Suicide behavior in college students and peers' response Open Access

Garcia-Williams, Amanda (2015)

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Suicide is a significant public health problem among college students. Suicidal college students generally do not seek help during their time of crisis but when they do, they tend to turn to their peers. There is growing evidence that college students have considerable exposure to suicidal people, with many students experiencing a suicidal communication event. Currently there is minimal understanding of what college students do when a peer discloses to them that they are suicidal, how they react, or the factors that shape their behavioral response toward the peer. The aim of this mixed methods dissertation project was to fill this gap in the literature and gain a comprehensive understanding of how college students experience suicidal peers from both an experimental and lived-experience perspective. The long-term objective of this project was to identify factors that predict helping behavior towards suicidal peers so that these factors can be targeted in behavioral interventions. Three studies were conducted as part of this dissertation. Study 1 examined the effect ambiguity of a suicide communication event and number of bystanders to a suicide communication event has on college student intention to engage in helping behaviors. Study 2 tested the efficacy of the Arousal: Cost/Reward Model (ACRM) to explain college student intention to seek advice about a suicidal peer. Study 3 developed a grounded theory based on data collected from in-depth interviews among college students with previous experience with a suicidal peer. Results of this dissertation suggest that interacting with, and providing support to, a suicidal peer is complicated. Across all three studies, aspects of the situation and the bystander shape the behavior of college students confronted with hypothetical and real suicidal peers. College students may assume an informal caregiving role when faced with a suicidal peer and as such, the ACRM may not be an ideal theoretical framework to use. Future work should incorporate a behavioral-systems perspective of prosocial behavior to understand why college students help suicidal peers, and utilize models of stress and coping to evaluate how students cope with the provision of care to a peer in crisis.

Table of Contents

Chapter 1: Introductory Literature Review. 1

Risk and Protective Factors. 2

Service Utilization and Help Seeking. 5

Exposure to and Perceptions of Suicide. 8

Helping Behaviors Towards Suicidal Peers. 9

Prosocial Behavior and the Arousal: Cost/Reward Model (ACRM). 10

Figure 1.1 Modified version of Arousal/Cost-Reward Model. 12

ACRM and Helping Behavior Towards Suicidal Peers. 20

Rational for Research. 22

Chapter 1 References. 25

Chapter 2: Relationship between bystanders and ambiguity on college students' perceptions and behavioral intention towards suicidal peers. 36

Abstract. 37

Introduction. 39

Methods. 43

Results. 46

Discussion. 49

Chapter 2 References. 59

Table 2.1 Hypothetical vignettes of peers disclosing suicidal ideation with varying levels of ambiguity and number of bystanders presented. 65

Table 2.2 The relationship between number of bystanders and perceived severity, perceived costs, and behavioral intention when level of ambiguity is held constant. 66

Table 2.3 The relationship between situation ambiguity perceived severity, perceived costs, and behavioral intention when number of bystanders are held constant. 67

Chapter 3: Seeking advice about a suicidal peer: An experimental study testing the Arousal: Cost-Reward Model. 68

Abstract. 69

Introduction. 70

Methods. 74

Results. 80

Discussion. 83

Chapter 3 References. 92

Table 3.1 Hypothetical vignettes of peers disclosing suicidal ideation with different levels of ambiguity. 97

Table 3.2 Correlation matrix of measures included in this study across both survey conditions. 98

Figure 3.1 Path analyses of perceived costs mediating the relationship between perceived severity, emotional prosocial personality, victim perception and behavioral intention. 99

Chapter 4: A grounded theory of college experience with suicidal peers: Shifting to a caregiving perspective. 101

Abstract. 102

Introduction. 103

Methods. 107

Results. 110

Discussion. 124

Chapter 4 References. 133

Table 4.1 Characteristics of interview participants and aspects of their experience with suicidal peer(s). 139

Figure 4.1 Grounded theory of college student experience with suicidal peers. 140

Table 4.2 Constructs that made up the helper, suicidal peer and contextual characteristics of Phase 1, their description, and exemplar quotes. 141

Table 4.3 Constructs that make up emotional response, coping response, and outcomes with exemplar quotes. 143

Chapter 5: Overall Summary and Conclusion. 145

Chapter 5 References. 157

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