A Guide to Depression and Suicide Among Students
Featuring expert advice from:
Lisa Alizadeh, LPC
Megan Lane, former suicide hotline volunteer and mental health advocate
Depression plays a significant role in suicide. The lifetime risk of suicide in patients with untreated depression is nearly 20%. According to Lisa Alizadeh, a professional counselor who holds an M.S. in clinical psychology, a person who has experienced anxiety, depression, or a mental health struggle is at a much higher risk for suicide.
This guide provides students, teachers, and parents with vital information about risk factors for suicide, how to help someone suffering from depression, the most common treatment options, and a list of resources.
Depression and suicidal thoughts or behaviors are complex mental health issues caused by a combination of environmental, genetic, and societal factors. Spotting these issues can be the first step in getting you or someone you love the help they need.
Risk factors of depression or suicide can include:
Patients treated for depression complete suicide at a rate of 2% to 6% depending on the type of treatment they undergo. While depression is a common correlate with suicidal thoughts and tendencies, several other disorders are also linked to them.
Alcohol Consumption and Drug Abuse
Alcohol and drug abuse are the second-most frequent risk factors for suicide, according to the Centers for Disease Control and Prevention (CDC). Approximately 60% of people who die by suicide have alcohol in their systems.
A history of bullying seems to correlate with student suicide attempts and completions.
Individuals facing the loss of life savings, fraud charges, or acute financial loss can increase the risk of suicide.
Emotional, Physical, or Chronic Pain
It’s been discovered that 50% of patients with chronic pain have seriously considered suicide. Emotional pain can also increase the risk of suicide.
Nearly 80% of all deaths by suicide in younger children are boys, although girls are twice as likely to attempt suicide. It’s been found that lesbian, gay, and bisexual students in grades seven to 12 are twice as likely to attempt suicide than their straight peers. In 2019, 35% of transgender students reported a suicide attempt and 44% said they’d seriously considered suicide within the past year.
It is essential to recognize that these risk factors are based on statistical probabilities and do not tell the whole story. Mental illness is a substantial risk factor, but according to the CDC, 54% of people who die by suicide did not have a mental health condition. In 2017, 5,016 young men between the ages of 15 and 24 died by suicide, compared with 1,225 women of the same age range.
Signs and Symptoms of Depression in Students
Untreated depression is a common cause of suicidal thoughts, attempts, and completions. Students who suffer from depression are more likely to struggle to develop and maintain relationships, concentrating, and learning new skills.
A person who feels down most of the day for weeks or months at a time may be clinically depressed and should see treatment. If you notice a friend or loved one displaying the following behavior, they may need help.
- Overwhelming feelings of sadness
- Frustration or anger over seemingly small issues
- Loss of interest or joy in activities
- Feelings of guilt or worthlessness
- Reduced personal hygiene
- Social isolation/loss of friendships
- Insomnia or excessive sleeping
- Unexplainable pain and headaches
- Suicidal thoughts or actions
Related Mental Health Disorders
Mental health disorders are key risk factors in predicting a suicide attempt. As such, helping people with mental health disorders get access to treatment is a critical step in reducing suicides.
The most common mental health disorders related to suicide include:
Inclusive of several types of anxiety disorder diagnoses, 58.1% of those ages seven to 17 report suicidal ideation.
Between 20% and 60% of bipolar disorder patients attempt suicide.
18% to 55% of patients with schizophrenia attempt suicide.
Borderline Personality Disorder
Patients with borderline personality disorder attempt suicide at a rate of 75%.
People with anorexia experience current suicidal ideation at a rate of 20% to 43%. Those with bulimia report this at 15% to 23%, and it’s estimated 21% to 23% of people with binge eating disorder and other specified feeding and eating disorder face suicidal ideation
27% of people with a diagnosis of PTSD have attempted suicide.
Approximately 20% of all suicides in the United States involved opiate use, and 22% of these deaths involve alcohol intoxication.
It is important to note that not every person diagnosed with a mental health disorder will have thoughts of suicide. However, getting treatment for mental illness could save lives.
Treatment for Mental Health Disorders
Getting treatment for mental health disorders is one of the most effective ways to reduce the prevalence of suicide. The treatment options vary depending on the type of mental disorder. However, talk therapy and medication are two of the most effective treatments for mental health disorders.
Below, we’ll review the most common treatment options for both depression and suicidal ideation.
Individuals with depression often feel overwhelmed and worry that nothing will ever change the way they feel. Frustration and helplessness is a symptom of depression, but it can also result in suicidal thoughts.
