Suicidal Behaviors Among Students from Impoverished Rural Communities in the US South

Background/Purpose: Suicide is the second leading cause of death among college-age adults (NCIPC, 2019). The risk of suicide is significantly higher among adults who were abused as children (Wu, Wang, & Jia, 2015). Spirituality has been regarded as a viable mechanism for adult survivors of childhood trauma to mitigate the negative effect of trauma on anxiety, depression, and suicide. Nonetheless, for some, childhood trauma has been linked with lowered spirituality (Song et al., 2016). Importantly, these protective effects varied and even reversed depending on the type of religious affiliation, networks and geographical locations (Eskin et al., 2019). Rural studies on spirituality have focused on older adults (Mitchell & Weatherly, 2000) or were conducted in non-Southern states (Galloway & Henry, 2014). Thus, the present study uses structural equation modeling (SEM) to examine the paths from childhood trauma to suicidal behaviors among rural adults in one of the most economically-disadvantaged Southern states in the US. We hypothesized that participants’ higher scores on suicidal behaviors would be associated with (H1) more childhood trauma and (H2) more symptoms of anxiety/depression. Additionally, (H3) anxiety/depression would mediate the relationship between spirituality and suicidal behaviors.

Methods: The study used a sample of 191 college students at a public university in a predominantly rural, poor Southern state with a deep racial history. Many were first-generation college students from families who have lived in the state for generations, often in racially-segregated, marginalized communities that lack resources for personal development and achieving social mobility. Approximately half were white and 44% black. The outcome variable was the composite score of suicidal ideation, plans, and attempt. The latent variables for childhood trauma, spirituality, and anxiety/depression were indicated by the items in the Adverse Childhood Experiences Questionnaire (ACEs; Anda, 2006), the Daily Spiritual Experiences (Underwood, 1999), and the Anxiety/Depression Scale of the Adult Self-Report (Achenbach & Rescorla, 2003), respectively.

Results: The SEM results suggest that students who had experienced and witnessed more violence during childhood had lower spirituality as young adults (p < 0.05). Lower scores on spirituality were associated with increased anxiety and depression (p < 0.001). Participants with more anxiety and depression symptoms were more likely to engage in suicidal behaviors (p < 0.001). Spirituality had a significant standardized indirect effect on suicidal behaviors mediated by anxiety/depression (p = 0.001). The model provided a good fit for the data, χ2 (50, N = 177) = 70.86, p < 0.05, CFI = 0.98, TLI = 0.97, RMSEA = 0.049.

Implication/Conclusions: The findings have important implications for practitioners who work with college students at-risk for suicide in communities with extremely-limited resources and a complex racial history. It is critical to understand the mediating role of anxiety/depression in the association between spirituality and suicidal behaviors. Spirituality is a strong protective factor for racial minorities in impoverished communities that have been subjected to racial segregation. Meanwhile, increased levels of ACEs are closely related to college students’ lower spirituality, which in turn increases their anxiety/depression and suicide behaviors. Thus, future research needs to better contextualize these relationships by incorporating the racial and socioeconomic characteristics of each region/community.