Suicide risk, prevention, and disparities on college campuses

[00:00:39]

ELENA RENKEN: Hi, everyone, and welcome to SciLine’s media briefing on suicide risk, prevention, and disparities on college campuses. My name is Elena Renken, and I’m SciLine’s journalism projects editor. With school years starting for many colleges, we’ll cover what research shows us about the trends in suicide risk among college students, disparities affecting minority student groups and the impact of discrimination and effective prevention efforts.

We’ll also explore suicide contagion and suicide clusters, as well as other key terms and context for journalists. If you’re not familiar with SciLine, we’re an editorially independent nonprofit based at the American Association for the Advancement of Science. All our services for journalists are free, and we’re philanthropically funded. We aim to make it easy for reporters to use scientific evidence and expertise in all kinds of stories you’re already covering. Maybe that’s a topic with a clear science angle like measles cases, or maybe it’s a topic where the scientific angle is less obvious but just as crucial, like election integrity or gas prices. More of our resources are available on sciline.org.

If you’re looking for a scientist’s expertise on a story you’re covering now, you can click the blue I Need an Expert button on our site, and we’ll look for a source with the right background to answer your questions before your deadline. Now, before we start, I’ll give each of our expert panelists a moment to introduce themselves. Dr. Adam Horwitz, would you go ahead?

[00:01:43]

ADAM HORWITZ: Sure. Thank you. I’m Adam Horwitz. I’m a clinical psychologist and an assistant professor in the department of psychiatry at the University of Michigan. My research focuses on developing and evaluating interventions that incorporate technology, things like wearables, mobile applications, text based interventions in order to increase accessibility of mental health interventions with an emphasis on depression, PTSD, and suicide risk.

[00:02:08]

ELENA RENKEN:  Thank you. And Dr. Jasmin Brooks Stephens?

[00:02:12]

JASMIN BROOKS STEPHENS:  Hi, I’m Dr. Jasmin Brooks Stephens. I’m an assistant professor and clinical psychologist at the University of California Berkeley. My research focuses on addressing racial trauma and suicide in black young adult communities, primarily through strengths-based approaches. So understanding what are the strengths and protective factors that can reduce suicide for these groups through mixed methods approaches, so interviews, surveys, and yeah, fieldwork. Thank you.

[00:02:40]

ELENA RENKEN:  Thanks. And, Dr. Christine Yu Moutier?

[00:02:43]

CHRISTINE YU MOUTIER:  Hi, everyone. Nice to meet you. So I’m Christine Moutier, and I’m a psychiatrist. I serve as the chief medical officer at the American Foundation for Suicide Prevention, which is the leading national nonprofit. We say fighting suicide through funding research. We’re the leading private funder of all suicide and suicide prevention research, globally, and we aim to translate research and disseminate into clinical practice and community-based and public health strategies. We have a chapter network across all 50 states to help us do that. Also involved in policy and advocacy. And so it’s science meets grassroots, real volunteers and people with lived experience, both losses and personal struggles, which includes myself, so happy to be here today. Thank you.

[00:03:33]

ELENA RENKEN:  Thank you. And I appreciate all of you bringing your expertise to the table here today. I’ll be asking each of our panelists a few questions before we start taking questions from the audience. So journalists, you can submit your questions at any time during the briefing. Just click that Q&A icon at the bottom of your Zoom screen. And please do let us know if you’d like your question directed to a specific panelist. The recording of this briefing will be up on our website later today, and a transcript will be added in the next couple of days. With that, I will get started. Dr. Horwitz, my first question for you is, how do clinicians and researchers define suicidal ideation and suicide risk? And why do precise definitions matter for reporting?

[00:04:16]

ADAM HORWITZ: Yeah. This is an important question because obviously there’s a lot of nuance and features of suicidal thinking. At a broad level, suicidal ideation refers to thoughts about ending your own life and can range from what we often refer to as passive ideation, which might be wishing to be dead or going be able to go to sleep and not wake up, but not necessarily having any method or plan or intent behind them. That can also then extend into more active forms of suicide ideation, where there might be specific methods, plans involved, and maybe some degree of intent to act upon those thoughts.

Suicidal behaviors are distinguished from thoughts or ideation by that transition into action, which might include things like preparatory behaviors. So these are things like giving away possessions, writing a suicide note, gathering or obtaining the means of making a suicide attempt, and up to and including actual suicide attempts, which we define as someone engaging in an act of self-harm that they believe has the potential to cause death and have at least some intent to die from that action.

