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CLINICAL and EMPIRICAL FINDINGS ABOUT COLLEGE

STUDENT SUICIDE

Morton M. Silverman, M.D.Senior Advisor, SPRC

Medical Consultant, The Jed FoundationColumbia University/NYSPI/AFSP Conference

New York, NYApril 21, 2005

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HIVDiabetes MellitusCongenital

AnomaliesCerebrovascularCerebrovascular

SuicideCerebrovascularCerebrovascularHIVSepticemia

LiverDisease

LiverDisease

Diabetes MellitusChronic Low. Respiratory Dis.

Chronic Low. Respiratory Dis.

Chronic Low. Respiratory Dis.HomicideHIV

CongenitalAnomalies

Heart Disease

DiabetesMellitus

HIVHeart DiseaseHeart

DiseaseSuicide

CerebrovascularSuicideMalignant

NeoplasmsMalignant

NeoplasmsHomicide

UnintentionalInjuries

Heart Disease

HomicideSuicideCongenitalAnomalies

Heart Disease

MalignantNeoplasmsSuicideHomicide

MalignantNeoplasms

MalignantNeoplasms

UnintentionalInjury

UnintentionalInjury

UnintentionalInjuries

UnintentionalInjuries

Age Groups5 - 14 15-24 25-34 45-64

Suicide Among Leading Causes of DeathsSuicide Among Leading Causes of DeathsUnited States United States -- 20022002

35-44

9

8

7

6

5

4

3

2

1

3

Suicide Rates by Ethnicity and Age GroupUnited States, 1995-1999

0

5

10

15

20

25

30

35

Age Group in Years

Rat

e pe

r 100

,000

pop

ulat

ion

Eur-Amer Non-LatinoAfr-Amer Non-LatinoNative AmericanAsian-PILatino

0-4 5-9 10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84 85

+

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The U.S. College and The U.S. College and University PopulationUniversity Population

More teenagers and young adults die from suicide than from all medical illnesses combined

Approx. 14 million students currently attend over 4,500 American colleges and universities.

An estimated 8 million college/university students are between ages 18-24 (representing over one-quarter of all 18-24 year-old in the U.S.)

Students’ health-risk behaviors, including suicidal behavior, have been only partially documented.

College and university students constitute an important, but in many respects underserved, population for public health interventions.

Why the Rise?Why the Rise?

Earlier identification and referral (high school)Improved treatment optionsDecreased stigma (high school & college)Increased accessibility/availabilityGreater parity with physical healthDecreased 3rd party coverage & reimbursementIncreased perturbation and uncertainty in worldCohort effect?

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Evidence for Rise in Psychological DistressEvidence for Rise in Psychological Distress

Big 10 Universities Student Suicide Study (1980-1990)CDC’s YRBS (2001; 2003)CDC’s NCHRBS (1995)ACHA Spring 2000 NCHAAUCCCD’s Annual SurveysPublished literatureChickering Insurance Company figures

Percentage of High School Students Who Felt Percentage of High School Students Who Felt Sad or Hopeless,* 1999 Sad or Hopeless,* 1999 -- 20032003

* Felt so sad or hopeless almost every day for > 2 weeks in a row that they stopped doing some usual activities during the 12 months preceding the survey1 No change over time

National Youth Risk Behavior Surveys, 1999 – 2003

28.3 28.3 28.61

0

20

40

60

80

100

1999 2001 2003

Perc

ent

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Percentage of High School Students Who Seriously Percentage of High School Students Who Seriously Considered Attempting Suicide,* 1991 Considered Attempting Suicide,* 1991 -- 20032003

* During the 12 months preceding the survey1 Significant linear decrease and quadratic effect, p < .05

National Youth Risk Behavior Surveys, 1991 - 2003

29.024.1 24.1

20.5 19.3 16.9119.0

0

20

40

60

80

100

1991 1993 1995 1997 1999 2001 2003

Perc

ent

Percentage of High School Students Who Percentage of High School Students Who Made a Suicide Plan,* 1991 Made a Suicide Plan,* 1991 -- 20032003

* During the 12 months preceding the survey1 Significant linear decrease, p < .05

National Youth Risk Behavior Surveys, 1991 - 2003

18.6 19.0 17.7 15.7 14.5 16.5114.8

0

20

40

60

80

100

1991 1993 1995 1997 1999 2001 2003

Perc

ent

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Percentage of High School Students Who Actually Percentage of High School Students Who Actually Attempted Suicide,* 1991 Attempted Suicide,* 1991 -- 20032003

* One or more times during the 12 months preceding the survey1 No change over timeNational Youth Risk Behavior Surveys, 1991 - 2003

7.3 8.6 8.7 7.7 8.3 8.518.8

0

20

40

60

80

100

1991 1993 1995 1997 1999 2001 2003

Perc

ent

Percentage of High School Students Percentage of High School Students Whose Suicide Attempt Required Whose Suicide Attempt Required Medical Attention,* 1991 Medical Attention,* 1991 -- 20032003

* During the 12 months preceding the survey1 No change over time

National Youth Risk Behavior Surveys, 1991 - 2003

1.7 2.7 2.8 2.6 2.6 2.912.6

0

20

40

60

80

100

1991 1993 1995 1997 1999 2001 2003

Perc

ent

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ECA STUDYECA STUDY

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BIG 10 UNIVERSITIES STUDENT SUICIDE BIG 10 UNIVERSITIES STUDENT SUICIDE STUDYSTUDY