Here is what you or your loved one can expect when seeking treatment for depression.
Also called talk therapy, many students with depression find speaking to a trained professional about symptoms and feelings can help them better manage their depression. Psychotherapy may include interpersonal therapy and cognitive behavioral therapy.
There are several medications on the market to treat a spectrum of issues related to depression and anxiety, including antidepressants and MAOIs. Finding the right medication can take time, so students should work a trained medical professional to find the right medication and dosage.
Depression support groups are small groups, often led by an experienced volunteer or trained professional, that provide those living with depression within a safe and accepting place to share frustrations and fears. Support groups should not be used in place of psychotherapy or medication. The National Alliance on Mental Illness (NAMI) provides support groups specifically geared toward individuals with depression.
Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT)
SAINT is a type of therapy that uses electrical or magnetic currents to stimulate the brain and impact brain activity. It can effectively treat some instances of depression and anxiety. A recent small-scale study at Stanford Medicine found that 90% of patients had rapid relief of severe depression symptoms.
Suicidal Thoughts Treatment
If you are or a friend is having thoughts of suicide, getting help is critical. Contact a teacher, counselor, or family member, or call the National Suicide Prevention Lifeline at 1-800-273-8255.
Treatment options for suicide will vary based on the severity of the symptoms and other mental health disorders. A treatment team will work to develop a customized plan to keep the individual safe.
Treatment plans for suicidal thoughts may include:
- In-person care at a mental health facility
- Out-patient care at a mental health facility
- Talk therapy
- Group or peer therapy
Warning Signs for Suicide in Students
The Suicide Prevention Resource Center defines warning signs as factors that “indicate that someone may be at immediate risk for suicide..” Teachers, educators, and students should carefully watch for these indicators for at-risk students.
According to Lisa Alizadeh, a professional counselor who provides psychoeducation, assessments, and interventions for suicide prevention in schools, therapy, and psychiatric settings, overlooked warning signs of suicide often include:
Sudden Behavioral Changes
This is an easy warning sign to miss because the changes may not appear linked to propensity to take one’s life. However, someone who is suicidal often demonstrates behavioral changes. For example, a usually respectful and kind person may suddenly become irritable, angry, or aggressive. Or, someone who typically appears depressed or sad may suddenly become peaceful and happy.
History or Current Bullying
Bullying or teasing is one of the most common experiences among students who have attempted or completed suicide. However, bullying can often be overlooked when discussing common suicide risk factors. A common statement bullied students will hear is, “Oh, go kill yourself,” or the bully will socially isolate them. These actions can increase depression and result in suicidal thoughts or attempts.
Questioning, Transitioning, or Opening Living in the LGBTQ+ Community
Another vulnerable population consists of individuals questioning, transitioning, or living openly within the LGBTQ+ community. Research directly links increased suicidal urges with every bullying incident such as threatening, harassing, persecution, or humiliating. Words have power, and these concerns should be immediately and appropriately addressed both with the targeted student and their peers.
Access to Lethal Means of Harm
This may seem like a visible warning sign, but it is often missed at school. Friends or teachers may not be aware that a student has access to a gun, pills, sharp objects, or rope that can put that individual at risk of acting on suicidal urges.
Access to a lethal means increases the risk of suicide, as a person can more easily plan their attempt. Developing awareness on the importance of limiting access to means of harm for students is very important.
Physical or chronic pain can be emotionally distressful. For some students, this can lead to suicidal behaviors in attempts to escape the pain. Physical and chronic pain can also cause significant life changes that impede the person’s emotional and mental health, which can lead to depression and suicidal urges. This is a commonly overlooked warning of suicide and depression, especially if the student is dealing with several other changes at the same time.
Family History of Incarceration, Suicide, Trauma, or Abuse
If a student has a parent or family member that is incarcerated or has watched a family member struggle, attempt, or complete suicide, they are at a higher risk of suicide. In addition, historical or current trauma and abuse can increase the thoughts of suicide. This warning sign can be overlooked as the concern may be placed on the family member directly involved with the abuse, rather than the student who is experiencing trauma due to the event.
History of Mental Health Concerns
If a person has experienced anxiety, depression, or any other mental health struggles, they can be at risk for suicide. Nearly 50% of individuals who have completed suicide were previously diagnosed with a mental health disorder. This does not consider the many individuals who may not have received treatment or a clinical diagnosis but were still struggling with these mental health concerns before their suicide.
Mental health and mental health treatment are often stigmatized, which leaves many afraid to share their concerns and receive treatment. Destigmatizing mental health and encouraging acceptance of and talking about mental health challenges could increase a student’s willingness to seek treatment for their mental health struggles, potentially preventing suicidal behaviors.
