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Suicide in colleges in the United States

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In colleges and universities in the United States, suicide is one of the most common causes of death among students.[1] Each year, approximately 24,000 college students attempt suicide while 1,100 attempts end up being fatal, making suicide the second-leading cause of death among U.S. college students.[2][3] Roughly 12% of college students report the occurrence of suicide ideation during their first four years in college, with 2.6% percent reporting persistent suicide ideation.[3] 65% of college students reported that they knew someone who has either attempted or died by suicide, showing that the majority of students on college campuses are exposed to suicide or suicidal attempts.[4]

According to the National Alliance on Mental Illness (NAMI), approximately 49% of the student population within the educational system have been diagnosed with or treated for depression.[5] Recent studies have also shown that underclassmen are less likely to commit suicide compared to upperclassmen due to a lack of worry over bills or work. Many are full-time students living with their parents.[6]

History

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During the 20th century, universities and colleges drew limited attention to the issue of student suicides to avoid damages to the reputation and image of their institutions.[7]

However, after a 1978 PBS broadcast of College Can Be Killing, awareness was raised concerning suicide whilst in college; leading most schools to begin creating programs to assist students while they were attending their institutions.[7]

One of the earliest records of suicides of college students in the United States was in 1927, when 20 students across the entire continent committed suicide.[7] In 2006, 1100 students in the US committed suicide, and 24,000 attempted it.[8]

Since the year 2000, rates of suicide deaths have increased significantly.[9]

However, most recently research regarding the impact of the Covid-19 epidemic on college students has shown that suicidal ideation has decreased in colleges due to the increased emphasis on mental health and adaptive learning by collegiate institutions.[10]

Risk factors

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Depression

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Depression is the strongest correlate of suicidal behavior in college students.[11] The 2017 National College Health Assessment found that half of college students reported being overwhelmed by feelings of sadness or anxiety.[12][13] The combination of new stressors, identity searching, and the fact that many common mental health problems arise within the age group most students fall under; all adds up as factors that can lead students to being more predisposed to depression.[14] The American College Health Association National College Health Assessment did a survey of over 20,000 students across the United States and found that almost 16% were diagnosed with depression.[15] Within that same study, it was found that 10.3% of the initial surveyed students had contemplated attempting suicide within the last year before taking the survey.[15] There is significant correlation between negative life events, such as sexual assault, and suicide risk. If untreated, the consequent emotional issues can result in the development of long-term mental health difficulties, including major depression, post-traumatic stress, and dissociation. [16]

Suicidal ideation

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Suicidal ideation refers to the act of thinking about, considering, or planning suicide. Suicidal ideation has risen in prevalence amongst college-age students.[17] A study at Emory University found that 11.1% of students reported having suicidal ideation within the past four weeks and 16.5% of students attempted suicide or had a self-injurious event at least once in their lifetime. Suicidal ideation is associated with symptoms of depression, and students who reported current suicidal ideation had more of the severe depression symptoms.[17]

Among college students, depressive symptoms along with the severity level of past suicidal ideations in an individual's lifetime, are two short-term predictors of current suicidal ideation.[18] Factors indicating risk for persistent suicidal ideation include low social support, childhood or adolescent exposure to domestic violence, depression related to motherhood, and high self-reported symptoms of depression.[3] Females, individuals who have been previously screened for psychiatric illness, those with a positive family history of suicide, those that are more impulsive, and those that have higher motor impulsivity may be at greater risk of actually attempting suicide, rather than just the ideation.[19]

Stress

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Stress has been shown to be highly correlated with suicide attempts.[20] The American College Health Association’s National College Health Assessment noted that 1.1% of college students made an attempt to commit suicide; citing that many other factors such as loneliness, issues within academics, relationships, money problems, and general helplessness play into that statistic.[21]

