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College Students and Suicide Prevention – Faculty and Staff


College Students and Suicide Prevention Faculty and Staff Ellen J. Anderson, Ph.D., SPCC Person To Person Resources May 27, 2009 – PowerPoint PPT presentation

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Title: College Students and Suicide Prevention – Faculty and Staff

College Students and Suicide Prevention Faculty
and Staff
  • Ellen J. Anderson, Ph.D., SPCC
  • Person To Person Resources
  • May 27, 2009

College Student Suicide
  • Suicide is the second leading cause of death for
    college students
  • The number one cause of suicide for college
    student suicides (and all suicides) is untreated

Despair At A Young Age
  • Unlike most disabling physical diseases, mental
    illness begins very early in life. Half of all
    lifetime cases begin by age 14 three quarters
    have begun by age 24. Thus, mental disorders are
    really the chronic diseases of the young,
    (National Institute of Mental Health)
  • Anxiety disorders often begin in late childhood
  • Mood disorders in late adolescence
  • Substance abuse in the early 20s
  • Unlike heart disease or most cancers, young
    people with mental disorders suffer disability
    when they are in the prime of life, when they
    would normally be the most productive

Despair At A Young Age
  • Many young people who come to college have not
    yet been diagnosed with Depression,
    Schizophrenia, or Bi-Polar Disorder
  • We are seeing an increase in suicidal ideation
    and behavior on campus as more people with severe
    mental illness attend college
  • Improved treatment has allowed many young people
    to continue a normal life despite the development
    of severe mental illnesses

Despair At A Young Age
  • In general, non-college young adults complete
    suicide at about twice the rate as college
  • Foreign students may have a higher risk for
  • Suicide is not more frequent in any of the four
    years of college, but it does occur more often in
    students who take more than four years to earn
    their degrees

High Levels Of Stress
  • Going to college can be a difficult transition
    period in which students may experience high
    levels of stress, which can lead to Clinical
  • Many college students also use higher levels of
    alcohol and drugs than at earlier times in their
    lives, increasing the risk of suicidal ideation
  • A hallmark of diagnosis for clinical depression
    is the presence of suicidal thinking
  • Yet our lack of knowledge about this illness
    means that we dont seek help, and our friends
    and family dont push us to get help

Unwilling To Seek Help
  • Stigma about treatment means that very few people
    with suicidal ideation actually seek treatment
  • Additionally, a survey indicates that one in five
    college students believe that their depression
    level is higher than it should be, yet only 20
    say they would go to the campus counseling center
  • Those whose symptoms improve when they activate a
    suicide plan may be especially resistant to
    seeking help
  • Nearly half of suicidal students present for some
    medical treatment in the months before completing
    suicide although they may not acknowledge
    suicidal thoughts

  • Faculty, coaches, advisors and residence hall
    staff should focus not only on disruptive
    students, but also on those who are quietly
    withdrawn or whose dormitory discussions or
    classroom essays disclose hopelessness and
    suicidal thinking
  • Training in awareness about depression and
    suicidal thinking is important for everyone on
  • Policies should be in place to discover students
    with suicidal ideation and help them to recover

How Common Is Suicide Among Teenagers And Young
  • Suicide is the 3rd largest killer of young people
    between the ages of 10 and 25, and the 2nd
    largest killer of young adults
  • Suicidal ideation is admitted by about 25 of
    adolescents at some time during high school
  • Suicide attempts are more frequent among the
    young than the old, although completions are less
  • About 4,000 young people die from suicide every
    year in the US
  • Teen suicide tripled between 1950 and 1990, but
    had dropped somewhat until 2003
  • Around the world, adolescent suicide declined in
    industrialized nations with the increase in use
    of anti-depressant medication, despite fears that
    meds will increase suicidal behavior in teens

