Mental Health in College
In May of 2013, the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published. The DSM-6 is expected any time from this year to 2028.
According to a Huffington post article announcing the publication, the DSM-5 includes a more robust investigation of suicidal behavior and its relationship to a number of different mental health disorders. Whereas before, suicide was often thought to be a result of depression or a personality disorder, the new DSM includes aliments such as anorexia, post traumatic stress disorder and schizophrenia as triggers for an increased risk. (huffingtonpost.com)
Suicide
The dictionary definition of suicide is the “act…of taking one’s own life voluntarily.” (www.merriam-webster.com) There may be many reasons why an individual would choose to end their own life, including mental illness, or terminal illness. Regardless of the reason, it is not a decision arrived at lightly, and is often the cumulation of immense emotional pain.
Monotheistic religions often forbid the practice. The Catholic Church views suicide as “an attempt against the dominion and right of ownership of the Creator” (www.catholic.com) and thus a sin sometimes rising to the practice of forbidding the deceased a proper burial. According to some Islamic scholars, “suicide is a major sin, and the one who does that is faced with a warning of eternity in the Fire of Hell.” (islamqa.info) In traditional Jewish thought, “the body belongs to God, and as such ending one’s life not considered within the scope of a person’s authority.” (www.myjewishlearning.com) The government too, has something to say about suicide. According to Mental Health Daily, there are many countries in which attempting suicide is a crime. In some places, if a person succeeds in ending his or her own life, there may be material repercussions for the families such as ostracism or fines. In the United States, currently there are no laws restricting the act of suicide. There is even a procedure for physical assisted suicide, in the case of a terminal illness. (mentalhealthdaily.com) After taking religious and legal ramifications into account, suicide still comes with heavy costs to family and friends as well as sufferers.
Scope of the Problem
Researchers from Georgia Southern University examined cultural acceptance of suicide among young people in America and in Japan. In 2009, they discovered that the rate of completed suicides per 100,000 Americans age 20-24 was 20.3 for men and 3.4 for women. (Saito, 2013) Rates were found to be higher in Japan. The researchers quote the Center for Disease Control, stating that “suicide is the leading cause of death among young adults in Japan, [and] the third leading cause of death among young adults in the United States.” (Saito, 2013) The study goes on to conclude that cultural attitudes toward suicide may influence young people’s decisions. American college students surveyed often cited concerns such as family and religion as being barriers to committing suicide. Authors note that in contrast, “the ‘suicide of resolve’ is perpetuated through the glamorization of suicidal expressions in Japanese art and media.” (Saito, 2013) Therefore, it seems that cultural acceptance of suicide may be a factor in the number of individuals who complete the act.
Lisa Hawley et. al surveyed students, faculty and staff of a single college, searching for suicidal ideation and beliefs. Based on their study of a single college, in which most of the participants identified as Caucasian and heterosexual, researchers found that minorities and LGBTQ students were more likely to be at higher risk for suicide. (Hawley, 2016) This important study may indicate that social support is a key protective factor and feeling alienated may contribute to suicidal risk.
In a study entitled “Victimization and suicidality among female college students,” researchers Leone and Carroll questioned the relationship between emotional, sexual and/or physical victimization and suicide. According to their research, “1 in 10 college students have seriously considered suicide, and 1.4% has attempted suicide.” (Leone, 2016) Interested in discovering reasons, and suspicious that there may be some link between suicidal ideation and victimization, Leone surveyed women in the United States about their experiences. Specifically, researchers discovered that women whose victimization resulted in Post Traumatic Stress Disorder were more likely to consider, attempt and complete suicide than women whose victimization did not, regardless of the details of the trauma. (Leone, 2016) A study on veteran students discovered that a positive PTSD diagnosis also correlated with lower grades, heavier drinking and more physical fights. (Bonar, 2015)
Many colleges and universities have counseling centers or other mental health awareness centers available to students. The Center for Colligate Mental Health collects data from 139 colleges and universities who provide counseling sessions. According to the 2023 annual report, threat to self increased while “students who reported discrimination consistently ended treatment with higher average levels of distress, demonstrating a persistent outcome disparity.”
The study of veteran students conducted by Dr. Erin Bonar et. al. claims that “students with military histories were less likely to seek counseling than students with no military connection.” (Bonar, 2015) Many veterans who saw combat are identified as suffering from PTSD. The disease, still misunderstood, was first diagnosed among veterans returning from war. First diagnosed as ‘nostalgia’ in the 1700s, this condition was called ‘soldier’s heart’ during the Civil War, to describe the rapid heart beat of sufferers. Later termed ‘shell shock’ after World War 1, the diagnoses was updated to ‘battle fatigue’ in World War 2. In 1980, the condition was reclassified by the Diagnostic and Statistical Manual of Mental Disorders as PTSD. (www.ptsd.va.gov) Subsequent research has included other types of trauma, rape and assault for example, as causing factors for this diagnosis.
