Introduction

Depression and suicidal thoughts are two of the most frightening things a person can face in
their lifetime. Unfortunately, acting on those suicidal thoughts is a far too common scenario for
many across the world, including students. In fact, suicide is the second-leading cause of death
for those between the ages of 15 and 24.

This guide is dedicated to helping those who are suffering or have suffered from depression,
suicidal thoughts or suicide attempts. It is also designed for concerned friends and family
members who might be worried that someone they love will experience death by suicide.
Finally, it is meant for students, so that they might spot the warning signs of suicide in others –
or in themselves – and find the proper resources.

CONTENT NAVIGATION

Meet the Experts

Understanding Suicide

From the Expert

Mental Health, Depression & Suicide

Depression & Suicide: The Facts

Help & Resources

Suicide Warning Signs

How to Get Help

Special Populations at Risk

Get Involved!

Meet the Experts

expertSTEVE SCHLOZMAN

Steve Schlozman, MD is associate director of The Clay Center for Young Healthy Minds at
Massachusetts General Hospital and an assistant professor of psychiatry at Harvard Medical
School. He practices child and adult psychiatry at Mass General and serves as the primary
consultant to the pediatric transplant service. Dr. Schlozman received BAs in English and biology
from Stanford University and his MD from the Dartmouth-Brown Program in Medicine. He serves
as supervisor for both general psychiatry residents and child psychiatry fellows. He has been
involved in national efforts to increase recruitment in psychiatry and decrease stigma with
regard to psychiatric illness. To learn more about Dr. Schlozman, follow him on Twitter
(@SSchlozman), or visit his page at the Clay Center.

expertA. MICHELE TEDDER

A. Michele Tedder holds an MS in Nursing Education. She is the founder & CEO of Joy for Life, a
life purpose, personal and professional development coaching organization, and the author of
“Don’t Let Grief Steal Your Joy.” She was employed for 18 years at Western Psychiatric Institute
and Clinic in Pittsburgh, PA., one of the largest behavioral health care providers in the country
and affiliated with the University of Pittsburgh Medical Center. During her tenure, Michele held
positions as a nurse clinician in the emergency room, a clinical nurse specialist for Services for
Teens at Risk (STAR), an outpatient clinic specializing in the treatment of adolescents suffering
from depression and suicide, and the Project Coordinator for an outreach program called
Reaching out to Adolescents with Depression (ROAD), specializing in the identification,
assessment and treatment of depressed adolescents in primary care settings.

Introduction

Depression and suicidal thoughts are two of the most frightening things a person can face in
their lifetime. Unfortunately, acting on those suicidal thoughts is a far too common scenario for
many across the world, including students. In fact, suicide is the second-leading cause of death
for those between the ages of 15 and 24.

This guide is dedicated to helping those who are suffering or have suffered from depression,
suicidal thoughts or suicide attempts. It is also designed for concerned friends and family
members who might be worried that someone they love will experience death by suicide.
Finally, it is meant for students, so that they might spot the warning signs of suicide in others –
or in themselves – and find the proper resources.
If a suicide attempt seems immediate, call 911. If the threat is urgent, you can also call the
National Suicide Hotline at 1-800-273-TALK, 1-800-SUICIDE, your local crisis center, dial 911, or
take the person to an emergency room. Remove guns, drugs, knives, and other potentially lethal
objects from the vicinity but do not, under any circumstances, leave a suicidal person alone. In
search of possible means for attempting suicide, don’t forget cars, glove compartments, trunks,
and other places within the car as a possible location for weapons.

Understanding Suicide

An overwhelming surge of emotions that never seems to end – that’s what some who have
attempted suicide try to describe to those who ask to understand why they feel the way they do.
Those who are contemplating suicide might literally feel as though there is no way out of their
situation. They are bombarded with feelings of hopelessness, fear, isolation, hatred toward
themselves and so much more. The pain they feel is often immeasurable, to a point where they
see no other option than to end their lives.

But many people who have attempted suicide will say that they wanted to live. They really didn’t
want to die; the desire to remain with loved ones remained very strong. They simply didn’t see
any other options.

What causes such a strong conflict in a person? What leads to that feeling of a dead-end, no-
way-out scenario?

There are many reasons that someone might choose suicide or contemplate suicidal thoughts.
Those reasons are often so complex and complicated that the person suffering from those
feelings might not be able to articulate exactly what is going on in their head and heart.
However, long and difficult research has found that the basic motivation for suicide is the feeling
of utter despair and hopelessness. How a person reaches that point is what varies from one to
another.
Why Are Student Suicides Rising?

