Understanding suicide risk in higher education: Institutional context, modifiable behaviors, and implications for campus health promotion

Objective: Individual-level suicide risk factors are well documented, yet contextual and behavioral influences remain less understood. Participants: Using survey data from 250,385 students across 373 U.S. universities collected from 2019 to 2022 by the American College Health Association. Methods: In this research, we hypothesized that institutional characteristics are associated with suicide risk and that physical and social activities mediate these relationships. Results: Institutional characteristics, including school location, geographic region, enrollment size, and having a religious affiliation, were significantly associated with suicide risks. Physical and social activities significantly mediated some of these relationships. The results highlight disparities in suicide risk across U.S. higher education institutions during the COVID-19 pandemic and suggest that institutional contexts and student behaviors jointly shape suicide risk. Physical and social activities may represent important modifiable pathways. Conclusions: This study supports a Healthy Campus framework that emphasizes context-responsive prevention strategies and opportunities for physical and social engagement.