chapter five: trauma and suicide
overview of the chapter
During the podcast episode, I spoke with Dr. Meek about trauma and suicide. This chapter contains various sections that build on the information from the podcast episode. In the first section, I explain the complex nature of trauma. The second section classifies suicide ideation or thoughts and suicide planning and intent and connects how trauma and other mental health factors can impact suicide. The third section explains how suicide specifically impacts college students. The fourth section explains the type of current interventions and provides information and resources that can help students. In the final section, I explain the significant gaps in the literature that remain researched and explored regarding trauma and suicide.
Additionally, the following chapters will delve into detail about traumatic events and circumstances and suicidal ideation, planning, and intent. Please consider this a trigger warning.
understanding the complex nature of trauma
Trauma can be thought of as a wound to the brain when it is exposed to sudden, unexpected, and emotional shocking stimuli (Leys, 2010). Traumatic events cause physical, emotional and/or psychological harm on the person experiencing them and some examples include the death of a loved one, natural disasters, war, sexual abuse, and car accidents (Cafasso, 2017). Traumatic events are encoded differently in our brains than normal memories (TEDxTalks, 2015).
However, as Dr. Meek mentioned during the episode, trauma, like many mental health challenges, is not a one-size-fits-all. People react to trauma in different ways and not all experiences of trauma will lead to a diagnosable mental health disorder such as post traumatic stress disorder (PTSD). In trauma research, there are two differnt characterizations of coping strategies: active and passive (Olff et al., 2005). Active coping strategies like disclosing the traumatic event or dealing actively with the problem have been associated with positive adaptation to the stress experienced from the traumatic event (Olff et al., 2005). Research shows that writing about our traumas can help process them (Pennebaker, 2000). On the other hand, maladaptive coping strategies like substance abuse, social isolation, and rumination, and avoidance are considered maladaptive to cope with stress (Olff et al., 2005).
But is trauma associated with suicide? And if so how? These are the questions that will be explored in the next section.
Classifying Suicide and How Trauma Impacts It
Suicide is an escape, a coping mechanism, from psychological pain that a person can no longer endure (JED Foundation, 2006). As Dr. Meek mentioned in the episode, suicide can be thought about as being at the end of a spectrum and there are various nuances when approaching suicide. Firstly, an individual may have suicidal thoughts, also known as suicidal ideation without the intention of actually carrying them out (Suicide is Different, 2019). The next step in suicidality is planning a suicide. Individuals at this stage may know how they would end their lives (Suicide is Different, 2019). Lastly, there is suicidal intent. When an individual has suicidal intent they mean to end their life if they are faced with the opportunity (Suicide is Different, 2019). Ultimately, suicide is considered the most severe consequence from this spectrum. To determine what questions one can ask to determine where on the spectrum an individual lies see Table 1.
Table 1. Asking Questions for Different Suicidal Spectrums.
This table highlights different questions that can be asked to determine where an individual lies in the spectrum of suicidality. Adapted from Suicide is Different, 2019.
Studies consistently have demonstrated that exposure to traumatic events early in life can lead to worse health outcomes later in life (Felitti et al., 1998; Zatti et al., 2017). One meta-analysis on the impact of childhood trauma on suicide attempts found that individuals who experienced sexual, physical, emotional abuse or physical neglect were associated with more lifetime suicide attempts (Zatti et al., 2017). Another study that observed the relationship between seven different types of adverse childhood experiences (ACE): psychological abuse, physical abuse, sexual abuse, exposure to substance abuse, exposure to mental illness, exposure to violent treatment of mother/stepmother, and exposure to criminal behavior (Felitti et al., 1998). They found that people who experienced four or more types of ACE had a 4 to 12 increase in suicide attempts (Felitti et al., 1998).
Although people may believe that suicide is not preventable, this is a myth as statistics indicate that around 90% of the people who die by suicide have a diagnosable mental illness, most commonly depression (JED Foundation, 2006). There are different types of treatment and interventions available to help prevent suicide. The following section will explore how trauma and suicide impact college students.
Suicide Among Undergraduate Students
Unfortunately, in the US, suicide is the second leading cause of death among college students and the suicide rate for that population has tripled since 1950 according to the American College Health Association (Burrell, 2020).
In one study of 67,000 students, one in five stated that they had thoughts of suicide during the academic year (Burrell, 2020). In a different meta-analysis of suicidal thoughts and behaviors, the researchers analyzed studies that pooled together observed 634,662 college students (Mortier et al., 2018). The study found that lifetime suicidal ideation was 22.3%, plans were 6.1%, and attempts were 3.2%, but during a 12-month period, the percentages dropped to 10.%, 3%, and 1.2% respectively (Mortier et al., 2018). Most students who die by suicide have never attended their counseling centers (JED Foundation, 2006) and studies show that the students most at risk for suicide are those that have a mental illness during their college career (Haas et al., 2003; Schwartz & Friedman, 2009).
Useful Resources and Interventions for Undergraduate Students
When combating suicide there are three primary stages: Prevention, Intervention, and Postvention. Each stage builds on the other and creates reinforcing feedback loops that help mitigate suicide (see Figure 1).