Suicide risk can be a little bit more tricky. It’s a bit of a broad concept, but basically refers to this balance between the risk factors for suicide, things like depression, loneliness and burdensomeness, weighed against some of the protective factors or things that might make suicide less likely, things like having strong supportive relationships, a sense of purpose and meaning in one’s life.

It’s this clinical judgment that comes into play when weighing those two things against each other. Since there is so much variability in those concepts or within suicidal ideation behaviors, using precise definitions can be helpful so that we really know what we talking about when it comes to a particular situation and making sure that we’re not overstating things, and likewise, not understating things either.

[00:06:11]

ELENA RENKEN:  And what do current data show about suicide rates among college students compared with similarly aged non-students?

[00:06:19]

ADAM HORWITZ: Yeah, so suicide risk is higher in the young adult group, both college students and their same age peers. It’s actually slightly higher among those who are not in college. Individuals in both groups might be undergoing major transitions, whether that’s entering college, entering the workforce, there might be a lot more independence, self-reliance, less structure, from a biological standpoint, folks in their later teens, early 20s. That’s when we sometimes see first onset for different mood disorders come into play.

The prefrontal cortex, which is in charge of our judgment and decision-making is still not fully developed until mid-20s, so there’s still susceptibility to that reward and pleasure center, which can lead to risky behaviors, things like substance use. You might have some of those academic pressures in college that might contribute to an increase in symptoms, but you also have more mental health services available often in those types of settings, which somewhat balances it out.

Oftentimes, there are just these more preexisting differences, whether from a mental health or environmental, economic, things that might distinguish those who go to college from those who don’t go to college. Those who don’t go to college includes folks who may not have graduated high school, and that might be because of a substance use issue or a mental health issue and things like that. It’s not necessarily setting itself that is either protective or risky, but there are some of those pre- selection factors that might come into play that makes risk a little bit higher among those who are not attending college.

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ELENA RENKEN:  And what trends have researchers observed over the past decade in student mental health and in suicide risk?

[00:08:01]

ADAM HORWITZ: Yeah. We’ve seen the rates of mental health conditions increase quite a bit over the past few decades. The rates have somewhat stabilized a bit. They peaked in the year or two after COVID and came back down, but they’re still quite a bit higher than what they were about ten years ago. For example, there’s this annual what’s called the Healthy Mind study that surveys college students from all sorts of different institutions across the United States.

And in the most recent cohort, 37% were meeting that screening threshold for probable depression compared to 25% back in 2015, 2016. Likewise, lifetime history of a psychiatric diagnosis was at 50% in this most recent one, that compares to 30% in 2015, 2016. We also see increases, likewise, in suicidal ideation plans and attempts. At the same time, we also see rates of treatment seeking increasing in those groups, with 38% receiving therapy in the past year compared to only 23% in the 2015, 2016 cohort.

And also, improvement even among those who have symptoms or who are screening positive on the screening surveys, 61% of those have had treatment in the past year compared to 49% in that earlier year. So it’s not strictly pure correlation of more people with the conditions seeking treatment, but also more treatment seeking among those who are reporting symptoms.

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ELENA RENKEN:  Yeah. What warning signs or behavioral changes should journalists and campus communities understand as potential indicators of elevated risk?

[00:09:44]

ADAM HORWITZ: Yeah, so there’s a long list of different warning signs or indicators. Sometimes it’s people talking about feeling trapped, hopeless, feeling like a burden, experiencing unbearable pain. On the behavioral side of things, you might see more substance use or risky behaviors, withdrawing from others, isolating, giving away possessions. From a mood standpoint, you might see irritability, loss of interest or apathy.

I think it’s a little bit tricky though because these signs are going to look very different from person to person and people also differ quite a bit in how much they might be communicating about their struggles versus not communicating. I think something that highlights this difficulty is that sometimes a sudden improvement in mood can actually be a potential warning sign because if you have someone who’s been struggling and contemplating suicide, if they reach that point where they’ve kind of made this decision that they’re going to do it and they’ve made this plan, there may be temporary relief or they might seem a little bit better to other people because they’ve resolved that internal ambivalence, but they’re still at risk. And so it remains a very challenging thing to prospectively identify. A lot of folks can look back after something has happened and pick out those warning signs, but to do it in a forward fashion is something that we continue to try to improve at, but remains very difficult to do.

