A pilot program called the College Screening Project, a suicide prevention outreach program, was successful in identifying and treating college students with severe depression and feelings of desperation that may have led to suicide. The study, supported by the American Foundation for Suicide Prevention (AFSP), was conducted with Emory University students over six college semesters from 2002-2005.
Depression is a significant risk factor for suicide, and according to the Centers for Disease Control and Prevention (CDC) suicide is the third leading cause of death for teenagers and young adults, behind accidents and homicides.
"A profound percentage of the students who participated in AFSP's College Screening Project reported current (past four weeks) suicide ideation and were subsequently treated," says Charles B. Nemeroff, MD, PhD, Reunette W. Harris Professor and chair of the Department of Psychiatry and Behavioral Sciences at Emory University. “That represents a large number of lives that were improved, and possibly saved, because of this program.”
The study, which began as simply an outreach program, revealed some startling statistics about suicide risk and depression in college students:
- 11 percent of the participants in the screening project reported current suicidal ideation
- 16.5 percent of the participants in the screening project had made at least one lifetime suicide attempt
- More than half had clinically significant depression
- Suicide ideation was related not just to depression, but also to feelings of desperation and feeling overwhelmed or out of control.
“These are important emotions to look for in at risk students," says Nemeroff.
From 2002-2005, approximately 8,000 students were invited to participate in the AFSP program and asked to complete a brief questionnaire that covered depression and related problems. The invitations were distributed on a secure, project-developed website. During the three-year study interval, a total of 729 Emory students participated by completing the questionnaire.
An experienced clinician reviewed the responses and a detailed personalized assessment was returned to each student's secured email address. Students whose questionnaire results suggested significant problems were urged to come in for a face-to-face evaluation. In addition, a dialogue feature on the website gave the students the option to exchange follow-up messages with the clinician while remaining anonymous.
Study data showed that 91 percent of the students who filled out the questionnaire viewed the counselor's assessment; 34 percent engaged in dialogues and 20 percent came in for an evaluation. More than 80 students characterized as high-risk entered psychotherapy after the in-person evaluation.
The study also found that among students designated to be at-risk, the rates of those coming for in-person evaluation and entering treatment were three times higher for those who engaged in online dialogues than for those who did not. In addition, for some students who dialogued with the counselor the online relationship appeared to have had a therapeutic effect.
Steve Garlow, MD, PhD, a study co-author, believes that college students are particularly vulnerable when it comes to feelings of depression, but don't seek treatment because of concerns about the stigma some people attach to mental illness. "The students responded to this program because it was readily available and they were using technology that they could relate to and trusted to keep their identity anonymous."
David Moore, MD, study investigator and psychiatrist at Emory University's Student Health Center says, "We have always tended to be proactive, but this project was so effective that we continued to use the AFSP program at Emory. We believe it is a very effective tool for supporting our students."
Dr. Charles Nemeroff was principal inv estigator for the study, and currently serves as President of the American Foundation for Suicide Prevention.
Drs. Moore and Garlow are assistant professors in Emory's Department of Psychiatry and Behavioral Sciences. Jill Rosenberg, LCSW, project counselor, was with the department when the study was implemented.
The University of North Carolina, Chapel Hill (UNC) was included in the project for the last three of the six semesters.
In addition to Emory faculty, study authors included, Ann Haas, PhD, and J. John Mann, MD, with the AFSP; Bethany Koestner, BS, with the AFSP at the time the project was implemented; Jan Sedway, PhD, and Linda Nicholas, MD, with the Department of Psychiatry at the University of North Carolina School of Medicine, Chapel Hill and Herbert Hendin, MD, with New York Medical College in Valhalla.
The research was supported by unrestricted grants to the American Foundation for Suicide Prevention from Eli Lilly and Company, Wyeth Pharmaceuticals, Janssen Pharmaceuticals and Solvay Pharmaceuticals, Inc. An article describing key findings of the initial implementation of the program recently appeared in the journal Depression and Anxiety (Vol 25: 482-488) 2008 and a second article summarizing the combined results of the pilot test that included both Emory University and UNC was published in the Journal of American College Health (Vol 57 (1): 15-22 (2008).