WHAT IS ALREADY KNOWN ON THIS TOPIC

College students represent a high-risk group for suicidal thoughts and behaviours (STBs).

Roughly half of suicides in the USA involved a firearm.

There are increasing instances of school-based acts of firearm violence.

WHAT THIS STUDY ADDS

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

Introduction

College students represent a high-risk group for suicidal thoughts and behaviours (STBs). Data on the health of US college students collected by the American College Health Association (ACHA) through the National College Health Assessment (NCHA) revealed that approximately a quarter of students reported past year suicidal ideation and approximately 9% of students endorsed a suicide attempt in the year prior.1 Meta-analytic research has highlighted that STBs are particularly common among college students.2 Moreover, there is a considerable impact of STBs on college students. For instance, research of first-year undergraduates found that a history of suicidal behaviour is associated with worse academic performance.3

Some research has examined the role of events that threaten safety, such as domestic violence on STBs4; however, there has been limited research on the impact of perceptions of safety on STBs. This is important to study because perceptions of safety may be a proximal mechanism of how exposure to violence increases risk for STBs and may also be relevant in individuals who have not been exposed to violence. One setting where examining the role of perceptions of safety’s effect on suicide risk may be particularly valuable is college campuses. College campuses often act as insular environments, making college students a unique population to consider based on the ability to assess campus safety and broader feelings of safety.

Relevant to suicide risk and feelings of safety is the presence of firearms. Roughly half of suicides in the USA involved a firearm.5 Regarding feelings of safety, beyond college campuses, some research suggests that Americans are split on whether the presence of firearms confers feelings of safety.6 Comparatively, investigation into student comfort with firearms at two large universities revealed that most students expressed low levels of comfort with concealed handgun carrying being permitted on campus.7 Recent research investigating support and opposition towards firearms on campus found that key stakeholders, including students, faculty, campus police and state legislators, were opposed to firearms on campus, whereas white, male and conservative stakeholders were more likely to be in support of campus carry laws.8

With increasing instances of school-based acts of firearm violence,9 there is also increasing concern regarding the impact of these experiences on student populations and the general impact of firearm presence on students. There is a need to investigate the extent to which feelings of safety relate to concerns about firearms and how such feelings and concerns impact one’s mental health—in particular, STBs. Leveraging ACHA-NCHA data, the present analyses aim to describe associations between feelings of safety, concerns about firearms on campus and STBs among college students.

MethodStudy design and participants

This study uses wave III of data from the ACHA-NCHA,10 which surveyed undergraduate and graduate students from fall 2019 to spring 2022. Schools opted in to have students complete items related to firearms. The present analyses contain data from the 29 schools that included firearm items, resulting in a sample of 24 682 participants. Participant demographic characteristics are reported in table 1.

Table 1

Demographics characteristics across wave

Measures

Safety. Participants were asked about feelings of safety in the following settings: ‘on my campus (daytime)’, ‘on my campus (night-time)’, ‘in the community surrounding my campus (daytime)’, ‘in the community surrounding my campus (night-time)’. Response options for each setting were: ‘not safe at all’, ‘somewhat unsafe’, ‘somewhat safe’, ‘very safe’.

Firearm violence concern. Participants were asked: ‘to what extent are you concerned about gun violence on campus?’ Response options were: ‘not at all concerned’, ‘slightly concerned’, ‘moderately concerned’, ‘very concerned’ and ‘extremely concerned’.

Past year suicide attempts. Participants were asked: ‘within the last 12 months, have you attempted suicide?’ with response options of ‘yes’ and ‘no’.

Past year suicidal ideation. Participants were asked: ‘how often have you thought about killing yourself in the past year?’ with response options of: ‘never’, ‘rarely—one time’, ‘sometimes—two times’, ‘often—three to four times’ and ‘very often—five or more times’. To be consistent with the binary format of past year suicide attempts, ‘never’ was recoded as no past year suicidal ideation and all other endorsements were collapsed to past year suicidal ideation.

Statistical analyses

Descriptive analyses are reported to describe rates of STBs and characterise feelings of safety and concerns about firearms. We conducted a series of multilevel logistic regressions using the lme4 R package11 to assess the impact of feelings of safety and concerns about firearm violence on suicidal ideation and suicide attempts. Cumulative link mixed models which handle ordered but non-continuous ordinal were used to assess the impact of concerns about firearm violence on feelings of safety, computed using the ordinal R package.12 All models used a multilevel structure grouped by school, given that features of the school (eg, location, school-wide safety procedures) may affect individual participants’ ratings within a school. The Benjamini-Hochberg correction procedure was used on all p values. Corrected and uncorrected p values are reported in all tables. Confusion matrices were calculated for all multilevel logistic regressions.

Results

Table 2 reports associations between concerns about firearm safety and STBs. Individuals with concerns about firearm safety on campus were more likely to report suicidal ideation compared with those reporting they were not at all concerned about campus firearm violence. This was not the case for suicide attempts.