[00:11:18]

ELENA RENKEN:  Thank you. That’s a good point to remember that it’s not always clear and it doesn’t always look the same way. And what misconceptions about suicide risk among young adults persist? And what does the evidence actually show about those?

[00:11:33]

ADAM HORWITZ: Yeah, so there’s a number. I think one that I’ll point out is that, sometimes folks perceive a non-fatal suicide attempt as being a form of, you know, seeking attention or a cry for help, when in reality, the vast majority of suicide attempts, whether fatal or non-fatal or regardless of what the method is that they’ve used, they’re done with ambivalence.

People who attempt suicide, there is parts of them that do want to live and do want to have a future, and that’s pushing up against this part of them that can’t cope with the pain or burden or struggle or whatever they’re dealing with. So the presence of ambivalence shouldn’t necessarily be treated as something that is an indicator that it wasn’t serious or they didn’t mean it. Every suicide attempt should be taken seriously.

[00:12:30]

ELENA RENKEN:  Great. Thank you very much. And now let’s move on to you, Dr. Stephens. To start off, what does current research tell us about suicide risk among gender and sexual minority college students? And what factors contribute to that risk?

[00:12:46]

JASMIN BROOKS STEPHENS:  Absolutely. So what the current research is showing is that a recent study by Danielle Busby and colleagues really found that and highlighted this more national statistic that lifetime history of suicide attempts are approximately 4% in the general population, 11% among sexual minorities, and 40% among gender minorities. And really, a lot of the reasons for this is when we think about our more known and traditional risk factors for suicide ideation, some of those can include what we call thwarted belongingness or this lack of belonging with other individuals.

You’re seeing that reports of some of those factors are higher in SGM communities. And so we’re seeing higher risk and reports of harassment, victimization, discrimination. Those are some of the risk factors that are associated with increased risk of suicide for sexual and gender minorities. But we’re also seeing, as I mentioned, a lot of my research does work on strengths and protective factors. And so when we think about LGBTQ+ identity affirmation and increasing a sense of connection and increasing the sense of belonging, research and evidence does point to that being helpful in reducing risk for suicide.

We’re also seeing that clinical interventions that emphasize this identity affirmation and connectedness due to increased reports of, as I was saying, some of that harassment, victimization and discrimination experiences. And I also want to emphasize that within group differences do matter that we are seeing that whether this is looking at research, Trevor project, annual reports. I encourage you all to review that, as well. But one in four black transgender and non-binary young people do report a suicide attempt in the past year. And so we’re also seeing a lot of differences when we look within groups, as well, when we consider some of the more recent rates for sexual and gender minority young adults.

[00:14:44]

ELENA RENKEN:  Thank you. Those differences are really important to remember for reporters, as well as I know a lot of reporters are often looking for next steps in their stories or mitigation measures, so there is a lot to mine there. Since the 988 hotline removed the option to speak to someone trained in supporting LGBTQ+ people, has there been any impact on suicide risk that we can detect?

[00:15:07]

JASMIN BROOKS STEPHENS:  So I want to emphasize that there has not yet been a published study that has isolated the effect of removing the option on suicide risk for certain groups. But with that, there is evidence to consistently show that community-level safety nets, which include 24/7 hotlines, text and chat that are staffed by LGBTQ+ supportive counselors are essential public health infrastructure.

There is research to support that. There’s also support that removing this safety net for a certain group may lead to increased risk. But again, I want to highlight that there is not a published study that can confirm that, but there is evidence to support that. There’s also evidence to support that population specific hotlines do increase help seeking by providing culturally sensitive care. For example, there was a recent study in 2023 by Zabelski. I can provide that if folks are interested, but they found that nearly half of callers to an LGBTQ+ youth crisis line reported that they would have not contacted. a non-LGBTQ+ line. So again, really underscoring that role of culturally sensitive care that comes from population specific hotlines.

[00:16:26]

ELENA RENKEN:  Thank you. And what is known about the role of racism, racial stress, and race-based trauma in shaping suicide risk among Black college students, particularly?

