Christopher Aiello broke into tears - again - when he got a call last month about Madison Holleran, a promising scholar-athlete at the University of Pennsylvania who jumped to her death from a Center City parking garage, stunning her family, friends, and campus community.
The call came from a friend, who in an eerie coincidence, knew Holleran's father. Aiello lost his own daughter, Paige, the same way nine months earlier.
Tennis team captain and an A student at the College of New Jersey, she was weeks shy of graduation and had been accepted to nine law schools when her body was recovered from the Hudson River.
"I just don't understand what's happening to these high-achieving kids," said Aiello, a New Jersey lawyer. "How did we get to this spot? The whole thing, for me, will never make any sense."
Two recent suicides at Penn and a smattering of others at college campuses over the last year - including a student who jumped off a parking garage at Pennsylvania State University in December - has brought renewed attention from administrators and talk on how to ramp up prevention and awareness.
Penn last week announced intentions to hire three new staffers for its counseling center and expand hours.
"This whole issue is a tragedy on our campus and on many campuses," said Drexel University president John A. Fry, who formed a suicide-prevention task force last year after the suicides of two students. "I wanted to make sure we were doing everything that we could."
Suicide is the second-leading cause of death for college students.
And when popular, high-achieving students, who seemingly have everything to live for, take their lives, it sends nothing short of a shock wave through their campuses and leaves families and friends grappling - even years later - for answers.
"You won't really know what triggered this in anybody," said Donna Ambrogi, whose son Kyle, a Penn football player, killed himself in 2005. "That's the hardest part for families."
Ambrogi, a Havertown nurse, started a foundation to raise money for suicide-prevention programs in high school and college.
When a student commits suicide, it's often the result of multiple factors, said Victor Schwartz, a psychiatrist and medical director for the Jed Foundation, a New York-based suicide-prevention group aimed at college students.
"It's more often personal- and family-relationship disruption," he said. "In many cases, alcohol or other substances are involved."
College age, he said, is also the time when many mental illnesses, including depression and schizophrenia, surface. Up to 90 percent of suicide victims have a diagnosable psychiatric condition, he said.
In addition, students are learning independence, testing boundaries, and discovering sexual identity.
"For most people who die by suicide, there is some underlying vulnerability, then some triggering, stressful situation," said Mary E. Kelly, lead psychologist and suicide-prevention specialist at Rutgers University, which was rocked by the 2010 suicide of freshman Tyler Clementi. The young man killed himself after learning that his roommate had used a webcam to record him having sex with another man.
At the Ivy League Penn, students can face enormous pressure. While most adapt, some struggle mightily, said William Alexander, director of counseling and psychological services at the university.
"It might be the first time where they are part of an academic community where they themselves are not easily at the top," he said.
Colleges aren't required to report suicides, so the problem is hard to track.
Penn officials said they don't know how many students died of suicide over the last five years.
"The university doesn't keep records like that," said spokesman Ron Ozio.
There have been at least four suicides of Penn students in the last year, most recently the death of sophomore Elvis Hatcher, who hanged himself at a fraternity last week - less than a month after Holleran's death.
About 7 percent of students nationally report having experienced suicidal thoughts in the last 12 months, statistics show. About 1 percent attempt suicide. For Penn, a school of 24,000 undergraduates and graduates, that would translate to 240 students.
"I'm not aware of 240 kids trying to kill themselves, but that's a scary little piece of data," Alexander said. "In any given moment, my staff is dealing with multiple people who are struggling with suicidal thoughts."
The center, which employs 15 psychologists, six social workers, and four psychiatrists, sees about 13 percent of the students each year.
Students who commit suicide often aren't on the radar of the campus counseling center, school officials say. At Penn, Alexander can recall only two who were being seen there at the time they died.
Madison Holleran wasn't one of them.
The striking self-portrait of a smiling Holleran, sketched when she was in eighth grade, hangs on a door near the family kitchen at her family's home in Bergen County, N.J.
That's how Jimmy Holleran, 52, a salesman for Dow Consumer & Industrial Solutions, remembers his daughter growing up: happy. The middle of five children, Holleran, 19, had established herself as a high achiever in class and on the sports field.
She was state champion in the 800-meter at Northern Highlands High School and played on the school's state-champion soccer team, while keeping a "4.0 plus" GPA, her father said.
Through a coach, she was introduced to Steve Dolan, Penn's track coach.
"They hit it off," Jimmy Holleran said.
Off to Penn she went.
Her schedule proved challenging. She practiced twice a day for cross country and track.
By Thanksgiving, her family noticed a "more stressful Madison," her father said.
