IJEP – International Journal of Educational Psychology, Vol. 8 No.

3
October 2019 pp. 246-269

College Student Suicide Risk: The

Relationship between Alexithymia,
Impulsivity, and Internal Locus of
Control
Mark A. Loftis Tony Michael
Tennessee Technological University Tennessee Technological University
Chad Luke
Tennessee Technological University

Abstract
Suicide has become the second leading cause of death for individuals between 15 and
29 years old and increasingly more common within college students (WHO, 2016).
The purpose of this study was to examine the associations among alexithymia,
impulsivity, and locus of control as predictors of suicide risk in college students.
Participants were comprised of 550 undergraduate students from two universities in
the southeastern United States. Multiple regression analyses were examined to
evaluate what variables could be significant predictors of suicide risk in college
students. Age, alexithymia subscales of difficulty identifying feelings and externally
oriented thinking, and impulsivity subscales of motor, self-control, and nonplanning
were considered significant in the regression analysis of suicide risk.
Psychoeducational implications, limitations, and future directions are also discussed.
Keywords: alexithymia, suicide risk, impulsivity, college students

2019 Hipatia Press

ISSN: 2014-3591
DOI: 10.17583/ijep.2019.3991
IJEP – International Journal of Educational Psychology, Vol. 8 No. 3
October 2019 pp. 246-269

Riesgo de Suicidio en Estudiantes

Universitarios: La Relación entre
Alexitimia, Impulsividad y Locus de
Control Interno
Mark A. Loftis Tony Michael
Tennessee Technological University Tennessee Technological University
Chad Luke
Tennessee Technological University
Resumen
El suicidio se ha convertido en la segunda causa de muerte entre las personas entre 15
y 29 años y es cada vez más común entre los estudiantes universitarios (WHO, 2016).
El propósito de este estudio fue examinar las asociaciones entre alexitimia,
impulsividad y locus de control como factores predictivos del riesgo de suicidio en
estudiantes universitarios. Los participantes fueron 500 estudiantes de grado de dos
universidades en el sureste de los Estados Unidos. Se realizaron análisis de regresión
múltiple para evaluar qué variables podrían ser predictores significativos del riesgo
de suicidio en estudiantes universitarios. La edad, las subescalas de alexitimia de
dificultad para identificar los sentimientos y el pensamiento orientado externamente,
y las subescalas de impulsividad de motor, autocontrol y no planificación se
consideraron significativas en el análisis de regresión del riesgo de suicidio. También
se discuten las implicaciones psicoeducativas, las limitaciones y las direcciones
futuras.
Palabras clave: alexitimia, riesgo de suicidio, impulsividad, estudiantes universitarios

2019 Hipatia Press

ISSN: 2014-3591
DOI: 10.17583/ijep.2019.3991
248 Loftis, Michael & Chad– College Students Suicide Risk

S uicide has become the second leading cause of death for individuals
between 15 and 29 years old worldwide (WHO, 2016). Colleges and
universities across the country are not immune to its impact, as suicidal
thoughts and behaviors (STB) are common among college students.
Specifically, 12-month suicidal ideation estimates (i.e., either characterized as
broad ideation or as seriously contemplating suicide) have been referenced to
be in the 5–35% range (Robins and Fiske, 2009, Wong et al., 2011), and 12-
month suicide attempts have been referenced to range between 0.6–11%
(Chou et al., 2013, Eisenberg et al., 2013). The American College Health
Association (2011) also stated that as many as six percent of college students
consider suicide each month, and one out of every 100 college students has
attempted suicide at some point in the past. Although a wide range of
prevention interventions have been developed and implemented in colleges
worldwide, a Cochrane review indicated minor support that these programs
lead to reductions in suicidality (Harrod et al., 2014). For this reason, policy
makers, college administrators, clinicians, and helping professionals must
have accurate insight into and knowledge regarding the identification of at-
risk students so that appropriate interventions may be put in to place to serve
this individuals (Haas, Hendin, & Mann, 2003). Therefore, the purpose of this
research was to examine the association among alexithymia, impulsivity,
locus of control, and suicide risk in undergraduate students to help better
explore the personal attributes or traits that may be associated with a
phenotype or profile for suicidal risk.

