SUICIDAL IDEATION AND SUICIDAL THOUGHTS IN UNIVERSITY STUDENTS DURING THE COVID-19 PANDEMIC: A SYSTEMATIC REVIEW
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Revista Argentina de Clínica Psicológica
2021, Vol. XXX, N°2, 390-405 390
DOI: 10.24205/03276716.2020.4038
SUICIDAL IDEATION AND SUICIDAL THOUGHTS IN
UNIVERSITY STUDENTS DURING THE COVID-19
PANDEMIC: A SYSTEMATIC REVIEW
Jonathan Martínez-Líbano1,2*, María Mercedes Yeomans Cabrera3,4
Abstract: Suicidal ideation and suicidal thinking are relevant phenomena to study given
their high incidence among university students in higher education, even more so if during
the academic period students are affected by a pandemic such as COVID-19.
Consequently, this systematic review's objective was to determine the prevalence of
suicidal ideation and suicidal thinking in university students during the COVID-19
pandemic and, as a secondary objective, to establish possible risk factors. The search was
performed following the PRISMA model in the Web of Science, Scopus, PubMed, and
Medline search engines between January 2020 and January 2021, and the Newcastle-
Ottawa Scale (NOS) was used to evaluate the methodological quality of the studies.
Regarding the results, at the end of the search, nine relevant studies were identified for
analysis: four on suicidal thoughts, four on suicidal ideation, and one on suicide as a
continuous variable. In conclusion, it was possible to stipulate that the average
prevalence of suicidal ideation and suicidal thoughts were 17.8% for the university
population. Likewise, the risk factors associated with the appearance of suicidal thoughts
and ideation in university students during the COVID-19 pandemic were ethnographic,
psychological, contextual and health factors.
Keywords: suicidal ideation, suicidal thinking, mental health, university students, COVID-
19 pandemic.
INTRODUCTION 2019). Suicide deaths are almost equally divided
Suicidal ideation is often an indicator of mental between male and female students (Farrell et al.,
health problems and a significant risk factor for 2017). However, knowledge of students'
suicide (Pereira & Cardoso, 2015). There is long- distinguishing characteristics with mental illness
standing concern about mental health and suicide who die by suicide may help us in clinical
risk among college students (McLaughlin & Gunnell, management (Farrell et al., 2017). Although a
2020). Since getting into higher education is a time systematic review of mental health problems in the
of transition that coincides with the typical onset of general population was recently conducted (Xiong
severe mental illness (Farrell, Kapur, While, et al., 2020), background information on the
Appleby, & Windfuhr, 2017), it may lead college prevalence of suicidal ideation and suicidal
students to be at an increased risk for suicidal thoughts in college students has not been
tendencies (Yi et al., 2020). Suicide is a leading accurately determined. Besides, there are scarce
cause of death in this population (Hedman- studies about the way this population has
Robertson, 2018); among college students aged 18 developed during the COVID-19 pandemic.
to 22 years, 6.6% reported severe suicidal thoughts, Consequently, the following systematic review's
2.2% reported suicide plans, and 1.1% reported objective was to determine the prevalence of
attempting suicide in the past year (SAMHSA, suicidal ideation and suicidal thoughts during the
1 Facultad de Salud y Ciencias Sociales, Universidad de Las Américas, Chile
2 Escuela de Ciencias Sociales y Jurídicas, Universidad Viña del Mar, Chile
3 Facultad de Comunicaciones y Artes, Universidad de Las Américas, Chile
4 Facultad de Educación, Universidad de Las Américas, Chile
*Corresponding autor: jmartinez@ctpi.cl
REVISTA ARGENTINA
2021, Vol. XXX, N°2, 390-405 DE CLÍNICA PSICOLÓGICA391 Jonathan Martínez-Líbano, María Mercedes Yeomans Cabrera
COVID-19 pandemic in college students and, as a 2010). The American Psychiatric Association
secondary objective, to establish associated risk proposed two new diagnostic entities called suicidal
factors. behavior disorder and nonsuicidal self-injury in the
chapter "Conditions for Further Study" in the fifth
LITERATURE REVIEW version of the Diagnostic and Statistical Manual of
Suicidal behavior is a significant public health Mental Disorders (DSM-V) (American Psychiatric
problem (Freeman et al., 2017). According to Association, 2014). A fundamental limitation to
various studies, suicide is the thirteenth leading progress in the field is incomplete or inaccurate
cause of death worldwide (Lozano et al., 2012). models of suicide and suicide risk (May & Klonsky,
Each year, more than 800,000 people die by suicide 2016). Although suicide is a public health problem,
worldwide, and it is estimated that between 10 and it can be prevented through timely, low-cost, data-
20 million more people attempt suicide (World driven interventions (Organización Mundial de la
Health Organization, 2014). Suicidal behavior is Salud, 2020).
defined as the desire or act that intentionally causes
harm or leads to death to oneself, encompasses MATERIALS AND METHODS
suicidal ideation, and the suicide attempt until it A systematic review was conducted, identifying
reaches its goal: consummated suicide (Alvarado & articles published in the Web of Science, Scopus,
Velez, 2016). Several factors can lead a person to PubMed, and Medline databases between January
have the capacity to commit suicide, including 2019 and January 2021, written in English and
genetic predispositions, courage in the face of Spanish.
death, greater tolerance to physical pain, and
familiarity and access to lethal means, which is a Search strategy
central component of modern theories of suicide The literature search was performed according
(Klonsky & May, 2015; O’Connor & Kirtley, 2018; to the preferred reporting protocol for systematic
Van Orden et al., 2010). Suicide-related behaviors reviews and meta-analyses PRISMA (Moher,
can be classified as ideations (i.e., thoughts), Liberati, Tetzlaff, Altman, & Group, 2009; Page et
communications, and behaviors (Van Orden et al., al., 2020; Urrútia & Bonfill, 2013). Title, abstract,
Identification
n = 34 records identified
n = 4 Web of Science Additional records identified
n = 6 Scopus through manual searching
n = 20 Pubmed (n=0)
n = 4 Medline
Screening
Records after duplicates removed
(n = 22)
Titles and abstractcs screened Records excluded
(n = 22) n=5
Eligibility
Full-text articles assessed for eligibility
(n = 17 )
Full-text articles excluded, with reasons
(n =8 )
6 articles removed for studying desing
2 articles removed for studying other
Included
polulation
Studies included in qualitative synthesis
(n = 9)
Figure 1. PRISMA flow chart.
REVISTA ARGENTINA
2021, Vol. XXX, N°2, 390-405 DE CLÍNICA PSICOLÓGICAand keyword fields were searched in each of the students. Of these, 12 were eliminated due to
databases. The following keywords combined with duplicates. Five articles were excluded by reading
Boolean operators (OR/AND) were used: (["COVID- the title and abstract; finally, eight were eliminated
19 "OR "SARS-CoV-2" OR "Coronavirus"] AND by reading the full text. Thus, nine articles that met
["suicide" OR "suicide ideation" OR "suicide the inclusion criteria were selected for the
thoughts"] AND ["university students" OR systematic review.
"undergraduate Students" OR "college students"]).
