Mental health

Suicide Realities

The recent suicides of college students at Yale and Cornell Universities are rightfully cause for shock and sadness, but also a call to action. No doubt, we wonder how young people with so much talent and promise could end their own lives. In struggling to make sense of these tragic events, it is all too appealing – and unhelpful – to resort to simple explanations and casting of blame. In fact, the science of suicide is highly complex, and suicide prediction and prevention present mental health clinicians, and college administrators, with formidable challenges. Even institutions with quality prevention services, like Cornell and Yale, are not immune from these calamities.

Consider that, after accident, suicide is the second leading cause of death among college students. It is estimated that in any given year approximately 7.5 suicides occur for every 100,000 college students, a figure that translates into some 1,400 suicides. Nevertheless, while any death of a young person is heartbreaking, suicides are numerically rare.

At the same time, we know from our own work and much other research that each year about 10 to 15 percent of college students seriously think about suicide, and approximately 2 to 4 percent will make an attempt. This means that for every college student who dies by suicide, there are hundreds who have tried and thousands who have thought about it. Yet, we still have no overarching psychological theory to explain exactly what moves someone from thinking about suicide to taking action.

We do know that most young people who die by suicide have a diagnosable, and often treatable, psychiatric condition, and, frequently, they have told someone of their plan. Regrettably, numerous studies have found that less than 50 percent of depressed college students seek help. And not all manifest obvious signs of their depression.

Recent research has shown that the brain continues to mature throughout one’s 20s, with the area most responsible for decision-making developing last. Some young people, therefore, may act impulsively, without fully appreciating the real consequences of their actions. As a result, suicide in young people sometimes occurs without any apparent warning, either in a setting in which the young person -- most often a young man -- has hidden his despair from others, or as the result of an abrupt and intense impulse, often in the context of judgment-blurring intoxication.

Despite this, it is important to keep the issues in perspective. While universities are seeing larger numbers of students with psychiatric difficulties -- in part because improvements in treatment make it possible for more students with such problems to successfully attend college – the number of suicides on campuses has remained stable over the past 10 years. This suggests that we may be doing a better job at identifying and treating the underlying causes of suicide, such as depression, bipolar disorder, schizophrenia and substance abuse.

We also know that elite colleges do not have higher rates of suicide than others. Academic competition and pressures are not frequent precipitants of suicide in undergraduates. More often, suicide is precipitated by family or relationship problems, often in the context of substance use.

Moreover, we have learned quite a bit about college suicide prevention in the past 15 years. We know that keeping the means used for self-harm out of the hands of potentially suicidal people will save lives. College students have about half the rate of suicide of non-college-attending young people, in part, it appears, because few guns are allowed on college campuses. And there are definitive measures that can prevent an impulsive young person from taking tragic action. The securing and alarming of windows and roofs have been helpful deterrents. Actions such as Cornell’s adding barriers on its bridges are therefore prudent and sensible.

Educational outreach programs are also effective in assisting students, faculty and administrators to identify psychological problems and decreasing the stigma often associated with seeking treatment. Preparing entering students with previously treated disorders to establish a system of continuing care while on campus is vital, as is communication with parents on the importance of such care.

Interestingly, we have learned that we don’t prevent suicides by focusing solely or even too intensively on suicide prevention. Rather, it is essential that colleges offer comprehensive, accessible and affordable systems of general physical and mental health care, and that they utilize community and public health approaches to educate parents, students, faculty and administrators about the need to communicate, support and care for each other. Steps such as "gatekeeper training," in which people most likely to have direct contact with troubled students (resident assistants, writing instructors, academic advisers, athletic coaches and chaplains, among others) are taught to identify and refer such students for counseling and peer education programs, have a proven track record. For example, the award-winning Active Minds on Campus, with chapters across the country, provides a forum in which students present programs focused on promoting acceptance and understanding of people with mental illness.

Many colleges employ online surveys to help students identify problems and utilize other technology-based modes of support, including appointment and medication reminders, to engage troubled students in a way they feel comfortable.

Among all key members of the college community, communication focused on the support and care of students in distress, while respecting the students' privacy, is also essential. Finally, we know that whenever possible, it is best for troubled students to remain in school among their friends and working toward a positive future. At the same time, colleges and universities must allow for students who temporarily cannot function to return home for more intensive assistance and treatment.

In fact, it turns out that when it comes to suicide prevention, students, faculty, administrators and parents are all in this together.

Victor Schwartz and Jerald Kay
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Victor Schwartz is university dean of students at Yeshiva University and associate professor of clinical psychiatry at Yeshiva's Albert Einstein College of Medicine. Jerald Kay is professor and chair of the psychiatry at Wright State University’s Boonshoft School of Medicine. They are the editors of Mental Health Care in the College Community (Wiley).

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