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The Director Discusses:

Depression and suicide among college students: problems, causes, and the emergence of solutions

Photo: John F. Greden, M.D. A recent New York Times article pointed out that 44% of students in campus counseling are dealing with meaningful mental illnesses. This is more than double the rate 10 years ago, according to a recent survey by the American College Counseling Association. More college students are also taking psychiatric medication for their conditions, most of which have co-occurring ("comorbid") symptoms—clinical depression, anxiety, sleep disturbances, "stress," substance abuse, and suicidal thoughts. Perhaps most troubling for campus clinicians and authorities, student mental health incidents on college campuses more frequently require immediate or emergency attention.

A number of variables almost certainly contribute to this striking upward trend. These include improved screening methods; progress in promoting mental health literacy and counteracting stigma so that most college students now perceive depression, anxiety and related conditions to be illnesses, not "weaknesses;" greater self-awareness and willingness to seek help for depression and other conditions; and college educational campaigns that focus on prevention and early recognition. In addition, evidence indicates that the increased use of effective, better-tolerated medications allow greater number of students with depression, bipolar disorder, and other related illnesses to attend college.

Whatever the causes, the result has meant strained campus mental health centers that struggle to meet greater demands, but usually without any increase in resources, and less individual attention for students in need of therapy, especially for those who require sustained treatment to maintain wellness. "Where does the student with clinical needs go for ongoing treatments?" This has become a perplexing problem for most campuses.

And perhaps the most troubling question is what to do with college students whose underlying disorders predispose them to suicidal thoughts or acts. Suicide within the college community is more common than many realize. Among people aged 15 to 24, suicide is the third-leading cause of death and accounts for 12% of all deaths annually in this age group. It is perhaps most notable that while various factors can seemingly set off a suicide attempt, an estimated 90% or more of college students who die by suicide lived with a mental illness, usually depression. When depression is present, substance abuse, rejection, bullying, financial strains, scholastic difficulties, and other stresses are far more likely to set off impulses of self-harm. Many college students who tragically end their lives never even seek help from within their institutions. We are beginning to see, too, how challenging it can be for students in trouble to know where to go or how to access assistance when it's most desperately needed. And all of us need to address the unresolved problem of "revolving doors"—seeking help in one venue and being referred to another.

There is hope amid all of these troubling statistics. For one, college counselors are dealing with the increased demand for their services by training faculty and others on campus – including students – to help identify those who are struggling and respond more appropriately to their needs. The Depression Center's Campus Mind Works website is an excellent illustration. It provides information to help support college students with depression, substance abuse, and other mental health disorders, as well as information for their professors, family members, and friends. The best approach for preventing suicide is to treat the underlying problems, not focus on suicide per se.

Encouraging greater awareness of the early manifestations of depression and warning signs of suicide can have a major impact in preventing tragedies. Such knowledge empowers individuals to take helpful rather than destructive actions in critical moments. For friends and fellow classmates, asking and caring rather than avoiding, and accompanying and escorting during times of crisis save lives. Parents, too, should be aware of the warning signs of depression and suicide, should know where and how to turn for help in the event of an emergency, and should understand that while it may take effort to find community treatment resources, they are available. Keeping open lines of communication with college students is crucially important for parents, ideally reinforcing with support and love, while recognizing that it is rarely therapeutic to convey the "just get over it" message.

As a final note, it is sometimes too easy to forget that another college-aged population is receiving an education outside of traditional classrooms, dormitories, and grassy quads – those young men and women serving in the armed forces, who confront the same life-stage stressors as their peers attending college, but who also face the enormous additional challenges that typically accompany military service. The Depression Center is dedicated to supporting these citizen soldiers through its Buddy-to-Buddy peer support program, the Welcome Back Veterans program, and the Welcome Back Parenting program, all of which work to build support for returning soldiers and their families in their process of reintegration into civilian life. We also are focused on helping those returning veterans when they return to college campuses.

These and other issues will be addressed on March 28-29, 2011 at the U-M Rackham Graduate School, when the Depression Center hosts its 9th annual Depression on College Campuses (DoCC) conference. This conference was inaugural and pivotal in focusing the nation's attention on the growing problems facing college students. The DoCC this year will feature a variety of approaches to preventing depression and suicide on college campuses on the theme of "Early Detection and Intervention" (prior issues of this column have emphasized their importance), and presentations and discussions will include models for campus peer-to-peer support programs, using technology as a tool to detect student depression, and preventing suicide on campus by fostering connectedness within the campus community. Visit to learn more. This will be an engaging, stimulating, and powerful conference. We learn from you at such conferences; I am confident you will learn from the program's wonderful faculty and staff, and from each other. I urge you to attend.


John F. Greden, M.D.

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