The search strategy for study selection is shown in Study Characteristics
Figure 1. The study characteristics and findings of this
review are summarized in Table 1. The nine articles'
Study selection and eligibility criteria sample sizes ranged between 1,000 and 69,054
The titles and abstracts of each article were participants, with a total of 106,814 higher
reviewed, then the full text was reviewed to education students. All studies had a cross-
determine eligibility. Studies were eligible for sectional study design. The 9 studies were
inclusion if: 1) they followed a cross-sectional study conducted in various countries around the world
design; 2) the population was in college students; 3) Greece (n = 2), France (n = 1), Bangladesh (n = 1),
application of clinical and non-clinical instruments; Libya (n = 1), USA (n = 1), Poland (n = 1), China (n =
4) positive and negative outcomes; 5) field studies; 1), and Indonesia, Taiwan, and Thailand (n = 1).
6) English and Spanish language texts; 7) data in the
articles were during COVID-19 pandemic. The Evaluation of methodological quality
following exclusion criteria were used, 1) studies The results of the evaluation of the
not under COVID-19 pandemic; 2) subjects who methodological quality of the studies are presented
were not university students; 3) academic notes, in Table 2. The overall quality of the included
letters to the editor or reflections; 4) longitudinal studies was moderate, with a total of 6 to 7 points.
studies. There were four studies with seven points
(Kaparounaki et al., 2020; M E Patsali et al., 2020;
Data extraction Tasnim, Islam, Hossain, Sikdera, & Potenza, 2020;
A data extraction form was used to include Xin, Luo, She, Yu, Li, et al., 2020), and five studies
relevant data: (1) Lead author, (2) Country, (3) with six points (Elhadi et al., 2020; Pramukti et al.,
Study design, (4) Sample size, (5) Measurement 2020; Wang et al., 2020; Wathelet et al., 2020).
instrument, (6) Prevalence, (7) Associated risk Results are shown in Table 2.
factors.
Measuring tools
Quality Assessment Various scales were used in the studies (n = 11)
The Newcastle-Ottawa Scale (NOS), adapted for in the following proportions: The Patient Health
cross-sectional studies, was used to assess the Questionnaire (PHQ-9) (n = 3); State-Trait Anxiety
studies' quality (Epstein et al., 2018). The scale Inventory (STAI) (n=3); Center for Epidemiologic
consists of three dimensions: selection, Studies-Depression (CES-D) (n = 2); Depression
comparability, and outcome. Seven categories Anxiety and Stress Scales-21 (DASS-21) (n = 2); The
assess: the sample's representativeness, sample Generalized Anxiety Disorder (GAD-7) (n = 2); Beck
size justification, comparability between Depression Inventory (BDI) (n = 1); The Depressive
respondents and non-respondents, exposure Symptom Index Suicidality Subscale (DSI-SS) (n = 1);
determinations, comparability based on study The Impact of Event Scale-Revised (IES-R) (n = 1);
design or analysis, outcome assessment, statistical Perceived Stress Scale (PSS) (n = 1); Risk Assessment
analysis appropriateness. A total of nine points may Suicidality Scale (RASS) (n = 1); Self-harm or suicidal
be awarded if the study meets certain criteria, with ideation (SH-SI) (n = 1).
a maximum of four points assigned for the selection
dimension, a maximum of two points assigned for Risk factors associated with university students
the comparability dimension, and a maximum of Within the risk factors for the occurrence of
three points assigned for the outcome dimension suicidal ideation and thoughts we found
(Epstein et al., 2018). ethnographic factors, psychological factors,
contextual factors, and health factors in the
RESULTS following proportions: depression (n = 5); anxiety (n
Search Results = 5); female gender (n = 3); stress (n = 3); age (n =
In total, 34 publications were identified on the 2); COVID-19 compatible symptoms (n = 2); history
suicide subject, suicidal thoughts, and suicidal of suicide attempts (n = 2); non-binary gender (n =
ideation in the COVID-19 pandemic in university 1); problems with income or housing (n = 1);
REVISTA ARGENTINA
2021, Vol. XXX, N°2, 390-405 DE CLÍNICA PSICOLÓGICA393 Jonathan Martínez-Líbano, María Mercedes Yeomans Cabrera
psychiatric history (n = 1); social isolation (n = 1); news (n = 1); studies of law, literature, pedagogy,
poor quality of information received (n = 1); sleep political science and related studies, as well as
disorders (n = 1); smoking (n = 1); past suicidal technical but not health sciences (n = 1); beliefs of
thoughts (n = 1); family history of suicide (n = 1); conspiracy theories (n = 1); fear of civil war (n = 1).
living with a Relative with Covid-19 (n = 1); living
alone (n = 1); low support (n = 1); overexposure to
Table 1. Summary of the study sample's characteristics, study design, evaluation tools used, prevalence rates,
and associated risk factors.
Main Study Sample Type of
Country Instrument Prevalence Risk factors
Author Design Students Measurement
Female or non-binary
gender, problems with
income or housing,
IES-R / PSS
Wathelet et Suicidal psychiatric history,
France Transversal 69.054 / STAI / 11,4%
al., 2020 thoughts symptoms compatible
BDI.
with COVID-19, social
isolation, low quality of
the information received.
Sleep disorders, smoking,
past suicidal thoughts,
Tasnim, et Suicidal history of suicide
Bangaldesh Transversal 3.331 DASS-21 12,8%
al., 2020 ideation attempts, family history
of suicide, depression,
anxiety, and stress.
Year of study, age,
psychological stress due
to civil war, living with
Elhadi et al., GAD-7 / Suicidal family or friends with
Libia Transversal 3.500 22,7%
2020 PHQ-9 ideation COVID-19, internal
displacement due to
conflict, and living with
family or alone.
Woman, presence of
Wang et al., PHQ-9 / Suicidal
EEUU Transversal 2.031 18% Anxiety and Depression,
2020 GAD-7 thoughts
Increased stress
Debowska DASS / DSI- Not young adult students
Poland Transversal 7.228 Suicidal
et al., 2020 SS specified (18-24 years old)
Kaparounaki STAI / CES- Suicidal Presence of high levels of
Greece Transversal 1.000 20,2%
et al., 2020 D / RASS thoughts anxiety and depression
Presence of depressive
symptoms and emotional
Xin et al., PHQ-9 / Suicidal distress, perceived risk of
China Transversal 24.378 12,9%
2020 SH-SI ideation infection, and mental
health variables were
significant.
Low Perceived Support,
Indonesian, Sadness and depressed
Pramukti et Suicidal
Taiwanese, Transversal1.985 STAI 26,7% mood, High Anxiety due
al., 2020 thoughts
and Thai to overexposure to
information
REVISTA ARGENTINA
2021, Vol. XXX, N°2, 390-405 DE CLÍNICA PSICOLÓGICA394 Jonathan Martínez-Líbano, María Mercedes Yeomans Cabrera
Female gender History of
self-harm. History of
suicide attempts.
Following studies of law,
Patsali et al., Suicidal It increases literature, pedagogy,
Greece Transversal1.535 CES-D
2020 ideation by 2.59% political science and
related studies, and
technical sciences, but
not health. Beliefs in
conspiracy theories.