How Serious Is The Problem On Campus?
  • Nearly half of all students at some point find
    themselves feeling so depressed they have trouble
  • 15 meet the criteria for clinical depression,
    according to a 2004 survey by the American
    College Health Association
  • Among students seen at campus counseling centers,
    the number taking psychiatric medications rose to
    24.5 percent in 2003-2004
  • 17 in 2000
  • 9 in 1994, according to the National Survey of
    Counseling Center Directors
  • (Duenwald, 2004, NYTimes)

What Is Mental Illness?
  • Prior to our understanding of illness caused by
    bacteria, most people thought of any illness as a
    spiritual failure or demon possession
  • Contamination meant spiritual contamination
  • People were frightened to be near someone with
    odd behavior for fear of being contaminated-spirit
    ually damaged

Gatekeeper Training- Dr. Ellen Anderson
What Is Mental Illness?
  • What do we say about someone who is odd?
  • Looney, batty, nuts, crazy, wacko, lunatic,
    insane, fruitcake, psycho, not all there, bats in
    the belfry, gonzo, bonkers, wackadoo, crazy
  • Why would anyone admit to having a mental
  • So much stigma makes it very difficult for people
    to seek help or even acknowledge a problem

Gatekeeper Training- Dr. Ellen Anderson
What Is Mental Illness?
  • We know that illnesses like epilepsy, Parkinson's
    and Alzheimers are physical illness in the brain
  • Somehow, clinical depression, anxiety, Bi-Polar
    Disorder and Schizophrenia are not considered
    physical illnesses requiring treatment
  • We confuse brain with mind
  • Talking about suicide is taboo- which means no
    research, no grants, no place for discussion on

Gatekeeper Training- Dr. Ellen Anderson
Is Suicide Really a Problem?
  • 87 people complete suicide every day
  • 32,466 people in 2005 in the US
  • Over 1,000,000 suicides worldwide (reported)
  • This data refers to completed suicides that are
    documented by medical examiners it is estimated
    that 2-3 times as many actually complete suicide
    (Surgeon Generals Report on
    Suicide, 1999)

Gatekeeper Training- Dr. Ellen Anderson
The Gender Issue
  • Women perceived as being at higher risk than men
  • Women do make attempts 4 x as often as men
  • But - Men complete suicide 4 x as often as women
  • Womens risk rises until midlife, then decreases
  • Mens risk, always higher than womens, continues
    to rise until end of life
  • Are women more likely to seek help? Talk about
    feelings? Have a safety network of friends?
  • Do men suffer from depression silently?

Gatekeeper Training- Dr. Ellen Anderson
What Factors Put Someone At Risk For Suicide?
  • Biological, physical, social, psychological or
    spiritual factors may increase risk-for example
  • A family history of suicide increases risk by 6
  • Access to firearms people who use firearms in
    their suicide attempt are more likely to die
  • Social Isolation people may be rejected or
    bullied because they are weird, because of
    sexual orientation, or because they are getting
    older and have lost their social network
  • (Goleman, 1997)

Gatekeeper Training- Dr. Ellen Anderson
  • A significant loss by death, separation, divorce,
    moving, or breaking up with a boyfriend or
    girlfriend can be a trigger
  • The 2nd biggest risk factor - having an alcohol
    or drug problem
  • Many with alcohol and drug problems are
    clinically depressed, and are self-medicating for
    their pain
  • (Surgeon Generals call to Action, 1999)

Gatekeeper Training- Dr. Ellen Anderson
  • The biggest risk factor for suicide completion?
  • Having a Depressive Illness
  • Clinically depressed people often feel helpless
    to solve problems, leads to hopelessness a
    strong predictor of suicide risk
  • At some point in this chronic illness, suicide
    seems like the only way out of the pain and
  • Many Mental health diagnoses have a component of
    depression anxiety, PTSD, Bi-Polar, etc
  • 90 of suicide completers have a depressive
  • (Lester, 1998, Surgeon General, 1999)