Literature Review

Research in the field of suicide has been problematic, as much of the work
completed to date has focused on the prediction of suicide rather than a clear
understanding of the phenomenological aspects of suicide (Silverman,
Berman, Sanddal, O’Carroll, & Joiner, 2007a; 2007b). Silverman et al.
(2007a) recognized that the nuances of the term suicide contributed to the
challenges faced in suicidology, and asserted how that a common
nomenclature would better serve the field. Typically, when the term suicide is
used, it is done so in a broad fashion, referring to many varied behaviors rather
than a single action. Such behaviors may include suicidal thoughts, intentions,
IJEP – International Journal of Educational Psychology, 8(3) 249

ideation, gestures, attempts, completions, and equivalents. In addition, another

problematic issue is that statistical data does not necessarily inform suicide
prevention. Linehan (2008) asserted that most research on suicide has been
based on the theory that suicide is a symptom of a mental disease. Under this
assertion, one must treat the underlying disease in order to effectively treat
suicide, which has resulted in various suicide prevention strategies being
developed based upon this theoretical premise. Linehan argued this model has
not been effective because no randomized trial has shown evidence that
targeting mental disorders results in significant reductions in suicide attempts
or deaths by suicide. She also referenced that suicide research should focus
not on pathology, but on personality factors or traits that better predict suicidal
ideation and behaviors.
Pompili (2010) similarly supported the theory that confining the etiology
of suicide to psychiatric illness is problematic. Within this premise, suicide
should be considered a phenomenological event, unique to individuals rather
than a syndrome or symptom of a psychiatric illness. Although suicide
research has focused on suicidal ideation, recent suicide attempts, and other
short-term risk factors, Pompili referenced researchers should center the focus
on personality factors because dispositions may hold the more precise cause
or deeper reasoning for desiring suicide.
Nock and colleagues (2008) reinforced the notion for researchers to depart
from examining demographic and psychiatric factors and move toward
examining theoretical models that explain suicidal behaviors. The authors’
premise was identifying risk factors and traits in a theoretical model would be
critical in aiding college and helping professionals to develop appropriate
interventions with suicidal students (Schwartz, 2006; 2011). By examining
personal attributes or traits, a theoretical model may be formed that would
better define a phenotype or profile for suicide. One such psychological
factor—alexithymia—is the subject of exploration in this study.

Alexithymia and Suicidal Ideation

Alexithymia is a personality construct described by the subclinical incapacity
to distinguish and verbalize emotions in the self. A number of studies have
supported the position that alexithymia is related to suicide risk (Laget et al.,
2006; Iancu et al., 1999; Alpaslan et al., 2015). In particular, Laget et al.
250 Loftis, Michael & Chad– College Students Suicide Risk

(2006) examined alexithymia scores on the Toronto Alexithymia Scale-20

with 570 participants who were characterized with dependence disorders. The
researchers found that repeat attempters (both past and recent) had a more
severe psychological profile compared to other suicide attempts. Furthermore,
their findings indicated TAS-20 scores were higher among recent and past
attempters. Iancu et al. (1999) studied alexithymia, affect intensity, and
emotional range in suicidal clients. Using 60 participants, the researchers
found that when comparing 20 suicidal depressed (SD) clients to 20 non-
suicidal depressed (NSD) clients to 20 control group participants, the SD
group had higher alexithymia scores on the Toronto Alexithymia Scale than
the NSD and control group participants. Although the results indicated that
alexithymia, affect intensity, and emotional range were not proven to be
represent sensitive predictors of suicidal behavior, the researchers found that
hopelessness and depression severity were more reliable in the prediction of
suicidal risk. Likewise, Alpaslan and colleagues (2015) suggested that the
presence of alexithymia is a significant predictor of suicide probability in a
sample of 381 non-clinical Turkish high school girls with disorder eating
attitudes (DEA). Their findings indicated the Suicide Probability Scale (SPS)
total score, Hopelessness, Suicide Ideation, and the Hostility subscale scores
of the SPS were significantly higher in the alexithymic DEAs group than the
non-alexithymic DEAs group.

Locus of Control and Suicide Risk

Previous findings have identified an association between locus of control and
suicidal behavior among adolescents and young adults. In particular, findings
indicated that individuals who had engaged in suicidal behaviors were
characterized by a more external locus of control orientation (Goldney et al.,
1989; Goldney et al., 1991; Topol & Reznikoff, 1982). In an 8-year
longitudinal study of suicidal ideation among high school students, Goldney
et al. (1989; 1991), found that locus of control scores correlated with suicidal
ideation over time. Goldney et al. (1991) proposed that suicidal ideation is not
merely a temporary experience but is linked with more pervasive
psychological traits. Topol and Reznikoff (1982) found that hospitalized
suicidal adolescents scored more externally than hospitalized nonsuicidal
teenagers and non-hospitalized controls. Topol and Reznikoff also proposed
IJEP – International Journal of Educational Psychology, 8(3) 251

the locus of control construct may be useful in identifying potentially suicidal

adolescents. Recent findings have indicated suicide risk scores correlated
negatively and significantly with self-esteem and resilience and positively
with locus of control (Montes-Hidalgo & Tomás-Sábado, 2016) and that locus
of control and family connectedness related to current nonsuicidal self‐injury
(NSSI) engagement (Wester et al., 2016).

