Adolescents’ Suicidal Thoughts and Behaviors,Mental Health,and Access to School Counselors: Evidence from Georgia

Abstract

When adolescents experiencing mental health difficulties lack access to mental health services, it can lead to negative consequences, including suicidal thoughts and behaviors (STBs). School counselors play critical roles in providing care to youth who might otherwise lack access, but extant literature on counselors rarely accentuates their effects on mental health outcomes. This study examines whether access to school counselors moderates the association between adolescents’ mental health difficulties and STBs. We find that, while adolescents’ mental health difficulties are highly associated with STBs, this relationship is weakened when students attend schools with more counselors. Our findings contribute to the growing body of research on the roles of school counselors, underscoring the importance of investing in support personnel who promote students’ socioemotional well-being and mental health.

Keywords

mental health adolescent suicide school counselors socioemotional well-being

Get full access to this article

View all access options for this article.

References

Abrutyn

Mueller

A. S.

Osborne

(2020). Rekeying cultural scripts for youth suicide: How social networks facilitate suicide diffusion and suicide clusters following exposure to suicide. Society and Mental Health, 10(2), 112–135. https://doi.org/10.1177/2156869319834063

American School Counselor Association. (2015). The school counselor and student mental health. https://counselor1stop.org/wp-content/uploads/2018/04/PS_StudentMentalHealth.pdf

American School Counselor Association. (2019). ASCA school counselor professional standards & competencies. https://schoolcounselor.org/getmedia/a8d59c2c-51de-4ec3-a565-a3235f3b93c3/SC-Competencies.pdf

American School Counselor Association. (2023). Student-to-school-counselor ratio 2023–2024. https://www.schoolcounselor.org/getmedia/b9d453e7-7c45-4ef7-bf90-16f1f3cbab94/Ratios-21-22-Alpha.pdf

Bélanger

Cantin

Archambault

(2023). Student engagement as a mediator process between peer-victimization and achievement at the beginning of middle school. Journal of School Health, 93(11), 973–981. https://doi.org/10.1111/josh.13388

Bergen

H. A.

Martin

Richardson

A. S.

Allison

Roeger

(2003). Sexual abuse and suicidal behavior: A model constructed from a large community sample of adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 42(11), 1301–1309. https://doi.org/10.1097/01.chi.0000084831.67701.d6

Blake

M. K.

(2020). Other duties as assigned: The ambiguous role of the high school counselor. Sociology of Education, 93(4), 315–330. https://doi.org/10.1177/0038040720932563

Blazar

Kraft

M. A.

(2017). Teacher and teaching effects on students’ attitudes and behaviors. Educational Evaluation and Policy Analysis, 39(1), 146–170. https://doi.org/10.3102/0162373716670260

Brooks

J. R.

Madubata

I. J.

Jewell

R. D.

Ortiz

D. A.

Walker

R. L.

(2023). Depression and suicide ideation: The role of self-acceptance for Black young adults. Journal of Black Psychology, 49(3), 382–403. https://doi.org/10.1177/00957984211037440

10.

Brown

Knight

(2019). Identifying optimal student-to-school counselor ratios: Evidence from Texas (Asca Research Grant Program). American School Counselor Association. https://expertise.utep.edu/orspannouncement/identifyingoptimalstudenttoschoolcounselorratiosevidencetexas

11.

Carey

Harrington

(2010). The impact of school counseling on student educational outcomes in high schools: What can we learn about effectiveness from statewide evaluations of school counseling practice in Nebraska and Utah? (2; Research Briefs). https://scholarworks.umass.edu/cscore_briefs/2

12.

Carey

Harrington

Martin

Hoffman

(2012). A statewide evaluation of the outcomes of the implementation of ASCA National Model School Counseling Programs in rural and suburban Nebraska high schools. Professional School Counseling, 16(2), 100–107. https://doi.org/10.1177/2156759X0001600202

13.

Carrell

S. E.

Carrell

S. A.

(2006). Do lower student-to-counselor ratios reduce school disciplinary problems? The B.E. Journal of Economic Analysis & Policy, 5(1), 1–24. https://doi.org/10.1515/1538-0645.1463

14.

Carrell

S. E.

Hoekstra

M. L.

(2010). Externalities in the classroom: How children exposed to domestic violence affect everyone’s kids. American Economic Journal Applied Economics, 2(1), 211–228. https://doi.org/10.1257/app.2.1.211

15.

CDC. (n.d). Web-based injury statistics query and reporting system (WISQARS). US Department of Health and Human Services, CDC, National Center for Injury Prevention and Control. Retrieved November 28, 2021, from https://www.cdc.gov/injury/wisqars/index.html

16.