The amount and type of motivations for suicide can vary from student to student; however, a common motivation for suicide has been stress.[22] In a 2008 physiological study conducted by the Associated Press and MTVU, eight out of ten college students reported a feeling of horrible stress that impacted their grades.[22] Another common motivating factor has been issues at home that can impact their academic career.[23] Home-based issues can be composed of abuse, starvation, and overall poor living conditions.[23] Depression can also be a factor.[24]

Prevention

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National Suicide Prevention Lifeline, a crisis line in the United States and Canada

Social support may be key to help prevent suicide in college populations. The link between depressive symptoms and hopelessness was shown to be reduced among college students who had high levels of social support.[25] Utilizing prevention training for those at colleges likely to interact with students has also been beneficial, as it has led to significant increases in the knowledge and skills needed for suicide prevention.[26]

Gatekeepers are another form of prevention utilized within some colleges and universities. “Gatekeepers” are those people who regularly encounter distressed individuals or groups. On college campuses, these individuals include instructors, students, resident assistants, and other campus life officials.[26] Gatekeeper training can teach those involved how to identify suicide warning signs and when and what to do when recognized.[27] Peer-led suicide prevention workshops are similar and have also been effective at improving participants’ knowledge about suicide and the resources available.[28]

Help-seeking behavior

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In a national survey, it was shown that less than half of the college students who had seriously contemplated suicide during the previous twelve months received any mental health treatment during that time.[29] Of those that received treatment, the survey showed that students who deemed treatment necessary believed that treatment was effective, had contact with those involved in mental health services, showed a lower personal stigma and higher perceived stigma, did not have many positive relationships, belonged in a sexual minority group, or was Caucasian.[29] These correlations show that help seeking behavior among suicidal college students cover a wide range of personal and social factors.[30]

College programs and initiatives

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Many universities and colleges have begun offering assistance to new and returning students with dealing with stress.[7] Some institutions have also begun providing educators and staff members with training and education on how to interact with a student that has expressed or shown suicidal interests or tendencies.[7] The most common intervention strategies used by colleges involve campaigns to reduce stigma and provide education on mental illness, screen the population and attempt to link at-risk individuals with resources, or train people who are in often in contact with other members of the community.[30]

Social and culture

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Legislation

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In total, nine states have passed legislation regarding suicide on college campuses.[31] Many of these laws require institutions of higher learning to inform entering students of available mental health resources, develop policies to inform students and staff of the proper procedures for addressing the needs of a suicidal student, and post all relevant mental health and suicide prevention information on the school's webpage.[31] Pending federal legislation would mandate that the Substance Abuse and Mental Health Services Administration to award financial grants to colleges and universities to improve mental health services, conduct research about the mental health of its students, and expand training programs on campus.[31]