Gatekeeper Training- Dr. Ellen Anderson
Depression Is An Illness
  • Our cultural view of suicide is wrong -
    invalidated by current understanding of brain
    chemistry and its interaction with stress,
    trauma and genetics on mood and behavior
  • Suicidal thinking is a severe symptom of the way
    depression is altering the brain causing
    changes in thinking, mood and body regulation
  • Suicide has been viewed for centuries as
  • a moral failing, a spiritual weakness, a mortal
  • an inability to cope with life
  • the cowards way out
  • A character flaw
  • This view must be replaced by more current
    understanding of brain disorders as treatable,
    physical illnesses

  • The research evidence is overwhelming -
    depression is far more than a sad mood. It
  • Body Regulation Problems
  • Weight gain/loss
  • Sleep problems
  • Sense of tiredness, exhaustion
  • Mood Regulation Problems
  • Sad or angry mood
  • Loss of interest in pleasurable things, lack of
  • Irritability
  • Thinking and Memory Problems
  • Confusion, poor concentration, poor memory,
    trouble making decisions
  • Negative thinking
  • Withdrawal from friends and family
  • Often, suicidal thoughts
  • (DSMIVR, 2002)

  • 20 years of brain research teaches that these
    symptoms are the behavioral result of
  • Changes in the physical structure of the brain
  • Damage to brain cells in the hippocampus,
    amygdala and limbic system
  • Depressed people suffer from a physical illness
    what we might consider faulty wiring
  • (Braun, 2000 Surgeon Generals
    Call To Action, 1999, Stoff Mann, 1997, The
    Neurobiology of Suicide)

Gatekeeper Training- Dr. Ellen Anderson
Faulty Wiring?
  • Literally, damage to certain nerve cells in our
    brains - the result of too many stress hormones
  • Cortisol
  • Adrenaline
  • Testosterone hormones activated by our
    Autonomic Nervous System to protect us in times
    of danger
  • Chronic stress causes changes in the ANS, so that
    fight or flight is set off with little stimulus
  • Constant stress hormone production without a way
    to relax causes physical changes in the brain and
  • (Goleman, 1997, Braun, 1999)

Faulty Wiring?
  • Constant ANS activation causes changes in muscle
    tension, imbalances in blood flow patterns -
    leads to asthma, IBS and depression, increased
    risk for death from heart disease
  • People with genetic predispositions, placed in a
    highly stressful environment will experience
    damage to brain cells from stress hormones
  • This leads to the cluster of thinking and
    emotional changes we call depression
  • Stress alone is not the problem, but our
    interpretation of the event
  • (Goleman, 1997 Braun, 1999)

One of Many Neurons
  • Neurons are the cells that make up the brain and
    their united, networked action is what causes us
    to think, feel, and act
  • Neurons must connect to one another (through
    dendrites and axons)
  • Stress hormones damage dendrites and axons,
    causing them to shrink away from other
  • As fewer and fewer connections are made, more and
    more symptoms of depression appear

Gatekeeper Training- Dr. Ellen Anderson
How Can We Stop Brain Damage?
  • As damage occurs, thinking changes in the
    predictable ways identified in our list of 10
  • Four things can reduce this brain damage
  • Stress reducing mental exercises - meditation
  • Exercise
  • Antidepressant medication
  • Cognitive/Behavioral Psychotherapy

  • Many cultures have developed stress reduction
    rituals/mental exercises Yoga, Tai Chi, Qi
    Jong, meditation, prayer these millennia old
    methods work well to reduce stress hormone
  • Exercise can help burn off high stress hormone
    levels and even reduce production
  • Antidepressants can counter the effects of stress
  • We know now that antidepressants stimulate genes
    within the neurons (turn on growth genes) which
    encourage the growth of new dendrites
  • New dendrites reconnect neurons and symptoms are
  • It can take longer than six weeks for the brain
    to repair itself enough that people feel better
  • (Braun, 1999)