Own elaboration
Table 2. Results of Study quality appraisal of the included studies
Total
Study Selection Comparability Outcome
Score
Non- Ascertainme Based on Assessme
Representativen Sample Statstic
Responde nts of Desing and nt of Quality
ess of the sample Size al Test
nts exposure analysis Outcome
Wathelet
6 * * ** * * satisfactory
et al., 2020
Tasnim, et
7 * * ** * * * good
al., 2020
Elhadi et
6 * * ** * * satisfactory
al., 2020
Wang et
6 * * ** * * satisfactory
al., 2020
Debowska
6 * * ** * * satisfactory
et al., 2020
Kaparouna
ki et al., 7 * * ** * * * good
2020
Xin et al.,
7 * * ** * * * good
2020
Pramukti
6 * * ** * * satisfactory
et al., 2020
Patsali et
7 * * ** * * * good
al., 2020
Own elaboration can be concluded that there is a diverse prevalence
in the studies consulted, from 11.4% to 26.7%,
The Patient Health Questionnaire (PHQ); State- obtaining an average of 17.8% prevalence of
Trait Anxiety Inventory (STAI); Center for suicidal ideation and thoughts. These results are
Epidemiologic Studies-Depression (CES-D); associated with other studies where the prevalence
Depression Anxiety and Stress Scales-21 (DASS-21); is similar without the effect of the COVID-19
The Generalized Anxiety Disorder (GAD-7); Beck pandemic, the indicators of suicidal ideation range
Depression Inventory (BDI); The Depressive from 8% to 25% (Villalobos-Galvis, 2009), 14.9%
Symptom Index Suicidality Subscale (DSI-SS); The (Rudd, 1989); 9.9% (Blasco et al., 2019); 21%
Impact of Event Scale-Revised (IES-R); Perceived (Sivertsen et al., 2019) in similar populations. From
Stress Scale (PSS) Risk Assessment Suicidality Scale the results described above, it cannot be asserted
(RASS)Self-harm or suicidal ideation (SH-SI) that the percentage of suicidal ideation or thoughts
was elevated in college students during the COVID-
DISCUSSION 19 pandemic. This may be since suicidal ideation is
The review conducted explored suicidal ideation transient and dynamic, increasing and decreasing
and thoughts in university students during the considerably over days (Siddaway, Holm-Denoma,
COVID-19 pandemic. At the end of this review, it Witte, & Ruscio, 2021). Nevertheless, the results
REVISTA ARGENTINA
2021, Vol. XXX, N°2, 390-405 DE CLÍNICA PSICOLÓGICA395 Jonathan Martínez-Líbano, María Mercedes Yeomans Cabrera
present many factors associated with the risk of and immaturity, generate stumbling blocks that can
suicidal ideation, which is reviewed below in four translate into moments of distress, loneliness, and
categories: ethnographic factors, psychological frustration, all risk factors for committing a suicidal
factors, contextual factors, and health factors. act or engaging in suicidal behaviors (Cortés, 2013).
However, it is essential to point out that age is not
1. Ethnographic Factors a determining factor, considering that in some
Among the risk factors presented in studies of countries, the highest suicide rate is found in adults
suicidal ideation and suicidal thoughts during the of the third and fourth ages (Ordóñez Monak,
COVID-19 pandemic is gender. Concerning the Franco Agudelo, & González Ortiz, 2013).
female and non-binary genders, they are at higher
risk. This study's results are consistent with 2. Psychological factors
previous studies, which indicate that females are From the psychological point of view, it has been
more likely to have suicidal thoughts (Boiett et al., established that students with a previous
2020; Villalobos-Galvis, 2009). Similarly, concerning psychiatric history may be subject to a high
the non-binary gender, some studies report that presentation of suicidal ideation and thoughts; this
this group of people may experience discrimination. is evidenced both in research focused on the period
This has been associated with a higher probability of the covid-19 pandemic, as well as in previous
of suicide attempts and depressive symptoms; the research (Coentre, Faravelli, & Figueira, 2016).
latter would be due to a more significant perceived In addition to personal psychiatric history,
burden and frustrated belonging beyond the effects family history of psychiatric disorders (Boiett et al.,
of childhood trauma and sociodemographic 2020), and family history of suicide and suicidal
variables (Wyman Battalen et al., 2020). Likewise, behavior in a family member (Villalobos-Galvis,
bisexual sexual orientations are significantly 2009) are essential factors in the suicidal ideation of
associated with suicidal ideation (Lytle, Blosnich, De a subject. This could be due to both genetic and
Luca, & Brownson, 2018). However, the above contextual factors, which should be scrutinized.
contrasts with other research where there is Past suicidal thoughts and suicidal ideation, such
evidence that there are no gender differences in as the subject's history of suicide attempts, are
suicidal ideation and suicidal thoughts (Dachew, central elements in the appearance of new and
Bifftu, Tiruneh, & Anlay, 2018; McAuliffe, Corcoran, repeated thoughts (McAuliffe et al., 2003;
Keeley, & Perry, 2003; Naderi & Esmaili, 2009; Sarmiento & Aguilar, 2011), especially when people
Schweitzer, McLean, & Klayich, 1995), so the feel overwhelmed by stressors (Denneson et al.,
gender factor should be deepened in new studies, 2015). The research reviewed shows that mood
considering that society has a permanent evolution. disorders, among others, depression, are the most
There is evidence of a difference because male recurrent risk in college students and are highly
university students may have a higher risk of death associated with suicidal ideation and thoughts
by suicide (Farrell et al., 2017; Granato, Smith, & (Eisenberg, Gollust, Golberstein, & Hefner, 2007;
Selwyn, 2015; McLaughlin & Gunnell, 2020), which Hayes et al., 2020; Mikaella E Patsali et al., 2020;
is associated with the fact that, apparently, the Ross, Dehay, & Deiling, 2020). Mood disorders are
male gender uses suicide as a form of escape from a cross-cutting factor regardless of gender
pain (Lester, Wood, Williams, & Haines, 2004). In (Miranda-Mendizabal et al., 2019). This is since, at
summary, the female and non-binary genders a cognitive level, the person experiences profound
present a greater tendency to suicidal ideation, hopelessness about the future, accompanied by
while the male gender tends to commit suicide. This death's perception as the only way out (Echeburúa,
tendency could be related to how the genders Psicología, Vasco, & Ehu, 2015).
proceed, where women tend to be more reflective Anxiety and distress, identified among the risks
(Bahamón Muñetón, Vianchá Pinzón, Alarcón that occur in college students, are negative feelings
Alarcón, & Bohórquez Olaya, 2012); on the that increase the likelihood of suicidal thoughts and
contrary, men tend to be more impulsive and ideation considerably (Dachew et al., 2018;
concrete (Peñas-Lledó, Fernández, & Waller, 2004). Eisenberg et al., 2007; Johnson & Hayes, 2003;
From a hetero ethnographic perspective, young Kaparounakia Chrysi K. et al., 2020; Ross et al.,
adult students (18-24 years old) have been prone to 2020). On the one hand, people suffering from
suicidal thoughts and ideation, even before the anxiety present fears of loss of control and
COVID-19 pandemic (Farrell et al., 2017). In this emotional intensity; these symptoms are also
specific group of young people, there is an associated with panic attacks connected to
increased burden of individual pressures or cognitive concerns, such as feeling a loss of sanity
responsibilities. This, together with inexperience or control and, in more extreme cases, the fear of
REVISTA ARGENTINA
2021, Vol. XXX, N°2, 390-405 DE CLÍNICA PSICOLÓGICA396 Jonathan Martínez-Líbano, María Mercedes Yeomans Cabrera
dying (Capron et al., 2012). This, in turn, can lead to cultural, or economic and have different impacts on
anxiety disorders, which can severely affect different groups (The Australian Curriculum, 2021).