[00:16:36]

JASMIN BROOKS STEPHENS:  So first, I want to highlight that when you look at suicide rates amongst black young adults and black college students, we are seeing that rates are increasing. Dr. Horwitz mentioned that healthy mind study, that’s a great resource for showing this as well. The Jed Foundation recently analyzed CDC data, and they actually found that suicide rates amongst black young adults aged 20 to 24 surpassed those of white peers.

Again, when we’re often thinking about how black individuals may not be as increased of a risk, some of these findings are really important for understanding just how much suicide rates are increasing for black young adults. We’re seeing that the death rate as well, has really increased exponentially for black young adults. When it comes to understanding the role of racism, racial stress, and race-based trauma, my answer will go a lot towards what I started to mention to you all around sexual and gender minorities, that these are interpersonal and structural forms of making someone feel uncomfortable in their identity and identities.

Especially when it comes to racial discrimination, racial trauma, we don’t necessarily have control over receiving. So that can fuel a lot of the hopelessness that you are seeing that can lead to risk for suicide. And so a lot of my work has really focused on that of demonstrating that racial discrimination and racial trauma are associated with increased suicide risk for black young adults. This identity-based discrimination is associated with increased risk for suicide.

We’re also seeing that, similar to some of those protective factors, finding supports that cultural and racial student organizations, being a member of some of these organizations can be associated with lower odds of suicide risk, and being referred to some of that culturally responsive care can be helpful in reducing some of those consequences. But certainly, through various studies that I’ve done, through various studies that exist in the literature, we have shown that racism and race-based trauma, specifically, those more traumatic symptoms that result from repeated exposure to racism can be associated with increased risk of suicide and decreased sense of belonging, as well.

[00:19:00]

ELENA RENKEN:  Thank you. And what barriers prevent many college students, particularly minority students from accessing mental health services?

[00:19:09]

JASMIN BROOKS STEPHENS:  Yeah. So, similarly, I will speak to, broadly, what the research supports in answering this question. And so studies show that cost and insurance gaps certainly are factor. We also see counseling center capacities. So wait list, session caps, staffing ratios, that can also be a potential barrier. And then, additionally, a lot of community colleges or minority serving institutions actually have, again, this larger burden where access to care and access to receiving these services can come with additional barriers there, just availability.

We also need to really think about the availability of culturally responsive care. So yes, we have the access to care, but then, once you get in the door, what is the likelihood that you receive services that validate your identity that don’t lead to further microaggressions? Those are the barriers that, also, a lot of minority students face, that they’re feeling this anticipated discrimination or also institutional mistrust. And so these are some more of the barriers that we see for minority college students.

Also, we have the role of stigma. So a lot of research supports that there are family, community-level norms around disclosure, particularly around mental health concerns. And yes, so we have stigma as well as what I really highlighted there, not just that access to care, but also the culturally responsive care that occurs once you’re there. Are you asking questions about racial discrimination? Are you asking questions about their sexual and gender minority status. Those are things that aren’t routinely in a lot of our screeners. And so sometimes that can lead to not feeling validated or seen or heard when they do seek mental health services in these settings.

[00:21:08]

ELENA RENKEN:  And what interventions or campus policies have shown promise in reducing disparities and improving mental healthcare access?

[00:21:16]

JASMIN BROOKS STEPHENS:  I want to emphasize, again, not necessarily causal evidence, here, but yes, that some of the policies that have shown promise is when you have more embedded counselors or even drop-in models, particularly if those occur in cultural centers, identity centers, as opposed to just the broader counseling center. So those have shown promise.

One example of the drop-in model is Let’s Talk, from Cornell, where they do offer informal confidential consultation as a drop-in service. That has been shown to be helpful, as well. Universal screening that then offers direct referral to care has been shown to be protective, as well. So a study by Kodish, in 2021, found that, in research protocols that happen at college, that embedding screening and treatment and referral to treatment within the study had a very positive effect on allowing college students, particularly college students of color, to receive mental health services there. So again, having that more direct connection that could reach everyone as opposed to having that individual have to then find the service themselves, that has been shown to be helpful.

Digital mental health tools have shown significant promise, particularly for college students, when it comes to opportunities to receive care in this way. Removing costs has been shown repeatedly to also increase ability to seek care and reducing those disparities is when those financial barriers can be lifted. Also want to encourage you all to review JED Campus. So that’s a four-year program that provides colleges and universities with expert support, evidence- based recommendation practices. So far, over 400 colleges and universities have participated in JED Campus training, and that has been shown to lead to students at these schools reporting less suicidal ideation and attempts, according to their annual report. So yes, those are some examples of things that can lead to those reduced disparities and improved access for college students on campus.