Impulsivity and Suicide Risk

Recent studies using the Barratt Impulsiveness Scale (BIS; Patton et al., 1995)
have indicated a connection between impulsivity and suicide risk (Izci et al.,
2016; Ponsoni, et al., 2018; Menon et al., 2015). In particular, higher BIS-11
attention factor scores were found to be higher in adults with bipolar II
disorder with a history of suicide attempts and higher BIS-11 motor and
nonplanning factor scores in adults with bipolar I with histories of suicide
attempt when compared to a nonclinical matched control group (Izci et al.,
2016). Ponsoni et al. (2018) referenced differences in BIS-11 motor factor
scores in clinical patients with a history suicide attempts compared to clinical
patients without a history of suicide attempts. Their study revealed that each
additional point on the BIS-11 motor factor scale increased probability of past
suicide attempts by 1.14%. Lower motor impulsivity as measured by the BIS-
11 have also been found to be an independent predictor of suicide intent with
medically stabilized attempted suicide subjects (Menon, Sarkar, Kattimani, &
Mathan, 2015). Furthermore, higher impulsivity and suicide risk was seen in
clients with dependence and a history of suicidal ideations compared with
same type clients without a history of suicidal ideations and significantly
higher nonplanning factor scores. (Khemiri, Jokinen, Runeson, & Jayaram-
lindström, 2016). Gvion & Apter (2012) proposed the construct of
impulsivity, particularly as it relates to suicide and suicidal behavior, needs
additional research to refine it to differentiate between state versus trait
impulsivity as well as the role of other factors such as aggression relate to
impulsivity as a risk factor in suicide.

College Students and Suicide Risk

A large national sample of undergraduate college students indicated that 8%
had attempted suicide at least once in their lives (Drum, Brownson, Denmark,
252 Loftis, Michael & Chad– College Students Suicide Risk

& Smith, 2009). In spite of the fact that suicide is one of the leading causes of
death on college campuses, few college students report receiving information
about suicide from their college or university. A majority of college students
(65.9%) reported they have not received information about suicide prevention
from their college or university. Instead many students referenced that
colleges and universities were much better about providing information
concerning other topics, such as violence prevention, sexually transmitted
disease/infection prevention, and stress reduction rather than suicide
prevention. Garlow et al. (2008) found 16% of university students with
suicidal ideation were actually receiving treatment. In another university
study, only 20% to 25% of students that died by suicide had contacted campus
counseling centers (Schwartz, 2006). Conversely, college students who
utilized campus counseling centers were 18 times more at risk of suicide. This
might indicate that more severely emotionally disturbed students are more apt
to use campus counseling services. Nevertheless, the point remains that only
about one in four college students who die by suicide contacted campus
counseling centers. The vast majority do not receive any form of treatment.
At this time, no statistics are available regarding how many college students
contact their professors, instructors, or advisors with these concerns.

Implications of Current Study

While previous findings have indicated separate associations between the

three constructs of alexithymia, locus of control, and impulsivity with suicide
ideation using various populations, the purpose of this study is to examine the
specific association between alexithymia, impulsivity, locus of control, and
suicide risk together within college students. In addition, demographic factors
such as age, sex, and race were investigated to understand the etiology of
suicide. Assuming that suicide risk is multidimensional, an individual may
understand the relationship between a dispositional variable (e.g.,
alexithymia) and suicide risk. If a dispositional precursor to suicide can be
better understood, such information may inform the development of
assessment and intervention protocols for colleges and universities that are
interested in identifying and assisting high risk students.
IJEP – International Journal of Educational Psychology, 8(3) 253

Hypotheses
The main null hypothesis of our study is that there is no relationship between
the variables of Alexithymia, Locus of Control, and Impulsivity, and the
Suicide Brief Questionnaire-Revised total score. The alternative
hypothesis/Ha is: At least one of the independent variables is useful in
explaining/predicting SBQ-R, expressed as: H1: At least one βi is ≠ 0. In
regards to expected results, the authors hypothesized that students with higher
alexithymia and impulsivity total and subscale scores would have be at higher
risk with suicide ideation and behavior. In addition, the authors theorized
college students with higher SBQ-R total scores would be more internalized
in their locus of control. If we fail to reject, we conclude that there isn't any
evidence of explanatory power, which suggests there is no point in using this
model or variables to evaluate these traits in college students for
understanding suicide risk.