people's lives, impairing health, work, family, and From this perspective, COVID-19 is a disease that
personal relationships. Among these disorders are has wreaked havoc in all areas of life, not only
generalized anxiety disorders, panic disorder, because of its high mortality rate but also because
phobias, social anxiety disorder, obsessive- of its political, social, educational, and economic
compulsive disorder, and post-traumatic stress consequences (Martínez-Líbano, 2020).
disorder (American Psychological Association, From the political perspective, public policies
2016). have seen the need to restrict personal freedoms
Although the medical impacts of COVID-19 are (Tisdell, 2020), implementing curfews, quarantines,
notable, the pandemic's interpersonal, financial, and military support in the streets, among other
and social consequences are likely to have a more measures (Yen-Hao Chu, Alam, Larson, & Lin, 2020).
significant and more sustained effect on Many criticize the political action, indicating that
psychological health (Madigan et al., 2020), both in the measures have been insufficient, late, or
the short and long term (C. L. Park et al., 2021). motivated by intentions unrelated to the pandemic,
Research on the psychological effects of COVID-19 which has caused great political tension in different
has found elevated levels of anxiety, depression, countries and among them (Wenham, 2021). On
and sleep disturbance in the general population the other hand, there is a series of negative feelings
(Huang & Zhao, 2020). There is now considerable towards the political class since before the
empirical evidence on the effects of COVID-19 on coronavirus, which has devalued the democratic
the psychological health of the population (Gruber structures regarding the pandemic crisis's response
et al., 2020a). These include increased family and (Flinders, 2020). Moreover, the way countries
occupational stress, increased health anxiety due to relate to each other has been disrupted by the
fear of illness or contagion (Asmundson et al., pandemic's rapid spread and will probably never be
2020), as well as job loss and financial insecurity, the same again (Brown & Wang, 2020).
fear of lack of essential supplies, fear of infection, From a social perspective, the confinement,
loss of resources, supports and interpersonal social isolation and interruption of daily life during
connection, and possible separation and/or death the COVID-19 period have impacted the population
of loved ones (Gruber et al., 2020b). to a great extent (Tasnim et al., 2020), becoming an
epidemic that affects all aspects of human life
3. Contextual Factors (Nguyen, Nguyen, & Le, 2021). In this sense, COVID-
The pandemic has brought a decline in the 19, has been characterized by presenting three
quality of life and mental health of people traumatic components: (i) fears of present and
worldwide, and students in higher education future infections, (ii) widespread economic impact,
institutions would not be exempt from such and (iii) disruption and isolation from routine (Kira
consequences (Kaparounaki et al., 2020). Many et al., 2020). Thus, the confinement generated by
factors can lead college students to be particularly this pandemic meant, for many people, a radical
vulnerable and predisposed to suicidal ideation, change in lifestyle, avoiding contact with friends
creating a public health crisis (Tasnim et al., 2020): and family and, in addition, stopping activities not
life instability and existing mental and physical related to work (Corvo & Caro, 2020).
health problems (Gurung & Stone, 2020), From the same social perspective, another risk
uncertainty about the future and loss of autonomy factor was isolation. Several authors report that
(Gruber et al., 2020b), the sudden transition to social isolation has historically been implicated as a
online learning (Besser, Flett, & Zeigler-Hill, 2020), factor that directly and fundamentally influences
high levels of stress and burnout (Humphrey, 2013), suicidal ideation and behavior (Masuda, Kurahashi,
feelings of tension, fear of infection, insomnia and & Onari, 2013; Trout, 1980). The low quality of the
low mood (Yang, Tu, & Dai, 2020), increased information received and the low tolerance to
psychological distress (Hamza, Ewing, Heath, & uncertainty increase the possibility of suicidal
Goldstein, 2020), increased moderate depression ideation and thoughts (Zerach & Levi‐Belz, 2019).
to severe depression, self-harm, and suicidal The subjective feeling of loneliness has a significant
ideation and emotional distress due to COVID-19 impact on people (Calati et al., 2019). However,
(Xin, Luo, She, Yu, Wang, et al., 2020), among other research has reported that social isolation has
others. affected young people to a lesser extent due to
When we speak of contextual factors, we refer their more significant social network interaction
to characteristics of the environment that affect (Orben, Tomova, & Blakemore, 2020). These have
behavior; these factors can be personal, social, been positively associated with psychological well-
REVISTA ARGENTINA
2021, Vol. XXX, N°2, 390-405 DE CLÍNICA PSICOLÓGICA397 Jonathan Martínez-Líbano, María Mercedes Yeomans Cabrera
being (Doo-Hun & Ghee-Young, 2020). On the other students. This is since in homes with drug use, the
hand, when referring to the psychological and absence of family warmth, lack of communication
psychosocial implications of covid on students, we with parents, and permanent family discord have
found a need to present emotional containment been observed (Larraguibel, González, Martínez, &
plans to the entire school community; they will Valenzuela, 2000).
serve to deal with the social crisis context; it was
also found that the psychological and pedagogical 4. Health Factors
impact of social restriction and online education In this review, sleep disorders were associated
should be analyzed. Strategies should be sought to with increased suicidal thoughts and suicidal
mitigate the psychological impact of confinement ideation, coinciding with other studies in which
at home—this includes providing access to sleep quality (Fekih-Romdhane et al., 2021; Soares
accessible, friendly platforms that minimize et al., 2020) and insomnia have been identified as
technical issues (Yeomans Cabrera & Silva Fuentes, risk factors for suicidal ideation (Chu et al., 2016).
2020). However, depending on the student, the Insomnia directly impacts the mood of the sufferer,
decrease in face-to-face contact for youth may be manifesting itself with irritability, fatigue,
less detrimental due to widespread access to digital headache, appetite alterations, accident
forms of social interaction through social proneness, or difficulty in attending and
networking technologies (Orben et al., 2020). concentrating on simple tasks, which increases the
On the other hand, stress and stressful life risk of suicidal ideation, even in pre-pandemic
events (such as living in a pandemic like COVID-19) contexts (Escobar, Quijano, & Calvo, 2017). Because
are situations that elevate suicidal ideation and are it is during sleep that all physical and psychological
phenomena that occur together regularly functions of the human being are restored and
(Brailovskaia, Teismann, & Margraf, 2020; regulated (Balk, de Jonge, Oerlemans, & Geurts,
Rodríguez-hidalgo et al., 2020). The person, feeling 2019), good quality sleep is of utmost importance
overwhelmed by various stressors and life changes, for the body's proper functioning. It is a fact that
perceives suicide as a solution to his or her not sleeping brings harmful consequences for
problems (Denneson et al., 2015). people (Cirelli & Tononi, 2008), since the brain
It adds the low social support perceived in activity that develops during sleep allows the body
university students, which is an essential element in to function (Fernandez & Lüthi, 2020). Poor sleep
the appearance of suicidal ideation and thoughts; quality affects people's health (Bernert, Turvey,
this same idea has been manifested in contexts Conwell, & Joiner, 2014; Leng et al., 2015), affecting
outside covid (Dachew et al., 2018; Soares et al., moods and cognitive functions (Belenky et al.,
2020). Besides, a connection has been found 2003). All people require a minimum number of
between suicidal thoughts and the negative view of hours of sleep (Lowe, Safati, & Hall, 2017),
social support, such as exaggerating their However, sleep deprivation caused by different
perception of conflict in interpersonal relationships factors I all sectors (Chen et al., 2006; Costa,
(Arria et al., 2009). Accattoli, Garbarino, Magnavita, & Roscelli, 2013;
In this review, financial distress is identified as Hoyos et al., 2020), including health and contextual
another contextual risk factor. This is in line with factors (Magnavita & Garbarino, 2017).
