Prevalence of Suicidal Ideation Among Clients Who Experience Discrimination

Suicidal ideation (SI) is a significant problem among college students. In addition to its burden of psychological suffering and distress, SI is associated with negative outcomes, such as increased risk of suicidal behavior and poorer academic performance (De Luca et al., 2016). While studies suggest that psychotherapy can reduce suicidality, some clients continue to have residual SI after a course of psychological treatment (Dunlop et al., 2019; Martin et al., 2023; Rallis et al., 2023; Treatment for Adolescents With Depression Study (TADS) Team, 2009).

Research has discovered that the experience of discrimination is associated with elevated mental health symptoms, which may be one factor that contributes to persistent SI after treatment (Center for Collegiate Mental Health, 2023; Oh et al., 2019; Paradies et al., 2015).  Numerous reasons could account for this relationship, including the cumulative effects of discriminatory experiences, and consequently, the expenditure of energy to cope with its consequences.  Additionally, groups of individuals that commonly experience discrimination are often oppressed at a structural level by factors such as legal frameworks, economic policies, and social environments, which can limit access to resources such as safe work environments, healthcare facilities, and educational opportunities (Bailey et al., 2017). The combination of cumulative stress from facing discrimination, structural oppression, and barriers to resources could contribute to increased mental health symptoms, including SI, by creating financial or other hardships, as well as limiting opportunities to treatment and other supports.

CCMH’s 2023 annual report found that college counseling clients who reported experiencing identity-based discrimination in the last 6 months were at increased risk of SI when they started treatment (Center for Collegiate Mental Health, 2023). Those who reported discrimination based on two or more of their identities were even more likely to endorse SI. However, CCMH’s report did not test the prevalence of SI among students who reported specific combinations of discrimination. For instance, differences in SI could exist for students who report various combinations of racial/ethnic, gender, or sexual orientation discrimination. A better understanding of how SI relates to discrimination based on intersecting identities such as these could help clinicians and counseling centers tailor their interventions and provide policy recommendations to support clients reporting discrimination. Thus, using the most updated CCMH data available, the following topics were investigated:  

1. Prevalence of discrimination among various student identity groups
2. Prevalence of suicidal ideation during the course of counseling services based on number of types of discrimination
3. Prevalence of initial suicidal ideation based on specific combinations of discrimination

In this blog, we utilized self-reported demographic data and mental health symptoms from 18,656 clients from the 2021-2024 academic years. Demographic data and self-reported identity-based discrimination in the past 6 months were collected using the Standardized Data Set (SDS) Client Information Form, and suicidal ideation at the beginning and end of treatment was measured with the Counseling Center Assessment of Psychological Symptoms-34 (CCAPS-34). Clients were separated into groups based on the unique combinations of discrimination they reported. While the SDS measures multiple types of discrimination, only discrimination based on gender, race/ethnicity/culture, and sexual orientation were included to avoid organizing the sample into groups that were too small for analysis.

Prevalence of Discrimination Among Various Student Identity Groups

CCMH previously examined the rates of specific identity-based discrimination within the corresponding identity group (Center for Collegiate Mental Health, 2022).  Using our most updated data from 2021 to 2024, the prevalence of racial, sexual orientation, and gender discrimination within the corresponding identity groups was evaluated. While all groups of students reported some level of identity-based discrimination, those with marginalized identities reported notably higher rates of recent discrimination, which was a consistent pattern across racial, sexual orientation, and gender identities.  

Prevalence of Suicidal Ideation During the Course of Services Based on Number of Types of Discrimination

The percentage of clients who reported SI decreased during treatment regardless of the number of types of discrimination they reported experiencing, suggesting that brief counseling was effective, on average, in reducing SI for the general population of students receiving counseling services. However, we found that overall, clients who experienced one or multiple types of discrimination were more likely to both enter and end treatment with higher levels of SI compared to those who reported no discrimination.   

Prevalence of Initial Suicidal Ideation Based on Specific Combinations of Discrimination

Clients who reported experiencing two types vs. one type of discrimination were generally more likely to endorse SI when they entered treatment. However, clients who reported either gender or sexual orientation discrimination only had a similar probability of endorsing SI as clients who reported any combination of two types of discrimination. Clients reporting all three areas of discrimination had greater likelihood of endorsing SI than any other combination of discriminatory experiences.

Summary, Implications, and Future Directions

• Clients with a wide variety of identities reported experiencing discrimination. Those who identify with historically marginalized groups in the U.S. demonstrated the highest rates of discrimination (e.g., transgender men and women, gay or lesbian clients, African-American clients).