Method

This study used a quantitative design to examine alexithymia, impulsivity, and

locus of control as predictors of suicide risk among college students and
frequencies associated with these variables. Participants were undergraduate
students recruited from two universities in the southeastern United States who
were asked to complete a web-based, self-report survey. The first university
was a mid-sized public university and the second was a mid-sized private
university. A multiple regression analysis was used to analyze the relationship
between each of the constructs and suicide risk. A number of covariates were
included in the regression model including gender, race, school, and age.
These analyses were conducted to help identify the factors that may be most
predictive of suicide risk.

Participants
Invitations were sent to 879 college students. Out of these invitations, 621
(71%) accessed the survey (95 students at the private university and 526 at the
public university). Of the 621 students to access the survey, 550 (89%)
completed the survey in its entirety. Partial or incomplete surveys were not
used in data analysis. Eligibility to participate in this study included an
254 Loftis, Michael & Chad– College Students Suicide Risk

enrolled status in the university systems and a required age limit of 18 years
old. The university samples differed significantly by gender—whereas only
46.1% of participants at the public university were female, 73.3% of
participants at the private university were female (X 2 = 22.35, p < .001).
Freshmen comprised 42.7% of participants; 31.0% were sophomores, 16.0%
were juniors, and 5.8% were seniors. Academic classification percentages
were comparable across the two universities. As for the race identified by the
participants, 446 (81.3%) were White or Caucasian, 29 (5.3%) were Black or
African American, 29 (5.3%) were Middle Eastern (i.e., Saudi), 26 (4.6%)
were Asian, 10 (2.6%) were Hispanic or Latino, seven (1.3%) were American
Indian or Alaska Native, and one (.2%) was a Pacific Islander (i.e., Filipino).
The public university was somewhat more racially diverse (i.e., 17.6%
specifying a racial minority vs. 12.2% at the private university). Lastly, the
mean age of respondents was 20.52 (SD = 3.60). The mean for the public
university was 20.55 (SD = 3.63) and the mean for the private university was
20.35 (SD = 3.42; i.e., a non-significant difference).

Measures
Toronto Alexithymia Scale–20. The Toronto Alexithymia Scale–20
(TAS– 20; Bagby, Parker, & Taylor, 1994a; 1994b) was developed with the
assumption that individuals with alexithymia have difficulty identifying
feelings, describing feelings, and are externally oriented in their thinking. The
20-item instrument includes a five-point Likert scale with three scales that can
be summed to create a total alexithymia score. Scores of 51 or lower are
considered low and scores equal to or higher than 61 are considered high
(Taylor et al., 1992). The total scale has shown good internal consistency (.81;
Bagby et al., 1994a). The TAS-20 has a three-factor model with: 1) Difficulty
Identifying Feelings, 2) Difficulty Describing Feelings and 3) Externally-
Oriented Thinking. Individual alexithymia factors have shown generally
acceptable internal consistencies of 0.78, 0.75, and 0.66, respectively (Bagby
et al., 1994a). Sample items include: “I have feelings I can’t identify”; “It is
difficult for me to find the right words for my feelings”; “Being in touch with
emotions is essential.”
Barratt Impulsiveness Scale. The Barratt Impulsiveness Scale (BIS;
Patton et al., 1995) is a 30-item instrument with a four-point Likert scale to
IJEP – International Journal of Educational Psychology, 8(3) 255

measure the construct of impulsivity. The scale has gone through eleven
revisions and found to be effective in examining the impulsivity personality
trait in clinical and non-clinical settings (Stanford et al., 2009). The BIS-11
assesses nine factors across two broader dimensions (Patton et al., 1995). Six
of the factors (i.e., attention, motor, self-control, perseverance, cognitive
complexity, and cognitive stability) have been identified as first order factors
(Stanford et al., 2009). Sample items include “I plan tasks carefully” (self-
control) and “I act on the spur of the moment” (motor). Second order factors
(i.e., attentional impulsiveness, motor impulsiveness, and non-planning
impulsiveness) include items such as “I spend or charge more than I earn”
(motor impulsiveness) and “I don’t pay attention” (attentional impulsiveness).
According to Stanford et al. (2009), total scores of 72 or above should be used
to indicate high impulsivity. The BIS-11 has shown well-established
concurrent validity in college samples in comparison to other measures of
impulsivity and that the measure had acceptable internal consistencies ranging
from .71 to .83.
Internal Control Index. The Internal Control Index (ICI; Duttweiler,
1984) is a 28-item instrument used to measure internal versus external locus
of control. The ICI measures two factors (internal and external) addressing an
individual’s expectancy for reinforcement. Sample items of Factor 1 include
“When faced with a problem I try to forget it,” and “Whenever something
good happens to me I feel it is because I earned it.” Factor 2 includes such
items as “I need encouragement from others for me to keep working at a
difficult task,” and “I prefer to learn the facts about something from someone
else rather than have to dig them out for myself.”. These items are all scored
through Likert-type responses of rarely, occasionally, sometimes, frequently,
or usually. Possible scores range from 28 to 140 with higher scores indicating
internal locus of control. The ICI has very good internal consistency (.84) and
the instrument has been found to have higher reliability than other instruments
measuring locus of control (Duttweiler, 1984).
Suicidal Behaviors Questionnaire-Revised. The Suicidal Behaviors
Questionnaire-Revised (SBQ-R; Linehan, 1981) is a four-item, instrument
used to measure past and future suicidal behavior (Osman et al., 2001). In
particular, the SBQ-R asks three questions about past suicidal behavior (e.g.,
“Have you ever thought or attempted to kill yourself”) and the fourth item is
256 Loftis, Michael & Chad– College Students Suicide Risk

