College Students and Suicide
Prevention – Administrators and
Staff
Ellen J. Anderson, Ph.D., SPCC
College Student Suicide
• Suicide is the second leading cause of death for
college students
• The number one cause of suicide for college
student suicides (and all suicides) is untreated
depression
Despair At A Young Age
• “Unlike most disabling physical diseases, mental illness begins
very early in life. Half of all lifetime cases begin by age 14; three
quarters have begun by age 24. Thus, mental disorders are really
the chronic diseases of the young,” (National Institute of Mental Health)
• Anxiety disorders often begin in late childhood
• Mood disorders in late adolescence
• Substance abuse in the early 20’s
• Unlike heart disease or most cancers, young people
with mental disorders suffer disability when they are in
the prime of life, when they would normally be the
most productive
Despair At A Young Age
• Many young people who come to college have
not yet been diagnosed with Depression,
Schizophrenia, or Bi-Polar Disorder
• We are seeing an increase in suicidal ideation
and behavior on campus as more people with
severe mental illness attend college
• Improved treatment has allowed many young
people to continue a normal life despite the
development of severe mental illnesses
Despair At A Young Age
• In general, non-college young adults complete
suicide at about twice the rate as college students
• Foreign students may have a higher risk for
suicide
• Suicide is not more frequent in any of the four
years of college, but it does occur more often in
students who take more than four years to earn
their degrees
High Levels Of Stress
• Going to college can be a difficult transition period in
which students may experience high levels of stress,
which can lead to Clinical Depression
• Many college students also use higher levels of alcohol
and drugs than at earlier times in their lives, increasing
the risk of suicidal ideation
• A hallmark of diagnosis for clinical depression is the
presence of suicidal thinking
• Yet our lack of knowledge about this illness means that
we don’t seek help, and our friends and family don’t
push us to get help
Unwilling To Seek Help
• Stigma about treatment means that very few people
with suicidal ideation actually seek treatment
• Additionally, a survey indicates that one in five college
students believe that their depression level is higher
than it should be, yet only 20% say they would go to
the campus counseling center
• Those whose symptoms improve when they activate a
suicide plan may be especially resistant to seeking help
• Nearly half of suicidal students present for some
medical treatment in the months before completing
suicide although they may not acknowledge suicidal
thoughts
Awareness
• Teachers, coaches, and residence hall counselors should
focus not only on disruptive students, but also on those
who are quietly withdrawn or whose dormitory
discussions or classroom essays disclose hopelessness
and suicidal thinking
• Training in awareness about depression and suicidal
thinking is important for all staff
• Policies should be in place to discover students with
suicidal ideation and help them to recover
How common is suicide among
teenagers and young adults?
• Suicide is the 3rd largest killer of young people between the ages of 10
and 25, and the 2nd largest killer of young adults
• Suicidal ideation is admitted by about 25% of adolescents at some time
during high school
• Suicide attempts are more frequent among the young than the old,
although completions are less likely
• About 4,000 young people die from suicide every year in the US
• Teen suicide tripled between 1950 and 1980, but has dropped somewhat
in the past 25 years
• Around the world, adolescent suicide declined in industrialized nations
with the increase in use of anti-depressant medication, despite fears that
meds will increase suicidal behavior in teens
What Is Mental Illness?
• Prior to our understanding of illness caused by
bacteria, most people thought of any illness as a
spiritual failure or demon possession
• Contamination meant spiritual contamination
• People were frightened to be near someone with
odd behavior for fear of being contaminated
Gatekeeper Training- Dr. Ellen
Anderson
10
What Is Mental Illness?
• What do we say about someone who is odd?
– Looney, batty, nuts, crazy, wacko, lunatic, insane,
fruitcake, psycho, not all there, bats in the belfry,
gonzo, bonkers, wackadoo, whack job
• Why would anyone admit to having a mental
illness?
• So much stigma makes it very difficult for
people to seek help or even acknowledge a
problem
Gatekeeper Training- Dr. Ellen
Anderson
11
What Is Mental Illness?