other research where it is referred that financial
difficulty promotes suicidal ideation and thoughts Study implications
(Dachew et al., 2018). This same factor has a This article is the first systematic review that
statistically significant influence on the risk of examines and summarizes the existing literature
depression (Areas et al., 2012) and increases the associated with suicidal ideation and thoughts, the
risk of having mental health problems in general COVID-19 pandemic in the college student
(Eisenberg et al., 2007). Stressful events often population, and the associated risk factors. Thus, a
precede suicidal behaviors, and debt can be seen as precedent is established to develop studies that will
a continuous source of stress (Bebbington, Jenkins, contribute to the prevention of suicide and
Mcmanus, & Dennis, 2011), leading to suicidal promote mental health in the university
behavior (Chen et al., 2006). population.
Similarly, other contextual factors affect the
individual's mind, such as tobacco and substance Limitations
use (Dachew et al., 2018; Fekih-Romdhane, There are certain limitations in this systemic
ElKhouni, Sassi, & Cheour, 2021), and alcohol review; all the studies reviewed were conducted
dependence (Decou & Skewes, 2016), which can through self-reports, leading to social desirability
increase suicidal thoughts and ideation in college responses. Also, as they were online studies, there
REVISTA ARGENTINA
2021, Vol. XXX, N°2, 390-405 DE CLÍNICA PSICOLÓGICA398 Jonathan Martínez-Líbano, María Mercedes Yeomans Cabrera
may be a population that could not access the with studies conducted before the COVID-19
evaluation. All the studies were cross-sectional, so pandemic. Among the risk factors found in the
they were measured at a specific point in time. appearance of suicidal thoughts and behaviors in
However, it is difficult to extrapolate these results higher education students during the pandemic
to the general population, so causal inferences there are ethnographic, psychological, contextual,
cannot be made. Also, most of the studies had a and health factors. Ethnographic factors include
higher number of women in the samples, so that being female and non-binary. Psychological factors
this situation could interfere with the data analysis. include depression, anxiety, stress, suicidal
Concerning the scales used to evaluate suicidal thoughts in the past, family history of suicide
ideation and suicidal thoughts, although they are attempts, own suicide attempts. Contextual factors
validated internationally (Hall et al., 2021; Lamela, include academic performance problems and
Soreira, Matos, & Morais, 2020; S. H. Park et al., financial problems. Finally, health factors include
2020), progress is required in the application of sleep problems and smoking. It is necessary to
much more specific scales such as the psychache emphasize this problem since students' mental
scale (Holden, Mehta, Cunningham, & Mcleod, health and future professionals should also be a
2001) and the suicidal behaviors questionnaire responsibility of university institutions.
revised scale (SBQR) (Linehan, 1996); These scales
have demonstrated superior performance in the
accurate identification of suicide and its REFERENCIAS
subcomponents, as evidenced in various [1] Alvarado, A., & Velez, L. (2016). Factores de
investigations (Liang et al., 2020; Troister, D’Agata, riesgo biopsicosociales predisponentes para la
& Holden, 2015). The use of non-specific scales conducta suicida en adolescentes de dos
could be the reason for not finding other risk factors unidades educativas fiscales de Guayaquil,
identified by the literature associated with the para promover factores protectores
occurrence of suicidal ideation and thoughts in (Universidad de Guayaquil. Facultad de
college students, such as low self-esteem (Man & Ciencias Médicas. Carrera de Medicina).
Rrez, 2002; Thompson, 2010), hopelessness Universidad de Guayaquil. Facultad de
(Boduszek & Dhingra, 2016; Chioqueta & Stiles, Ciencias Médicas. Carrera de Medicina.
2007), stressful situations in the student's life Retrieved from
(Brailovskaia et al., 2020), alcohol dependence http://repositorio.ug.edu.ec/handle/redug/3
(Decou & Skewes, 2016), academic and financial 6267
problems (McLaughlin & Gunnell, 2020), and [2] American Psychiatric Association. (2014).
dissatisfaction with academic performance DSM V.pdf. Manual Diagnóstico y Estadístico
(Madadin et al., 2020). de Los Tratornos Mentales, p. 1000. Retrieved
All of the above should continue to motivate the from
study of the effects of the pandemic in different https://www.bibliopsi.org/docs/guia/DSM
populations around the world and, by the way, V.pdf
continue to delve into the mental health of higher [3] American Psychological Association. (2016).
education students, who will be the ones called to Beyond worry: How psychologists help with
lead the future of our society in the coming years. anxiety disorders. American Psychological
Association, 19, 1–2. Retrieved from
Future studies http://www.apa.org/helpcenter/anxiety.aspx
Further studies are needed to investigate the [4] Areas, U., Mojs, E., WarchoŁ-Biedermann, K.,
relationship between sleep quality and suicidal GŁowacka, M. D., Strzelecki, W., Ziemska, B.,
ideation, gender and suicidal ideation, and the & Marcinkowski, J. T. (2012). Social and health
Covid-19 pandemic's impact on suicide rates. care needs of elderly people living in the
countryside in poland. Annals of Agricultural
CONCLUSIÓN and Environmental Medicine, 19(4), 770–774.
We can conclude that little research addresses [5] Arria, A. M., Grady, K. E. O., Caldeira, K. M.,
suicidal ideation and thoughts in college students Kathryn, B., Wilcox, H. C., Wish, E. D., … Wish,
during the COVID-19 pandemic period around the E. D. (2009). Suicide Ideation Among College
world and none in Latin America. According to this Students : A Multivariate Analysis Suicide
study, between 11.4% to 26.7% of the university Ideation Among College Students : A
population could present suicidal ideation and Multivariate Analysis. 1118.
suicidal thoughts during the COVID-19 pandemic https://doi.org/10.1080/1381111090304435
(x̄=17.8%). This percentage is high and correlates 1
REVISTA ARGENTINA
2021, Vol. XXX, N°2, 390-405 DE CLÍNICA PSICOLÓGICA399 Jonathan Martínez-Líbano, María Mercedes Yeomans Cabrera
[6] Asmundson, G. J. G., Paluszek, M. M., Landry, Proximal Factors in Spanish University
C. A., Rachor, G. S., McKay, D., & Taylor, S. Students. Suicide an Life-Threatening
(2020). Do pre-existing anxiety-related and Behavior, 49(3), 881–898.
mood disorders differentially impact COVID- https://doi.org/https://doi.org/10.1111/sltb.