future-oriented (i.e., “How likely is it that you will attempt suicide

someday?”). Linehan (1981) developed the original version of the SBQ to be
used as a structured interview to assess suicide risk. The SBQ-R has been
normed using clinical and non-clinical samples. The non-clinical sample
included high school students and undergraduate general psychology students.
The SBQ-R has shown acceptable internal consistency among undergraduates
(.76). Furthermore, Osman et al. (2001) determined that the SBQ-R scores
was useful to determine risk factors for suicidal behaviors. A cutoff score of
seven is recommended to be used for both non-clinical, adult samples (Osman
et al. 2001). The SBQ-R has shown concurrent validity when compared to
other measures of suicide risk (Cotton, Peters, & Range, 1995).

Results

Sums, means, standard deviations, and internal consistencies are provided for
the TAS-20 (Bagby, Parker, & Taylor, 1994a), BIS-11 (Patton et al., 1995),
ICI (Duttweiler, 1984) and SBQ-R (Osman et al., 2001). Furthermore, each
instrument showed good internal consistency, ranging from .80 to .84.

Table 1. Scale Sums, Means, Standard Deviations, and Internal Consistencies

Scale Sum Score M SD Α

TAS-20 48.39 2.42 .52 .83
BIS-11 63.30 2.11 .32 .80
ICI 98.73 3.54 .46 .84
SBQ-R 48.25 4.63 2.53 .80

Alexithymia
The TAS-20 sum scores ranged from 20 to 100. The overall mean was 48.39
(SD = 10.33), indicating low to moderate (or nearly moderate) scores. Mean
scores were also computed by calculating the average score of individual
items on the TAS-20. The overall mean score was 2.42 (SD = .52) on a five-
point scale. Males had significantly higher alexithymia scores (M = 2.50, SD
= .49) than females (M = 2.34, SD = .53), where t = 3.67, df = 548, p < .001.
Examining mean differences across the samples, alexithymia was
significantly higher among students at University 1 (the large public
IJEP – International Journal of Educational Psychology, 8(3) 257

university) (M = 2.46, SD = .50), t = 4.05, df = 548, p < .001. Mean

alexithymia at University 2 was 2.22 (SD = .54).
Using the Taylor et al. (1992) alexithymia cut-off scores, 326 participants
were in the low range (59.5%), 152 were in the medium range (27.7%), and
70 participants were in the high range (12.8%). Frequencies of participants in
low, medium, and high ranges differed across university samples. In
University 1, the breakdown was 56.8%, 29.9%, and 13.3%, respectively. In
comparison, the percentages at the private university were 73.3%, 16.7%, and
10.0%, indicating a higher-than-expected frequency of students with medium
and high alexithymia at University 1 (X2 = 8.88. df = 2, p = .012). Given the
large difference in the proportion of males and females in the two universities,
the gender breakdown of alexithymia scores was examined. It was found that
males had significantly higher rates of high and medium alexithymia scores
(15.6% and 32.2%, respectively) compared to females (10.1% and 23.4%; X2
= 11.81. df = 2, p = .003). These findings suggest that gender may account
for the differences in alexithymia scores across universities.

