Original Article Risk and Protective Factors Associated with Moderate and Acute Suicidal Ideation among a National Sample of Tribal College and University Students 2015-2016 Myra Parker, JD, MPH, PhD ; 1 Bonnie Duran, DrPH; 2 Isaac Rhew, PhD; 1 Maya Magarati, PhD; 2 Mary Larimer, PhD; 1 & Dennis Donovan, PhD 3 1 Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington 2School of Social Work, Indigenous Wellness Research InstituteUniversity of Washington, Seattle, Washington 3 Alcohol and Drug Abuse Institute, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington Disclosures: All authors attest that they do not have any financial or nonfinancial conflicts of interest regarding the funded research or publications resulting from the research. Funding: Funding for this project was from a grant by the National Institute on Minority Health and Health Disparities, Award Number 5P60MD006909. Acknowledgments: The authors wish to acknowledge our Tribal Colleges and Universities community partners, whose collaboration and participation were instrumental in planning and implementing the study, as well as contextualizing the data for this paper. In alphabetical order, our partners for the TCU Student Epidemiology Survey Study are: The American Indian Higher Education Consortium (Washington, DC), Bay Mills Community College (Brimley, MI), Blackfeet Community College (Browning, MT), Diné College (Tsaile, AZ), Fond du Lac Tribal & Community College (Cloquet, MN), Fort Peck Community College (Poplar, MT), Ilisagvik College (Utqiagvik, AK), Institute of American Indian Arts (Santa Fe, NM), Keweenaw Bay Ojibwa Community College (Baraga, MI), Lac Courte Oreilles Ojibwa Community College (Hayward, WI), Little Priest Tribal College (Winnebago, NE), Navajo Technical University (Crownpoint, NM), Nebraska Indian Community College (Macy, NE), Northwest Indian College (Bellingham, WA), Oglala Lakota College (Kyle, SD), Red Crow Community College (Cardston, Alberta, Canada), Saginaw Chippewa Tribal College (Mt. Pleasant, MI), Salish Kootenai College (Pablo, MT), Sitting Bull College (Fort Yates, ND), Southwestern Indian Polytechnic Institute (Albuquerque, NM), Stone Child College (Box Elder, MT), United Tribes Technical College (Bismarck, ND), and Turtle Mountain Community College (Belcourt, ND). For further information, contact: Myra Parker, JD, MPH, PhD, Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 1100 NE 45th Street, Suite 300, Seattle, WA 98105; e-mail: myrap@uw.edu. doi: 10.1111/jrh.12510 Abstract Objectives: We examined the relationship between suicide risk and disability status, as well as risk and protective factors, adjust- ing for demographic characteristics, among students attending 22 Tribal Colleges and Universities (TCU; 20 rural and 2 urban) across the United States in fall 2015 and 2016. Methods: Tribal college students (N = 3,239) participated in a cross- sectional online or paper survey assessing alcohol use patterns and mental health outcomes, yielding a response rate of 31.3%. Results: Of the students surveyed, 8.8% indicated moderate or high suicide risk. Hearing impairment was signifcantly associated with moderate/high suicide risk (OR = 2.11; 1.24-3.61, P = .006), as was vision impairment (OR = 3.03; 1.92-4.77, P < .001), having a physical/mental/or emotional condition (OR = 2.12; 1.75-2.57, P < .001), experiencing critical appraisal (OR = 1.30; 1.24-1.36, P < .001), and experiencing critical isolation (OR = 1.83; 1.66-2.01, P < .001). Scoring high on resilience (OR = 0.93; 0.92-0.95, P < .001), reporting higher emotional social support (OR = 0.75; 0.70-0.79, P < .001), and reporting higher levels of instrumental social support (OR = 0.69, 0.62-0.76, P < .001) were signifcantly associated with lower suicide risk. Conclusions: Students attending tribal colleges who ex- perience hearing impairment, sight impairment, or a physi- cal/emotional/mental condition have a greater risk of suicidality. Students experiencing critical appraisal and critical isolation may beneft from behavioral health interventions to reframe these experiences and develop resiliency skills. Developing avenues of emotional and instrumental social support within TCU settings of- fers key protective factors to buffer the risk of suicidality. Examining additional ways to build resiliency may also offer protection from suicide risk in this population. Key words American Indians and Alaska Natives, disability status, resilience, social support, suicide risk. The Journal of Rural Health 00 (2020) 1–9 © 2020 National Rural Health Association 1