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Change in Suicidal Ideation Among Clients Who Experience Discrimination

by: Serena Chen
Category: New Findings
May
18

CCMH’s 2023 Annual Report annual report found that college counseling center clients who experienced identity-based discrimination were more likely to have suicidal ideation (SI) at the beginning of treatment. A more recent CCMH Blog also discovered that while clients’ average levels of SI improved regardless of their report of discrimination, there were disparities between those with and without discrimination: clients who reported any discrimination had higher SI at the end of treatment, and this discrepancy was even more pronounced among those with discrimination based on multiple aspects of their identity.

Building on these previous findings, this blog examines change in SI from the first to last counseling sessions among clients who reported 0, 1, 2, and 3 types of discrimination out of gender, sexual orientation, and race/ethnicity/culture discrimination. While our past research indicated that disparities exist in prevalence of SI at the end of treatment between clients who do and do not experience discrimination, our goal was to explore the magnitude of improvement in SI and determine if the outcome gaps were narrowed between clients who indicated various types of discrimination. 

To answer this question, we used data from 45,640 clients who received treatment from 93 college counseling centers in the United State from 2021 to 2024.  The Standardized Data Set (SDS) - Client Information Form was utilized to collect self-reported identity-based discrimination in the past six months, and the Counseling Center Assessment of Psychological Symptoms-34 (CCAPS-34) was used to measure SI at the beginning and end of treatment.

Change in SI Across Number of Types of Discrimination

Consistent with prior findings, clients who reported discriminatory experiences had higher SI severity at the beginning of treatment. Specifically, the more identities a client reported being discriminated against, the more severe their initial SI was likely to be. In terms of change during treatment, the average level of SI decreased from the first to last administration of the CCAPS among each client group (ranging from no discrimination to discrimination based on three identities). The magnitude of improvement in SI was slightly more for students who experienced discrimination (regardless of number) than for those who denied discriminatory experiences. Thus, the difference in SI among groups was smaller at the end of treatment than at the beginning. Despite this, clients who reported discrimination still endorsed higher SI when ending counseling than those without.

Summary, Implications, and Future Directions

  • Consistent with prior CCMH findings, clients who experienced discrimination in the past six months reported more severe suicidal ideation (SI) at the beginning of treatment. On average, this gap was more pronounced among those who experienced discrimination against multiple aspects of their identity.
  • All clients, on average, experienced improvement in SI during treatment regardless of whether they reported discrimination. However, SI declined to a slightly greater degree among those who had experienced discrimination. This demonstrates a slight narrowing of the disparities in SI over the course of services at college counseling centers.
  • Despite improvement in SI, clients who reported discrimination still ended treatment with higher SI on average than those without discriminatory experiences. This was especially true for those who experienced discrimination based on multiple identities.
  • Discrimination is not a mental health problem, rather it is an important contextual factor regarding a student’s environment that is associated with more severe SI. Students who report discrimination are more likely to experience SI, and college counseling services help relieve these symptoms. However, while college counseling centers can effectively support students with experiences of discrimination, addressing the psychological symptoms is only a small piece of the solution. Services such as cultural centers, identity-based programs, and outreach and advocacy are important in buffering the negative impact of discrimination above and beyond college counseling services (2023 Annual Report)

Published May 18, 2026  

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