See also

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References

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  1. ^ Taub, Deborah J.; Thompson, Jalonda (Spring 2013). "College Student Suicide". New Directions for Student Services. 2013 (141): 5–14. doi:10.1002/ss.20036.
  2. ^ Appelbaum, Paul S. (July 2006). "Law & Psychiatry: "Depressed? Get Out!": Dealing With Suicidal Students on College Campuses". Psychiatric Services. 57 (7): 914–916. doi:10.1176/ps.2006.57.7.914. ISSN 1075-2730. PMID 16816275.
  3. ^ a b c Wilcox, Holly C.; Arria, Amelia M.; Caldeira, Kimberly M.; Vincent, Kathryn B.; Pinchevsky, Gillian M.; O'Grady, Kevin E. (2010). "Prevalence and predictors of persistent suicide ideation, plans, and attempts during college". Journal of Affective Disorders. 127 (1–3): 287–294. doi:10.1016/j.jad.2010.04.017. PMC 2924459. PMID 20471691.
  4. ^ Cerel, Julie; Bolin, Mary Chandler; Moore, Melinda M (2013). "Suicide exposure, awareness and attitudes in college students". Advances in Mental Health. 12 (1): 46–53. doi:10.5172/jamh.2013.12.1.46. ISSN 1838-7357. S2CID 58339266.
  5. ^ "College Student Mental Health Statistics". National Alliance on Mental Illness (via Chadron State College).
  6. ^ De Luca, Susan (January 2016). "The Relationship Between Suicide Ideation, Behavioral Health, and College Academic Performance". Community Mental Health Journal. 52 (5): 534–540. doi:10.1007/s10597-016-9987-4. PMID 26831304. S2CID 7963924.
  7. ^ a b c d e Brown, Peggy (Winter 2014). "College Can Be Killing: United States College and University Responses to Student Suicide During the 20th Century and Early 21st Century". Journal of College Admission: 35–48.
  8. ^ Fernández Rodríguez, M. del C., & Huertas, I. B. (2013). Suicide Prevention in College Students: A Collaborative Approach. Revista Interamericana de Psicologia = Interamerican Journal of Psychology, 47(1), 53–60.
  9. ^ Iarovici, Doris (July 2015). "Perspectives on College Student Suicide". Psychiatric Times: 27–32.
  10. ^ Zhai, Yusen; Du, Xue (October 2022). "Trends and prevalence of suicide 2017–2021 and its association with COVID-19: Interrupted time series analysis of a national sample of college students in the United States". Psychiatry Research. 316: 114796. doi:10.1016/j.psychres.2022.114796. ISSN 0165-1781. PMC 9375853. PMID 35987067.
  11. ^ Holdaway, Alex S.; Luebbe, Aaron M.; Becker, Stephen P. (2018). "Rumination in relation to suicide risk, ideation, and attempts: Exacerbation by poor sleep quality?". Journal of Affective Disorders. 236: 6–13. doi:10.1016/j.jad.2018.04.087. PMC 6047760. PMID 29704657.
  12. ^ Fieseler, Robert W. (28 June 2019). "High Falls: A Human Chain". The Delacorte Review. Retrieved 2020-05-21.
  13. ^ "Publications and Reports: ACHA-NCHA II". www.acha.org. Retrieved 2020-05-21.
  14. ^ Kang, Harmeet Kaur; Rhodes, Christopher; Rivers, Emerald; Thornton, Clifton P.; Rodney, Tamar (2021-02-01). "Prevalence of Mental Health Disorders Among Undergraduate University Students in the United States: A Review". Journal of Psychosocial Nursing and Mental Health Services. 59 (2): 17–24. doi:10.3928/02793695-20201104-03. ISSN 0279-3695.
  15. ^ a b Miller, Elissa J.; Chung, Henry (September 2009). "A Literature Review of Studies of Depression and Treatment Outcomes Among U.S. College Students Since 1990". Psychiatric Services. 60 (9): 1257–1260. doi:10.1176/ps.2009.60.9.1257. ISSN 1075-2730.
  16. ^ Li, Wenjing; Dorstyn, Diana S.; Jarmon, Eric (2020-07-02). "Identifying suicide risk among college students: A systematic review". Death Studies. 44 (7): 450–458. doi:10.1080/07481187.2019.1578305. ISSN 0748-1187.
  17. ^ a b Garlow, Steven J.; Rosenberg, Jill; Moore, J. David; Haas, Ann P.; Koestner, Bethany; Hendin, Herbert; Nemeroff, Charles B. (2008-06-01). "Depression, desperation, and suicidal ideation in college students: results from the American Foundation for Suicide Prevention College Screening Project at Emory University". Depression and Anxiety. 25 (6): 482–488. doi:10.1002/da.20321. PMID 17559087. S2CID 34343779.
