More than half of college students reported thinking about suicide at some point in their lives, studies show that these thoughts have been intense and persistent (Brownson et al., 2016). Approximately 6.5-7.5 percent of 100,000 college-aged students die by suicide every year (Hawley et al., 2016). Arriving to campus for the first time can be a facilitator for more serious transitional issues which stem from changes in relationships, routines, and daily living (Canto et al., 2017). With the new challenges and additional stress, it is thought that college students today could be the most distressed population on campuses (Canto et al., 2017). It is important to note that for many students these psychological states are not long-lasting and could be considered healthy prompts towards personal development (Canto et al., 2017). However, for students with maladaptive responses, these transitions could trigger chronic complications which need attention or intervention (Canto et al., 2017).
The Education Resource Information Center (ERIC) was utilized when searching for information in regard to suicide prevention. ERIC is a database which consists of information from 1966-present; there are over 300,000 abstracts, journal articles, and Education Documents. Search terms used were; mental health, crisis prevention, higher education, identification, intervention, psychological services, psychological needs, and suicide prevention. There was an overwhelming amount of research on this topic as it pertains to higher education. Boundaries used to narrow down search outcomes were peer-reviewed and full text only. The literature chosen below focuses on recent statistics of suicidality in higher education, signal detection, and various prevention strategies.
While there is an increase in students seeking mental health services while at college there is also an increase in the severity of their needs (Brownson et al., 2016). However, despite the increased use of campus wellness centers counseling services, there is still a significant amount of students who attempt to cope with challenges of mental health without the support of professionals (Brownson et al., 2016; Kaslow et al., 2012). Institutions of higher education need to take mental health as a serious prevention measure in crisis management; as suicide is the second most cause of death for students enrolled in college (Brownson et al., 2016). In order to address this growing concern, some colleges and universities have started population-focused programs. These programs teach students how to cope with stress, identify their own signs and symptoms, and refer themselves and peers to services in an effort to increase suicide prevention efforts (Brownson et al., 2016; Catanzarite et al., 2013). This type of peer education is a strong means of risk management as studies show that students with suicidal ideations rely on their peers rather than campus professionals (Canto et al., 2017; Catanzarite et al., 2013).
Population-focused interventions can be used for the entire student body or as a means to target specific subgroups which may be at risk based on specific characteristics (Brownson et al., 2016). Although focusing on at-risk subpopulation can be beneficial as a crisis management practice, suicidality affects a significant amount of students; therefore, prevention intervention should be for the entire student population (Brownson et al., 2016). Beyond suicidal thoughts and behaviors, there is also importance placed on educational efforts to reduce stress and increase students’ resilience (Brownson et al., 2016). In order for institutions to provide support for individual needs faculty, staff, and students must be able to identify behaviors of a student in need. There is an assumed layer of distress associated with transitional issues faced by college students. However, there are typical safe ways to process these events and also pathological or problematic reactions when responding to challenges (Canto et al., 2017). Students may feel that their behavior will help them to relieve stress however it fails to bring them relief, their behavior may reduce their ability to manage, and place them at an increased risk of danger (Canto et al., 2017). For instance, students who use or even abuse substances increase their use as a coping mechanism during stressful times as a way to self-medicate (Canto et al., 2017). It is important to note the differentiation among healthy and maladaptive behaviors. Students that experience the same distress may cope in a healthy way by responding to the stress in a positive way in order to reduce the problem (Canto et al, 2017).
For instance, a student worrying about an upcoming test may positively cope by spending extra time studying. By understanding how students choose to cope, institutions can pinpoint which students may be in need of additional or professional support. The creation of coalitions as a means for suicide prevention and distress reduction are evidence-based tools for achieving a reduction in ideation (Kaslow et al., 2012). Coalitions are alliances for combined actions; in this case, concerned constituents work together to promote the communities well-being. There are several factors which contribute to successful outcomes of coalitions. First and foremost, coalition leadership must be experienced and dependable as well as committed to the mission (Kaslow et al., 2012). These leaders must be knowledgeable on the topic and able to express themselves and the mission of the group while simultaneously gaining the trust of the supporting members (Kaslow et al., 2012). Empowering members through frequent communication, shared decision making, and collaboration creates a positive coalition climate which keeps members task-oriented (Kaslow et al., 2012).
University community buy-in is another area which impacts the outcomes of the coalition. Having a strong university community enables the willingness to work with the coalition towards its desired goals, therefore embedding suicide prevention into the foundation of the institutions’ administration and student population (Kaslow et al., 2012). There is a high importance placed on creating a community atmosphere that encourages help-seeking behavior and early identification (Mitchell et al., 2013). Experts recommend community training so that peers can serve as “gatekeepers” that would identify signs of mental distress and guide the at-risk student to appropriate resources for suicide intervention (Mitchell et al., 2013). Through the creating of this strong supportive community, there is an increase in peer-level support for students which would lead to professional support through referral action. Through training and community engagement the campus community can be transformed (Kaslow et al., 2012). With time and continued effort from faculty, staff, and students institutions will have these positive changes embedded into the community for long-lasting results (Kaslow et al., 2012).
