Increasing Engagement of College Students At-Risk for Suicide in Online Intervention

Purpose: We aim to address the significant unmet mental health needs of college students at-risk for suicide through improving the uptake, retention, and effectiveness of online intervention. Nearly 25% of college students experience suicidal ideation and one in 30 attempt suicide. It is well documented that suicidal ideation, depression, and anxiety are highly prevalent in college students and are major risk factors for suicide attempts. Alarmingly, most of these students do not receive treatment, and 90% who die by suicide never sought treatment at campus counseling centers. College resources are being outpaced by the increasing demand for services, and students are reluctant to seek in-person treatment. Online interventions have significant promise for increasing treatment availability in a format that addresses barriers and preferences specific to this population. However, previous online intervention studies have been limited by low adherence and high attrition, and efficacy has not been tested for college students at-risk for suicide. Research Aims and Hypotheses: To address these significant gaps, we will: 1) assess perceptual and practical barriers to using online intervention; 2) develop engagement strategies to increase enrollment and retention in online intervention; and 3) test the feasibility, acceptability, and potential efficacy of an online intervention, Therapist Assisted Online, with engagement strategies (Enhanced TAO). We hypothesize that Enhanced TAO will be feasible and acceptable as evidenced by: a) high proportion of suicidal students enrolling (at least 60%); b) high retention of participants (at least 60% complete 7 modules); c) high reported levels of satisfaction; and d) significant reductions in suicidal ideation following Enhanced TAO. Sample: Undergraduate students enrolled at Montclair State University (MSU) experiencing suicidal ideation or history of suicide attempt and elevated depression or anxiety symptoms. Twenty-four students will participate in focus groups, 10 in the individual interviews, and 40 in the open trial. Measures: Data will be collected on enrollment rates, number of sessions completed, attrition, participant satisfaction, suicidal ideation and behavior, depression, anxiety, and treatment readiness. Procedures: We will first conduct focus groups and interviews to assess barriers to using online interventions. Engagement strategies will be informed by the Unified Theory of Acceptance of Technology and qualitative data, and along with Co-investigators and Consultants be developed and piloted in conjunction with TAO in an open trial. Students who participate in routine MSU suicide screenings and meet study eligibility will be invited to participate. Following informed consent, students will receive Enhanced TAO, and complete study assessments at baseline, three- and seven-weeks. Potential Impact: This work has the potential to serve as a model to increase treatment engagement among at-risk students who would otherwise not seek help, expand existing mental health services on college campuses, and improve efficiency. It extends AFSP's work on web-based suicide prevention by testing a novel intervention strategy that can be paired with online mental health screening and possibly used in a stepped approach to treatment. Next Steps: If we can demonstrate that Enhanced TAO is acceptable, feasible, and potentially efficacious, additional testing via a larger controlled trial would be warranted.