[00:23:36]

ELENA RENKEN:  Thank you so much. Now I will turn to you, Dr. Moutier. My first question, what are some important opportunities for suicide prevention on college campuses and what roles can universities, faculty, staff, peers, student organizations play in supporting help-seeking and reducing risk?

[00:23:57]

CHRISTINE YU MOUTIER:  Sure. Thank you for this opportunity to speak about this. Suicide prevention on college campuses, I think, in the past, was a bit of an afterthought. It was reactive in response to suicides or crises that were occurring, and we know that suicide is a complex health outcome. A public health approach, when it is applied really robustly, it means that there will be a true prioritized strategic plan that’s sustained and measuring the impact of all of the multi-tiered approaches, Dr. Stephens covered many of them, that is then adjusting and measuring against, as time goes on, much like the four-year JED Campus program.

Suicide prevention is generally not a one and done, slice in time way to see success with this. So again, having the leadership prioritize suicide prevention with a strategic plan with clear objectives and with accountability so that the measurement actually feeds back into the system with leadership support. And a public health strategy can look like a number of, again, layers, and we have to think about the fact that protective factors for suicide include increasing sense of belongingness and building community and connection.

Another thing that is really important is that a strategic plan needs to build a connected network so that every member of the campus, faculty, staff, and peers, as well as anyone who has eyes on students knows what to do when they become concerned about a student. Having that coordination that is campus-wide is a more modern approach to suicide prevention.

Peer-to-peer programs are really important because oftentimes young people do not reveal when they are struggling, although their peers may be the first to know and they’re more likely to tell a peer. And so peer-to-peer programs have been shown to have success, and educating staff and faculty so that there are reasonable approaches even within the classroom, within an academic setting, that take into account that mental health is dynamic, suicide risk is present in every classroom, in every setting, that any of us are in, actually, in any place, including out in the community.

And so understanding that struggle is oftentimes hidden so that policies around attendance, deadlines, leave of absence, when students need it, that really care for that student as a whole person rather than splitting their academic performance from their mental health and their brain health. Anything that encourages early connection to support, both peer support as well as clinical treatment, can reduce suicide risk. So much of what we’ve already heard from my colleagues, that anything that makes help- seeking psychologically safe, concretely attainable, lower cost. There needs to be something that meets people in the moment of their need.

And as I mentioned before, because of the shame and stigma, reaching in becomes a very important part of suicide prevention and not only relying on the person in distress to reach out. I’ll close this part with just two quick things. Lethal means safety, access reduction is a really critical component on college campuses as well as other workplaces to reduce suicide risk, and we can talk more about that with regard to lethal means safety if that’s of interest. And then, we have a saying in the suicide prevention field that postvention is prevention, and that means that after a suicide has occurred, there are a series of steps, communication-wise, allowing the community to grieve and that also decreases risk of suicide contagion, which I believe will get into that topic a little bit more.

[00:28:10]

ELENA RENKEN:  That’s very good to know. Thank you. What campus policies or practices can unintentionally create barriers to help-seeking? Are there common approaches that may be well intentioned but have unintended consequences?

[00:28:24]

CHRISTINE YU MOUTIER:  Yes, I will highlight a couple of specific policies, but I’ll just preface by saying that, oftentimes, with all good intentions, when a well-intentioned policy or practice does not land well or feel attainable or psychologically safe when people can’t see themselves in those resources, those are the ways that they fall short. And so having student representation as well as other representatives from the campus is a really important part of developing policies and programs and procedures.

Now, the two specific policies that I’ll just highlight, because there are many things we could talk about, but mandatory or involuntary leave policies have to have very careful consideration because what that has looked like in its worst shape, that is frankly illegal, is when a student has a health symptom like suicidal ideation or behavior and has been forced to either take a leave of absence, or even worse, to be expelled. And so there are times and places where a leave of absence is necessary for their health and well-being.

The clear communication and parameters around that need to have extra consideration because nothing drives people into silencing distress more if they hear the stories, even if it’s not on your own college campus, that this is still happening in this day and age, that a student can be expelled for revealing their suicidal thoughts that really should be a never event because, again, suicide is a health issue, and suicidal thoughts are symptoms and signs of distress, and we want to encourage people to disclose those.

