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Suicide remains a leading cause of death among college students, underscoring the need for effective and scalable interventions. Intensive outpatient programs (IOPs) represent a critical level of care for students at elevated suicide risk; however, limited research has examined whether treatment response varies across demographic and clinical subgroups. Identifying moderators of treatment outcomes may inform personalized intervention strategies and optimize care for high-risk students.
Objectives:
This study examined whether demographic (race, sex at birth, age) and clinical characteristics (prior suicide attempts, comorbidity, sleep disturbance, substance use) moderate treatment trajectories in a suicide-focused IOP.
Methods:
Participants (N = 427; mean age = 20.1 years) were enrolled in a 4–6-week IOP and completed weekly assessments of depression, anxiety, suicidal ideation, sleep disturbance, substance use, and non-suicidal self-injury. Mixed-effects models were used to evaluate moderation of symptom trajectories over time. False discovery rate correction was applied to account for multiple comparisons.
Results:
Several demographic and clinical characteristics were associated with greater baseline symptom severity, including female sex, transgender identity, sleep disturbance, and comorbid mood and anxiety disorders. Prior suicide attempt was strongly associated with higher baseline suicidal ideation. However, most moderators were not associated with differential rates of symptom change over time after correction for multiple comparisons. Prior suicide attempt emerged as the only robust moderator, such that students with a history of attempt demonstrated greater reductions in suicidal ideation over time, despite higher initial severity.
Conclusion:
Findings suggest that suicide-focused IOP treatment is broadly effective across diverse demographic and clinical subgroups of college students. Although baseline disparities in symptom severity persist, trajectories of improvement are largely comparable. The observed pattern for prior suicide attempt highlights the potential importance of tailoring interventions for students with elevated clinical risk. These results support the robustness of IOP care while underscoring the value of personalized treatment approaches in suicide prevention.