Even so, many students who consider and attempt suicide do not seek counseling. Using web based questionnaires, researchers Czyz et. al. sought reasons for students’ reluctance to use campus mental health clinics. The questions were open ended, and researchers dissected and coded each response to aggregate data. Sixty six percent of respondents felt that treatment was not needed, 26.8% of students mentioned lack of time as a barrier and 18% preferred self-management. (Czyz, 2013) In addition, or as a possible explanation of their findings, researchers cite two federal initiatives, the Surgeon General’s Report on Mental Health and the President’s New Freedom Commission on Mental Health in reporting “stigma has been declared as a pervasive barrier to the effective treatment of mental health problems.” (Czyz, 2013) Further discussion weighs stigma, costs, time and normal levels of college stress against students’ perceived need for treatment.
Recommendations
College is a stressful time for young adults. Often it is the first time they have left home, they have to juggle social, academic and work concerns. They may not be aware that the thoughts they have are dangerous or outside of the scope of normal. Substance abuse and risky behavior can be almost commonplace, making what are objectively dangerous actions seem natural. It is important to take this into account when seeking to assist sufferers of mental health disorders on college campus.
1. Use existing cultural stigma against suicide. In research contrasting Japanese and American cultural ideas about suicide, it was found that American young people are less at risk than Japanese people of the same age. This existing cultural deterrent could be used to channel individuals into therapy. If art and music represented themes of sufferers receiving help instead of taking their own lives, this might encourage some people to seek treatment.
2. Host discussions about normal stress levels. Students need the tools to distinguish between normal levels of stress in college and unhealthy stress levels. Discussions could be had on college campuses, drawing from the pool of talent at the local mental health centers. In this way, the mental health centers could assist more students without singling anyone out or attaching stigma to an individual.
3. Provide substance abuse programs on college campus. Many times depression, PTSD, anxiety or other serious mental health issues may be “self medicated” by use of alcohol or intoxicating substances. Colleges are hotbeds for this type of activity, and mainstream centers for sober activities, lifestyles and friendships might help.
4. Include veterans, minorities and LGBTQ students in activities and assist people in connecting to communities on campus. As demonstrated in research and understood in common practice, community can provide much needed protection against despair. This could take the form of clubs, activities, discussions, sports, movies, “eat lunch with me” projects and other campus outreach.
Author Bio
Dr. James J. Ruffin is an experienced instructional leader with a record of accomplishment in leading successful "turn-around" school and district-wide efforts, in high poverty low achievement schools. He believes that public education is the most powerful instrument for promoting equity and justice for all children and families. Dr. Ruffin holds a EdD in Innovative Leadership from Wilmington University.
References
Hawley, L., MacDonald, M., Wallace, E., Smith, J., Wummel, B., Wren, P. 2016. Baseline assessment of campus-wide general health status and mental health: Opportunity for tailored suicide prevention and mental health awareness programming. Journal of American College Health
Leone, J., Carroll, J., 2016. Victimization and suicidality among female college students. Journal of American College Health
Saito, M., Klibert, J., Langhinrichsen-Rohling, J., 2013. Suicide Proneness in American and Japanese College Students: Associations with Suicide Acceptability and Emotional Expressivity. Death Studies
Czyz, E., Horwitz, A., Eisenberg, D., Kramer, A., King, C., 2013. Self Reported Barriers to Professional Help Seeking Among College Students at Elevated Risk for Suicide. Journal of American College Health
Bonar, E., Bohnert, K., Walters, H., Ganoczy, D., Valenstein, M., 2015. Student and Nonstudent National Guard Service Members/Veterans and their Use of Services for Mental Health Symptoms. Journal of American College Health
Retrieved from: https://www.ptsd.va.gov/public/ptsd-overview/basics/history-of-ptsd-vets.asp
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Retrieved from: https://www.huffingtonpost.com/david-j-kupfer-md/dsm-5-suicide_b_3731260.html
Retrieved from: https://www.merriam-webster.com/dictionary/suicide
Retrieved from: https://www.catholic.com/encyclopedia/suicide
Retrieved from: https://islamqa.info/en/111938
Retrieved from: https://www.myjewishlearning.com/article/suicide-in-jewish-tradition-and-literature/
Retrieved from: https://mentalhealthdaily.com/2014/07/24/is-suicide-illegal-suicide-laws-by-country/
Retrieved from: https://ccmh.psu.edu/assets/docs/2023_Annual Report.pdf