Impulsivity
The results indicated sum scores on the BIS-11 ranged from 36.3 to 93.9 with
a mean score of 63.3 (SD = 9.6). This was comparable to Stanford et al.’s
sample mean of 62.3 (SD = 10.3). The findings indicated 72 participants
(22.2%) who scored above 71 (i.e., denoted high impulsivity) and 428
participants (77.8%) who scored below 71 (i.e., denoted normal impulsivity).
The mean score for the BIS-11 was 2.11 (SD = .32) on a four-point scale.
Males were slightly more impulsive (M = 2.15, SD = .31) than females (M =
2.07, SD = .33), t = 2.82, df = 548, p = .005.

Locus of control
The range of ICI sum scores in this sample was 63 to 135 with a mean sum
score 98.7 (SD = 13.81). This mean sum score was significantly lower than
the mean found by Duttweiler (1984) for similarly aged respondents (M =
103.7, SD = 12.20), t = -8.85, df = 549, p < .001. The ICI mean score was 3.54
on a four-point scale (Table 2). Higher scores on the ICI indicate greater
internal locus of control. Female participants had higher internal locus of
control (M = 3.60, SD = .47) than male participants (M = 3.48, SD = .45), t =
258 Loftis, Michael & Chad– College Students Suicide Risk

-2.91, df = 548, p = .004. ICI scores at University 1 (M = 3.51, SD = .46) did

not differ significantly from scores at University 2 (M = 3.66, SD = .46).

Suicide risk
The average SBQ-R score in this sample was 4.63 (SD = 2.5). Females
showed a higher suicide risk (M = 4.86, SD = 2.70) than males (M = 4. 39, SD
= 2.33), where t = -2.19, df = 539.3, p = .029. The Levene’s test for equality
of variances showed significantly higher variability in female suicide risk
scores (F = 4.02, p = .046). Table 2 compares SBQ-R suicide risk of the two
university samples. The range of SBQ-R scores in the current sample was 3
to 17. The recommended cutoff score for clinical samples is greater than or
equal to 7 (Osman et al., 2001). In this sample, 99 college student participants
had scores indicating suicide risk (18.0%).

Table 2. SBQ-R Suicide Risk Rates (N = 550)

Variable <7 % ≥7 % Total

University 1 381 82.8 79 17.2 460
University 2 70 77.8 20 22.2 90
Total 451 82.0 99 18.0 550

Multiple Regressions
When evaluating the total scores of TAS-20, BIS, and ICI with the variables
of Age, Gender, University, and Race in a multiple regression with the
dependent variable as the SBQR total, the overall regression model was
significant, F(8, 137.39) = 2.85, p < .004, R2 = .048, and adjusted R2= .031
(see Table 3). A closer evaluation of the variables within the regression model
indicated Age, and TAS-20 total score as being considered significant in
regards to the SBQR total. In addition, Gender was also very close to the
cutoff score with a .058.
IJEP – International Journal of Educational Psychology, 8(3) 259

Table 3. Coefficientsa of Multiple Regression Analysis with Total Scores of TAS20,

BIS, and ICI
Standardized
Unstandardized Coefficients Coefficients
Model B Std. Error Beta t Sig.
1 (Constant) -1.021 2.119 -.482 .630
University .105 .322 .015 .326 .744
Gender .455 .239 .091 1.900 .058
Age .085 .035 .127 2.429 .016
Race .039 .134 .014 .294 .769
Class -.131 .140 -.049 -.934 .351
TAS-20 .044 .013 .183 3.495 .001
SUM
ICI SUM .006 .011 .030 .525 .600
BIS SUM .014 .014 .056 1.020 .308
a. Dependent Variable: SBQR_Total

To provide a more thorough analysis, a multiple regression of the subscales

of the TAS-20, BIS, and ICI were also examined. Utilizing the findings of the
previous multiple regression, non-significant variables were eliminated (e.g.,
university affiliation, race, etc.). The overall regression model was
significant, F(12, 367.65) = 5.48, p < .001, R2 = .13, and adjusted R2= .11 (see
Table 4). The variables considered as significant in regards to SBQR total
within the regression model were Age, TAS-20 Difficulty Identifying
Feelings, TAS-20 Externally Oriented Thinking, BIS Motor, and BIS Self-
Control.
260 Loftis, Michael & Chad– College Students Suicide Risk

Table 4. Coefficientsa of Multiple Regression Analysis with Subscales of TAS20, BIS,

and ICI
Unstandardized Standardized
Coefficients Coefficients
Model B Std. Error Beta T Sig.
1 (Constant) 1.888 1.976 .955 .340
Age .074 .032 .109 2.314 .021
TAS20 DIF .141 .028 .298 4.996 <.001
TAS20 DDF -.033 .034 -.057 -.951 .342
TAS20 EOT -.070 .032 -.117 -2.186 .029
BIS Attention .016 .055 .017 .296 .768
BIS Motor -.107 .041 -.134 -2.627 .009
BIS Self-Control .108 .045 .147 2.399 .017
BIS Cognitive Complexity-.017 .054 -.017 -.312 .755
BIS Perseverance .026 .077 .018 .342 .733
BIS Cognitive Stability .103 .077 .070 1.346 .179
ICI Autonomous Behavior -.011 .018 -.033 -.609 .543
ICI Self-Confidence .016 .018 .053 .880 .379
a. Dependent Variable: SBQR_Total

