Objective-This study describes help-seeking among college students with a lifetime history of suicide ideation.Methods-Life-history interviews assessed psychological distress episodes, formal treatment, and informal help-seeking among 158 college students with lifetime suicide ideation history.Results-The first distress episode typically occurred in adolescence (62%; n=94); 52% (n=78) had episodes in both adolescence and young adulthood. Overall, 87% (n=131) received informal help, 73% (n=110) received treatment, and 61% (n=92) received both. Depression, anxiety, more lifetime episodes, and earlier onset were positively associated with obtaining treatment. Leading sources of help were family (65%), friends (54%), psychiatrists (38%), and psychologists (33%). Treatment barriers reflected ambivalence about treatment need/effectiveness, stigma, and financial concerns.Conclusions-Most students had some contact with treatment, but family and friends might be important gatekeepers for facilitating treatment access. Parents of college-bound children should consider continuing mental health care over time.Keywords college students; service delivery; suicide; suicidal behavior; treatment utilization Suicide remains a leading cause of death among U.S. young adults (1) and college students in particular, among whom one in ten contemplated suicide during the previous year, and 1-2% made an attempt (2,3). Suicide ideation is sometimes regarded as a transitory (4), yet epidemiologic evidence indicates that adolescent suicide ideation often recurs in adulthood (5). Campus counseling center directors have observed recent increases in the number of college students exhibiting severe mental health problems (6), including suicidality (7).Unfortunately, among U.S. adolescents, only 28% of suicide ideators received counseling in the past year (8). Help-seeking rates are similarly low among college students with suicide ideation (3,9), with typically cited barriers including a preference to manage the problem on one's own, fears about what others might think (10), negative attitudes and beliefs about mental health services, and stigma (11).Help-seeking can include both formal professional treatment and informal help (e.g., friends, parents, and informational resources). Few studies have explored informal help-seeking in young adults. Australian researchers asked youth about recent problems that caused them "considerable distress" and found that students sought help more readily from informal sources than professionals (12).The current study focused on an understudied population-namely, college students with a lifetime history of suicide ideation-and used a novel life history interview method to capture a broad range of help-seeking behaviors. The study aimed to: describe help-seeking behaviors; explore the degree of continuity between pre-college and college experiences with psychological distress and/or help-seeking; examine the sociodemographic correlates of service utilization; and describe barriers among students with an...