How Does Therapy Help?
  • Medications may relieve physical suffering and
    improve brain function, but do not change how we
    interpret stress
  • Cognitive or interpersonal psychotherapy helps
    people change the (negative) patterns of thinking
    that lead to depressed and suicidal thoughts
  • Changing our inaccurate beliefs and thought
    patterns alters our response to stress we are
    not as reactive or as affected by stress at the
    physical level
  • Research shows that cognitive therapy is as
    effective as medication in reducing depression
    and suicidal thinking (Lester, 2004)

How Does Therapy Help?
  • The Talking Cure as Freud originally called it
    turns out to have a scientific basis for success
  • Daniel Goleman, Daniel Siegal, Antonio DAmasio
    and others are explaining how social interaction
    with others literally alters our neuronal paths,
    allowing different ways of thinking to change the
    chemical, electrical and thought pattern flow in
    our brains
  • We know that people raised in highly abusive
    homes have visibly different brains than people
    from normal homes, as seen on MRIs and CAT scans
  • We also know that healing relationships, changed
    perspectives (reframing) and altered self-beliefs
    change how people react to stress

Possible Sources Of Depression
  • Genetic a predisposition to this problem may be
    present, and depressive diseases run in families
  • Predisposing factors Childhood traumas, car
    accidents, brain injuries, abuse and domestic
    violence, poor parenting, growing up in an
    alcoholic home, chemotherapy
  • Immediate triggers violent attack, illness,
    sudden loss or grief, loss of a relationship, any
    severe shock to the system
  • (Anderson, 1999, Berman Jobes, 1994, Lester,

Gatekeeper Training- Dr. Ellen Anderson
What Happens If We DontTreat Depression?
  • Significant risk of increased alcohol and drug
  • Significant relationship problems
  • Lost work days, lost productivity (up to 40
    billion a year)
  • High risk for suicidal thoughts, attempts, and
    possibly death
  • (Surgeon Generals Call To Action, 1999)

Gatekeeper Training- Dr. Ellen Anderson
What Are "Best Practices" In Staff Training And
Educational Programming
  • The United States Air Force model
  • Develop a campus-wide commitment to suicide
  • Reduce stigma against seeking professional help
  • Depression screening programs and online
    resources Jed Foundation, American Foundation
    For Suicide Prevention

What Are Administrative Responsibilities?
  • We should not be looking at student suicide
    primarily from a risk-management perspective
  • College administrator responses to students seem
    to become defined legally and not through primary
    responsibility as educators
  • As educators, we have to take some risks. That
    means working harder to keep students at risk of
    suicide enrolled, working with them, giving them
    the help they need, and not finding faster and
    more creative ways to remove them. (Gary
    Pavela, 2006, The Chrone)

A Protective Environment
  • Mandatory-removal policies carry legal risks of
    their own - ADA
  • Office for Civil Rights within the U.S.
    Department of Education has been called upon to
    issue letter rulings pertaining to these policies
    students with documented mental health
    diagnoses may win a lawsuit
  • The risk of liability for suicides is low most
    cases focus on high risk immediate suicidality
  • College administrators, may err on the side of
    under-reaction, in terms of notifying parents, in
    terms of hospitalization
  • Decisions in some recent cases do not define the
    law nationally and do not mean your proper
    response as an administrator is to find a quick
    way to get rid of the student
  • Cases point to reacting promptly and
    appropriately to a student who is manifesting
    imminent risk of suicide (Pavela, 2006)

Parental Notification
  • Should colleges notify parents of students at
    risk of suicide?
  • Previously, a strong bias not to notify parents
    about student problems
  • In recent years a shift toward more parental
  • FERPA Family Educational Rights and Privacy Act
    amended able to notify parents in certain
    alcohol incidents
  • Who should notify parents and under what
  • Mental-health professionals will have a legal and
    ethical obligation to breach confidentiality in
    an emergency, when a person is at imminent risk
    of harming themselves
  • Parents would be notified by the hospital
  • When students enroll, it should be part of their
    file Who do you want notified in case of