Students are under more pressure than ever before, and the grim reality is that student suicides
have increased by over 50 per cent since 2007

Suicide is extremely complex’ psychiatrist Dr Alberto Pertusa, tells The Debrief: ‘we don’t have
studies to know what works and what doesn’t. Although poor mental health increases the risk of
suicide, most people who take their own lives don’t have diagnosable conditions, very often the
problem is with the environment.’ While certain environmental pressures have always existed for
students - debt, exams, navigating a new social sphere - today there are arguably more than ever
before. Once you’ve solved the existential riddle of deciding what you want to do with your life,
you have to scavenge your way into a highly competitive job market, where decently paid
graduate roles are few and far between, conjure up a viable living situation/accept that your new
roommates are your parents, and ensure that you get at least a 2:1 in order to even pass go. Not
to mention the increasingly volatile political landscape: it started with Brexit (which 75% of those
aged 18-24 voted against); culminated in governmental upheaval and has left us with a shock
snap election.‘It makes me feel unheard’ says Naomi, a final year Cardiff student, ‘as older
generations continue to vote against us, millennials are left feeling more and more isolated.’

Abstract

BACKGROUND:

Suicide is a leading cause of death among young people. While suicide prevention is considered
a research and intervention priority, longitudinal data is needed to identify risk and protective
factors associate with suicidal thoughts and behaviors. Here we describe the UNIVERSAL
(University and Mental Health) project which aims are to: (1) test prevalence and 36-month
incidence of suicidal thoughts and behaviors; and (2) identify relevant risk and protective factors
associated with the incidence of suicidal thoughts and behaviors among university students in
Spain.

METHODS:

An ongoing multicenter, observational, prospective cohort study of first year university students
in 5 Spanish universities. Students will be assessed annually during a 36 month follow-up. The
surveys will be administered through an online, secure web-based platform. A clinical reappraisal
will be completed among a subsample of respondents. Suicidal thoughts and behaviors will be
assess with the Self-Injurious Thoughts and Behaviors Interview (SITBI) and the Columbia-Suicide
Severity Rating Scale (C-SSRS). Risk and protective factors will include: mental disorders,
measured with the Composite International Diagnostic Interview version 3.0 (CIDI 3.0) and
Screening Scales (CIDI-SC), and the Epi-Q Screening Survey (EPI-Q-SS), socio-demographic
variables, self-perceived health status, health behaviors, well-being, substance use disorders,
service use and treatment. The UNIVERSAL project is part of the International College Surveys
initiative, which is a core project within the World Mental Health consortium. Lifetime and the
12-month prevalence will be calculated for suicide ideation, plans and attempts. Cumulative
incidence of suicidal thoughts and behaviors, and mental disorders will be measured using the
actuarial method. Risk and protective factors of suicidal thoughts and behaviors will be analyzed
by Cox proportional hazard models.

DISCUSSION:

The study will provide valid, innovative and useful data for developing prevention programs for
youth suicide and for improving early identification for high-risk students. The longitudinal
design of this study will improve causal interpretation of analyzed associations, needed for
generating and validating predictive models. It will represent the first results about suicidal
thoughts and behaviors in the Spanish university population. The World Mental Health Survey
collaboration will permit accurate cross-national comparisons.
Abstract

Suicide is a leading cause of death for adolescents and represents a major national health

concern (American Foundation for Suicide Prevention, [AFSP], 2015; (Centers for

Disease Control [CDC], 2013). Because adolescents spend the majority of their day at

school (Erbacher, Singer, & Poland, 2015), the effectiveness of school-based suicide

prevention programs may be improved through better understanding of adolescents’

views on the subject of suicide and the factors that may influence participation in

prevention efforts. The present study explored the attitudes and perceptions of seventh

grade students from a suburban middle school in Pennsylvania, using archival survey

data. Variables that were examined included attitudes toward suicide, real or perceived

stigma toward suicide, suicide literacy, and attitudes toward help-seeking for suicidal

thoughts and behaviors. Results indicated that an overwhelming majority of participants

believe that suicide can be prevented and that intervention is necessary; however,

adolescents still hold some degree of stigmatizing attitudes toward suicide and are

uncertain about how to identify and assist those at risk. There were few significant

differences between the perceptions and attitudes of males and females on this topic. The

results confirm the need for school-based suicide prevention education, with specific

focus on identification of warning signs and on ways to intervene when concerns for self

or a peer arises. More importantly, the results emphasize the need to implement schoolbased
suicide prevention education programs much earlier than what is considered

typical. Limitations to the study and directions for future research are also discussed
Suicidal behavior generally refers to ideations, communications, and behaviors

that involve some degree of intent to die (Van Orden et al., 2010). Adolescents who

struggle with suicidal thinking or behavior often exhibit unhealthy thought patterns due to

mental health issues such as depression (Substance Abuse and Mental Health Services