BIG 10 UNIVERSITIES STUDENTSUICIDE STUDY

1980 - 1990

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12

13

14

15

16

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NCHA vs. NCHRBS FindingsNCHA vs. NCHRBS Findings

68 (1.5%)

39 (1.4%)

29 (1.7%)

Attempted Suicide

469 (10.0%)

302 (10.4%)

167 (9.3%)

Seriously Considered Attempting Suicide

NCHRBS 1995(N=4,609)

214 (1.5%)

126 (1.4%)

88 (1.6%)

Attempted Suicide

1,374 (9.5%)

893 (9.9%)

481 (8.7%)

Seriously Considered Attempting Suicide

TotalFemaleMaleNCHA Spring 2000(N=15,977)

AUCCCD 2003 Survey AUCCCD 2003 Survey

81.4% report seeing more students with serious psychological problems than 5 years ago. This is the #1 service provision concern (772%) and the #1 administrative concern (49.5%)

40.7% of clients have severe psychological problems

Utilization of services: 9.8% is average (goes up to 40%) for entire campus per year

160 suicides in 2002-03, but only 31 were current or former counseling center clients

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FACTS AND FIGURESFACTS AND FIGURES

Upwards of 20% of students use antidepressants at some point in their college yearsAUCCCD reports 18% of students seeking help at counseling centers received psychotropic meds –up from only 7% in 19921.6 million incoming freshmen experience episodes of depression

Jed Foundation/NMHA estimate 1088 suicides/year on college campuses

CoCo--MorbidityMorbidity

7-10% with MDD die from suicide

60% completed suicides have an MDD diagnosis

8-10% with bipolar disorder die from suicide

over 50% of suicides have alcohol or other drugs in their system

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CoCo--MorbidityMorbidity

a sleep disturbance is a symptom of depression, anxiety, and/or stress

perceived stress can be a symptom of depression

alcohol is often used to self-medicate for anxiety, stress, or depression

impulsivity, aggressive behavior, and irritability are associated with suicidal behavior

Overlap of spheres of influence for Overlap of spheres of influence for suicidal behaviorsuicidal behavior

Individual Administration

School CommunityHealth/

Mental Health Svcs.

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Prevent Suicide and Promote Mental Health

Awareness & Well-BeingLeadership: President’s Office

Training of Mental Health Service (MHS) Providers to:

• Identify and treat depression, threats of suicide, and other emotional disorders

• Refer cases as appropriate• Lead: Suicide prevention experts• Target: MHS, community resources,

local hospitalsLife Skills Development (Protective

Factors) to:• Improve students’ management of

the rigors of college life• Equip students with tools to

recognize and manage triggers and stressors

• Lead: VP of Student Affairs, Deans of Students, MHS, Faculty & Staff, Advisors, Residential Life

• Target: Students

Educational Programs to:• Train gatekeepers and students to:

(1) identify signs of individuals in distress; (2) take the steps that get them help

• Lead: Provost, VP Student Affairs• Target: Students and gatekeepers

(Deans of Students, Faculty & Staff, Advisors, Residential Life, Student Gov’t, Student & Greek Orgs., Athletic Dept., Dining Services, Public Safety, Chaplainry)

Pre-Enrollment Survey to:• Identify high-risk and potentially

high-risk students• Provide snapshot of incoming class• Proactively work (programs,

treatment) with identified students• Lead: Admission Office or Freshman

Dean with MHS and the Health Service• Target: Incoming first-year students

Social Network Promotion to:• Reduce student isolation and

promote feeling of belonging• Encourage the development of

smaller groups within the larger campus community

• Lead: Deans of Students, Faculty & Staff, Residential Life, Student Gov’t, Student & Greek Orgs., Chaplainry

• Target: Students

Social Marketing to:• Stimulate campus-wide cultural

change that de-stigmatizes mental health, removes barriers, and encourages help-seeking behavior

• Target both high-risk students and general campus community

• Lead: VP Student Affairs, Deans of Students, MHS, Marketing Department, Campus Media

• Target: Entire campus community

Draft 8-8-03

Crisis Management to:• Establish policies and implement

programs (including medical leave and re-entry) that respond to suicide attempts and high-risk behavior

• Respond with comprehensive postvention program

• Lead: VP Student Affairs, MHS• Target: Students; gatekeepers (with

implementation responsibility)

Means Restriction to:• Limit access to lethal means• Lead: Buildings & Grounds, Public

Safety, Residential Life, Chemistry Dept., Athletic Dept.

• Target: Entire campus community

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UlifelineUlifeline

Schools can join the Ulifeline NetworkTool that helps students cope with the stress of everyday college lifeEmpowers students to help one another and themselves

• Self E-Valuator• Q&A

Free serviceStudent-friendlyConnects students to the counseling services available to them on campus

Internal resources of a university can be used to create an effective awareness of Ulifeline

Ulifeline.org

Ulifeline.org leverages the anonymity of the internet to provide students with anon-threatening link to their counseling centers as well as important mental health information

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For more information:

See: www.jedfoundation.org

See: www.ulifeline.org

E-mail: jkonvisser@jedfoundation.org

Contact SPRCContact SPRC

Phone: 877-GET-SPRC (438-7772)TTY: 617-964-5448Web: www.sprc.orgEmail: info@sprc.orgMail: Suicide Prevention Research Center55 Chapel StreetNewton, MA 02158-1060