Table 2

Associations between concerns of firearm violence on campus, feelings of safety and suicidal thoughts and behaviours

Table 2 also reports associations between feelings of safety and STBs. Suicidal thinking was significantly associated with feeling unsafe at night on campus and in the surrounding area. Suicide attempts were significantly associated with feeling unsafe at night on campus. For feelings of safety at night-time in the surrounding area, there was a significant difference such that individuals who felt ‘not safe at all’ were 48% more likely to report suicide attempts compared with individuals who felt ‘somewhat safe’. Feelings of safety during the day on campus was not significantly associated with STBs. For feelings of safety during the daytime on campus, there was only a significant difference such that individuals who felt ‘not safe at all’ were 44% more likely to report suicidal ideation compared with individuals who felt ‘very safe’. Feeling unsafe during the day in the surrounding area was significantly associated with suicide attempts. Online supplemental table S1 provides confusion matrices for the multilevel logistic regressions displayed in table 2.

Tables 3 and 4 report associations between concerns of firearm violence on campus and feelings of safety. Participants who reported being concerned about firearm violence felt significantly less safe on campus during the daytime and night-time and less safe in the surrounding areas in the daytime and night-time.

Table 3

Associations between concerns of firearm violence on campus and feelings of campus safety

Table 4

Associations between concerns of firearm violence on campus and feelings of surrounding area safety

Discussion

Findings from this large study of college students highlight important relationships between feelings of campus safety, firearm safety concerns and STBs. Some consistent patterns emerged. For instance, participants who reported being concerned about firearm violence felt significantly less safe on and off campus, and during the daytime and night-time, revealing a consistent relationship between firearm concern and decreased safety feelings, regardless of setting and time of day. Regarding safety, feeling unsafe at night was associated with both suicidal ideation and suicide attempts. Accordingly, with feelings of safety on campus associated both with increased concerns about firearm violence and increased STBs, there may be value in seeking to promote safety on campus.

These results support existing research regarding college campus stakeholders being opposed to firearms on campus,7 8 with the present results particularly highlighting the association between firearm concern and safety concern among a large sample of college students. Therefore, efforts to specifically address concerns about firearm safety may also help to increase feelings of safety. Future longitudinal research would help to increase the ability to comment on the directional nature of these variables to determine whether improving firearm safety would improve overall safety feelings, and accordingly lead to decreased STBs.

Beyond the distinct relationships between feelings of safety with concerns about firearm violence and STBs, concerns about firearm safety were also related to STBs. Individuals with concerns about firearm safety on campus were up to 42% more likely to report suicidal ideation compared with those reporting they were not at all concerned about campus firearm violence. While limited prior research has examined the impact of firearm violence on suicide-related outcomes, previous research has demonstrated that anxiety, stress and depression all increased following the increase in active shooter drills,13 which represents a direct response to firearm violence. However, this relationship of firearm concerns associated with suicide-related outcomes, did not hold up with suicide attempts in the present analyses. This may demonstrate a negative impact of the presence of firearms on mental health in the form of suicidal ideation. However, because of firearm concerns, these individuals may be more prone to engage in safety planning, which may include limiting access to lethal means,14 thereby not having an association with suicide attempts.

It is worth considering that the present analyses focus on safety perceptions. Both the campus safety item and the concern of firearms item refer to one’s own feelings and level of concern. Notably, this means that the results do not speak to actual safety. Importantly, long-standing evidence consistently suggests that the presence of firearms reduces safety.15 Therefore, for schools where firearms are prohibited, it may be worthwhile enacting public health messaging initiatives that highlight this information as a way to increase knowledge and potentially increase feelings of safety.16

There are several limitations to consider. First, universities had to opt in to have their students respond to questions related to firearms, thereby potentially introducing bias. Schools both firmly supportive and against the presence of firearms may have been inclined to opt out. Additionally, due to not having identifiers to link survey respondents across semesters, we lack the ability to comment on the longitudinal nature of these findings. Future research should seek to build on the current findings by leveraging prospective data.

Overall, these analyses highlight nuanced relationships between feelings of safety, concerns about firearms on campus and STBs among college students. The results highlight increased risk of STBs among those with reduced safety feelings and heightened concerns about firearms. There is a need for college campuses to intervene and promote campus safety, with consideration for the presence of firearms on campus and the implications of allowing such weapons to be present in environments with increasing instances of firearm violence.

Ethics statementsPatient consent for publication

Consent obtained directly from patient(s).

Ethics approval

This study involves human participants. This study involves the use of existing data from the ACHA-NCHA database and was therefore exempt from IRB approval. Participants gave informed consent to participate in the study before taking part.

Acknowledgments

The original data set for the American College Health Association—National College Health Assessment is available by contacting the American College Health Association (https://www.acha.org//NCHA). The opinions, findings and conclusions presented/reported in this article/presentation are those of the author(s) and are in no way meant to represent the corporate opinions, views or policies of the American College Health Association (ACHA). ACHA does not warrant nor assume any liability or responsibility for the accuracy, completeness or usefulness of any information presented in this article/presentation.