College students respond to stressful experiences along a continuum of distress and suicidality. This study investigated, from students' perspectives, the contributors to stress, nature of stress, coping strategies used, and role of drugs and alcohol during stressful periods--all with particular relevance for suicidality. Undergraduate and graduate students were sampled on an online survey from 73 institutions, totaling 26,292 respondents. The pervasiveness of stressful experiences students endorse appears to be more than traditional clinical interventions can manage on their own. Recommendations are, therefore, made about how to utilize population-based prevention to reduce students' distress and suicidality and improve their mental health.