Parental Notification
  • Administrators have more latitude than
    mental-health professionals to notify parents
  • Err on the side of treating suicidal statements
    as a genuine suicide threat or gesture,
  • Arrange for immediate evaluation of that student,
  • Ask the student about needing to involve the
    parents immediately,
  • Listen to arguments about why that wouldn't work,
    and talk to a mental-health professional.
  • Once there is a suicide threat or gesture -
    notify parents, even when it isn't a full-blown

Should Colleges Withdraw Students Who Threaten Or
Attempt Suicide?
  • Rate of young-adult suicide for people going to
    college is about one-half of the rate for young
    adults who are not going to college
  • Campus environments, human connection, and
    limited access to firearms are protective
  • College campuses do a good job of limiting
    firearms, the most dangerous choice of a suicide
  • Sending kids home means taking them out of a
    protective environment
  • Use the administrative process as a lever to get
    the student help
  • Policies can use the threat of removal as
  • We are a community that can't tolerate violence,
    including violence to self, and we have a
    mechanism to help you, if not, we can remove you

Jed Foundation Prevention Model
Empowering Students To Help Prevent Suicides
Among Peers
  • Often peers know about potentially suicidal and
    depressed behavior and comments
  • Increase discussion with students about the
    responsibility of friendship
  • A higher loyalty is to save a person's life, not
    keep a persons secret
  • Friends don't let depressed students handle their
    problem alone, and they get help for that
    student, even if they have to break
  • Teach when to get help and where to get it this
    goes beyond the ability of friendship to manage

What Are Faculty Responsibilities?
  • Faculty members and others are seldom mental
    health professionals, but may be mentors who can
    become aware of students experiencing
  • As educators, we need to help students become
    more aware of symptoms that might mean they need
  • This means educating ourselves to know what the
    symptoms of depression and suicidal thinking are,
    and becoming able to move past the centuries old
    taboo against talking about these problems as
    something other than an illness

Faculty Must React Appropriately
  • Training is needed so that faculty will not
    under-react to suicidal references
  • Training to understand what depression is and how
    it can lead to suicide
  • Realizing that relationship and support is not
    enough we dont simply offer kindness when
    someone is having a heart attack

Mentoring and Connection
  • One of the triggering factors to depression is
    isolation, the feeling of not being a part of a
  • College students still need adult support and
    someone to talk with
  • Faculty and students alike need training in these
    issues, but stigma makes it difficult for people
    to talk openly
  • Try a stress-management seminar
  • Talk about relationship issues, as many suicidal
    thoughts come up as a response to relationship
  • Dont be afraid to bring up suicide in any
    appropriate discussion setting

What On Earth Can I Do?
  • We are reluctant to ask questions of depressed
    students because we feel it is none of my
    business, or fear the responsibility
  • Depression is an illness, like heart disease, and
    suicidal thoughts are a crisis, like a heart
  • Anyone can learn to ask the right questions to
    help a depressed and suicidal person

What Stops Us?
  • Most of us still believe suicide and depression
    are none of our business
  • Most are fearful of getting a yes answer
  • What if we knew how to respond to yes?
  • What if we could recognize depression symptoms
    like we recognize symptoms of a heart attack?
  • What if we were no longer afraid to ask for help
    for ourselves, our parents, our children?
  • What if we recognized our feelings of despair and
    hopelessness, as symptoms of a brain disorder?

Learning QPR Or, How To Ask The S Question
  • It is essential, if we are to reduce the number
    of suicide deaths in our country, that community
    members/gatekeepers learn QPR
  • First identified by dr. Paul Quinnett as an
    analogue to CPR, QPR consists of
  • Question asking the S question
  • Persuade getting the person to talk, and to seek
  • Refer getting the person to professional help
  • (Quinnett, 2000)

Ask Questions!
  • Ask questions about suicide like, "Do you ever?
  •  have thoughts of hurting yourself?
  •  feel so badly that you have thoughts of dying?
  •  wish you could runaway or disappear?
  •  wish you could go to sleep and not wake up?
  •  have scary dreams about dying?
  • Remember, you cannot make someone suicidal by
    talking about it. If they are already thinking of
    it they will probably be relieved that the secret
    is out.
  • If you get a yes answer, dont panic. Ask a few
    more questions.