How Can You Tell if Suicide Is a Possibility?
Suicide is often hard to predict. However, there are some risk factors, which we covered in detail in above. For example, depression or other mental health disorders and substance abuse can increase the risk of suicide.
However, there are also warning signs of suicide that teachers, friends, and families, and students themselves should pay attention to. These signs may indicate a higher likelihood of suicidal thoughts or a suicide attempt.
Teachers are in a unique position to recognize the warning signs of suicide. Teachers interact with students daily and may be the first to notice the signs. Reaching out to students in danger may provide the lifeline students need to get treatment and work toward recovery.
Common warning signs of suicide teachers should be mindful of include:
- A drastic change in behavior, such as anger, frustration, or violent outbursts
- Previous suicide attempt(s)
- A recent suicide of a friend or family member or a rise in suicides in the community
- Significant losses, such as the loss of a family member, scholarship, job, or significant other
- An increase in alcohol or drug use
- Access to means to attempt suicide, such as access to a gun or large stash of pills
- Barriers to mental health treatment
- Any comments that set off alarm bells/li>
For Friends and Family
Suicide attempts rarely occur without warning signs. However, these signs are not always apparent even to friends and family who know the individual well. In some cases, it may seem as if the student is coming out of their depression and is happy or content. In reality, they may have decided to end their life.
Friend and family should look for warning signs of suicide, which may include:
- Talking directly or indirectly about dying or not being around
- Socially isolating themselves from friends and family
- Commenting that people would be “better off without them”
- Significant changes in hygiene, including failing to bathe regularly
- Self-harm or mutilation, such as cutting or burning
- Giving away valued possessions or making other preparation for death
- An unwillingness to seek treatment for a mental health disorder
Students who are considering suicide may not immediately realize that’s what is happening. You may believe that everyone thinks about suicide at some point, particularly when facing challenges at school or home.
Passing suicidal thoughts can be relatively common, for example, thinking, “I wish I weren’t alive.” However, if you find yourself formulating a suicidal plan – no matter how hypothetical – it is time to get help. Here are a few other warning signs that you should call a support line or talk to someone you trust immediately:
- Overwhelming feelings of worthlessness or guilt
- Losing interests in the subjects, people, or places you used to enjoy
- Making plans for what will happen to your pets or belongings after you die
- Feeling as if life isn’t worth living
- Participating in risky behaviors such as driving very fast, drinking and driving, or engaging in sexual activity with people or in settings you normally wouldn’t
- Buying a weapon or hoarding medication that you could use to attempt suicide
If these warning signs sound familiar, please talk to a teacher, family member, or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
During a crisis, it can be challenging to know where to turn for support or help. If you believe your friend is at risk of attempting suicide, do not wait to get them help.
Do not try to offer comfort by saying things like, “You’re got to get over this, it’s not a big deal,” or “Why are you worried, move on.” Avoid blaming statements, such as “Maybe you would have more friends if you changed your attitude,” or “You’ve got no one to blame but yourself for these problems.”
Instead, reach out to a teacher or mental health professional. You can also seek help by calling the local police department or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). You can also send the text message “Home” to the Crisis Text Line at 741741.
Several other organizations provide support and resources, including:
National Eating Disorders (NEDA) Hotline
Provides support via phone, chat, or text for individuals suffering from eating disorders.
- Call: 800-931-2237
(Monday – Thursday 11am-9pm ET, Friday 11am-5pm ET)
- Text: 800-931-2237
(Monday – Thursday 3pm-6pm ET)
- Online Chat: NEDA Chat
(Monday – Thursday 9am-9pm ET, Friday 9am-5pm ET)
National Alliance on Mental Illness (NAMI) HelpLine
Free peer-support service that provides individuals with mental health conditions and their families with access to support, information, and resource referrals.
- Call: 1-800-950-NAMI (6264)
(Monday – Friday 10am-6pm ET)
Substance Abuse and Mental Health Services Administration (SAMHSA):
Provides 24/7 multilingual crisis support and counseling year-round.
- Call: 1-800-985-5990
The Trevor Project
Suicide prevention support for LGBTQ+ with a 24/7 crisis support line.
- Call: 1-866-488-7386
United Suicide Survivors International
Provides support for those suffering from suicidal thoughts, suicidal loss, and friends and family of those struggling with suicide.
Now Matters Now
A website that provides access to educational videos, skills training, stories from those who have experienced suicidal thoughts, and a crisis support line.
