Predicting Suicide Risk among South African University Students: Optimal Cutoff Score for the Center for Epidemiological Studies Depression Scale

Abstract

University students have been identified as a particularly vulnerable group for adverse mental health outcomes owing to the distinctive implications of the COVID-19 prevention measures on the educational sector. Even prior to the pandemic, university students were identified as being at increased risk for adverse mental health outcomes and suicidality. Although various factors can enhance the risk of suicide, one of the strongest predictors of suicidality is the presence of depressive symptomology. The current study used receiver operating characteristic (ROC) analysis to determine the optimal cutoff score on the CES-D when screening for suicide risk in university students during COVID-19 in South Africa. Participants (n = 337) were students at a historically disadvantaged university in South Africa. The ROC analysis showed no statistically significant difference between men’s and women's area under the curve (AUC); thus, a single AUC can be used for the whole sample. The study found that a cutoff score of 30 with a sensitivity of 89.30 and a specificity of 62.60 represented an acceptable cutoff point. It is recommended that when the instrument is used among student populations, those with scores of 30 and above need to be followed up with a clinician-administered interview to confirm suicide risk and facilitate timely intervention.