• We know that illnesses like epilepsy, Parkinson's
and Alzheimer’s are physical illness in the brain
• Somehow, clinical depression, anxiety, Bi-Polar
Disorder and Schizophrenia are not considered
physical illnesses requiring treatment
• We confuse brain with mind
• Talking about suicide is taboo
Gatekeeper Training- Dr. Ellen
Anderson
12
Is Suicide Really a
Problem?
• 87 people complete suicide every day
• 32,466 people in 2005 in the US
• Over 1,000,000 suicides worldwide
(reported)
• This data refers to completed suicides that
are documented by medical examiners – it is
estimated that 2-3 times as many actually
complete suicide
Gatekeeper Training- Dr. Ellen
Anderson
13
(Surgeon General’s Report on Suicide, 1999)
The Gender Issue
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•
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Women perceived as being at higher risk than men
Women do make attempts 4 x as often as men
But - Men complete suicide 4 x as often as women
Women’s risk rises until midlife, then decreases
Men’s risk, always higher than women’s, continues to
rise until end of life
• Are women more likely to seek help? Talk about
feelings? Have a safety network of friends?
• Do men suffer from depression silently?
Gatekeeper Training- Dr. Ellen
Anderson
14
What Factors Put
Someone At Risk For Suicide?
• Biological, physical, social, psychological or spiritual
factors may increase risk-for example:
• A family history of suicide increases risk by 6 times
• Access to firearms – people who use firearms in their
suicide attempt are more likely to die
• Social Isolation: people may be rejected or bullied
because they are “weird”, because of sexual orientation,
or because they are getting older and have lost their
social network
(Goleman, 1997)
Gatekeeper Training- Dr. Ellen
Anderson
15
• A significant loss by death, separation, divorce,
moving, or breaking up with a boyfriend or
girlfriend can be a trigger
• The 2nd biggest risk factor - having an alcohol
or drug problem
– Many with alcohol and drug problems are clinically
depressed, and are self-medicating for their pain
(Surgeon General’s call to Action, 1999)
Gatekeeper Training- Dr. Ellen
Anderson
16
• The biggest risk factor for suicide completion?
Having a Depressive Illness
• Someone with clinical depression often feels helpless to solve
his or her problems, leading to hopelessness – a strong
predictor of suicide risk
• At some point in this chronic illness, suicide seems like the
only way out of the pain and suffering
• Many Mental health diagnoses have a component of
depression: anxiety, PTSD, Bi-Polar, etc
• 90% of suicide completers have a depressive illness
(Lester, 1998, Surgeon General, 1999)
Gatekeeper Training- Dr. Ellen
Anderson
17
Depression Is An Illness
• Our current cultural view of suicide is wrong - invalidated by
current understanding of brain chemistry and it’s interaction with
stress, trauma and genetics on mood and behavior
• Suicidal thinking is a severe symptom of the way depression is
altering the brain – causing changes in thinking, mood and body
regulation
• Suicide has been viewed for centuries as:
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a moral failing, a spiritual weakness, a mortal sin
an inability to cope with life
“the coward’s way out”
A character flaw
• This view must be replaced by more current understanding of
brain disorders as treatable, physical illnesses
(Anderson, 1999)
•
The research evidence is overwhelming - depression is far more than a sad mood.
It includes:
•
Body Regulation Problems
1. Weight gain/loss
2. Sleep problems
3. Sense of tiredness, exhaustion
Mood Regulation Problems
1. Sad or angry mood
2. Loss of interest in pleasurable things, lack of motivation
3. Irritability
Thinking and Memory Problems
1. Confusion, poor concentration, poor memory, trouble making
decisions
2. Negative thinking
3. Withdrawal from friends and family
4. Often, suicidal thoughts
•
•
(DSMIVR, 2002)
 20 years of brain research teaches that these
symptoms are the behavioral result of
 Changes in the physical structure of
the brain
 Damage to brain cells in the
hippocampus, amygdala and limbic
system
 Depressed people suffer from a physical
illness – what we might consider “faulty
wiring”
(Braun, 2000; Surgeon General’s Call To Action, 1999, Stoff & Mann,
1997, The Neurobiology of Suicide)
Gatekeeper Training- Dr. Ellen
Anderson
20
Faulty Wiring?