  18. ^ Nam, Boyoung; Wilcox, Holly C.; Hilimire, Matthew; DeVylder, Jordan E. (2018-11-17). "Perceived need for care and mental health service utilization among college students with suicidal ideation". Journal of American College Health. 66 (8): 713–719. doi:10.1080/07448481.2018.1434779. ISSN 0744-8481. PMID 29384469. S2CID 4477617.
  19. ^ Wang, Yong-guang; Chen, Shen; Xu, Zhi-ming; Shen, Zhi-hua; Wang, Yi-quan; He, Xiao-yan; Cao, Ri-fang; Roberts, David L.; Shi, Jian-fei (2017). "Family history of suicide and high motor impulsivity distinguish suicide attempters from suicide ideators among college students". Journal of Psychiatric Research. 90: 21–25. doi:10.1016/j.jpsychires.2017.02.006. PMID 28214643.
  20. ^ Liu, Cindy H.; Stevens, Courtney; Wong, Sylvia H.M.; Yasui, Miwa; Chen, Justin A. (January 2019). "The prevalence and predictors of mental health diagnoses and suicide among U.S. college students: Implications for addressing disparities in service use". Depression and Anxiety. 36 (1): 8–17. doi:10.1002/da.22830. PMC 6628691. PMID 30188598.
  21. ^ Hanover, MD (2012). "American College Health Association- National College Health Assessment II: Reference Group Executive Summary Fall 2011" (PDF). American College Health Association.
  22. ^ a b Wu, Joanne (February 29, 2000). "Stress in College Students". The American Institute of Stress.
  23. ^ a b Foster, Dawn (February 4, 2016). "Poor housing is bad for your mental health". The Guardian.
  24. ^ Hawksworth, Elizabeth (September 18, 2014). "College drove me to the brink of Suicide". Washington Post.
  25. ^ Lamis, Dorian A.; Ballard, Elizabeth D.; May, Alexis M.; Dvorak, Robert D. (2016). "Depressive Symptoms and Suicidal Ideation in College Students: The Mediating and Moderating Roles of Hopelessness, Alcohol Problems, and Social Support: College Student Suicidal Ideation". Journal of Clinical Psychology. 72 (9): 919–932. doi:10.1002/jclp.22295. PMID 27008096.
  26. ^ a b Wolitzky-Taylor, Kate; LeBeau, Richard T.; Perez, Marcelina; Gong-Guy, Elizabeth; Fong, Timothy (2019-03-25). "Suicide prevention on college campuses: What works and what are the existing gaps? A systematic review and meta-analysis". Journal of American College Health. 68 (4): 419–429. doi:10.1080/07448481.2019.1577861. ISSN 0744-8481. PMID 30908123. S2CID 85515338.
  27. ^ Ross, Sarah G.; DeHay, Tamara; Deiling, Megan (January 2021). "The Suicide Prevention for College Student Gatekeepers Program: A Pilot Study". Crisis. 42 (1): 48–55. doi:10.1027/0227-5910/a000686. ISSN 0227-5910. PMID 32228037.
  28. ^ Tsong, Yuying; Young, Jennifer T.; Killer, Jane Duong; Takemoto, Mary Ann; Compliment, Brad (2019-04-03). "Suicide Prevention Program on a Diverse College Campus: Examining the Effectiveness of a Peer-to-Peer Model". Journal of College Student Psychotherapy. 33 (2): 131–144. doi:10.1080/87568225.2018.1434716. ISSN 8756-8225. S2CID 148759163.
  29. ^ a b Downs, Marilyn F.; Eisenberg, Daniel (2012). "Help Seeking and Treatment Use Among Suicidal College Students". Journal of American College Health. 60 (2): 104–114. doi:10.1080/07448481.2011.619611. ISSN 0744-8481. PMID 22316407. S2CID 205582972.
  30. ^ a b Eisenberg, Daniel; Hunt, Justin; Speer, Nicole (2012). "Help Seeking for Mental Health on College Campuses: Review of Evidence and Next Steps for Research and Practice". Harvard Review of Psychiatry. 20 (4): 222–232. doi:10.3109/10673229.2012.712839. ISSN 1067-3229. PMID 22894731. S2CID 25881991.
  31. ^ a b c "State Laws: Suicide Prevention on University and College Campuses" (PDF). American Foundation for Suicide Prevention. 2017. Retrieved April 21, 2019.
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