As the Barrett Impulsivity Scale also has second order factors of attentional
impulsiveness, motor impulsiveness, and nonplanning impulsiveness, a
regression analysis was performed using these variables with TAS-20 in
regards to the dependent variable of SBQR total. The overall regression model
was significant, F(7, 339.03) = 8.73, p < .001, R2 = .12, and adjusted R2= .10
(see Table 5). In this model, Age, TAS-20 Difficulty Identifying Feelings,
TAS-20 Externally Oriented Thinking, BIS Nonplanning Impulsiveness, and
BIS Motor Impulsiveness were significant. In addition, BIS Attentional
impulsiveness was also very close to the cutoff score with a .059.
IJEP – International Journal of Educational Psychology, 8(3) 261

Table 5. Coefficientsa of Multiple Regression Analysis with TAS20 and BIS Second-
Order Factors
Unstandardized Standardized
Coefficients Coefficients
Model B Std. Error Beta t Sig.
1 (Constant) 5.268 1.403 3.756 .000
Age .068 .030 .101 2.258 .024
TAS20 DIF .147 .027 .312 5.498 <.001
TAS20 DDF -.029 .033 -.050 -.880 .380
TAS20 EOT -.078 .028 -.132 -2.817 .005
BIS Nonplanning -.084 .030 -.133 -2.767 .006
Impulsiveness
BIS Motor -.070 .032 -.107 -2.215 .027
Impulsiveness
BIS Attentional .088 .046 .095 1.895 .059
Impulsiveness
a. Dependent Variable: SBQR_Total

To further illustrate the relationship between alexithymia and suicide risk,

alexithymia categories (low, medium, high) were cross-tabulated with suicide
risk. Overall, 18% of students were at risk for suicide, but the percentage of
those classified at risk was highest among students with high alexithymia (n
= 70; 30%), followed by 19.7% of those with moderate alexithymia (n = 152),
and 14.7% in the low alexithymia group (n = 326; X2 = 9.48, p = .009).

Discussion

The current study examined alexithymia, impulsivity, and locus of control as

possible predictors of suicide risk in college students. When the alexithymia
subscales were examined separately, Difficulty Identifying Feelings and
Externally Oriented Thinking were the subscales most strongly associated
with suicide risk recurrently throughout every multiple regression analysis.
Impulsivity first-order subscales of Motor and Self-Control and second-order
subscales of Motor Impulsiveness and Nonplanning Impulsiveness were
found to be a significant variables of suicide risk. Locus of control subscales
262 Loftis, Michael & Chad– College Students Suicide Risk

were not significant with suicide risk. Examination of the four covariates
indicated that age was a significant variable. In particular, for every year
increase in age, suicide risk was .06 points higher. These results suggest that
among these participants, alexithymia and impulsivity may better explain
suicide risk in college students.

Psychoeducational Implications
Dealing with a suicidal student brings out anxiety in even the most seasoned
mental health clinicians yet alone educators and academic staff (Rudd, 2006).
Therefore, any empirical data that can help identify directions for risk
assessment and referral are cogent. One study found that only 16% of
university students with suicidal ideation were actually receiving treatment
(Garlow et al., 2008). In another university study, only 20% to 25% of students
that died by suicide had contacted campus counseling centers (Schwartz,
2006). Conversely, college students who utilized campus counseling centers
were 18 times more at risk of suicide. This might indicate that more severely
emotionally disturbed students are more apt to use campus counseling
services. Nevertheless, the point remains that only about one in four college
students who die by suicide contacted campus counseling centers. The vast
majority do not receive any form of treatment. At this time, no statistics are
available in regards to how many college students contact their professors,
instructors, or advisors with these concerns.
In this study, nearly one in five students (18%) received SBQ-R scores
highlighting that they were at risk of suicide. A large national sample of
undergraduate college students indicated that 8% had attempted suicide at
least once in their lives (Drum, Brownson, Denmark, & Smith, 2009). Our
results indicated 2.2% of students reported a previous suicide attempt.
Accurately predicting suicide is improbable, but the importance of identifying
risk factors cannot be ignored (Bryan & Rudd, 2006). Discovering such risk
factors is important if there is any hope to reduce suicide risk in college
students. Our findings indicated the subscales of difficulty identifying feelings
and externally oriented thinking of alexithymia, the first-order subscales of
motor and self-control, and the second-order subscales of motor and
nonplanning of impulsivity showed significance in relation to suicide risk.
IJEP – International Journal of Educational Psychology, 8(3) 263

