Blog: University Mental Health Day: How can we help young adults struggling with suicidal thoughts?

As University Mental Health Day, (this year Thursday 14 March), calls for us all to make student mental health a priority, it is important to consider the impact that suicidal thoughts can have on the lives of young adults and those around them.

A blog by research student Emily Bolland, Trainee Counselling Psychologist and BACP Registered Counsellor and Psychotherapist at the University of Wolverhampton. 

Warning – This Blog post discusses suicidal thoughts

Suicidal thoughts and behaviours (such as self-harm) are worryingly prominent amongst young people. Although suicidal behaviour in adolescents and young adults is becoming increasingly large scale and concerning (Carballo et al., 2020); there have been relatively few studies examining adolescent suicide (Yen at al, 2013).  So what can be done to help young adults who are struggling with thoughts of suicide, and why is it so common?

 Why are we losing more young people to suicide?

Although rates among other populations have remained relatively stable, rates of suicide among those aged between 15 and 24 have risen dramatically in recent decades (Bearman and Moody, 2004; Murrell et al., 2014). So why is it that more young people are losing their lives to suicide?  Adolescents and young people as a population are particularly vulnerable to suicidal behaviour for a number of reasons (Carballo et al., 2020; O’Connor & Nock, 2014; Surace et al., 2021). Young adults are subject to academic pressure, relationship difficulties, social media pressures and those who experience adverse childhood experiences (such as abuse) also have an increased vulnerability.

Another possible factor is that help-seeking behaviour for suicidal thoughts in adolescents is low (Kaess et al., 2022).   Those who are experiencing difficult thoughts and feelings (at any age) can find it hard to reach out for support. They may be worried about upsetting family and friends, or can feel embarrassed about talking about how they are feeling. Suicidal thoughts have a tremendous impact on individuals’ lives and are not only a frightening concept to them and their friends and families, they are also shrouded in misconceptions, stigma, secrecy, and shame. Individuals can often feel like they are alone in feeling this way and struggle to reach out for help.

Students

Research indicates that students can be particularly susceptible to developing suicidal thoughts (Paula et al., 2020). Academic stressors, moving away from home for the first time, increased independence, social pressures and being away from family and friends are possible contributing factors. Although this is likely to be a difficult time for many young adults, there is a lack of research on university students. Akram et al. (2020) built on the limited studies that suggests poor wellbeing and psychological distress (including suicidal thoughts) in students is not only widespread, but rising (Akram, et al., 2020). These authors found that over a third of students (37.3%) reported significant risk for suicidal behaviour (Akram et al., 2020). It is interesting that differing rates of psychological distress and suicidal thoughts can be found in different countries. Paula et al. (2020) found two studies which suggested that Portugal has the lowest rates of suicidal thoughts among students (3.9% and 5.2 %); with studies suggesting that Austria and Mongolia had much higher rates (49.1% and 47.0% respectively). The authors highlight that the studies reviewed used different methods to identify prevalence, but due to the extreme difference between rates, it is worth considering what interventions (if any) are offered at universities within other countries.

The consequences of a completed or attempted suicide of a young person are not only devastating to them and their family and friends, but can also be far-reaching. Research has suggested that adolescents and young people can be particularly vulnerable to the effects of social contagion (Mueller and Abrutyn, 2015). There are many studies that support the theory that suicide is socially contagious (Mueller and Abrutyn, 2015) and research has consistently indicated that those who witness the suicide of a role model, are at an increased risk of suicide (Bearman and Moody 2004; Niederkrotenthaler et al. 2012). Unfortunately, this is especially true in younger populations. A study conducted on suicide clusters concluded that adolescents and young adults are the population group at the highest risk of being part of a suicide cluster (Haw et al, 2013). We have seen a shocking case of this within the K-pop culture with the recent deaths of Korean celebrities Sulli, 25, and Goo Hara, 28, as well as actor Cha In-ha, 27; this could possibly be seen as a suicide cluster.

Considering all of this, what help is available for those young adults experiencing thoughts of suicide? And what, if any, has shown to be helpful?