• Literally, damage to certain nerve cells in our brains - the
result of too many stress hormones
– Cortisol
– Adrenaline
– Testosterone – hormones activated by our Autonomic Nervous
System to protect us in times of danger
• Chronic stress causes changes in the ANS, so that high
levels of activation occur with very little stimulus
• Constant activation in the ANS causes changes in muscle
tension, imbalances in blood flow patterns - leads to
asthma, IBS and depression, increased risk for death from
heart disease
(Goleman, 1997, Braun, 1999)
Faulty Wiring?
• Every time something upsets us it causes the
ANS to activate – stresses accumulate and keep
us in a state of high arousal – stress hormones
build up
• People with genetic predispositions, placed in
a highly stressful environment will experience
damage to brain cells from stress hormones
• As damage occurs, thinking changes in the predictable
ways identified in our list of 10 criteria
(Goleman, 1997; Braun, 1999)
One of Many Neurons
•Neurons are special cells that make up
the brain and their united, networked
action is what causes us to think, feel,
and act
•Neurons must connect to one another
(through dendrites and axons)
•Stress hormones damage dendrites and
axons, causing them to “shrink” away
from other connectors
•As fewer and fewer connections are
made, more and more symptoms of
depression appear
Gatekeeper Training- Dr. Ellen
Anderson
23
How Can We Stop Brain
Damage?
• As damage occurs, thinking changes in the
predictable ways identified in our list of 10
criteria
• Four things can reduce this “brain damage”
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Stress reducing mental exercises - meditation
Exercise
Antidepressant medication
Cognitive/Behavioral Psychotherapy
• Many cultures have developed stress reduction rituals/mental
exercises – Yoga, Tai Chi, Qi Jong, meditation, prayer – these
millennia old methods work well to reduce stress hormone
production
• Exercise can help “burn off ” high stress hormone levels and even
reduce production
• Antidepressants can counter the effects of stress hormones
• We know now that antidepressants stimulate genes within the
neurons (turn on growth genes) which encourage the growth of
new dendrites
• New dendrites reconnect neurons and symptoms are reduced
• It can take longer than six weeks for the brain to repair itself
enough that people feel better
(Braun, 1999)
How Does Therapy Help?
• Medications may improve brain function, but do not
change how we interpret stress
• Cognitive or interpersonal therapy helps people change
the (negative) patterns of thinking that lead to depressed
and suicidal thoughts
• Changing our inaccurate beliefs and thought patterns
alters our response to stress – we are not as reactive or as
affected by stress at the physical level
• Research shows that cognitive therapy is as effective as
medication in reducing depression and suicidal thinking
(Lester, 2004)
How Does Therapy Help?
• “The Talking Cure” as Freud originally called it turns out to have a
scientific basis for success
• Daniel Goleman, Daniel Siegal, Antonio D’Amasio and others are
explaining how social interaction with others physically alters our
neuronal paths, allowing different ways of thinking to change the
chemical, electrical and thought pattern flow in our brains
• We know that people raised in highly abusive homes have visibly
different brains than people from normal homes, as seen on MRI’s
and CAT scans
• We also know that healing relationships, changed perspectives
(reframing) and altered self-beliefs change how people react to stress,
and what they react to
Possible Sources
Of Depression
• Genetic: a predisposition to this problem may be present,
and depressive diseases run in families
• Predisposing factors: Childhood traumas, car accidents,
brain injuries, abuse and domestic violence, poor
parenting, growing up in an alcoholic home,
chemotherapy
• Immediate triggers: violent attack, illness, sudden loss or
grief, loss of a relationship, any severe shock to the
system
(Anderson, 1999, Berman & Jobes, 1994, Lester, 1998)
Gatekeeper Training- Dr. Ellen
Anderson
28
What Happens If We Don’t
Treat Depression?
• Significant risk of increased alcohol and drug
use
• Significant relationship problems
• Lost work days, lost productivity (up to $40
billion a year)
• High risk for suicidal thoughts, attempts, and
possibly death
(Surgeon General’s Call To Action, 1999)
Gatekeeper Training- Dr. Ellen
Anderson
29
Can Suicide Be Predicted?