Reduce Stigma
  • Knowing what to ask and where to get help is not
  • Reducing the fear and shame we carry about having
    such shameful problems can only be done through
    a public health approach
  • Shame keeps people from seeking help or talking
    about their pain
  • Teach people that depression is truly a disorder
    that can be treated a deadly killer that we can
    no longer ignore or fear discussing

Do . . .
  • Talk openly- reassure them that they can be
    helped - Try to instill hope
  • Encourage expression of feelings say Tell me
  • Listen without passing judgment
  • Make empathic statements
  • Use warning signs to get help
  • early for the individual,
  • Stay calm, relaxed, rational

  • Make moral judgments dont argue or lecture
  • Encourage guilt
  • Promise total confidentiality/offer reassurances
    that may not be true
  • Offer empty reassurances youre luckier than
    most people wont help
  • Minimize the problem/offer simplistic
    solutions(e.g. all you need is a good nights
  • Dare the suicidal person (e.g.You wont really
    do it.)
  • Use reverse psychology (e.g. Go ahead and kill
  • Leave the student alone

Never Go It Alone!
  • Get help!!!
  • A friend go to a teacher, your parent, their
    parents, a counselor, a pastor
  • If it is you ask for help right now! Talk with
  • Family and friends
  • School Personnel
  • Crisis Hotline
  • Community Agencies
  • Family doctor
  • Clergy
  • If it is your parent/grandparent get adult help
    Clergy, Guidance counselor, crisis line, family

Local Professional Resources
  • Hospital Emergency Room
  • Local Mental Health Agencies
  • Local Mental Health Board
  • National Crisis Hotlines
  • Physicians
  • Local Police/Sheriff
  • College Counselors
  • Staff nurses
  • Local Crisis Hotlines
  • Local Clergy
  • 911

After A Suicide
  • Schools should prepare postvention plans in case
    a suicide does occur on campus
  • Plans should focus on outreach to survivors and
    prevention of suicide contagion by managing
    information that is presented to the press and
  • Opportunities to talk should be made available to
    students and staff
  • Connections should be maintained with other
    students who are known to have suicidal thoughts,
    and with friends of the person who died

Permanent Solution- Temporary Problem
  • Remember a depressed person is physically ill,
    and cannot think clearly about right or wrong,
    cannot think logically about their value to
    friends and family
  • You would try CPR if you saw a heart attack
    victim. Dont be afraid to interfere when
    someone is dying more slowly of depression
  • Most students, when treated, are able to overcome
    their suicidal thoughts, and recover from their
  • Depression is a treatable disorder
  • Suicide is a preventable death

Websites For Additional Information
  • National Suicide Prevention Lifeline at
    1-800-273-TALK (8255)
  • NAMI
  • National Institute of Mental Health
  • American Association of Suicidology
  • Suicide Prevention Resource Center
  • Suicide Awareness/Voice of Education
  • American Foundation for Suicide Prevention
  • Suicide Prevention Advocacy Network

College Prevention Websites
  • Campus Blues (http//
    features information and resources for college
    students on mental health, anxiety, loneliness,
    alcohol abuse, gambling, and other social and
    emotional issues
  • Go Ask Alice! (http//
    ) is a web-based health question-and-answer
    service produced by Alice!, Columbia University's
    Health Education Program. Go Ask Alice! provides
    information to help young people make better
    decisions concerning their health and well-being.
    Go Ask Alice! answers questions about
    relationships, sexuality, emotional health,
    alcohol and other drugs, and other topics. The
    addresses of e-mails sent to Go Ask Alice! are
    electronically scrambled to preserve the senders'
    confidentiality. Questions are answered by a team
    of Columbia University health educators and
    information and research specialists from other
    health-related organizations. The Go Ask Alice!
    archive on emotional health also contains
    information on suicide and depression.