19 stress responses and coping? Journal of 12491
Anxiety Disorders, 74(July). [14] Boduszek, D., & Dhingra, K. (2016). Construct
https://doi.org/10.1016/j.janxdis.2020.10227 Validity of the Beck Hopelessness Scale ( BHS )
1 Among University Students : A Multitrait –
[7] Bahamón Muñetón, M. J., Vianchá Pinzón, M. Multimethod Approach. 28(10), 1325–1330.
A., Alarcón Alarcón, L. L., & Bohórquez Olaya, [15] Boiett, E., Bert, F., Savatteri, A., Scattaglia, M.,
C. I. (2012). Estilos individuales de Ferrara, M., Langiano, E., … Siliquini, R. (2020).
Aprendizaje: implicaciones en la conducta Prevalence and predictors of stress, suicidal
vocacional. Pensamiento Psicológico, 10(1), thoughts and depression in Italian university
129–144. Retrieved from students. European Journal of Public Health,
http://www.scielo.org.co/scielo.php?script=s (30).
ci_arttext&pid=S1657-89612012000100009 https://doi.org/https://doi.org/10.1093/eurp
[8] Balk, Y. A., de Jonge, J., Oerlemans, W. G. M., ub/ckaa165.055
& Geurts, S. A. E. (2019). Physical recovery, [16] Brailovskaia, J., Teismann, T., & Margraf, J.
mental detachment and sleep as predictors of (2020). Positive Mental Health, Stressful Life
injury and mental energy. Journal of Health Events, and Suicide Ideation: A 2-Year Follow-
Psychology, 24(13). Up Study. Crisis, 41(5), 383–388.
https://doi.org/10.1177/1359105317705980 https://doi.org/10.1027/0227-5910/a000652
[9] Bebbington, P. E., Jenkins, R., Mcmanus, S., & [17] Brown, K., & Wang, R. C. (2020). POLITICS AND
Dennis, M. S. (2011). Personal debt and SCIENCE: THE CASE OF CHINA AND THE
suicidal ideation. (April). CORONAVIRUS. Asian Affairs, 51(2).
https://doi.org/10.1017/S003329171000126 https://doi.org/10.1080/03068374.2020.175
1 2567
[10] Belenky, G., Wesensten, N. J., Thorne, D. R., [18] Calati, R., Ferrari, C., Brittner, M., Oasi, O.,
Thomas, M. L., Sing, H. C., Redmond, D. P., … Olié, E., Carvalho, A. F., & Courtet, P. (2019).
Balkin, T. J. (2003). Patterns of performance Suicidal thoughts and behaviors and social
degradation and restoration during sleep isolation : A narrative review of the literature
restriction and subsequent recovery: A sleep population. Journal of Affective Disorders,
dose-response study. Journal of Sleep 245(September 2018), 653–667.
Research, 12(1). https://doi.org/10.1016/j.jad.2018.11.022
https://doi.org/10.1046/j.1365- [19] Capron, D. W., Fitch, K., Medley, A., Blagg, C.,
2869.2003.00337.x Mallott, M., & Joiner, T. (2012). Role of anxiety
[11] Bernert, R. A., Turvey, C. L., Conwell, Y., & sensitivity subfactors in suicidal ideation and
Joiner, T. E. (2014). Association of poor suicide attempt history. Depression and
subjective sleep quality with risk for death by Anxiety, 29(3), 195–201.
suicide during a 10-year period a longitudinal, https://doi.org/10.1002/da.20871
population-based study of late life. JAMA [20] Chen, E. Y. H., Chan, W. S. C., Wong, P. W. C.,
Psychiatry, 71(10). Chan, S. S. M., Chan, C. L. W., Law, Y. W., … Yip,
https://doi.org/10.1001/jamapsychiatry.2014 P. S. F. (2006). Suicide in Hong Kong: A case-
.1126 control psychological autopsy study.
[12] Besser, A., Flett, G. L., & Zeigler-Hill, V. (2020). Psychological Medicine, 36(6), 815–825.
Adaptability to a sudden transition to online https://doi.org/10.1017/S003329170600724
learning during the COVID-19 pandemic: 0
Understanding the challenges for students. [21] Chioqueta, A. P., & Stiles, T. C. (2007). The
Scholarship of Teachingand Learning in Relationship Between Psychological Buffers ,
Psychology. Advance Online Publication. Hopelessness , and Suicidal Ideation
https://doi.org/10.1037/stl0000198 Identification of Protective Factors. 28(2), 67–
[13] Blasco, M. J., Vilagut, G., Almenara, J., Roca, 73. https://doi.org/10.1027/0227-
M., Piqueras, J. A., Gabilondo, A., … Alonso, J. 5910.28.2.67
(2019). Suicidal Thoughts and Behaviors: [22] Chu, C., Hom, M. A., Rogers, M. L., Ringer, F.
Prevalence and Association with Distal and B., Hames, J. L., Suh, S., & Joiner, T. E. (2016).
REVISTA ARGENTINA
2021, Vol. XXX, N°2, 390-405 DE CLÍNICA PSICOLÓGICA400 Jonathan Martínez-Líbano, María Mercedes Yeomans Cabrera
Is Insomnia Lonely ? Exploring Thwarted 23(10).
Belongingness as an Explanatory Link https://doi.org/https://doi.org/10.1080/136
between Insomnia and Suicidal Ideation in a 9118X.2019.1574860
Sample of South Korean University Students. [32] Echeburúa, E., Psicología, F. De, Vasco, P., &
12(5). Ehu, U. P. V. (2015). Las múltiples caras del
[23] Cirelli, C., & Tononi, G. (2008). Is sleep suicidio en la clínica psicológica The many
essential? PLoS Biology, Vol. 6. faces of suicide in the psychological clinic.
https://doi.org/10.1371/journal.pbio.006021 Terapia Psicológica, 33, 117–126.
6 https://doi.org/http://dx.doi.org/10.4067/S0
[24] Coentre, R., Faravelli, C., & Figueira, M. L. 718-48082015000200006
(2016). Assessment of depression and suicidal [33] Eisenberg, D., Gollust, S. E., Golberstein, E., &
behaviour among medical students in Hefner, J. L. (2007). Prevalence and Correlates
Portugal. 354–363. of Depression , Anxiety , and Suicidality
https://doi.org/10.5116/ijme.57f8.c468 Among University Students. 77(4), 534–542.
[25] Cortés, A. (2013). Conducta suicida https://doi.org/10.1037/0002-9432.77.4.534
adolescencia y riesgo. Revista Cubana de [34] Elhadi, M., Buzreg, A., Bouhuwaish, A.,
Medicina General Integral, 30(1), 132–139. Khaled, A., Alhadi, A., Msherghi, A., … Khaled,
[26] Corvo, E., & Caro, W. De. (2020). COVID-19 A. (2020). Psychological Impact of the Civil
and Spontaneous Singing to Decrease War and COVID-19 on Libyan Medical
Loneliness , Improve Cohesion , and Mental Students: A Cross-Sectional Study. Frontiers
Well-Being : An Italian Experience. in Psychology, 11, 570435.