Suicidal thoughts do not have one single cause and their development is likely due to a number of complex interconnecting factors. Suicidal thoughts are a known predictor of suicide (McFeeters, Boyda and O’Neill, 2015), and the majority of cases of suicide attempt that lead to death are observed in those who have previously attempted suicide for the first time (Bagheri-Sheykhangafshe, et al 2022). Therefore, identifying those dealing with suicidal thoughts and finding effective methods to help them cope and relieve their negative thoughts is vital. However, once these individuals have been identified, helping clients to manage suicidal ideation in a therapeutic setting still prevents a challenge for clinicians (Ducasse et al., 2018). So far, research has found that student interventions for suicidal thoughts are largely ineffective (Akram et al., 2020).

Given the possible devastating consequences, research into suicidality and young adults is critical, and yet there is still a relative scarcity of research into effective treatments (Kothgassner et al., 2021; Tighe et al., 2018). There is an increasing body of research that illustrates the limited general efficacy of therapeutic modalities when treating suicidal ideation and self-harm (Kothgassner et al, 2021). So, it can be difficult to know how to approach offering support, or to know what interventions may be most helpful. Research investigating which specific principles, techniques, and ideas are effective is of utmost importance. The value of a strong therapeutic alliance is well established in general therapy, but again little is known as to how this impacts suicidal thoughts in particular (Huggett et al., 2022).

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy is a third-wave cognitive behavioural therapy approach and aims to increase psychological flexibility. Several studies have shown Acceptance and Commitment Therapy (ACT) to be effective in reducing suicidality in the general population, and small scale research has indicated promising outcomes when delivering ACT interventions with young people (Livheim et al., 2014). However, there has been limited research focusing specifically on ACT and suicidality in adolescents and young people and this may be a vital element in working towards reducing these tragic losses.

My research

I have designed a study which aims to deliver 8 sessions of ACT based therapy to 18-25 year-olds experiencing suicidal thoughts. Evidence has shown that ‘experiential avoidance’ (the avoidance of distressing thoughts and experiences) is related to suicidality, and ACT targets EA using its core processes such as acceptance, openness and values. ACT involves learning how to manage difficult thoughts and feelings more effectively, so that you can life a fulfilling life.

I’m hoping to find out whether ACT is an effective form of therapy for working with young adults expediting difficult thoughts and feelings (such as wanting to harm themselves), and what, if anything about ACT, is particularly helpful. My long-term goal is to identify tools to help those suffering and ultimately reduce the tragic losses and their impact. 

If you would like to contact me about this research, or if you are struggling with thoughts and feelings related to suicide and would like to take part, contact me at e.s.bolland@wlv.ac.uk.

Help and support

Help and support is available for those who may be struggling with these thoughts.

Papyrus – offers confidential advice for young people struggling with suicidal thoughts as well as family and friends. They are open 24/7, every day of the year. 0800 068 4141; 07860039967 pat@papyrus-uk.org.

Samaritans – you can always contact the Samaritans for support on 116123 or email jo@samaritans.org.

The Mix – support and advice for people under 25. Call 0808 808 4994 or text THEMIX to 85258.

Shout – offers support 24/7 for anyone struggling to cope. Text SHOUT to 8528.

Campaign Against Living Miserably (CALM) – provides listening services for anyone who needs to talk. Call 0800 58 58 58.

Support from the University 

You can find more support resources on the Uni Mental Health Day (14 March) page.

Students can access support and resources at any time from the University Mental Health and Wellbeing webpages, where you can register for support, join wellbeing workshops, and access self-care resources, including WLV Student Life Connect - a FREE, CONFIDENTIAL, INDEPENDENT, and IMPARTIAL source of support for you with a dedicated phone line and webpage with an online chat function 24/7, 365 days a year.

References

_{Akram, U., Ypsilanti, A., Gardani, M., Irvine, K., Allen, S., Akram, A., Drabble, J., Bickle, E., Kaye, L., Lipinski, D., Matuszyk, E., Sarlak, H., Steedman, E., & Lazuras, L. (2020). Prevalence and psychiatric correlates of suicidal ideation in UK university students. Journal of Affective Disorders, 272, 191–197. https://doi.org/10.1016/j.jad.2020.03.185}

_{Bagheri-Sheykhangafshe, F., Kiani, A., Savabi-Niri, V., Aghdasi, N., & Bourbour, Z. (2022). The Efficacy of Acceptance and Commitment Therapy on Psychological Capital and Emotion Regulation of Students with Suicidal Ideation. International Journal of Behavioural Sciences, 16(2), 96–102.}

_{Bearman, P. S., & Moody, J. (2004). Suicide and friendships among American adolescents. American Journal of Public Health, 94(1), 89–95. https://doi.org/10.2105/ajph.94.1.89}