• No
• That said, there are Practice Guideline standards for
assessment that should be followed
• Be aware of the Impulsive nature of most suicides
• Responsibility for knowledge of risk factors for suicide
• Dangers of misusing risk assessment scales-may not
account for today’s danger
College Mental Health Professionals
• What are ethical obligations for college mental
health professionals?
– As with any mental health professional, a duty to warn and a
responsibility to students with suicidal ideation to treat and
keep safe
– Responsible to assess risk and help students manage
symptoms,
– Responsible to seek medical assistance and hospitalization as
needed
– Need for a fully documented risk assessment
– Dangers of abandonment, negligent referral, and fragmented
care
– Maintain standards of care
What Are "Best Practices" In Staff Training
And Educational Programming
• The United States Air Force model
• Develop a campus-wide commitment to suicide
prevention
• Reducing stigma against seeking professional
help
• Depression screening programs and online
resources – Jed Foundation, American
Foundation For Suicide Prevention
What Are My Responsibilities?
• We should not be looking at student suicide primarily
from a risk-management perspective
• College administrator responses to students become
defined by the law and not through primary
responsibility as educators
• “As educators, we have to take some risks. That means
working harder to keep students at risk of suicide
enrolled, working with them, giving them the help they
need, and not finding faster and more creative ways to
remove them. “ (Gary Pavela, 2006, The Chrone)
A Protective Environment
• Mandatory-removal policies carry legal risks of their own - ADA
• Office for Civil Rights within the U.S. Department of Education has been
called upon to issue letter rulings pertaining to these policies – students with
documented mental health diagnoses may win a lawsuit
• The risk of liability for suicides is low – most cases focus on high risk
immediate suicidality
• College administrators, may err on the side of under-reaction, in terms of
notifying parents, in terms of hospitalization
• Decisions in some recent cases do not define the law nationally and do not
mean your proper response as an administrator is to find a quick way to get
rid of the student
• What the cases would point to is that you must react promptly and
appropriately to a student who is manifesting signs of imminent risk of
suicide (Pavela, 2006)
Parental Notification
• Should colleges notify parents of students at risk of suicide?
• Previously, a strong bias not to notify parents about problems a student was
having
• In recent years a shift toward more parental notification
• FERPA [Family Educational Rights and Privacy Act] amended; able to notify
parents in certain alcohol incidents
• Who should notify parents and under what conditions?
• Mental-health professionals will have a legal and ethical obligation to breach
confidentiality in an emergency, when a person is at imminent risk of harming
themselves
• Parents would have to be notified by the hospital. When students enroll, it
should be part of their file: Who do you want notified in case of
emergency?
Parental Notification
• My role of an administrator
• Administrators have more latitude than mental-health professionals to notify
parents
• Err on the side of treating suicidal statements as a genuine suicide threat or
gesture,
• Arrange for immediate evaluation of that student,
• Ask the student about needing to involve the parents immediately,
• Listen to arguments about why that wouldn't work, and I would
• Talk to a mental-health professional.
• Once there is a suicide threat or gesture - notify parents, even when it isn't a
full-blown emergency
Should Colleges Withdraw Students Who
Threaten Or Attempt Suicide?
• Rate of young-adult suicide for people going to college is about one-half of
the rate for young adults who are not going to college
• Campus environments, human connection, and limited access to firearms are
protective
• College campuses do a good job of limiting firearms, the most dangerous
choice of a suicide weapon
• Sending kids home means taking them out of a protective environment and
putting them where they may be more likely to hurt themselves
• policies can use the threat of removal as "leverage" to get students
help they need.
• Use the administrative process as a lever to get the student help
• We are a community that can't tolerate violence, including violence to self,
and we have a mechanism to help you, and if not, we can remove you
• Both are using discipline as a threat, but one is carrying through immediately,
and the other is doing everything possible not to use it.