• College counseling center clients who reported multiple types of discrimination were more likely to begin and end treatment with SI. Rates of SI decrease, on average, after a course of treatment for all clients, regardless of whether they reported discrimination. However, there were consistent disparities in endorsement of SI between those with and without discriminatory experiences.

• Various combinations of discrimination are associated with different levels of SI during treatment. For example, of students who reported two types of discrimination, those who had experienced discrimination based on both their gender identity and sexual orientation demonstrated the highest levels of SI at both the beginning and end of therapy.

• Because of the connection between discrimination and SI, we encourage counseling centers and clinicians to ask clients about potential experiences of discrimination or unfair treatment based on their identity, regardless of the identities they may hold. The presence of specific combinations of discrimination based on intersectional identities should also be assessed, given these appear to be disproportionately associated with SI and treatment outcome.

• Attention should be given to improving SI-focused interventions for college counseling clients who report experiencing discrimination. Based on previous research, increasing social connection, fostering engagement in meaningful activities, and supporting positive identity development and belonging may all be fruitful treatment targets.

• Clinicians and administrators should note that individuals who report perceived discrimination may be more likely to need additional counseling for SI beyond what can be provided in an abbreviated treatment model typically offered at college counseling centers. One way to support these individuals may be to provide extended session limits for these clients or implement standard procedures for providing referrals to culturally competent, longer-term care.

• Although discrimination is not a mental health problem, it provides vital environmental and contextual information that is associated with more severe mental health symptoms. Students who have discrimination experiences are more likely to report SI, and college counseling services help to relieve these symptoms. While college counseling centers can effectively support students with experiences of discrimination, addressing the psychological symptoms are only a small piece of the solution. Culturally informed support services (e.g., cultural centers, identity-based programs) are vital to buffer the impact of discrimination experiences, provide education/professional development to the campus community, and initiate advocacy to remedy societal sources of discrimination. 

References

Bailey, Z. D., Krieger, N., Agenor, M., Graves, J., Linos, N., & Bassett, M. T. (2017). Structural racism and health inequities in the USA: Evidence and interventions. Lancet, 389(10077), 1453-1463. https://doi.org/10.1016/S0140-6736(17)30569-X

Center for Collegiate Mental Health. (2022). Annual Report. https://ccmh.psu.edu/assets/docs/2022%20Annual%20Report.pdf

Center for Collegiate Mental Health. (2023). Annual Report. https://ccmh.psu.edu/assets/docs/2023_Annual%20Report.pdf

De Luca, S. M., Franklin, C., Yueqi, Y., Johnson, S., & Brownson, C. (2016). The relationship between suicide ideation, behavioral health, and college academic performance. Community Mental Health Journal, 52(5), 534-540. https://doi.org/10.1007/s10597-016-9987-4

Dunlop, B. W., Polychroniou, P. E., Rakofsky, J. J., Nemeroff, C. B., Craighead, W. E., & Mayberg, H. S. (2019). Suicidal ideation and other persisting symptoms after CBT or antidepressant medication treatment for major depressive disorder. Psychol Med, 49(11), 1869-1878. https://doi.org/10.1017/s0033291718002568

Martin, C. E., Stayton Coe, L. E., Pease, J. L., & Chard, K. M. (2023). Suicidal ideation in veterans enrolled in evidence-based psychotherapy for posttraumatic stress disorder. Psychological Services, 20(3), 465-473. https://doi.org/https://doi.org/10.1037/ser0000598

Oh, H., Stickley, A., Koyanagi, A., Yau, R., & DeVylder, J. E. (2019). Discrimination and suicidality among racial and ethnic minorities in the United States. Journal of Affective Disorders, 245, 517-523. https://doi.org/https://doi.org/10.1016/j.jad.2018.11.059

Paradies, Y., Ben, J., Denson, N., Elias, A., Priest, N., Pieterse, A., Gupta, A., Kelaher, M., & Gee, G. (2015). Racism as a determinant of health: A systematic review and meta-analysis. PLOS ONE, 10(9), e0138511. https://doi.org/10.1371/journal.pone.0138511

Rallis, B. A., Justin, P., E., S. B., Sangsun, K., & Locke, B. D. (2023). A comparison of treatment response between college students with and without suicide risk at university counseling centers. Cogent Mental Health, 2(1), 2169583. https://doi.org/10.1080/28324765.2023.2169583

Treatment for Adolescents With Depression Study (TADS) Team. (2009). The Treatment for Adolescents With Depression Study (TADS): Outcomes Over 1 Year of Naturalistic Follow-Up. American Journal of Psychiatry, 166(10), 1141-1149. https://doi.org/10.1176/appi.ajp.2009.08111620

Published May 22, 2025