College Prevention Websites
  • (http// is a
    web-based resource created by the Jed Foundation
    to provide students with a non-threatening and
    supportive link to their college's mental health
    center as well as important mental health
    information. Students are able to download
    information about various mental illnesses, ask
    questions, make appointments, and seek help
    anonymously via the Internet. Resources offered
    on include a customized version of
    Go Ask Alice! that allows students to have
    virtually any mental health question answered 24
    hours a day a mental health and drug information
    library that features consumer health information
    from Harvard Medical School and the Duke
    Diagnostic Psychiatry Screening Program, which
    allows the Ulifeline user to be screened for
    different mental disorders. While this screening
    is not meant to take the place of an evaluation
    by a mental health professional, a positive
    result suggests that the student would benefit
    from comprehensive mental health screening      

And Finally
  • If one cannot state a matter clearly enough so
    that even an intelligent twelve-year-old can
    understand it, one should remain within the
    cloistered walls of the university and laboratory
    until one gets a better grasp of one's subject
  • Margaret Mead

A Brief Bibliography
  • American Foundation for Suicide Prevention (AFSP)
    has launched the College Screening Project - a
    pilot program aimed at identifying college
    students at risk for suicide and encouraging them
    to get help they need
  • Anderson, E. The Personal and Professional
    Impact of Client Suicide on Mental Health
    Professionals. Unpublished Doctoral dissertation,
    U. of Toledo, 1999
  • Berman, A. L. Jobes, D. A. (1996) Adolescent
    Suicide Assessment and Intervention.
  • Blumenthal, S.J. Kupfer, D.J. (Eds) (1990).
    Suicide Over the Life Cycle Risk Factors,
    Assessment, and Treatment of Suicidal Patients.
    American Psychiatric Press.
  • Jacobs, D., Ed. (1999). The Harvard Medical
    School Guide to Suicide Assessment and
    Interventions. Jossey-Bass.

  • Jamison, K.R., (1999). Night Falls Fast
    Understanding Suicide. Alfred Knopf 
  • Lake, P. (2002). The Emerging Crisis of College
    Student Suicide Law and Policy Responses to
    Serious Forms of Self-Inflicted InjuryStetson
    Law Review, Vol. 32, No. 1, 2002
  • Lester, D. (1998). Making Sense of Suicide An
    In-Depth Look at Why People Kill Themselves.
    American Psychiatric Press
  • Oregon Health Department, Prevention. Notes on
    Depression and Suicide ttp//
  • Putukian, M. Wilfert, M, 2004. Student Athletes
    Also Face Dangers From Depression
  • Pavela, G. (2006) College Student Suicide Legal
  • Presidents New Freedom Council on Mental Health,
  • Quinnett, P.G. (2000). Counseling Suicidal
    People. QPR Institute, Spokane, WA
  • Schneidman, E.S. (1996). The Suicidal Mind.
    Oxford University Press.
  • Schwartz AJ and Whitaker LC. Suicide among
    college students Assessment, treatment and
    intervention. In SJ Blumenthal DJ Kupfer (Eds)
    Suicide over the life cycle Risk factors,
    assessment, and treatment of suicidal patients.
    (pp. 303-340). Washington DC American
    Psychiatric Press, 1990.

  • Signs of Depression in Youth. Oregon State Dept.
    of Health. http//
  • ipe/depression/signs.cfm
  • Stoff, D.M. Mann, J.J. (Eds.), (1997). The
    Neurobiology of Suicide. American Academy of
  • Styron, W. (1992). Darkness Visible. Vintage
  • Surgeon Generals Call to Action (1999).
    Department of Health and Human Services, U.S.
    Public Health Service.
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