Empowering Students To Help Prevent
Suicides Among Peers
• Often peers know about potentially suicidal and
depressed behavior and comments
• Increase discussion with students about the
responsibility of friendship
• A higher loyalty is to save a person's life, not keep a
person’s secret
• Friends don't let depressed students handle their
problem alone, and they get help for that student, even
if they have to break confidentiality
• Teach when to get help and where to get it – this goes
beyond the ability of friendship to manage
Help Faculty React Appropriately
• Training is needed so that faculty will not
under-react to suicidal references
• Training to understand what depression is and
how it can lead to suicide
• Realizing that relationship and support is not
enough – we don’t simply offer kindness when
someone is having a heart attack
Mentoring and Connection
• One of the triggering factors to depression is isolation,
the feeling of not being a part of a community
• College students still need adult support and someone
to talk with
• Faculty and students alike need training in these issues,
but stigma makes it difficult for people to talk about
• Try a stress-management seminar
• Talk about relationship issues, as many suicidal
thoughts come up as a response to relationship loss
• Don’t be afraid to bring up suicide in any appropriate
discussion setting
After A Suicide
• Schools should prepare postvention plans in case a
suicide does occur on the campus
• The plans should focus on outreach to survivors and
on preventing suicide contagion by managing the
information that is presented to the press and public
• Opportunities to talk should be made available to
students and staff
• Connections should be maintained with other students
who are known to have suicidal thoughts, and on
friends of the person who died
Jed Foundation Prevention Model
• If one cannot state a matter clearly enough so
that even an intelligent twelve-year-old can
understand it, one should remain within the
cloistered walls of the university and laboratory
until one gets a better grasp of one's subject
matter
Margaret Mead
A Brief Bibliography
• American Foundation for Suicide Prevention (AFSP) has launched the College
Screening Project - a pilot program aimed at identifying college students at risk
for suicide and encouraging them to get help they need
• Anderson, E. “The Personal and Professional Impact of Client Suicide on
Mental Health Professionals. Unpublished Doctoral dissertation, U. of Toledo,
1999
• Berman, A. L. & Jobes, D. A. (1996) Adolescent Suicide: Assessment and
Intervention.
• Blumenthal, S.J. & Kupfer, D.J. (Eds) (1990). Suicide Over the Life Cycle: Risk
Factors, Assessment, and Treatment of Suicidal Patients. American Psychiatric
Press.
• Jacobs, D., Ed. (1999). The Harvard Medical School Guide to Suicide Assessment
and Interventions. Jossey-Bass.
• Jamison, K.R., (1999). Night Falls Fast: Understanding Suicide. Alfred Knopf
• Lake, P. (2002). The Emerging Crisis of College Student Suicide: Law and
Policy Responses to Serious Forms of Self-Inflicted Injury
Stetson Law Review, Vol. 32, No. 1, 2002
• Lester, D. (1998). Making Sense of Suicide: An In-Depth Look at Why People
Kill Themselves. American Psychiatric Press
• Oregon Health Department, Prevention. Notes on Depression and Suicide:
ttp://www.dhs.state.or.us/publickhealth/ipe/depression/notes.cfm
• Putukian, M. & Wilfert, M, 2004. Student Athletes Also Face Dangers From
Depression http://www.ncaa.org/news/2004/20040412/active/4108n32.html
•
Pavela, G. (2006) College Student Suicide: Legal Issues
• President’s New Freedom Council on Mental Health, 2003
• Quinnett, P.G. (2000). Counseling Suicidal People. QPR Institute, Spokane,
WA
• Schneidman, E.S. (1996). The Suicidal Mind. Oxford University Press.
• Schwartz AJ and Whitaker LC. Suicide among college students: Assessment,
treatment and intervention. In SJ Blumenthal & DJ Kupfer (Eds) Suicide over
the life cycle: Risk factors, assessment, and treatment of suicidal patients. (pp.
303-340). Washington DC: American Psychiatric Press, 1990.
• Signs of Depression in Youth. Oregon State Dept. of Health.
http://www.dhs.state.or.us/publichealth/
ipe/depression/signs.cfm
• Stoff, D.M. & Mann, J.J. (Eds.), (1997). The Neurobiology of
Suicide. American Academy of Science
• Styron, W. (1992). Darkness Visible. Vintage Books
• Surgeon General’s Call to Action (1999). Department of Health
and Human Services, U.S. Public Health Service.
• Tang, T.Z. & De Rubeis, R.J. ((1999). “Sudden Gains and critical
sessions in cognitive-behavioral therapy for depression”. Journal
of Consulting and Clinical Psychology 67: 894-904.