Provides five action steps to prevent suicide, suicide prevention resources, and shares personal stories of suicide prevention.
What are some of the signs of depression and suicidality a teacher or colleague may see in a student?
You can keep an eye out for drastic changes in mood, both positive and negative. When people are suicidal, they may seem calmer and more content, as they believe that their suicide plan will bring them relief from the emotional pain they’re experiencing.
Since mental illnesses are very person-dependent, you might also notice a sudden drop in mood. Perhaps the student who once seemed cheerful, or maybe mildly depressed, is now obviously depressed. Some signs include not making eye contact, a lack of socialization, failing to show interest in subjects they usually enjoy. These examples could mean that depression has taken hold.
But this isn’t always the case — family emergencies, the death of a loved one, illicit drug use, and an unpleasant life situation can trigger similar behaviors. While you shouldn’t jump to assumptions, you should speak with the student in question, and if they’re under age 18, consult with their parents too.
There are less obvious things you can watch out for, such as student’s joking around about suicide, expressing feelings of hopelessness, displaying impulsivity, appearing withdrawn, and bursts of rage or anxiety.
What is the most useful way people can help those struggling with depression?
When someone you care about is suffering from depression, one of the best things you can do is conduct reliable and trustworthy research.
For example, one of the trademark symptoms of depression is oversleeping — you want to gently nudge the person, not shove them. Rather than telling them to cheer up and get out of bed, remind them of the positive aspects of their life, and don’t let them forget about their favorite hobbies.
If your attempts are failing, give it a rest for the day; pushing someone too much can cause regression. I suffer from depression myself, and I know that when I’m pushed past my limitations, I begin feeling overwhelmed, which doesn’t help my situation at all. The best thing you can do is wait until the following day and attempt to stir up some motivation.
What is the most useful way people can help those struggling with suicidal thoughts?
Once the warning signs appear, it’s time to take preventative action. Interventions can be useful but think about the person as an individual, and ask yourself if an intervention could potentially worsen the situation.
Asking direct yet sensitive questions can help you gain a better understanding of what they’re going through. The following questions often prove useful:
- How are you coping with life right now? I know that it can be hard.
- Do you ever wonder if you’d be better off if you weren’t born?
- Are you considering harming yourself or killing yourself?
- Have you attempted suicide in the past?
- Do you have a plan or a date set in place to end your life?
When you ask questions in a non-interrogative manner, you’re providing the person with a safe space to speak about their feelings, which can reduce the risk of acting on suicidal thoughts.
You can also encourage anyone struggling to seek immediate help (like admitting themselves into a short-term psychiatric ward within their local hospital,) call the national suicide prevention hotline, and offer reassurance that things will not stay this way forever. Additionally, if there are weapons or guns in their household, removing them is a priority.
If you are struggling with suicidal thoughts, where can you get help?
There is a big difference between being actively suicidal and having suicidal thoughts or ideations. If you are suicidal with a plan set in place to end your life, it’s of the utmost importance to err on the side of caution. You can call 911 and explain your current mindset to the local EMT responders. Alternatively, you can check-in at your local emergency room (ER,) but it’s best to have someone else drive you there. In safe, therapeutic settings like hospitals, a psychiatrist will evaluate your mental health and decide whether or not an inpatient psychiatric admission is necessary.
What are some ways to improve your mental health?
There are so many different ways that you can improve your mental health, but when it comes to mental illnesses, treatment isn’t a one-size-fits-all situation. Nonetheless, you can see what works best for you — prescribed medication, therapy, holistic supplements, exercise, or embodiment and distracting activities.
Don’t lose hope before the miracle happens. With psychiatric medications, it’s not uncommon to play the “trial-and-error game” where you test different dosages and combinations before finding that sweet spot.
Holistic supplements, such as CBD and herbal products, can ease presenting symptoms of depression, bipolar disorder, and generalized anxiety. Bear in mind, these over-the-counter (OTC) products are not regulated by the FDA. You’ll need to consult with your primary care physician before consuming OTC supplements.
Distraction and embodiment activities take your mind off how you’re feeling, which provides temporary relief and an ongoing coping system you can set in place. Distracting activities include binge-watching television, eating, and taking on tons of time-consuming work projects. Embodiment activities include meditation, prayer, yoga, journaling, painting, dance, and anything creative that brings you into your body more.
It is really up to you which activities you choose to utilize. The distracting ones help you cope, so that’s important. And the more often you do activities that lead to awareness, presence, and embodiment, the more you realize that everything in life is temporary, including emotions.