Administration [SAMHSA], 2012). Thoughts of hopelessness, helplessness, and

worthlessness are common thought distortions associated with suicidal behavior

(SAMHSA, 2012). This can lead to significant school-based impairment (Klein, Kujawa,

Black, & Pennock, 2013). Symptoms that may be readily observed in the school setting

include an inability to concentrate, to think rationally, or make even minor decisions;

other observable symptoms include difficulty getting necessary things done, self-harm

behavior, withdrawing from normal relationships or isolating oneself, and increased

absenteeism in school (Klein et al., 2013). Such problems may be reflected in students’

lassroom behavior, homework habits, and academic performance (AAS, 2010b;

American Psychiatric Association [APA], 2013; Huberty, 2006). Clearly, suicide is a

phenomenon that should be of particular concern to those in the educational system

(Lam, 2014), yet currently, little is known about why those at risk of suicide do not seek

help (Calear, Batterham, & Christensen, 2014; Pandey, 2013).

In the Philippines, the rise in the number of suicide cases and youth with mental health issues is
brought about by a mix of social and biological factors. (READ: How does the PH fare in mental
health?)

However, a common theme stands out: disconnectedness and deterioration of relationships

brought about by social media and technology. Experts said young people today tend to be more
disconnected despite the internet supposedly opening up the world to everyone.

“With all the social media, there’s just too many things to do; too many things to prove….Young
people today tend to be very pressured, very stressed, live very complicated lives, and tend to be
socially disconnected,” Chua said.

The lack of connectedness can often lead to a breakdown in relationships, which are crucial in
fostering good mental health. A recent 2017 study published in the Association for Psychological
Science also found that adolescents who spent more time online – such as social media – were
more likely to report mental health issues.

“That sense of lack of social connectedness is very, very prevalent….They’re connected but they
can’t seem to have a trusted person,” Nadera said.

This was echoed by Celis who observed that children nowadays do not always understand the
difference between “true friendship” and belonging. “There’s a need to fit in and there’s a need
to stand out and you tend to forget what really matters,” he said.

The breakdown in connectedness is often seen in high school and college students but
Balderrama said it had already been observed even among elementary students.

Meanwhile, relationships at home may not always be better either. Experts said many Filipino
children also have parents who work abroad. Some of them experience increased busyness
themselves, too.

In addition, experts said children nowadays are also often exposed to events and information
that older generations might have encountered at a later stage. For instance, Nadera highlighted
the case of children who have gone through traumatic events such as armed conflict, sexual
abuse, and even exposure to a more “chaotic” world.
Coupled with high levels of stress from increased competition and school, these can have an
impact on how children learn to cope as brain development may not be at a stage where one
would know how to deal with changes and heightened expectations.

Experts also observed this has often led to children with low self-esteem and high self-
expectations.

High risk

While there is no one factor that causes these, the rise in mental illnesses and suicide cases can
also be explained by what Chua described as a simultaneous increase in “risk factors” like social
disconnection and weakened “protective factors” such as genuine relationships and healthy
lifestyles.

“If that happens for a long time then the mental health tends to be not so good, leading to
different kinds of mental health conditions, which, of course, would predispose to suicide,” he
said.

Globally, the World Health Organization reported an average of 3,000 people who die by suicide
daily – this translates to one suicide every 40 seconds. Suicide is also listed as the second highest
cause of death among people between the ages of 15 and 29.

Locally, there is no one figure for mental health and suicide cases as data is often scattered in
different government agencies, and varies across years. Latest available data on the Philippines
recorded by the WHO, however, reported over 2,000 cases of suicide from 2000 to 2012 with
majority of individuals dying by suicide also aged between 15 to 29 years old.

But beyond the numbers, experts said paying attention to mental illnesses among the youth
remains urgent.
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“You also know it’s on the rise if you feel and see one person suffering and that story isn’t very
different from others. You know it can happen to anyone,” Nadera said.

Experts added the problem is not hard to fathom, with majority of people knowing at least one
person who may be dealing with a mental health illness or even unstable mental health.

Balderamma added, “There’s always somebody we know. We communicate it as urgent because

it cuts all strata and it cuts all professions.” – Rappler.com