anyone I felt I could turn to”
50
Reasons For Not Seeking Help
2011 Study: Asked of those who indicated seeking help from no one during stressful
period
Had a prior negative experience seeking
help (Pointless)
Thought there could be negative
consequences (Repercussions)
Other
Worried would be judged or thought of
differently (Stigma)
Did not want anyone to interfere or help
(Interference)
Considered Suicide (N= 199)
Felt ashamed or embarrassed (Shame)
Did Not Consider Suicide (N=2,904)
Did not feel there was anyone to talk to
(Perceived lack of confidants)
Did not want to burden others
(Solicitude)
Did not think I needed help (Low Risk)
Typically do not share concerns (Privacy)
Did not think it would be helpful
(Pointless)
0%
10%
20%
30%
40%
50%
60%
51
Future Help-Seeking & Referral of Others
to Counseling Center Services
Undergraduate sample, N = 13,960, M = 2.54
4-5 (Very likely)
After going through this stressful
period, how likely would you be to
seek help through your campus
counseling center for future stressful
experiences?
3 (Neither more nor less likely)
If you had a friend who was going
through a similarly stressful
experiences, how likely would you be
to refer her or him to the campus
counseling center?
1 (Not at all Likely)-2
0%
10%
20%
30%
40%
50%
52
Discussion Questions
Knowing that students are the most important
gatekeepers but the hardest to train, what can we
do?
 What are ways that IHEs can create a greater
sense of connectedness and belongingness among
students?
 Knowing how students connect to others
generally and when in stress, how do we best use
social media for creating meaningful connections?

53
Special Thanks To





The 26,000 Student Research Participants
The 74 Research Consortium Participating Institutions and
Counseling Center Directors
David Drum, Ph.D.
Adryon Burton Denmark, Ph.D.
The entire Research Consortium Team!!
http://cmhc.utexas.edu/researchconsortium.html
National Director: Chris Brownson, PhD
Email: cbrownson@austin.utexas.edu
54
References
American College Health Association-National College Health Assessment II [ACHA-NCHA II]:
Reference Group Data Report Spring 2011. Baltimore: American College Health
Association; 2011.
Brownson, C., Drum, D. J., Smith, S. E., & Denmark, A. B. (2011). Differences in suicidal experiences
of male and female undergraduate and graduate students. Journal of College Student
Psychotherapy, 25(4), 277–294.
Brownson, C., Swanbrow Becker, M., Shadick, R., & Smith, S. (in press). Suicidal behavior and help
seeking among diverse clients. Journal of College Counseling.
Drum, D. J., Brownson, C., Burton Denmark, A., & Smith, S. E. (2009). New data on the nature of
suicidal crises in college students: Shifting the paradigm. Professional Psychology: Research and
Practice, 40(3), 213-222.
Mościcki, E. K. (2001). Epidemiology of completed and attempted suicide: toward a framework
for
prevention. Clinical Neuroscience Research, 1(5), 310–323.
Schwartz, A. J. (2006). College Student Suicide in the United States: 1990-1991 Through 20032004. Journal of American College Health, 54(6), 341-352.
Schwartz, A. J. (2011). Rate, relative risk, and method of suicide by students at 4-year colleges and
universities in the United States, 2004-2005 through 2008-2009. Suicide and Life-Threatening
Behavior, 41(4), 353-371.
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