Chandler

J. W.

Burnham

J. J.

Riechel

M. E. K.

Dahir

C. A.

Stone

C. B.

Oliver

D. F.

Davis

A. P.

Bledsoe

K. G.

(2018). Assessing the counseling and non-counseling roles of school counselors. Journal of School Counseling, 16(7), 1–33. https://files.eric.ed.gov/fulltext/EJ1182095.pdf

17.

Chapman

J. F.

Ford

J. D.

(2008). Relationships between suicide risk, traumatic experiences, and substance use among juvenile detainees. Archives of Suicide Research, 12(1), 50–61. https://doi.org/10.1080/13811110701800830

18.

Currie

Stabile

Manivong

Roos

L. L.

(2010). Child health and young adult outcomes. Journal of Human Resources, 45(3), 517–548. https://doi.org/10.3368/jhr.45.3.517

19.

Eisenberg

Golberstein

Hunt

J. B.

(2009). Mental health and academic success in college. The B.E. Journal of Economic Analysis & Policy, 9(1), 1–35. https://doi.org/10.2202/1935-1682.2191

20.

Elbogen

E. B.

Lanier

Blakey

S. M.

Wagner

H. R.

Tsai

(2021). Suicidal ideation and thoughts of self-harm during the COVID-19 pandemic: The role of COVID-19-related stress, social isolation, and financial strain. Depression and Anxiety, 38(7), 739–748. https://doi.org/10.1002/da.23162

21.

Fletcher

J. M.

(2010). Adolescent depression and educational attainment: Results using sibling fixed effects. Health Economics, 19(7), 855–871. https://doi.org/10.1002/hec.1526

22.

Gaylor

E. M.

Krause

K. H.

Welder

L. E.

Cooper

A. C.

Ashley

Mack

K. A.

Crosby

A. E.

Trinh

Ivey-Stephenson

A. Z.

Whittle

(2023). Suicidal thoughts and behaviors among high school students—Youth risk behavior survey, United States, 2021. MMWR Supplements, 72(1), 45–54. https://doi.org/10.15585/mmwr.su7201a62023.

23.

Graham

(2022). Explaining the Racial School Climate Gap: Evidence From Georgia. AERA Open, 8. https://doi.org/10.1177/23328584221131529

24.

Hurwitz

Howell

(2014). Estimating causal impacts of school counselors with regression discontinuity designs. Journal of Counseling & Development, 92(3), 316–327. https://doi.org/10.1002/j.1556-6676.2014.00159.x

25.

Irteja Islam

Kabir

Khanam

. (2020). Suicidality, mental disorder and the utilization of mental health services among Australian adolescents. Children and Youth Services Review, 111, 104821.

26.

Ivey-Stephenson

A. Z.

Demissie

Crosby

A. E.

Stone

D. M.

Gaylor

Wilkins

Lowry

Brown

(2020). Suicidal ideation and behaviors among high school students—Youth risk behavior survey, United States, 2019. MMWR Supplements, 69(1), 47–55. https://doi.org/10.15585/mmwr.su6901a6

27.

Jackson

C. K.

(2012). Non-cognitive ability, test scores, and teacher quality: Evidence from 9th grade teachers in North Carolina (p. w18624). National Bureau of Economic Research. https://doi.org/10.3386/w18624

28.

Jackson

C. K.

(2018). What do test scores miss? The importance of teacher effects on non–test score outcomes. Journal of Political Economy, 126(5), 2072–2107. https://doi.org/10.1086/699018

29.

Kearney

Akos

Domina

Young

(2021). Student-to-school counselor ratios: A meta-analytic review of the evidence. Journal of Counseling & Development, 99(4), 418–428. https://doi.org/10.1002/jcad.12394

30.

Lapan

R. T.

Gysbers

N. C.

Stanley

Pierce

M. E.

(2012). Missouri professional school counselors: Ratios matter, especially in high-poverty schools. Professional School Counseling, 16(2), 108–116. https://doi.org/10.1177/2156759X0001600207

31.

La Salle

T. P.

George

H. P.

McCoach

D. B.

Polk

Evanovich

L. L

. (2018). An examination of school climate, victimization, and mental health problems among middle school students self-identifying with emotional and behavioral disorders. Behavioral Disorders, 43(3), 383–392. https://doi.org/10.1177/0198742918768045

32.

La Salle

T. P.

McCoach

D. B.

Meyers

. (2021). Examining measurement invariance and perceptions of school climate across gender and race and ethnicity. Journal of Psychoeducational Assessment, 39(7), 800–815. https://doi.org/10.1177/07342829211023717

33.

La Salle

T. P.

Parris

Morin

Meyers

. (2016). Deconstructing peer victimization: Relationships with connectedness, gender, grade, and race/ethnicity. School Psychology Forum, 10(1), 41–54.

34.

La Salle

T. P.

Wang

Parris

Brown

J. A

. (2017). Associations between school climate, suicidal thoughts, and behaviors and ethnicity among middle school students. Psychology in the Schools, 54(10), 1294–1301. https://doi.org/10.1002/pits.22078

35.

