Emotional abuse emerges as top predictor of suicidal thoughts in largest-ever student study

A massive international study has found that almost half of all first-year university students have experienced suicidal thoughts at some point in their lives, a rate significantly higher than that of the general population. The research, which is the largest of its kind ever conducted, also identified key risk factors, including childhood adversity and specific mental health conditions, that are associated with these thoughts and behaviors. The findings were published in the journal Psychiatry Research.

The transition to university represents a period of profound change and heightened stress for young people. Many students are leaving home for the first time, facing new academic pressures, and navigating complex social environments. Previous research has indicated that this age group has seen a concerning rise in suicidal ideation in recent years.

Scientists have long understood that factors like difficult childhood experiences and mental health disorders are linked to suicide risk. However, there was a need for a large-scale, comprehensive study to quantify the prevalence of these issues among a global student population and to better understand the specific pathways that lead from suicidal thoughts to plans and attempts. This investigation aimed to fill that gap by examining these connections in an exceptionally large and diverse group of students.

The research was conducted as part of the World Mental Health International College Student Initiative, a project led by Harvard University. Between 2017 and 2023, the researchers gathered data from nearly 73,000 students, most of whom were in their first year of university. The participants were spread across 71 universities in 18 different countries, including Australia, Canada, Spain, Kenya, Mexico, South Africa, and Sweden.

Students at participating institutions were invited via email to complete a confidential online survey. This questionnaire was designed to gather information on several fronts. It asked students if they had ever experienced suicidal thoughts, made a suicide plan, or attempted suicide. It also included questions to assess their history of mental health disorders and whether they had faced adverse life events, particularly during childhood.

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The survey responses painted a stark picture of the mental health challenges facing this population. The data revealed that 47 percent of the students who participated had experienced suicidal thoughts at some point in their lifetime. Beyond thinking about suicide, 26 percent reported having made a specific plan, and 10 percent had made a suicide attempt.

The numbers were also high for the 12 months immediately preceding the survey. Within that one-year period, 30 percent of students had experienced suicidal thoughts, 14 percent had made a plan, and 2.3 percent had attempted suicide.

The researchers noted that these rates are substantially higher than those found in the general population. They did offer a word of caution, suggesting that the results might be slightly overestimated. This is because students who have struggled with suicidal ideation may have been more inclined to participate in a survey on mental health, a phenomenon known as self-selection bias.

A central finding of the study was the connection between childhood experiences and later suicide risk. Philippe Mortier, a researcher at the Hospital del Mar Research Institute who was involved in the study, explained that experiences of emotional abuse, sexual abuse, and neglect are strongly associated not only with the initial development of suicidal thoughts but also with the progression to making plans and attempting suicide.

“Exposure to emotional abuse, sexual abuse, and neglect—especially during childhood—is directly linked to suicidal ideation and the progression to planning and attempting suicide,” explains Mortier. “All these factors carry risk — every traumatic event, every mental disorder, without exception — increases the risk of suicidal thoughts and suicide attempts.”

The results also pointed to the impact of having parents with mental health disorders, which was identified as a risk factor that can contribute to a child’s exposure to adversity.

The analysis also shed light on how risk is distributed unevenly across different student groups. Gender identity emerged as a significant factor. Students who identified as transgender were found to be at a substantially higher risk for suicidal behaviors. Compared to their peers, they were 2.4 times more likely to experience suicidal thoughts and 3.6 times more likely to attempt suicide. The researchers suggest that this is because transgender individuals are often exposed to a greater number of risk factors, including social stigma and discrimination.

The study also found that sexual orientation was a key predictor. Students identifying as non-heterosexual faced a greater likelihood of suicidal thoughts and behaviors. These risks remained even after accounting for other factors like childhood adversity and mental health disorders.

When all factors were considered together, the three strongest predictors of suicidal behavior were a history of emotional abuse, a diagnosis of major depressive disorder, and a diagnosis of bipolar disorder.

The study also provided a more nuanced look at how different factors influence different stages of suicidal behavior. For example, mood disorders like major depression were most strongly associated with the initial emergence of suicidal thoughts. In contrast, other conditions, such as panic disorder and bipolar disorder, were more strongly linked to the transition from having thoughts to making an attempt.

This distinction helps to show the complex processes involved in escalating suicide risk. Similarly, emotional abuse was a very strong predictor for the onset of suicidal thoughts, while physical abuse was uniquely associated with the repetition of suicide attempts over time. These patterns suggest that different types of interventions may be needed for students at different points on the risk spectrum.

Mortier stated that preventing these outcomes will require a greater investment in mental health support at the university level. He argued that institutions need more resources to help reduce the prevalence of mental health disorders and lower the risk of suicide among their students.

Jordi Alonso, the Spanish coordinator of the initiative, added that effective prevention must be comprehensive. He explained that any successful strategy has to take into account the combination of risk factors that a student may face. This includes their sex, gender identity, sexual orientation, and any accumulation of adverse childhood experiences. These factors can interact in ways that create a negative feedback loop, progressively increasing an individual’s vulnerability to suicide.

The researchers acknowledged several limitations to their work. The study was cross-sectional, meaning it captured a single moment in time. A longitudinal study that follows the same group of students over several years would provide a deeper understanding of how these risk factors develop and interact over time.

The information on mental health disorders and childhood adversity was also based on students’ self-reports rather than on formal clinical interviews. Finally, because the study included a specific set of 18 countries, the results may not be generalizable to all university students globally. Future research is needed to replicate these findings in other populations and to design and test prevention programs based on the risk factors identified in this extensive investigation.

The study, “The associations of childhood adversities and mental disorders with suicidal thoughts and behaviors – Results from the World Mental Health International College Student Initiative,” was authored by Philippe Mortier, Xue Yang, Yasmin A. Altwaijri, Jacob A. Holdcraft, Sue Lee, Nancy A Sampson, Yesica Albor, Ahmad N. Alhadi, Jordi Alonso, Nouf K. Al-Saud, Claes Andersson, Lukoye Atwoli, Randy P. Auerbach, Caroline Ayuya Muaka, Patricia M. Báez-Mansur, Laura Ballester, Jason Bantjes, Harald Baumeister, Marcus Bendtsen, Corina Benjet, Anne H. Berman, Ronny Bruffaerts, Paula Carrasco, Silver C.N. Chan, Irina Cohut, María Anabell Covarrubias Díaz Couder, Marcelo A. Crockett, Pim Cuijpers, Oana A. David, Dong Dong, David D. Ebert, Jorge Gaete, Mireia Felez-Nobrega, Carlos García Forero, Margalida Gili, Raúl A. Gutiérrez-García, Josep Maria Haro, Penelope Hasking, Xanthe Hunt, Mathilde M. Husky, Florence Jaguga, Leontien Jansen, Álvaro I. Langer, Yan Liu, Scarlett Mac-Ginty, Vania Martínez, Andre Mason, Muthoni Mathai, Margaret McLafferty, Andrea Miranda-Mendizabal, Elaine K. Murray, Catherine M. Musyoka, Siobhan M. O’Neill, Claudiu C. Papasteri, José A. Piqueras, Codruta A. Popescu, Charlene Rapsey, Kealagh Robinson, Tiscar Rodriguez-Jimenez, Damian Scarf, Oi-ling Siu, Dan J. Stein, Sascha Y. Struijs, Cristina T. Tomoiaga, Karla Patricia Valdés-García, Shelby Vereecke, Daniel V. Vigo, Angel Y. Wang, Samuel Y.S. Wong, Ronald C. Kessler, and the World Mental Health International College Student collaborators.