The anguish of youth suicide

I

f you were walking on a college campus today, could you identify the minds that are plagued by  despair and suicidal urges? How many would tell you

there's nothing I can do to make it better… my family would be better off without me … no one would miss me if I am gone

? In fact, 18 percent of undergraduates in the U.S. have suicidal thoughts, and about one in 10 make plans to end their lives. Nearly every day on campus, three die by suicide.

Isn't this an epidemic?

College is a major transition in life, and can also be a period of emotional vulnerability. The student struggles with the blossoming of individuality, defining oneself in a novel context, the competition and challenges in mastering knowledge and peer pressures. It can be exhilarating —  and terrifying.

How can the student — much less friends, parents, student health services, and professors — distinguish between transient thoughts of suicide and thoughts that lead to action? This is the great dilemma. What makes thoughts of suicide cross the line into action; and what differentiates the one in many attempts that result in death by suicide? Numbers for such ratios exist, but they give an illusion of certainty. In reality, definitions are fuzzy and our statistics imprecise.

For the great majority of people, suicidal leanings are a transient emotional state. It is a mental and existential situation that can be modified; but it can only be modified if one is both aware and prepared to confront it. The great majority do confront, master and overcome it. For others, it becomes an overwhelming urge; the only answer; the only way to resolve seemingly insoluble conflicts; the only way to get revenge; the only way to get love; the only way to have reunion with a lost beloved; the only way to be reborn,  or the only way to have true repose.

Is suicide among college students really getting appropriate attention? A student's suicide is always poignant—the loss of such promise, of a life unlived. But this is also a pressing public health issue. That means we must focus on what happens on each day between the stories of these tragedies. Colleges throughout the country take action in response to suicide: letters to parents; changes in the infrastructure (sealing off balconies, reducing roof access); special training and screening/evaluation tools for students; and, of course, counseling and availability of mental health professionals. It is hard to quantify the impact of these efforts, but it is likely that they are having some effect. The ability to identify a young adult at risk of suicide is much improved with screening tools and counseling, but the tools are not perfect. There is no blood test, no scan, no physical sign. All the good work is still not enough. The number of college-age adults who die by suicide should be zero. A campaign to achieve that goal should be maximum, relentless, and now.

We need more education. We've made giant strides talking about pregnancy, smoking, drugs, sexually transmitted diseases, and other public health issues. We need to talk about suicide. We need to explain that our own brain can modify itself to control urges and choose a path for life. We need to explain the difference between automatic, conditioned living, versus purposeful choosing. We need to tell students that we are social beings influenced by culture. We need to explore with them the boundaries that mark the beginning of illness. We need to talk about available treatments. We need to do it now, and not just once in a while, but all the time. The tragedy is not just that suicide happens; it's that we do not deal with it as the public health crisis it is.

We may need more screening. Although the U.S. public health service task force has declared that the benefit of screening for suicide cannot be justified in the general practice of primary care for all adults, college students are a specific and highly vulnerable group at risk. In college, a closed community with a fabric of communication, it may be that a broad screening program has the collateral benefit of maintaining awareness; not just of the risk of suicide but also of the significance of ideation. What would it be like if students found out that their suicidal thoughts were not so uncommon? A screening program that explains the risk might just make way for a more intelligent and less onerous discussion. Can students feel comfortable talking about these issues among themselves? Can we find a way for them to urge their peers to seek counseling without the fear of rejection or stigma? For too many, the very nature of the problem shames them from reaching out, or deludes them into denial and the illusion that greater effort will suffice. But students cannot dig themselves out of a hole — at least not with the same tools that got them into it.

And what are we doing to identify students at risk through the communication tools that they use most commonly? Does every college student need an ongoing connection to a suicide hot line, or a supportive community center/webpage that serves as a suicide prevention network? A place where a college-age student can share an experience that might just be able to lead them to the right place, whether a social worker, nurse, psychologist or psychiatrist at the college? And should the tools teenagers use routinely to communicate be tapped for communication about suicide? Students today do not go to the student health service like those of a generation ago. They go to their social network. That's where we need an immediate and sustained connection to a suicide counselor, and an immediate intervention.

We do not have a cleanly packaged answer to this problem . . .

We just point out that not a single change in attitude toward health takes place without a nonstop, high-volume campaign of awareness, education, understanding and access to professional help.

We Must Demystify the Hobgoblin of Suicide!

Dr. Joseph S. Camardo is senior vice president for corporate medical affairs at Celgene Corporation.

Dr. Philip T. Ninan is affiliate professor of psychiatric medicine at East Carolina University and serves on the board of the American Foundation for Suicide Prevention.

Dr. George M. Wohlreich is the Thomas W. Langfitt chair and CEO of The College of Physicians of Philadelphia.

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