The other policy that I will mention that is actually a really good one but needs to be handled with care, these are called medical amnesty policies. And this says to students that if you are in distress or you know a student in distress, but there was something that you’re worried about revealing because it might come back to hurt you with a disciplinary event. So for example, if alcohol or other substances are involved or other code of conduct issues were involved in a crisis situation, medical amnesty policies would provide protections for those students to raise their hand, either about themselves or their peers, so that they do not need to fear those punitive consequences and so that students can get the help that they need.

[00:31:12]

ELENA RENKEN:  And what does research tell us about suicide contagion and suicide clusters among college students, among young adults. Why is this particularly relevant to colleges and universities?

[00:31:25]

CHRISTINE YU MOUTIER:  Right. This is really relevant for a media briefing and thank you all for joining us here, those of you who are journalists and reporters. Suicide contagion is a real valid phenomenon that is known to occur when an individual has an exposure to others suicide or suicidal behavior and when they are already struggling or have risk factors for suicide. Contagion is not thought to generally occur amongst a well group of individuals exposed. However, with peer exposure, that is one known way that suicide contagion can occur, but media messaging and also campus leadership messaging can also impact the risk for suicide contagion.

So contagion with regard to suicidal behavior is thought to occur via several psychological and neurological mechanisms where if you think about how we are hardwired as extremely social creatures, and in a very unconscious way, there are mirror neurons in our brain that are constantly at work that create imitative behaviors. Again, not thought to occur amongst young people without suicide risk factors already at play. But again, this is an unconscious process that occurs and so suicide clusters are when multiple suicides occur within a period of time or within a geographical location that are thought to be at a higher rate than would typically occur.

Those clusters have been observed both with peer exposure to suicide, as well as media exposure, as well as after a suicide has occurred if postvention protocols are not closely followed. This is something that is extremely concerning that can occur, and the reason it is especially important for college campus work is that suicide contagion is more likely to occur amongst youth and young adults than middle to older age adults.

That has to do with the developmental stage of peer-to-peer influence and that ability for the brains of developing young people to be more influenced by those messages and peer behaviors. It’s also true that suicidal ideation and impulses are highest when you look across the lifespan amongst younger people. Now, on college campuses, these tend to be very socially close-knit communities where a sense of isolation can absolutely occur. And so all of those risk factors can be accentuated because of the age, because of the developmental stage, because the age of onset of mental health conditions tends to be around that time as well. And so suicide contagion, and again, the mitigation, the prevention of contagion needs to be a strong part of suicide prevention efforts on college campuses for all of those reasons.

[00:34:56]

ELENA RENKEN:  Thank you so much. I’m now going to start asking questions to our experts from the audience. So reporters on your line, please submit your questions using the Q&A box found at the bottom of your Zoom screen. So the first question that I have for all of you is, how can media coverage avoid inadvertently contributing to suicide risk while still reporting meaningfully on the issue? Dr. Horwitz?

[00:35:25]

ADAM HORWITZ: I think there are a number of different considerations. I know that AFSP kind of have guidelines and a website that lays out a bunch of particular recommendations. I think one thing in particular that’s on that list that I know for me is one that I think about a lot has to do with interviewing family members of individuals who have maybe died from a suicide attempt, and oftentimes I see the quote and what might be very comforting for families is this idea of someone no longer being in pain or they’re free from that struggle.

And while for many folks, that thought, again, family included, and to most lay people, that idea may be comforting and potentially harmless. And at the same time, when come across someone who might be more vulnerable to suicide or has been thinking about suicide, getting that reinforcement around the idea, that we don’t necessarily want, which is this idea that suicide is a solution to that problem of that pain or of that struggle.

And sometimes, those comments, when quoted, while potentially comforting for the family, no one needs to say, Oh, no, family, you can’t believe that, but from a reporting standpoint, being mindful of that message can potentially create an inadvertent harm to someone who may be contemplating suicide and reads that.

[00:37:03]

ELENA RENKEN:  Thank you. And Dr. Brooks Stephens?

