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As the second leading cause of death in college students after car accidents, suicide is a serious problem that can affect teenagers and young adults at an age when serious mental illness first manifests itself and often goes undiagnosed. A psychiatrist and an authority on suicide at Columbia University Medical Center and NewYork-Presbyterian Hospital offers parents and students advice on how to spot and address potentially suicidal behavior.

"College can be a difficult transition, with new independence, responsibilities and expectations arriving just as a student's previous support system of family and friends are often not readily available. To add to the problem, the late teen years are often when biologically-based illnesses, such as depression and bipolar disorder, begin to manifest themselves. And students, who are new at asserting and managing their independence, can be especially reluctant to seek out help," says Dr. David Kahn, vice chair for clinical affairs for the Department of Psychiatry at NewYork-Presbyterian Hospital/Columbia University Medical Center. He is also clinical professor of psychiatry at Columbia University College of Physicians and Surgeons and a staff member of the New York State Psychiatric Institute.

"While the warning signs of mental illness can be difficult to spot in the context of college where unusual sleeping patterns, experimental 'phases,' drug taking and binge drinking are common, there are several behaviors that should indicate that intervention is necessary," adds Dr. Kelly Posner, a leading expert in suicide research who helps the FDA and CDC on suicidality issues. She is an assistant professor of clinical psychiatry in the Division of Child and Adolescent Psychiatry at Columbia University College of Physicians and Surgeons and a child psychologist at NewYork-Presbyterian Hospital. She is also on staff at the New York State Psychiatric Institute.

Warning Signs

• Any signs of depression, such as sad mood, reduced interest and enjoyment in life and a sense of hopelessness.
• Withdrawing from friends and activities.
• Talking about suicide. This may be stated directly — "I'm going to kill myself." Or indirectly — "You would be better off without me," "I wish I were not alive any more," or "Soon you won't have to worry about me anymore." Eight of 10 suicides verbalize their intention to commit suicide.
• Giving away possessions.
• Abrupt change in personality and behavior — including appearing sad, anxious or hostile most of the time or displaying unusual calmness after a loss or period of depression.
• Sudden drop in school performance.
• Dwelling on an academic or relationship setback or other loss of prestige or physical health.

"Virtually all college students who take their own lives had a diagnosable, treatable mental illness. The issues that lead to suicide are usually temporary — sadly suicide is permanent. If treated, these students will receive the necessary tools to manage their depression and develop coping mechanisms later in adult life," says Dr. Kahn. "When you suspect that someone might be considering suicide, trust your instincts and, as awkward as it might seem, reach out to them and ask them about their intentions. This is an important first step toward getting them the help they need."

What to Do When You Suspect a Student Is Suicidal

Ask the following questions to assess their seriousness:

• Develop a relationship with them or strengthen your current relationship by being available to listen and talk. Show and say that you care about them.
• Ask directly about suicide. You will not be "putting thoughts into the person's head" or causing them distress — in fact, it's the best thing you can do. Don't act shocked or scared and don't argue about morality of suicide.
  • Are you thinking about hurting yourself or committing suicide?
  • When would you do it?
  • hat would you do?
  • What method(s) would you use?
  • How available is this method to you?
  • Who can you turn to for help?
  • When are your family members home?
• If you've determined that the situation is serious enough that they have a plan and means to execute the plan, do not leave the student alone unless you yourself are physically threatened.
• Call your college suicide hotline, security department or 911.
• Encourage the student to seek professional guidance. If they refuse help, contact someone in authority immediately — an angry friend is better than a dead one. Maintain contact with the student until help is secured.

"Almost half of all college students report being depressed at some time, and as many as 10 percent of all college students consider suicide in a given year. It is vitally important that young people, whether in college or not, understand that mental illness, including thoughts of suicide, is not something to be ashamed of and will not be penalized. Confidential treatment is available," says Dr. Posner. "Most people who have mental illness or depression are grossly undertreated and suffering silently. The most helpful thing one can do, which truly can be lifesaving, is to facilitate treatment."

Columbia University Medical Center's East 60th St. Location Expands Day Treatment for College Students

Columbia University Medical Center (CUMC) has expanded its existing Day Treatment Program to specifically address mental health problems in college age young people. The program is located at CUMC's East 60th St. location. The program provides psychiatric evaluation and treatment services for college students who are either currently enrolled in college, are home on break from college, or who have had to leave school to address mental health problems. It is unlike any other program in New York City in its emphasis on group treatment and the creation of a supportive community of peers with similar problems. Diagnoses that are treated in this program vary from depression to bipolar disorder to schizophrenia as well as eating disorders and addiction problems. The core of the program is diagnostic evaluation, paired with individualized treatment that may include medication, individual therapy and specialized group therapy programs. The Columbia Day Treatment Program specifically addresses the unique concerns of college age young adults and is aimed at returning young people to a level of function in society. For some this may mean a return to school, for others it may mean meaningful work environments or volunteer activities. After careful, thorough diagnostic evaluation, specific forms of psychological treatment are recommended for each patient. For more information about this program, call 212-326-8441.

Columbia Psychiatry

The Department of Psychiatry at Columbia University's College of Physicians & Surgeons is preeminent among academic medical institutions in clinical care, psychiatric research, and education about mental illness. Its world-class research, training programs, and state-of-the-art clinical services lead the translation of the latest scientific findings into standards of care for the field of psychiatry. As a result, the department has earned a reputation as among the best psychiatric programs in the nation. Clinical facilities and laboratories of the department are located in a matrix of institutions including Columbia University Medical Center, the New York State Psychiatric Institute and NewYork-Presbyterian Hospital. For more information, visit www.columbiapsychiatry.org.

NewYork-Presbyterian Hospital/Columbia University Medical Center

NewYork-Presbyterian Hospital/Columbia University Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and its academic partner, Columbia University College of Physicians and Surgeons. NewYork-Presbyterian/Columbia provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, research, education and community service. NewYork-Presbyterian is among U.S.News & World Report's top 10 hospitals nationally and also comprises NewYork-Presbyterian Hospital/Weill Cornell Medical Center and its academic affiliate, Weill Medical College of Cornell University.