Psychological Trauma:Theory, Research, https://doi.org/10.3389/fpsyg.2020.570435
Practice, and Policy, 12, 247–248. Retrieved [35] Epstein, S., Roberts, E., Sedgwick, R., Finning,
from https://psycnet.apa.org/fulltext/2020- K., Ford, T., Dutta, R., & Downs, J. (2018). Poor
44059-001.pdf school attendance and exclusion: A
[27] Costa, G., Accattoli, M. P., Garbarino, S., systematic review protocol on educational
Magnavita, N., & Roscelli, F. (2013). Sleep risk factors for self-harm and suicidal
disorders and work: Guidelines for health behaviours. BMJ Open, 8(12), 1–5.
surveillance, risk management and https://doi.org/10.1136/bmjopen-2018-
prevention [I disturbi del sonno in ambito 023953
lavorativo: Indirizzi di sorveglianza sanitaria, [36] Escobar, F., Quijano, M., & Calvo, J. (2017).
prevenzione e gestione del rischio]. Medicina Evaluación del Insomnio como Factor de
Del Lavoro, 104(4). Riesgo para Suicidio. Revista de La Facultad de
[28] Dachew, B. A., Bifftu, B. B., Tiruneh, B. T., & Ciencias Médicas, 74(1), 37–45.
Anlay, D. Z. (2018). Suicidal thoughts among [37] Farrell, S., Kapur, N., While, D., Appleby, L., &
university students in Ethiopia. Annals of Windfuhr, K. (2017). Suicide in a national
General Psychiatry, 17(1), 1–5. student mental health patient population,
https://doi.org/10.1186/s12991-017-0172-0 1997-2012. Crisis, 38(2), 82–88.
[29] Decou, C. R., & Skewes, M. C. (2016). https://doi.org/10.1027/0227-5910/a000412
Symptoms of Alcohol Dependence Predict [38] Fekih-Romdhane, F., ElKhouni, C., Sassi, H., &
Suicide Ideation Among Alaskan Cheour, M. (2021). The Role of Personal
Undergraduates. Factors and Learning Environment in Suicidal
https://doi.org/10.1027/0227-5910/a000373 Ideation Among Tunisian Medical Students.
[30] Denneson, L. M., Teo, A. R., Ganzini, L., Crisis, 42, 20–31.
Helmer, D. A., Bair, M. J., & Dobscha, S. K. https://doi.org/https://doi.org/10.1027/022
(2015). Military Veterans’ Experiences with 7-5910/a000678
Suicidal Ideation: Implications for [39] Fernandez, L. M. J., & Lüthi, A. (2020). Sleep
Intervention and Prevention. Suicide and Life- spindles: Mechanisms and functions.
Threatening Behavior, 45(August), 399–414. Physiological Reviews, 100(2).
https://doi.org/10.1111/sltb.12136 https://doi.org/10.1152/physrev.00042.2018
[31] Doo-Hun, C., & Ghee-Young, N. (2020). The [40] Flinders, M. (2020). Democracy and the
influence of social media use on attitude Politics of Coronavirus: Trust, Blame and
toward suicide through psychological well- Understanding. Parliamentary Affairs.
being, social isolation, and social support. https://doi.org/10.1093/pa/gsaa013
Information, Communication & Society, [41] Freeman, A., Mergl, R., Kohls, E., Székely, A.,
REVISTA ARGENTINA
2021, Vol. XXX, N°2, 390-405 DE CLÍNICA PSICOLÓGICA401 Jonathan Martínez-Líbano, María Mercedes Yeomans Cabrera
Gusmao, R., Arensman, E., … Rummel-Kluge, Latent Classes. 67(1), 104–114.
C. (2017). A cross-national study on gender [49] Hedman-Robertson, A. S. (2018).
differences in suicide intent. BMC Psychiatry, Undergraduate Students’ exposure,
17(1), 1–11. https://doi.org/10.1186/s12888- knowledge, utilization, and intended use of
017-1398-8 the national suicide prevention lifeline. Crisis,
[42] Granato, S. L., Smith, P. N., & Selwyn, C. N. 39(2), 110–118.
(2015). Acquired capability and masculine https://doi.org/10.1027/0227-5910/a000480
gender norm adherence: Potential pathways [50] Holden, R. R., Mehta, K., Cunningham, E. J., &
to higher rates of male suicide. Psychology of Mcleod, L. D. (2001). Development and
Men and Masculinity, 16(3), 246–253. Preliminary Validation of a Scale of Psychache.
https://doi.org/10.1037/a0038181 Canadian Journal of Behavioural Science,
[43] Gruber, J., Prinstein, M. J., Clark, L. A., 33(4), 224–232. Retrieved from
Rottenberg, J., Abramowitz, J. S., Albano, A. https://recursos-
M., … Weinstock, L. M. (2020a). Mental Health electronicos.udla.cl:2145/doi/10.1037/h0087
and Clinical Psychological Science in the Time 144
of COVID-19: Challenges, Opportunities, and a [51] Hoyos, C. M., Gordon, C., Terpening, Z.,
Call to Action. American Psychologist. Norrie, L., Lewis, S. J. G., Hickie, I. B., &
https://doi.org/10.1037/amp0000707 Naismith, S. L. (2020). Circadian rhythm and
[44] Gruber, J., Prinstein, M. J., Clark, L. A., sleep alterations in older people with lifetime
Rottenberg, J., Abramowitz, J. S., Albano, A. depression: A case-control study. BMC
M., … Weinstock, L. M. (2020b). Mental Psychiatry, 20(1).
Health and Clinical Psychological Science in https://doi.org/10.1186/s12888-020-02606-z
the Time of COVID-19: Challenges, [52] Huang, Y., & Zhao, N. (2020). Generalized
Opportunities, and a Call to Action. American anxiety disorder, depressive symptoms and
Psychologist. sleep quality during COVID-19 outbreak in
https://doi.org/10.1037/amp0000707 China: a web-based cross-sectional survey.
[45] Gurung, R. A. R., & Stone, A. M. (2020). Psychiatry Research, 288, 1–3. Retrieved from
Scholarship of Teaching and Learning in https://pubmed.ncbi.nlm.nih.gov/32325383/
Psychology Learning During the Pandemic. [53] Humphrey, K. R. (2013). Using a Student-Led
Cholarship of Teaching and Learning in Support Group to Reduce Stress and Burnout
Psychology. Advance Online Publication. Among BSW Students. Social Work with
Retrieved from Groups, 36(1), 73–84.
https://psycnet.apa.org/record/2020-78359- https://doi.org/10.1080/01609513.2012.712
001 905
[46] Hall, B. J., Patel, A., Lao, L., Liem, A., Mayawati, [54] Johnson, C. V., & Hayes, J. A. (2003). Troubled
E. H., & Tjipto, S. (2021). Structural validation spirits: Prevalence of predictors of religious
of The Patient Health Questionnaire-9 (PHQ- and spiritual concerns among university
9) among Filipina and Indonesian female students and counseling center clients.
migrant domestic workers in Macao: Journal of Counseling Psychology, 50(4), 409–
STRUCTURAL VALIDATION OF PHQ-9. 419. https://doi.org/10.1037/0022-
Psychiatry Research, 295(June 2020), 113575. 0167.50.4.409
https://doi.org/10.1016/j.psychres.2020.113 [55] Kaparounaki, C. K., Patsali, M. E., Mousa, D.-P.