More research needs be done to examine alexithymia and impulsivity, and the
conditions in which these factors may contribute to suicidality.
If a college student comes to an educator or academic staff and is unable
to identify their feelings, externally orient, and struggle with motor, self-
control, and nonplanning impulsivity, our findings suggest the value of the
educator referring to a mental health professional. In particular, motor
impulsive responses such as “I do things without thinking” and “I act on
impulse,” coupled with self-controlled and non-planning impulsive
statements of “I don’t plan tasks carefully” and “I say things without thinking”
would be important to note. In addition, these previous type of comments with
an inability to identify how he or she feels with statements such as “I am often
confused about what emotion I am feeling” and “I have physical sensations
that even doctors don't understand” with externally-oriented comments like “I
prefer talking to people about their daily activities rather than their feelings”
or “I prefer to watch "light" entertainment shows rather than psychological
dramas” could make an individual more at-risk for suicide ideation or
behaviors, and therefore, may warrant additional evaluation from a mental
health professional..
In spite of the fact that suicide is one of the leading causes of death on
college campuses, few college students report receiving information about
suicide from their college or university. As cited in our literature review, a
majority of college students (65.9%) report that they have not received
information about suicide prevention from their college or university
(American College Association, 2011). If this held true in the current sample,
only 33 of the 99 participants who had significant suicide risk would have
received information from their respective institutions about suicide
prevention. The study also referenced that colleges and universities were
much better about providing information concerning other topics, such as
violence prevention, sexually transmitted disease/infection prevention, and
stress reduction rather than suicide prevention. Our findings suggest support
towards this end, as many of our participants appear that they could benefit
from psychoeducational activities of support groups, transfer of information,
self-care, and provision of a safe place to identify and describe emotions.
264 Loftis, Michael & Chad– College Students Suicide Risk

Limitations
This study has several important limitations. First, the sample was fairly
homogeneous, with 81% of participants identifying themselves as White or
Caucasian. The university samples differed little in demographics, which
suggests homogeneity of sub-groups (i.e., in spite of the relative size
difference). Both universities were liberal arts schools in the southeast United
States. As such, the results may not be generalized to other regions.
Furthermore, the sample was drawn from psychology and business classes,
based on convenience and access. The samples were not representative of the
student bodies as a whole at either university.

Recommendations and Future Directions

There is a tremendous need for suicide risk assessment instruments to have
good sensitivity (correctly identifying suicidal risk) and specificity (high
accuracy in ruling out non-suicidal individuals). Schiepek et al. (2011) found
that specificity is easier to determine than sensitivity; for the most part,
however, investigation of risk factors has been conducted using linear models.
Simply adding more variables to explanatory models may not overcome
problems achieving sensitivity. According to Schiepek et al., the course of
suicidality is nonlinear, requiring dynamic statistical analyses to model these
processes. If variables such as alexithymia are to be used in models of suicide
risk, they must earn their place by proving their predictive power, and future
research needs to employ periodic assessment of at-risk samples to assess the
veracity of these traits and their relationship to suicide risk.
Multiple attempters of suicide pose the greatest risk for eventual death by
suicide (Joiner, 2005). Our findings identified a small percentage (2.2%) of
college students who were previous attempters. Future research should focus
on how and why alexithymia and impulsivity are linked, as college students
who scored highest on these traits appear to be at higher risk for completed
suicide. Joiner’s model of suicide risk includes three elements: belongingness,
burdensomeness, and acquired ability to enact lethal harm. We recommend
that future studies should examine alexithymia in the context of Joiner’s
model (i.e., especially belongingness and burdensomeness), as well as how
impulsivity relates to the act of self-harm.
IJEP – International Journal of Educational Psychology, 8(3) 265

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Dr Mark A. Loftis, is an Associate Professor at Tennessee

Technological University. ORCID: https://orcid.org/0000-0002-5356-
0867

Dr Tony Michael, is an Associate Professor at Tennessee

Technological University. ORCID: http://orcid.org/0000-0002-5532-
2563

Dr Chad Luke, is an Associate Professor at Tennessee Technological

University. ORCID: https://orcid.org/0000-0002-7327-7129

Contact Address: P.O. Box 5031, Cookeville, TN 38505

Email: mloftis@tntech.edu
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