Suicidal behavior is a significant concern on college campuses, and suicide is the second leading cause of death in college student populations. Consistent with recommendations in the National Strategy for Suicide Prevention and spearheaded by organizations such as the American Foundation for Suicide Prevention, many universities have initiated voluntary web-based screening to identify students at elevated risk for suicide and in need of mental health services. This is a promising direction; however, research is needed to determine the efficacy of such an approach and how to most effectively link students with positive screens to professional services. With NIMH funding for an R34 intervention development grant, we developed, pilot tested and iteratively refined a theoretically-driven intervention, Students' eBridge to Mental Health (eBridge), which identifies students at elevated suicide risk and facilitates their linkage to mental health (MH) services. eBridge incorporates motivational interviewing (MI) principles and draws from health behavior promotion models that emphasize autonomy and self-determination. Following a web-based screen using standardized instruments to identify students at elevated risk (positive screens on any two or more of: lifetime suicide attempt, current suicidal ideation, alcohol abuse, depression), eBridge offers students the options of receiving personalized feedback (provided online in a conversational MI-adherent format) and corresponding online with professionals trained in MI and knowledgeable about local resources. In our R34 pilot randomized trial, students in the control condition received personalized feedback only, which was provided automatically and in graphic format. At 2-month follow-up, students assigned to eBridge reported (a) significantly higher levels of readiness to seek MH services; (b) significantly lower levels of stigma related to MH services; and (c) a higher likelihood of linking to MH services. In this application, we propose to conduct a large-scale, well-powered randomized controlled intervention trial across multiple universities to address the following specific aims: (1) determine the impact of eBridge on linkage to MH services, MH outcomes (suicidal thoughts and behaviors, depression, alcohol/substance misuse), and academic outcomes (grade point average, retention) at 6-month follow-up; and (2) examine possible moderators (gender, baseline levels of functioning, baseline recognition of problem) and mediators (engagement in online counseling, linkage to MH services) of eBridge effectiveness. Secondary aims include determining the costs associated with, and cost effectiveness of, the intervention. If the intervention is shown to be effective in his large-scale trial, it could be disseminated broadly to address suicide risk and associated mental health conditions and adverse consequences among college adults nationwide.
Suicide is a leading cause of death among young adults. Moreover, recent national surveys indicate that 6 - 10% of college students have seriously considered attempting suicide within the past year. In keeping with recommendations in the National Strategy for Suicide Prevention (US DHHS, 2012), this project will examine the efficacy of e-Bridge, an online intervention that identifies students at elevated suicide risk and facilitats their linkage to mental health services, in a multi-university randomized trial.