"Penn has a lot of academic pressures," he said, though she had a 3.5 GPA, "and she wasn't quite honestly thrilled about doing track twice a day."
By Christmas, her mood had worsened.
Holleran had gone to Penn's counseling center for help and didn't like it, her father said. So her parents found her a therapist near home. She had gone several times, most recently on Jan. 10, the day before her father took her back to Penn.
"Her therapist said if you get a suicide plan in your head, you will call your dad, you will call your mom or you will call me," Jimmy Holleran said. "Madison said, 'I will.' "
The therapist recommended that Holleran take medication, and she made an appointment to see a doctor in Philadelphia, her father said.
As far as he could tell, she was coping. She was looking into transferring to a new dorm, where she thought she'd be happier. She and her coach decided she'd cut back practice to once a day. The day before she died, she slept over at a friend's and watched The Parent Trap.
Jimmy Holleran texted his daughter the morning of Jan. 17: "How are you doing?"
"I'm OK," he said she replied.
He called her at noon. She told him she was buying books at the Penn bookstore. Later, she said, she had track practice, then planned to have dinner with friends.
Jimmy Holleran said he reminded his daughter of the doctor's appointment.
" 'Yeah, Daddy, I'll do it,' " he said she told him.
About 6 p.m., she posted a twilight scene of a Rittenhouse Square bedecked in holiday lights on her Instagram account. Less than an hour later, she was dead.
"You can't really understand why a girl who seemingly has everything going for her would want to end it," her father said.
National statistics show that 6.5 college students per 100,000 commit suicide annually, a rate that has declined slightly since 1990. The rate for college students is only about half that of noncollege students that age.
Locally, Penn State estimated it had six suicides per year for the last three years among the more than 77,000 students who attend its main and branch campuses. Rutgers reported 10 suicides (one on campus) over the last five years among 43,000 students on its main campus in New Brunswick.
Rowan University had two - one off campus and one on. Widener University and Ursinus each had one on campus, and West Chester University and Immaculata each had one off.
At Temple in 2012, a former student shot himself on Liacouras Walk, a bustling campus thoroughfare, and a female student did the same in an on-campus parking garage.
Drexel had two suicides on campus since 2003, and there have been at least two off campus, including a freshman whose body was found in the Schuylkill in 2012. In response to the task force, the school hired someone to oversee suicide-prevention programs, trained staff to identify students at risk, and made a psychiatrist available five days a week.
To encourage students to seek help, Rowan integrated its mental health services within its "Wellness Center," which opened in the heart of campus in September.
Universities, too, have added training for staff and students in how to recognize suicidal signs in others and help.
At Rowan next fall, freshmen for the first time will be trained in how to intervene in a crisis.
For parents, questions linger. None blame the universities.
"Penn didn't know. She didn't tell her friends," Jimmy Holleran said.
Kyle Ambrogi, a senior running back, was being treated for depression and getting counseling at Penn, his mother said.
"They saw him every day," she said.
The family of Owen Thomas, an all-league defensive lineman for Penn's football team who died in his off-campus apartment in 2010, learned later that he suffered from early stages of chronic traumatic encephalopathy, a disease linked to depression.
"How much that was a factor, it's hard to know," said his mother, the Rev. Katherine Brearley, who lives near Allentown.
Aiello said his daughter didn't exhibit depression until a few weeks before she died. She had lost weight and was having trouble functioning. The family got her into therapy and on medication, he said. She moved home and commuted for classes.
She left no note before she jumped, he said.
James Fisher's son, Andrew, did, but even that provided no real answers. Andrew had been a chemical-engineering major and A student at Northeastern in Boston.
"He just said he couldn't take it anymore" and that his brain "had reached its capacity," said Fisher, an Atlantic City firefighter.
Both Fisher and his wife still see a psychologist as they try to work through the grief that engulfed them 17 months ago.
"Each day's a step forward," he said.
Talking about wanting to die.
Talking about feeling hopeless or having no reason to live.
Talking about feeling trapped or in unbearable pain.
Talking about being a burden to others.
Increasing the use of alcohol or drugs.
Acting anxious or agitated.
Sleeping too little or too much.
Withdrawing or isolating.
Showing rage or talking about seeking revenge.
Displaying extreme mood swings.
What to do if someone
exhibits warning signs
Do not leave the person alone.
Remove any firearms, alcohol, drugs, or sharp objects that could be used in a suicide attempt.
Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
Take the person to an emergency room or seek help from a medical or mental health professional.
SOURCE: National Suicide Prevention LifelineEndText