575 V, Papadopoulou, E. V. K., Papadopoulou, K. K.
[47] Hamza, C. A., Ewing, L., Heath, N. L., & K., & Fountoulakis, K. N. (2020, August).
Goldstein, A. L. (2020). When Social Isolation University students’ mental health amidst the
Is Nothing New: A Longitudinal Study COVID-19 quarantine in Greece. Psychiatry
Psychological Distress During COVID-19 Research, Vol. 290, p. 113111.
Among University Students With and Without https://doi.org/10.1016/j.psychres.2020.113
Preexisting Mental Health Concerns. 111
Canadian Psychology. [56] Kaparounakia Chrysi K., Patsalia, M. E.,
https://doi.org/10.1037/cap0000255 Mousaa, D.-P. V., Papadopouloua, E. V. K.,
[48] Hayes, J. A., Petrovich, J., Janis, R. A., Yang, Y., Papadopouloua, K. K. K., & Fountoulakis, K. N.
Castonguay, L. G., & Locke, B. D. (2020). (2020). University students’ mental health
Suicide Among College Students in amidst the COVID-19 quarantine in Greece.
Psychotherapy : Individual Predictors and Psychiatry Research Journal, (January).
REVISTA ARGENTINA
2021, Vol. XXX, N°2, 390-405 DE CLÍNICA PSICOLÓGICA402 Jonathan Martínez-Líbano, María Mercedes Yeomans Cabrera
[57] Kira, I. A., Shuwiekh, H. A. M., Alhuwailah, A., Neuroscience and Biobehavioral Reviews, Vol.
Ashby, J. S., Sous, M., Sous, F., … Jamil, H. J. 80.
(2020). Traumatology The Effects of COVID-19 https://doi.org/10.1016/j.neubiorev.2017.07.
and Collective Identity Trauma ( Intersectional 010
Discrimination ) on Social Status and Well- [66] Lozano, R., Naghavi, M., Foreman, K., Lim, S.,
Being. Traumatology. Retrieved from Shibuya, K., & Aboyans, V. (2012). Global and
https://psycnet.apa.org/fulltext/2020-87181- regional mortality from 235 causes of death
001.pdf for 20 age groups in 1990 and 2010: a
[58] Klonsky, E. D., & May, A. M. (2015). The Three- systematic analysis for the Global Burden of
Step Theory (3ST): A New Theory of Suicide Disease Study. The Lancet, 380(9859), 2095–
Rooted in the “Ideation-to-Action” 2128.
Framework. International Journal of Cognitive https://doi.org/https://doi.org/10.1016/S014
Therapy, 8(2). 0-6736(12)61728-0
https://doi.org/https://doi.org/10.1521/ijct.2 [67] Lytle, M. C., Blosnich, J. R., De Luca, S. M., &
015.8.2.114 Brownson, C. (2018). Association of Religiosity
[59] Lamela, D., Soreira, C., Matos, P., & Morais, A. With Sexual Minority Suicide Ideation and
(2020). Systematic review of the factor Attempt. American Journal of Preventive
structure and measurement invariance of the Medicine, 54(5), 644–651.
patient health questionnaire-9 (PHQ-9) and https://doi.org/10.1016/j.amepre.2018.01.0
validation of the Portuguese version in 19
community settings. Journal of Affective [68] Madadin, M., Menezes, R. G., Alassaf, M. A.,
Disorders, 276(June), 220–233. Almulhim, A. M., Abumadini, M. S., Alnemer,
https://doi.org/10.1016/j.jad.2020.06.066 F. A., … Alramadhan, A. K. (2020). Crisis : The
[60] Larraguibel, M., González, P., Martínez, V., & Journal of Crisis Suicidal Ideation Among
Valenzuela, R. (2000). Factores de riesgo de la Medical - Students in Dammam , Saudi Arabia.
conducta suicida en niños y adolescentes. [69] Madigan, S., Racine, N., Cooke, J. E., Korczak,
Revista Chilena de Pediatria, 71(3). D. J., Madigan, S., Racine, N., … Korczak, D. J.
https://doi.org/http://dx.doi.org/10.4067/S0 (2020). Canadian Psychology / Psychologie
370-41062000000300002 canadienne and Future Directions and Future
[61] Leng, Y., Cappuccio, F. P., Wainwright, N. W. Directions.
J., Surtees, P. G., Luben, R., Brayne, C., & CanadianPsychology/Psychologiecanadienne.
Khaw, K. T. (2015). Sleep duration and risk of Retrieved from
fatal and nonfatal stroke: A prospective study https://psycnet.apa.org/fulltext/2020-80476-
and meta-analysis. Neurology, 84(11). 001.pdf
https://doi.org/10.1212/WNL.000000000000 [70] Magnavita, N., & Garbarino, S. (2017). Sleep,
1371 health and wellness at work: A scoping
[62] Lester, D., Wood, P., Williams, C., & Haines, J. review. International Journal of
(2004). Motives for suicide - A study of Environmental Research and Public Health,
Australian suicide notes. Crisis, 25(1), 33–34. Vol. 14.
https://doi.org/10.1027/0227-5910.25.1.33 https://doi.org/10.3390/ijerph14111347
[63] Liang, J., Kõlves, K., Lew, B., Leo, D. De, Yuan, [71] Man, A. F. De, & Rrez, B. I. B. G. (2002). The
L., & Talib, M. A. (2020). Coping Strategies and Relationship Between Level of Self-Esteem and
Suicidality : A Cross-Sectional Study From Suicidal Ideation With Stability of Self-Esteem
China. FRONTIERS IN PSYCHOLOGY, as Moderator. 235–238.
11(March), 1–6. [72] Martínez-Líbano, J. (2020). Salud mental en
https://doi.org/10.3389/fpsyt.2020.00129 estudiantes chilenos durante confinamiento
[64] Linehan, M. M. (1996). Suicidal behaviors por Covid-19 : revisión bibliográfica Mental
questionnaire (University of Washington). Health in Chilean Students during
University of Washington. Retrieved from Confinement by Covid-19 : literature review.
https://wbma.cc/wp- Revista Educación Las Américas, 2.
content/uploads/2018/01/Suicidal_Beh_Que https://doi.org/https://doi.org/10.35811/rea
st_pre_assessment.pdf .v10i2.126 Cada
[65] Lowe, C. J., Safati, A., & Hall, P. A. (2017). The [73] Masuda, N., Kurahashi, I., & Onari, H. (2013).
neurocognitive consequences of sleep Suicide Ideation of Individuals in Online Social
restriction: A meta-analytic review. Networks. PLoS ONE, 8(4), 1–8.
REVISTA ARGENTINA
2021, Vol. XXX, N°2, 390-405 DE CLÍNICA PSICOLÓGICAYou can also read
