Nancy Downs

College Students and Suicide Risk: Prevention and the Role of Academic Psychiatry

An 18-year-old freshman college student, “A.B.,” was handsome, athletic, and artistically gifted. A.B. seemed to have everything going for him. Yet, he actually had few close friends, had always seemed a bit aloof, and was considered a “worry-wart.” He had a brief period of psychotherapy for depression and social anxiety when he was in junior high school. He had otherwise never been treated for depression and was in good physical health. His maternal grandmother had died by suicide, and his mother had chronic and recurrent depression. At school, A.B. often felt isolated and alone. During their weekly phone calls, he told his parents how lonely and unhappy he felt; he listened to them when they encouraged him to “push on.” After barely passing his first mid-term examination, he became preoccupied with failing, worried incessantly, and felt increasingly overwhelmed by the demands of studying for other examinations while attempting to keep up with daily work. To increase his concentration and energy, he began experimenting with stimulants during the day, which was soon followed by alcohol at night to help him relax and fall sleep. At his mother’s urging, he visited the student counseling center. He made it clear that he did not want medications, and his therapist complied by not requiring a psychiatric assessment. Still, he did not feel comfortable with his therapist, failed to show up for his third appointment, and never called to reschedule. During a 10-day holiday break, A.B. returned home and almost immediately began to feel less depressed, anxious, and withdrawn. His parents were heartened to hear of his enthusiasm to return to school and to switch from a premedical to an art history major. One week after returning to school, he was found dead from hanging in his dormitory room. The case vignette above is not an actual case, but is an amalgam of several tragic instances of college students who have died by suicide. It illustrates several points about suicide among college students, including risk factors and missed opportunities for prevention. Drawing upon A.B.’s history, course of illness, and outcome, this commentary will discuss college student suicide in terms of epidemiologic risk factors and the roles of academic psychiatry and psychiatric intervention in preventing suicide. A.B. is not alone. The estimated global burden of suicide is one million deaths per year (1), making suicide the tenth-leading cause of death worldwide. Tragically, in the United States, suicide is the third-leading cause of death among college-age individuals and may even surpass homicide as the second-leading cause of death on college campuses (2, 3). In a national survey of over 20,000 college students, on 39 campuses, over 10% had seriously considered attempting suicide; 8% had made a plan; and almost 2% had actually attempted suicide in the previous year (4). Another recent survey of over 1,000 college students at a large mid-Atlantic university reported that 12% of students had pondered killing themselves at least once, 25% of whom said they thought about it repeatedly; 1% had made specific plans or carried out full-fledged attempts (5). Why are the rates of suicidal thoughts and behaviors so high among college students? “College and the transition to adulthood are a time of infinite possibilities; but, for students struggling with unaddressed mental health problems, those possibilities fade” (6). As during other phases of life, mental illness, particularly unor undertreated mood disorders, are the most robust risk factors. Major depression affects individuals of all ages, ethnicities, and socioeconomic groups, and the age at onset of depression most often is during adolescence and early adulthood (7, 8). When depression occurs early in life, it is a particularly virulent disease associated with even higher Received November 3, 2010; revised March 1, 2011; accepted March 18, 2011. From the Dept. of Psychiatry, Univ. of California, La Jolla, CA. Correspondence: s.zisook@ucsd.edu (email). Copyright

The Relationship of Affective Illness and Personality Disorders in Psychiatric Outpatients

AbstractIn a retrospective chart review of 424 patients treated at the UCSD Outpatient Psychiatric Clinic, 37.8% of atients with an unequivocal psychiatric xiagnosis were diagnosed with an Axis I affective disorder (AD), and the these, 45% were also diagnosed with an Axis II ersonality disorder (AD + PD). Comparetf with 82 patients diagnosed with AD and no Axis II diagnosis (AD Alone), AD + PD patients were initially more impaired and received more medications-secifically antipsychotics and benzodiazepines. AD + PD patients improved at least as much as did AD Alone patients; Borderline Personality Disorder (BPD) patients showed the most impairment prior to treatment as well as the most improvement with treatment.

Treat and Teach Our Students Well: College Mental Health and Collaborative Campus Communities

This article presents a selective review of best practices for the psychiatric care of college student populations. It describes psychiatric advances in evidence-based practice for college students and offers a brief compendium for college health practitioners. College mental health services are delivered in a specialized milieu, designed to address many of the unique needs of college students and to support their successful scholastic advancement and graduation. Practical steps for implementing these best practices within the college community setting are identified, with a focus on the initial student evaluation, risk assessment, treatment planning and goal setting, and steps to optimize academic functioning during psychopharmacologic and nonpharmacologic treatment. At the center of these practices is the use of a collaborative team and psychoeducation that engages students to actively learn about their mental health. By applying common sense and evidence-based practices within interdisciplinary and student-centered services, college communities can effectively meet the mental health needs of their students and empower them to reach their educational goals.