Lazaratou

Dikeos

D. G.

Anagnostopoulos

D. C.

Soldatos

C. R.

(2010). Depressive symptomatology in high school students: The role of age, gender and academic pressure. Community Mental Health Journal, 46(3), 289–295. https://doi.org/10.1007/s10597-010-9296-2

36.

Liang

S.-W.

Chen

R.-N.

Liu

L.-L.

X.-G.

Chen

J.-B.

Tang

S.-Y.

Zhao

J.-B.

(2020). The psychological impact of the COVID-19 epidemic on Guangdong College students: The difference between seeking and not seeking psychological help. Frontiers in Psychology, 11, 2231. https://doi.org/10.3389/fpsyg.2020.02231

37.

Lindsey

M. A.

Sheftall

A. H.

Xiao

Joe

(2019). Trends of suicidal behaviors among high school students in the United States: 1991–2017. Pediatrics, 144(5), 1–10. https://doi.org/10.1542/peds.2019-1187

38.

Liu

C. H.

Stevens

Wong

S. H. M.

Yasui

Chen

J. A.

(2019). The prevalence and predictors of mental health diagnoses and suicide among U.S. College students: Implications for addressing disparities in service use. Depression and Anxiety, 36(1), 8–17. https://doi.org/10.1002/da.22830

39.

LoCurto

Pella

J. E.

Chan

Ginsburg

G. S.

(2021). Caregiver report of the utilization of school-based services and supports among clinically anxious youth. Journal of Emotional and Behavioral Disorders, 29(2), 93–104.

40.

Lund

E. M.

Blake

J. J.

Ewing

H. K.

Banks

C. S.

(2012). School counselors’ and school psychologists’ bullying prevention and intervention strategies: A look into real-world practices. Journal of School Violence, 11(3), 246–265.

41.

(2017). Child and adolescent mental disorders and health care disparities: Results from the National Survey of Children’s Health, 2011–2012. Journal of Health Care for the Poor and Underserved, 28(3), 988–1011. https://doi.org/10.1353/hpu.2017.0092

42.

(2019). Adolescent depression: National trends, risk factors, and healthcare disparities. American Journal of Health Behavior, 43(1), 181–194. https://doi.org/10.5993/AJHB.43.1.15

43.

Marraccini

M. E.

Griffin

O’Neill

J. C.

Martinez

R. R.

Jr Chin

A. J.

Toole

E. N.

Grapin

S. L.

Naser

S. C.

(2022). School risk and protective factors of suicide: A cultural model of suicide risk and protective factors in schools. School Psychology Review, 51(3), 266–289. https://doi.org/10.1080/2372966X.2020.1871305

44.

Miller

D. N.

Eckert

T. L.

Mazza

J. J.

(2009). Suicide prevention programs in the schools: A review and public health perspective. School Psychology Review, 38(2), 168–188. https://doi.org/10.1080/02796015.2009.12087830

45.

Mueller

A. S.

Abrutyn

(2015). Suicidal disclosures among friends: Using social network eata to understand suicide contagion. Journal of Health and Social Behavior, 56(1), 131–148. https://doi.org/10.1177/0022146514568793

46.

Mueller

A. S.

Diefendorf

Abrutyn

Beardall

K. A.

Gallagher

Jackson

Liang

Steinberg

Watkins

J. T.

Worton

(2021). Strategies to Prevent Suicide in Schools and Communities. SocArXiv. https://doi.org/10.31235/osf.io/znrgj

47.

Mueller

A. S.

James

Abrutyn

Levin

M. L.

(2015). Suicide ideation and bullying among US adolescents: Examining the intersections of sexual orientation, gender, and race/ethnicity. American Journal of Public Health, 105(5), 980–985. https://doi.org/10.2105/AJPH.2014.302391

48.

Mulhern

(2023). Beyond teachers: Estimating individual school counselors’ effects on educational attainment. American Economic Review, 113(11), 2846–2893. https://doi.org/10.1257/aer.20200847

49.

Paschall

M. J.

Bersamin

(2018). School-based mental health services, suicide risk and substance use among at-risk adolescents in Oregon. Preventive medicine, 106, 209–215. https://doi.org/10.1016/j.ypmed.2017.11.004

50.

Pincus

Hannor-Walker

Wright

Justice

(2020). COVID-19’s effect on students: How school counselors rise to the rescue. NASSP Bulletin, 104(4), 241–256.

51.

Reback

(2010a). Noninstructional spending improves noncognitive outcomes: Discontinuity evidence from a unique elementary school counselor financing system. Education Finance and Policy, 5(2), 105–137.

52.

Reback

(2010b). Schools’ mental health services and young children’s emotions, behavior, and learning. Journal of Policy Analysis and Management, 29(4), 698–725. https://doi.org/10.1002/pam.20528

53.

