Suicide is the second leading cause of death among college students and the third leading cause of death in persons aged 15-24. According to the National Institute of Mental Health, more than 90 percent of people who kill themselves had been suffering from illnesses such as depression or substance abuse, and could have been treated and possibly saved had they been diagnosed. These alarming statistics have challenged mental health professionals to find a way to get help to adolescents and young adults before it's too late.
Charles B. Nemeroff, MD, PhD, Reunette W. Harris professor and chairman, David J. Moore, MD, assistant professor, and Jill Rosenberg, LCSW, senior research associate, Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine, are working on a pilot study funded by the American Foundation for Suicide Prevention (AFSP) which they hope will assist them in developing a plan to identify and treat students at high risk for depression and suicide. The study, called the College Screening Project, began in 2002.
"We know that the majority of students who are in need of counseling services don't seek help through the traditional route," said Dr. Nemeroff. "We want to be proactive in finding out how to reach these students in a way that makes sense to them."
With this program, students receive an email in staggered groups - beginning with seniors in the Fall semester and ending with freshmen at the beginning of their second semester - inviting them to complete a Depression Screening Questionnaire on a secure website. The students are asked to answer questions, including questions about suicidal thoughts and attempts, and problems often related to depression such as anxiety, alcohol and drug abuse, and eating disorders. The questionnaire takes about 10 minutes to complete.
To ensure anonymity, students then choose a USER ID and password, which is the only identifier on the questionnaire, and they are asked to supply an email address to receive notification that the counselor's response to their questionnaire is ready. The email address is encrypted so that it cannot be linked to their identity.
The computer program classifies students into three tiers based on their responses. Students who indicate they have been thinking about suicide within the past four weeks, score high on the depression scale, or indicate other serious problems are placed in Tier 1. Tier 2 includes students who have mid-range depression scores or who indicate problems related to anxiety, alcohol or drug abuse, or eating disorders. All other students fall into Tier 3. Tier 1 students are told to return to the site for their Counselor's Assessment in 24 hours; Tier 2, in 3-4 days and Tier 3, in 5-7 days.
The clinical social worker is notified via email of the student's tier and is provided a link to that student's questionnaire, which she reads and evaluates. She then prepares an individualized Counselor's Assessment that is sent back to the student's USER ID. Students can then choose to dialogue with the counselor by email, or come in to see the project psychiatrist. The computer system also sends email reminders to students in Tiers 1 and 2.
"The key to making this work for the students is that they can remain anonymous," says Ms. Rosenberg. "Even if students are aware of counseling services, they may not come forward out of fear of the embarrassment that other students will find out. If we reach out to them proactively and give them an opportunity to dialogue on-line, chances are good that they will come in for counseling."
"We know that some students shy away from treatment," continues Ms. Rosenberg. "This project provides a way to identify students who might benefit from mental health services and help them access these services. We believe that what works best in reaching the greatest number of students is communicating on their level by using the appropriate language."