Web-Based Tools and Mobile Applications To Mitigate Burnout, Depression, and Suicidality Among Healthcare Students and Professionals: a Systematic Review

ObjectiveBeing a healthcare professional can be a uniquely rewarding calling. However, the demands of training and practice can lead to chronic distress and serious psychological, interpersonal, and personal health burdens. Although higher burnout, depression, and suicide rates have been reported in healthcare professionals, only a minority receive treatment. Concerns regarding confidentiality, stigma, potential career implications, and cost and time constraints are cited as key barriers. Web-based and mobile applications have been shown to mitigate stress, burnout, depression, and suicidal ideation among several populations and may circumvent these barriers. Here, we reviewed published data on such resources and selected a small sample that readily can be used by healthcare providers.MethodsWe searched PubMed for articles evaluating stress, burnout, depression, and suicide prevention or intervention for healthcare students or providers and identified five categories of programs with significant effectiveness: Cognitive Behavioral Therapy (online), meditation, mindfulness, breathing, and relaxation techniques. Using these categories, we searched for Web-based (through Google and beacon.anu.edu.au—a wellness resource website) and mobile applications (Apple and mobile.va.gov/appstore) for stress, burnout, depression, and suicide prevention and identified 36 resources to further evaluate based on relevance, applicability to healthcare providers (confidentiality, convenience, and cost), and the strength of findings supporting their effectiveness.ResultsWe selected seven resources under five general categories designed to foster wellness and reduce burnout, depression, and suicide risk among healthcare workers: breathing (Breath2Relax), meditation (Headspace, guided meditation audios), Web-based Cognitive Behavioral Therapy (MoodGYM, Stress Gym), and suicide prevention apps (Stay Alive, Virtual Hope Box).ConclusionsThis list serves as a starting point to enhance coping with stressors as a healthcare student or professional in order to help mitigate burnout, depression, and suicidality. The next steps include adapting digital health strategies to specifically fit the needs of healthcare providers, with the ultimate goal of facilitating in-person care when warranted.

Update on the UC San Diego Healer Education Assessment and Referral (HEAR) Program

Burnout, depression and suicide are rampant amongst health care professionals. Current evidence shows the problem is worsening. In the aftermath of physician suicides, the Physician Wellbeing Commi...

Implementing a college mental health program – an overview of the first twelve months

ABSTRACT Objective: To evaluate the demographics and clinical utilization patterns among college students during the initial 12 months of a novel, multi-disciplinary, collaborative, college mental health program (CMHP). Participants: Undergraduate and graduate students receiving treatment at the CMHP from Jan-Dec 2015. Methods: De-identified data was obtained via electronic health records for all students receiving care through the CMHP. Results: 1.2 FTE clinical providers treated 278 undergraduate and graduate students during the year (65.1% < age 26, 53.6% female, 49.6% caucasian). There were 1822 CMHP outpatient visits, 318 other medical visits and 103 total emergency room (ER)/inpatient visits. Ten students were identified as high utilizers of ER/inpatient services, while charges to the CMHP totaled

Be True to Our Schools—Models of Care in College Mental Health

470,157 and total charges to the Health System were

Diagnosis and Treatment of Depression in Late Life

2,378,315. Conclusions: Students with complex psychiatric/medical co-morbidities received cost effective, convenient and integrative treatment. Over time, we hope to intervene earlier and decrease ER/inpatient visits.

Supersensitive endocrine response to physostigmine in dopamine-depleted rats: a model of depression?

Purpose of ReviewTo review and synthesize the previous, current, and proposed models of care in college mental health in order to identify best practices that will address the mental health needs of today’s students. To highlight data that supports existing or proposed models and describe areas where more data is needed.Recent FindingsDespite the potentially appealing attributes of integrated care, empirical evidence supporting these systems and structures in campus settings is mixed. Recent surveys show less than half of campuses have an integrated mental health care model. Overall, there is only partial consensus on optimal models of campus mental health care.SummaryMental health needs in college student populations are greater and more complex than ever. While the resources available are vast and varied, there is limited evidence to support which models and programs can best meet students’ needs.