Rivas-Koehl

Valido

Espelage

D. L.

Robinson

L. E.

Hong

J. S.

Kuehl

Mintz

Wyman

P. A.

(2022). Understanding protective factors for suicidality and depression among U.S. sexual and gender minority adolescents: Implications for school psychologists. School Psychology Review, 51(3), 292–303. https://doi.org/10.1080/2372966X.2021.1881411

54.

Romanelli

Sheftall

A. H.

Irsheid

S. B.

Lindsey

M. A.

Grogan

T. M.

(2021). Factors associated with distinct patterns of suicidal thoughts, suicide plans, and suicide attempts among US adolescents. Prevention Science, 23(1), 73–84. https://doi.org/10.1007/s11121-021-01295-8

55.

Roy

(2005). Childhood trauma and impulsivity. Possible relevance to suicidal behavior. Archives of Suicide Research, 9(2), 147–151. https://doi.org/10.1080/13811110590903990

56.

Savitz-Romer

(2019). No counselor left behind. The Learning Professional, 40(3), 50–53.

57.

Savitz-Romer

Rowan-Kenyon

H. T.

Nicola

T. P.

Alexander

Carroll

(2021). When the kids are not alright: School counseling in the time of COVID-19. AERA Open, 7, 23328584211033600.

58.

Singer

J. B.

(2017). Identifying and responding to suicide risk in schools. Psychiatric Annals, 47(8), 401–405. https://doi.org/10.3928/00485713-20170703-01

59.

Singer

J. B.

Erbacher

T. A.

Rosen

(2019). School-based suicide prevention: A framework for evidence-based practice. School Mental Health, 11(1), 54–71. https://doi.org/10.1007/s12310-018-9245-8

60.

Smalley

K. B.

Warren

J. C.

Barefoot

K. N.

(2017). Connection between experiences of bullying and risky behaviors in middle and high school students. School Mental Health, 9(1), 87–96. https://doi.org/10.1007/s12310-016-9194-z

61.

Suldo

S. M.

Shaunessy

Hardesty

(2008). Relationships among stress, coping, and mental health in high-achieving high school students. Psychology in the Schools, 45(4), 273–290. https://doi.org/10.1002/pits.20300

62.

Vogel

Meigen

Sobek

Ober

Igel

Körner

Kiess

Poulain

(2021). Well-being and COVID-19-related worries of German children and adolescents: A longitudinal study from pre-COVID to the end of lockdown in Spring 2020. JCPP Advances, 1(1), 1–9. https://doi.org/10.1111/jcv2.12004

63.

Walker

R. L.

Salami

T. K.

Carter

S. E.

Flowers

(2014). Perceived racism and suicide ideation: Mediating role of depression but moderating role of religiosity among African American adults. Suicide and Life-Threatening Behavior, 44(5), 548–559. https://doi.org/10.1111/sltb.12089

64.

Walsh

Eggert

L. L.

(2007). Suicide risk and protective factors among youth experiencing school difficulties. International Journal of Mental Health Nursing, 16(5), 349–359.

65.

Wang

La Salle

Liu

J. L.

(2022). Do parental involvement and adult support matter for students’ suicidal thoughts and behavior in high school? School Psychology Review, 51(3), 329–342. https://doi.org/10.1080/2372966X.2021.1873058

66.

Wang

La Salle

T. P.

K. A.

Sullivan

K. E.

(2019). Does parental involvement matter for students’ mental health in middle school? School Psychology Review, 34(2), 222–232. https://doi.org/10.1037/spq0000300

67.

Warren

J. M.

Jones

S. J.

Unger

D. L.

(2020). Strengthening professional school counseling: A call to action. Professional Issues in Counseling, 6(1), 61–76.

68.

Williams

D. Y.

Wexler

Mueller

A. S.

(2022). Suicide postvention in schools: What evidence supports our current national recommendations? Journal of School Social Work, 46(2), 23–69.

69.

World Health Organization. (2014). Preventing suicide: A global imperative. Author. https://apps.who.int/iris/bitstream/handle/10665/131056/9789241564779_eng.pdf

70.

Yang

(2024). Influences of prepandemic bullying victimization and COVID-19 peer discrimination on Chinese American adolescents’ mental health during the COVID-19 pandemic. School psychology, 39(1), 20–30. https://doi.org/10.1037/spq0000554

71.

Zolopa

Burack

J. A.

O’Connor

R. M.

Corran

Lai

Bomfim

DeGrace

Dumont

Larney

Wendt

D. C.

(2022). Changes in youth mental health, psychological wellbeing, and substance use during the COVID-19 pandemic: A rapid review. Adolescent Research Review, 7(2), 161–177. https://doi.org/10.1007/s40894-022-00185-6