Substance abuse, an unfortunate fact of life on many U.S. campuses, can also make the difference between suicidal ideation and a lethal attempt. Researchers at the CDC are among those who see a link between substance abuse and increased vulnerability to suicide. In one study, researchers found that students with a history of suicidal ideation were more likely to use tobacco, alcohol(Drug information on alcohol) and illegal drugs (Brener et al., 1999). While study design did not allow researchers to determine whether suicidal ideation preceded substance use, data were robust enough to warrant recommendations that substance abuse screening be integrated into suicide prevention efforts.
In a separate study, CDC researchers found that 18-year-old to 24-year-old college students who reported suicidal ideation were significantly more likely to engage in "injury-related risk behaviors" (Barrios et al., 2000). Specifically, this group was more likely to drive while intoxicated, ride with an intoxicated driver, swim or boat after drinking alcohol, engage in a physical fight, carry a weapon, and fail to wear seatbelts regularly if at all.
A freshman survey on a health center intake form "would be a perfect place to ask these questions, especially since alcohol is so closely related to both suicidal ideation and completion and to these other risk behaviors," Lisa Cohen Barrios, Dr.P.H., told PT. "Again, the asking of the questions is pretty simple. What takes more effort is preparing the staff to deal with the answers. When you're talking about suicide they really don't want to know the answer because they have to talk about this difficult problem," said Barrios, study co-author and CDC health scientist. "It's not comfortable."
Today's colleges and universities also are drawing many more students who arrive on campus with diagnosed mental illnesses. Thanks to advances in medication, many students with major depression, bipolar disorder and even schizophrenia are able to attend college. "We are the recipients of our own success stories," said University of Chicago's Silverman. "The degree to which we have been successful as mental health practitioners in identifying and successfully treating disorders that appear in adolescence [is the degree to which] we have been successful in giving these adolescents the opportunity to continue pursuing academic training." Silverman cautioned that while many can and do thrive, there is still a segment of this population that may be particularly vulnerable to the stressors inherent in college.
There is considerable debate as to whether a school's selectivity increases the likelihood of student suicide. The latest round of the debate is being played out in Cambridge, Mass., where Massachusetts Institute of Technology (MIT) is in the midst of a $27 million wrongful death suit over the death of a troubled sophomore in April 2000. Media reports have painted a portrait of an institution in the midst of a suicide epidemic. In fact, MIT's suicide rate is below the national average if one adjusts figures for the school's overwhelmingly male student body (American Foundation for Suicide Prevention, 2002). Regardless of student status, suicide rates for men continue to be significantly higher than for women, despite the fact that women are more likely to attempt suicide.
"You enter an environment like Harvard or MIT or Stanford or Yale and that may, for a variety of reasons, not be a good match for you, yet it's painful and disappointing to realize that," said Miller. "Most of us would push through it, some of us put our hands up in the air, some feel trapped and don't know what to do," he said. The pressure engendered by the demands of an elite college does not in and of itself cause suicidality but can tip the scales in vulnerable individuals. "The important thing is that there is a place for the student to go to discuss these things."
Silverman disagreed with the notion that elite colleges breed the kind of stress that can fuel suicidality. "Kids who end up at pressure-cooker schools tend to thrive on that kind of stress. I don't think stress, in and of itself, or the academic calendar, in and of itself, accounts for this."
Students' perceptions of achievement -- and failure -- may be far more important than their choice of alma mater. "A different but not uncommon profile of an adolescent suicide is that of a high-achieving, anxious or depressed perfectionist," wrote Jamison in Night Falls Fast. "Setbacks or failures, either real or imagined, can sometimes precipitate suicide. It may be difficult to determine the extent of such a child's psychopathology and mental suffering, due to the tendency to try to appear normal, to please others, not to call attention to oneself. The real reasons for suicide remain fugitive."