_{Carballo, J. J., Llorente, C., Kehrmann, L., Flamarique, I., Zuddas, A., Purper-Ouakil, D., Hoekstra, P. J., Coghill, D., Schulze, U. M. E., Dittmann, R. W., Buitelaar, J. K., Castro-Fornieles, J., Lievesley, K., Santosh, P., Arango, C., Sutcliffe, A., Curran, S., Selema, L., Flanagan, R., … _Aitchison, K. (2020). Psychosocial risk factors for suicidality in children and adolescents. European Child & Adolescent Psychiatry, 29(6), 759–776. https://doi.org/10.1007/s00787-018-01270-9}

_{Huggett, C., Gooding, P., Haddock, G., Quigley, J., & Pratt, D. (2022). The relationship between the therapeutic alliance in psychotherapy and suicidal experiences: A systematic review. Clinical Psychology & Psychotherapy, 29(4), 1203–1235. https://doi.org/10.1002/cpp.2726}

_{Kaess, M., Schnyder, N., Michel, C., Brunner, R., Carli, V., Sarchiapone, M., Hoven, C. W., Wasserman, C., Apter, A., Balazs, J., Bobes, J., Cosman, D., Haring, C., Kahn, J. P., Keeley, H., Kereszteny, A., Podlogar, T., Postuvan, V., Varnik, A., … _Wasserman, D. (2022). Twelve-month service use, suicidality and mental health problems of European adolescents after a school- based screening for current suicidality. European Child and Adolescent Psychiatry, 31(2), 229– _238. https://doi.org/10.1007/S00787-020-01681-7}

_{Livheim, F., Hayes, L., Ghaderi, A., Magnusdottir, T., Högfeldt, A., Rowse, J., Turner, S., Hayes, S. C., & Tengström, A. (2015). The Effectiveness of Acceptance and Commitment Therapy for Adolescent Mental Health: Swedish and Australian Pilot Outcomes. Journal of Child and Family Studies, 24(4), 1016–1030. https://doi.org/10.1007/s10826-014-9912-9}

_{McFeeters, D., Boyda, D., & O`Neill, S. (2015). Patterns of Stressful Life Events: Distinguishing Suicide Ideators from Suicide Attempters. Journal of Affective Disorders, 175, 192–198. https://doi.org/10.1016/j.jad.2014.12.034}

_{Murrell, A. R., Al-Jabari, R., Moyer, D., Novamo, E., & Connally, M. L. (2014). An acceptance and commitment therapy approach to adolescent suicide. International Journal of Behavioral Consultation and Therapy, 9(3), 41–46. https://doi.org/10.1037/h0101639}

_{Niederkrotenthaler, T., Floderus, B., Alexanderson, K., Rasmussen, F., & Mittendorfer-Rutz, E. (2012). Exposure to parental mortality and markers of morbidity, and the risks of attempted and completed suicide in offspring: an analysis of sensitive life periods. Journal of Epidemiology and Community Health, 66(3), 233–239. https://doi.org/10.1136/jech.2010.109595}

_{O_’Connor,R. C., & Nock, M. K. (2014). The psychology of suicidal behaviour. The Lancet Psychiatry, 1(1), 73–85. https://doi.org/10.1016/S2215-0366(14)70222-6}

_{Paula, W. de, Breguez, G. S., Machado, E. L., & Meireles, A. L. (2020). Prevalence of anxiety, depression, and suicidal ideation symptoms among university students: a systematic review. Brazilian Journal of Health Review, 3(4), 8739–8756. https://doi.org/10.34119/bjhrv3n4-119}

_{Surace, T., Fusar-Poli, L., Vozza, L., Cavone, V., Arcidiacono, C., Mammano, R., Basile, L., Rodolico, A., Bisicchia, P., Caponnetto, P., Signorelli, M. S., & Aguglia, E. (2021). Lifetime prevalence of suicidal ideation and suicidal behaviors in gender non-conforming youths: a meta-analysis. European Child and Adolescent Psychiatry, 30(8), 1147–1161. https://doi.org/10.1007/S00787-020-01508-5}

_{Yen, S., Weinstock, L. M., Andover, M. S., Sheets, E. S., Selby, E. A., & Spirito, A. (2013). Prospective predictors of adolescent suicidality: 6-month post-hospitalization follow-up. Psychological Medicine, 43(5), 983–993. https://doi.org/10.1017/S0033291712001912}