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Suicide Among College Students in Psychotherapy: Individual Predictors
and Latent Classes
Jeffrey A. Hayes, Justin Petrovich, Rebecca A. Janis, Ying Yang, Louis G. Castonguay,
and Benjamin D. Locke
Pennsylvania State University
This study sought to identify predictors of suicidal behavior among college students who are psycho-
therapy clients, as well as to determine underlying classes of clients with suicidal ideation. Data were
gathered from 101,570 clients, 391 of whom engaged in suicide behavior during treatment. Regression
analyses revealed that suicide behavior was positively associated with 3 pretreatment variables: depres-
sion, prior suicide behavior, and prior nonsuicidal self-injury. Four latent classes of clients with suicidal
ideation were identified that were named “prior ideation,” “extensive risk,” “prior treatment,” and
“circumscribed depression.” The number of clients in each class varied widely, as did the relative risk of
suicide behavior. Implications for treatment, suicide assessment, and suicide prevention are discussed.
Public Significance Statement
This study demonstrates that psychotherapists should attend to particular indicators of possible
suicide behavior among their college student clients and that there are different types of suicidal
college student clients, each with their own associated risk of suicide behavior.
Keywords: suicide, psychotherapy, college students, depression
Suicide represents a significant public health concern. More
than 45,000 people in the United States die by suicide each year
(Centers for Disease Control and Prevention [CDC], 2018). Ap-
proximately 7% of U.S. citizens have experienced the death of a
friend or family member due to suicide (Berman, 2011). In addi-
tion to the obvious emotional toll of suicide for individuals, fam-
ilies, and communities, suicide behavior (i.e., any action intended
to take one’s own life) results in more than $70 billion in medical
and work-related costs in the U.S. every year (CDC, 2018).
Suicide is the second leading cause of death among traditionally
aged college students in the U.S., with a prevalence of approxi-
mately 14 deaths per 100,000 persons (CDC, 2018). Some studies,
however, indicate that death by suicide is less common among
college students than similarly aged peers (Schwartz, 2013;Sil-
verman, Meyer, Sloane, Raffel, & Pratt, 1997), due in part to lower
rates of gun ownership. Research suggests that, each year, 10% of
college students seriously consider suicide and roughly 1.5% en-
gage in suicide behavior (Schwartz, 2006;Westefeld et al., 2005;
Wilcox et al., 2010); these rates have increased slightly every year
since 2010 (Center for Collegiate Mental Health, 2019). Fortu-
nately, effective programs have been developed whose goal is to
direct at-risk college students to campus counseling centers to
receive psychological help (Garlow et al., 2008;Haas et al., 2008).
Inherent in such efforts is the recognition that university counsel-
ing centers serve high-risk students. Students attended more than a
million sessions of psychotherapy on U.S. campuses during the
2016 –2017 academic year (LeViness, Bershad, & Gorman, 2017),
and compared with students in general, those who seek psycho-
therapy are more depressed, hostile, and anxious. They are also
three times more likely than their classmates to report high levels
of suicide ideation and five times more likely to have made a
previous suicide attempt (McAleavey et al., 2012). A survey of
counseling center directors indicated that, on average, four clients
per year in each center engage in suicidal behavior (LeViness et
al., 2017). It has been estimated that the relative risk of suicide for
This article was published Online First September 26, 2019.
XJeffrey A. Hayes, Department of Educational Psychology, Counseling,
and Special Education, Pennsylvania State University; Justin Petrovich, De-
partment of Statistics, Pennsylvania State University; Rebecca A. Janis, De-
partment of Psychology, Pennsylvania State University; Ying Yang, Depart-
ment of Educational Psychology, Counseling, and Special Education,
Pennsylvania State University; Louis G. Castonguay, Department of Psychol-
ogy, Pennsylvania State University; Benjamin D. Locke, Department of Coun-
seling and Psychological Services, Pennsylvania State University.
Justin Petrovich is now at the Department of Business at St. Vincent
College.
This study was funded by a grant from the American Foundation for
Suicide Prevention, SRG-1-063-13. The authors are grateful to Janet E.
McCracken for her helpful comments on a previous version of this article.
We are grateful to the Center for Collegiate Mental Health for gathering the
data that were analyzed in this research. The specific data that were
analyzed have not been examined prior to this study, and the findings from
this article have not been disseminated previously in any format.
Correspondence concerning this article should be addressed to Jeffrey A.
Hayes, Department of Educational Psychology, Counseling, and Special
Education, Pennsylvania State University, 307 Cedar Building, University
Park, PA 16802. E-mail: jxh34@psu.edu
This document is copyrighted by the American Psychological Association or one of its allied publishers.
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Journal of Counseling Psychology
© 2019 American Psychological Association 2020, Vol. 67, No. 1, 104–114
ISSN: 0022-0167 http://dx.doi.org/10.1037/cou0000384
104