A common intervention applicable at the Prevention stage is to raise awareness about signs and symptoms of mental illness and suicide risk factors. This can be achieved in multiple ways. Firstly, the National Suicide Prevention Lifeline has a webpage called We Call All Prevent Suicide. This page identifies different suicide risk factors and warning signs to be attuned to (National Suicide Prevention Lifeline, 2020). Figure 2 delineates some of the most common risk factors and warning signs so students can educate themselves and identify these signs among their friends. If you don’t know where to begin a conversation about mental health, another useful resource is the Seize the Awkward campaign, which provides various resources and conversation starters to help promote healthy conversations about mental health (Seize the Awkward, 2020).
Figure 1. Three primary stages for suicide prevention.
Adapted from JED Foundation, 2006.
Figure 2. Suicide Risk Factors and Warning Signs.
This figure depicts some of the most common suicide risk factors and warning signs to help students identify them and help prevent suicide. Adapted from National Suicide Prevention Lifeline, 2020.
At the Intervention stage common interventions include outlining formal crisis protocols and providing accessible and effective mental health services to all college students. A highly important resource is the US National Suicide Prevention Lifeline at 1-800-273-8255. If you or any of your friends are having serious thoughts of suicide, please call this line. They provide free and confidential support to people in distress and are available 24/7. Moreover, as Dr. Meek mentioned, another resource at your disposal is the My SSP app. You can download it and talk or chat with providers at any point (My SPP, 2020). Additionally, for any students currently enrolled in university, when in doubt, you can always check the school resources for Counseling and Psychological Services. Most counselors are happy to see students and would rather they come in before problems are too serious.
At the postvention stage, college campuses can provide outreach programs to help recovering students. Additionally, as a society, we need to ensure responsible reporting of suicide by the media.
Limitations and Current Gaps in the Research
A significant problem of the literature is how researchers assess and measure suicidal ideation (Mortier et al., 2018) Self-report measures are commonly used. However, there are various limitations to that approach given that students may not remember accurately and may not wish to disclose truthful information regarding the highly stigmatized topic of suicide.
Moreover, a significant gap in the suicide literature is determining the network interactions between different risk factors. It is very possible that risk factors contribute to other risk factors and vice versa, but these mechanisms are not yet well understood.
references
Burrell, J. (2020, February 03). The Grim Numbers Behind Adolescent Suicides and Attempts. Retrieved March 17, 2021, from https://www.verywellmind.com/college-and-teen-suicide-statistics-3570768
Cafasso, J. (2017). Traumatic Events. Retrieved March 19, 2021, from https://www.healthline.com/health/traumatic-events
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245-258.
Haas, A., Hendin, H., & Mann, J. (2003). Suicide in college students. American Behavioral Scientist, 46, 1224–1240.
JED Foundation. (2006). Framework for Developing Institutional Protocols for the Acutely Distressed or Suicidal College Student. Retrieved March 18, 2021, from https://www.jedfoundation.org/wp-content/uploads/2016/07/framework-developing-institutional-protocols-acutely-distressed-suicidal-college-student-jed-guide_NEW.pdf
Mortier, P., Cuijpers, P., Kiekens, G., Auerbach, R. P., Demyttenaere, K., Green, J. G., … & Bruffaerts, R. (2018). The prevalence of suicidal thoughts and behaviours among college students: a meta-analysis. Psychological medicine, 48(4), 554-565.
My SSP. (2020). Call. Chat. Anytime. Anywhere. Retrieved March 16, 2021, from https://myssp.app/ca/home
National Suicide Prevention Lifeline. (2020). We Can All Prevent Suicide. Retrieved March 16, 2021, from https://suicidepreventionlifeline.org/how-we-can-all-prevent-suicide/
Olff, M., Langeland, W., & Gersons, B. P. R. (2005). The psychobiology of PTSD: coping with trauma. Psychoneuroendocrinology, 30(10), 974–982. https://doi.org/10.1016/j.psyneuen.2005.04.009
Pennebaker, J. W. (2000). The effects of traumatic disclosure on physical and mental health: the values of writing and talking about upsetting events.
Schwartz, L., & Friedman, H. (2009). College student suicide. Journal of College Student Psychotherapy, 23(2), 78–102.
Seize the Awkward. (2020). Shatter the silence and Seize The Awkward. Retrieved March 16, 2021, from https://seizetheawkward.org/
Suicide is Different. (2019). Suicide as a Spectrum. Retrieved March 19, 2021, from https://www.suicideisdifferent.org/suicide-spectrum
TEDxTalks. (2015, May 26). Return from Chaos: Treating PTSD | Peter Tuerk | TEDxCharleston. Retrieved March 19, 2021, from https://www.youtube.com/watch?v=ORs3-tRokGU
Zatti, C., Rosa, V., Barros, A., Valdivia, L., Calegaro, V. C., Freitas, L. H., … & Schuch, F. B. (2017). Childhood trauma and suicide attempt: A meta-analysis of longitudinal studies from the last decade. Psychiatry research, 256, 353-358.