College Depression and Suicide: The Numbers, the Words, the Pills, and Beyond

Isabel Leveque, Science 37’s college correspondent, examines the link between depression and suicide and how we treat health issues in college.
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It feels like everyone around me thinks college students have the perfect life — no real responsibilities, no rules, no obligations. But the reality is, we all experience the very real human feelings and experiences that everyone else does. This includes stress, disappointment, anxiety, and depression. I have read countless emails, statistics, and articles about college students attempting or completing suicide. I am here to tell you that my peers are not receiving one bad grade on a test and then walking themselves to the top floor of the tallest building and throwing themselves off. No, suicide is not one seemingly melodramatic decision. I know that suicide cannot be explained by one bad event, so I have questions.

The Numbers.
After my last blog post, we know that 1 in 12 college students makes a suicide plan and that in the past 50 years, the suicide rate for those ages 15–24 has increased by 200%. But why? Because they are depressed. It is estimated that 60–70% of people who attempt suicide suffer from a mood disorder, and the American Association of Suicidology reports that depression is the psychiatric diagnosis most commonly associated with suicide. Depression is present in at least 50% of all suicides (this does not account for the cases where depression was undiagnosed). The organization also found that 15% of patients with treated depression eventually die by suicide and those suffering from depression are at 25 times greater risk for suicide than the general population. And although there are no national databases analyzing suicide deaths, attempts, or thoughts specifically among college students, all of these numbers include college students. So should we ignore these statistics and tell society’s next generation of leaders to just focus on the positive when there are clearly real mental health problems within their community?

The Words.
Beyond the statistics, another method we can use to analyze the link between depression and suicide is to look at the descriptions. For example, Merriam-Webster defines depression as “a mood disorder marked especially by sadness, inactivity, difficulty in thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of dejection and hopelessness, and sometimes suicidal tendencies.” Depression and suicide are linked, even in our dictionaries.

The words we use to inform and describe things matter. The Mayo Clinic has an entire article, under “Tween and Teen Health” titled “College Depression: What parents need to know.” The article states that the transition to college life presents new challenges involving “pressures, anxieties, living on their own for the first time, new schedule, workload, money, intimate relationships, and struggling with how to belong, which can all trigger or unmask depression.” First and foremost, this article states that “feelings of depression can get in the way of your child’s academic success.” Although it acknowledges the link between depression and suicide, is academic failure really the most important effect of college depression? Feelings of depression do not just get in the way of getting a high GPA. How can we be productive members of society if instead of walking across the graduation stage, we are walking off of rooftops?  

The Pills.
Now that we have established the many links between depression and suicide, it’s clear we need to address depression in order to address suicide. The first line of defense on most college campuses is a counseling center where students can have access to counselors and the ability to start a treatment plan. There are lots of options for treatment plans today that can include all types of therapy (including behavioral, cognitive, holistic, art, drama therapy, etc.), diet, supplements, exercise, and medication. The most common combination for all demographics to treat depression is medication and psychotherapy. This remains true even after the Food and Drug Administration (FDA) decision in 2007 that ordered “all antidepressant medication carry an expanded black box warning about an increased risk of suicidal symptoms in young adults 18–24 years of age.” The black box warning was issued in 2007, but clinicians have known for years that “during the first few weeks of treatment with antidepressants, some patients become ‘activated’ — energized and agitated — before their depressed mood lifts, and that combination makes them more likely to act on pre-existing suicidal impulses.” This is because “suicidal thinking, feeling, and behavior are core symptoms of depression.” Not just a whim. Not just a bad test grade.

The Decision.
The black box warning was a controversial decision because the FDA ran the risk of discouraging patients and clinicians from seeking help for and treating depression. And we did see that effect to an extent. The prescription of antidepressants dropped markedly after the advisory was issued, falling to less than the “levels that would have been expected on the basis of pre-warning patterns.” Looking back and analyzing the data 10 years after the advisory, it is not only the antidepressant prescription rates that have fallen, but also the rate of diagnosis of new cases of depression in adults and adolescents. The new labels were meant to balance the value of the drugs against the risk in young adults, but what has been done since then? Are new drugs being developed to address this specific population, including myself, my friends, and my peers?

The Power of Listening.
Depression and suicide are not going away, and these are real, connected problems for everyone, including college students. One out of five adolescents has a diagnosable mental health disorder and only 50% ever receive the help they need. How do we start to shift those numbers? We have to ask more questions and we have to look for answers. Are we doing enough preventative care and education? When we say we “care” about students’ mental health, what does that look like in practice? Colleges could organize guest lectures on the importance of self-care, or sponsor free meditation and mindfulness classes, or place an in-house therapist in all dorms. After all, schools are receiving money from us, so shouldn’t they be investing in our well-being?  

And if you know a college student, ask them questions too, like:

  • How are you doing?
  • How is life going outside of school?
  • How are you taking care of yourself mentally and physically?

These are important questions, because reduced academic success is not the worst thing that can happen to a depressed student, and grades are not always an indication of someone’s well-being. And the most important part comes after you ask the question — you have to listen. Listen, and when they tell you how they’re feeling, don’t tell them they have no reason to feel that way. Listen, and don’t just assume everything will be okay because college is such a wonderful part of life. Listen, and who knows what you will find out.

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