Question, Persuade, Refer (QPR) is a suicide prevention training program, often used to educate student leaders on how to identify and support a person with suicide ideations. Participants of QPR training conveyed a better understanding of suicide, prevention, and resources (Mitchell et al., 2013). Assessment of QPR training showed positive effects. Surveyed participants said that they would engage in suicide prevention behaviors learned in training, such as, directly asking if they are suicidal, calling a crisis hotline to get the person help, and even going with the person to get help (Mitchell et al., 2013). One downfall was that participants lost contextual information like suicide statistics and the etiology of suicidal thinking over time (Mitchell et al., 2013). Based on this data it appears that QPR training should be offered every semester to student staff like Resident Assistants and other student leaders like student-athletes. Following this suggestion could help students in leadership positions retain the knowledge rather than lose the insight in a short-term period. Peer education is a tool often utilized in higher education through multiple departments offering a variety of services. Studies show that peer educators are helpful to students because they are seen as being similar to the student in need, enough so, to understand their problems or perspective (Catanzarite et al., 2013). Implementing groups such as Friends Helping Friends creates supportive environments for students experiencing suicidal thoughts (Catanzarite et al., 2013). The missions of this group have several components; raise awareness, decrease stigma, promote healthy coping strategies, and implement outreach initiatives on campus (Catanzarite et al., 2013). Assessment of this peer education program shows significant positive effects on the campus culture (Catanzarite et al., 2013). Moreover, the campus partnerships have a noteworthy impact on the institutionalization of peer health education (Catanzarite et al., 2013).
Many institutions of higher education build their reputation and pride themselves in the rigor of their academic offerings. However, it may be important for colleges and universities to assess whether the academic challenges are suitable for the student body. Healthy levels of academic stress should motivate students to transcend their potential, whereas unnatural levels of academic challenge could impede students’ academic achievement and also emotional well-being (Brownson et al., 2016).
The Saint Louis University School of Medicine made changes to their academic expectations and found a decrease in student’s depression, anxiety, and stress levels which improved the community environment (Brownson et al., 2016). Creating centers for LGBTQ+ students is another avenue to promote positive mental health for this specific subpopulation of college students (Brownson et al., 2016). Research shows a significant need to support the LGBTQ+ community, as this groups suicidality rates are higher than their peers (Brownson et al., 2016). Compared to heterosexual peers, LGBTQ+ students reported more problems related to psychological stress (Hawley et al., 2016). By establishing these centers on college campuses, there is the opportunity to educate while also providing support and a sense of community to these students (Brownson et al., 2016). Supporting student veterans is another way that institutions of higher education can take action towards suicide prevention. Every day twenty-two veterans commit suicide (Department of Veteran Affairs 2012b). Moreover, 46% of college veterans have suicidal ideations and 8% attempt suicide (Rudd et. al 2011).
Student veterans are a growing population in colleges across the nation (Department of Veteran Affairs 2012b). Very few institutions offer locations and services solely dedicated to those who have served our country or their dependents. Research shows that student veterans often feel unsupported by their campuses and misunderstood by their institutions (Griffin & Gilbert, 2015). In order to support the needs of this unique population, there should be dedicated veterans’ offices on college campuses (Griffin & Gilbert, 2015). This office is crucial to supporting their needs as well as fostering an expansive sense of institutional support and creating an environment for positive interactions (Griffin & Gilbert, 2015). Veterans may feel that they do not fit in, as age differences with traditional students create social distance (Griffin & Gilbert, 2015). Therefore, the opportunity of a veterans’ office and peer positions will provide student veterans access to those who understand their experiences (Griffin & Gilbert, 2015). Substance use plays a crucial role in suicide prevention initiatives. Data collection shows that over half of students who attempted suicide had used substances before or during their attempt (Brownson et al., 2016). The use of substances may have facilitated their attempt, been the method of the attempt, or even the reason for the attempt (Brownson et al., 2016). This data shows that there is high importance in including information about substances in prevention procedures. A passive yet informative and accessible means of information and support services come from web-based material about suicide. This method relies on students reaching out for information and support rather than the community reaching out to those affected (Keyes, 2012). This should not be an institution’s only means of prevention; however, it is a model that students can rely on as an entry into continued support. These web pages usually detail suicide facts, response tips for friends in distress, and offer on and off campus resources (Keyes, 2012).
Typically campuses that offer these web pages also pair this model with targeted programming, this could include, an awareness week, hosting a speaker, and smaller-scale programming throughout the campus (Keyes, 2012). Although many emergency response plans (ERP) highlight prevention as a key foundation for crisis management, in the case of suicide prevention the role and responsibility for intervention and prevention are often not clearly placed on specific departments or task forces. That being said, suicide prevention does not go without efforts across campuses of higher education, however, if efforts were collaborative across departments there could be more insightful training and programming efforts. Often times residence life and wellness centers focus on these efforts but by assigning specific tasks outcomes could be better. If institutions designate specific roles for departments to focus on it could be said that more inclusive and effective efforts would result. For instance, if residence life staff focused on training student staff in regard to learning warning signs, referring to resources, and programming on resiliency and positive coping methods, then the wellness center staff can focus on training peer mentors, while academics can focus on restructuring the rigor of academic expectations, and health and safety offices can look to adjusting physical facilities to make spaces safer. Additionally offices of veteran affairs, LGBTQ+, and multicultural services can focus on supporting their unique populations. By understanding the scope of departmental responsibilities efforts can be better distributed across campuses to affect the whole community.
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