[00:37:06]

JASMIN BROOKS STEPHENS:  Yes. So I was also going to point to a really good resource preventing suicide, a resource for media professionals through the World Health Organization. So really, also, I would consider that. But a couple that I would like to highlight from there is that it can really be an opportunity to educate the public about the facts of suicide and suicide prevention based on accurate information, and also an opportunity to provide accurate information about where to seek help.

So I think, not just reporting and then leaving, but really using it as an opportunity to provide resources and to provide psycho-education, since those are also things that we know that can be helpful and that a lot of individuals have access to the media. I think, similarly to what Dr. Horwitz was just saying, I think the other thing that has come up a lot in our conversations is the celebrity suicides and how you all report on celebrity suicides.

I acknowledge that certainly that is a popular topic when it comes to reporting. I’m thinking about Cheslie Kryst. I’m thinking about Twitch, especially, recently, given how I told you all that I work primarily with Black communities, but those are certainly particular instances where I think that they provide great guidelines on not just how you report them and understanding that these reports can be linked to suicide deaths amongst vulnerable readers.

And so glorifying a celebrity’s death may inadvertently suggest that someone receives more acknowledgment in the media if this happens, right? And so just really being mindful on how you’re also focusing on the celebrity’s life, how they contributed to society, and their death may negatively impact others. It provides really good guidelines on that as well. But I think particularly when it comes to celebrity death, that was one that I also wanted to highlight, but really making sure that you all understand that it is an opportunity to provide education and solutions and just resources as well.

[00:39:13]

ELENA RENKEN:  And Dr. Moutier?

[00:39:14]

CHRISTINE YU MOUTIER:  Yeah. There is actually quite a large body of research that really clearly points to certain features in reports and even headlines that are linked to increases in suicide contagion, unfortunately. They include some things that really go against journalistic normal instincts, which makes it extra tricky, things like including the method, the actual lethal means and method of death, even reporting repeatedly on the same celebrity’s suicide, over and over again, has been linked to increases in death in that age group demographic by that method.

So there’s a host of opportunity, though, as well, not portraying suicide as an inevitable outcome, balancing those stories by messages that show people who have lived through struggles, those actually have been linked to the opposite, positive effect. So there’s something called the Werther effect, which is what we’re talking about in terms of contagion. But the Papageno effect has also been shown, which is when these positive narratives with help seeking can actually reduce suicidal behavior.

So I’ll just say that all of this is not only in the World Health Organization resource that Dr. Brooks Stephens mentioned, but AFSP has just launched this new web resource called the safe storytelling studio, at afsp.org, and I would just encourage you to go there because it has things for newsrooms and editors, as well as journalists, as well as entertainment content creators and influencers. So there’s different ways that the research can be applied.

[00:41:06]

ELENA RENKEN:  Thank you all. I have a first question here, from the Sacramento Observer, that’s directed at Dr. Stephens. There have been a number of deaths recently involving Black people found hanging, including a young man on a college campus in Mississippi, in 2025. The incidents are typically ruled as suicides, which some have questioned given both the current climate and history of lynching in America. How can journalists report on these incidents without ignoring the historical context of racialized violence?

[00:41:39]

JASMIN BROOKS STEPHENS:  Yeah, that is a really good question. Well, one, think about what you all just heard. And especially, I liked the points that doctor Moutier just highlighted at the very end, as well, of just how not reporting the method, and I think that’s going to be particularly important in these instances. I think that I understand that, as journalists, you all may be bound if that is the report.

I think that there are some potential real barriers there, but I do think that, as much as you can, realizing and thinking about some of those opportunities that we mentioned here and how to report on suicide deaths, thinking about ways to also provide resources, thinking about ways to discuss the person’s life story, as well.

I think that, certainly, what we just mentioned could be helpful when it comes to some of these instances, but I think that, on the same side, even if you can’t necessarily connect what has happened through a journalistic perspective, talking about the role of racism, talking about ways to overcome some of those experiences that I mentioned around the sources of affirmation, around potential ways to share resources and hotlines for Black communities, like, are there still ways that I can still discuss some of this work so that if people are experiencing that, they feel validated in seeing that not only is racism still linked to these outcomes and are people still reporting on it, but that there are also some ways that I can seek help or there are some resources that are available to me to where I can feel, again, that source of validation and psycho-education there.

Let me know if that doesn’t answer. I think that when you’re being mindful of if you can’t necessarily explicitly link them. Are there ways to still provide and do some of those recommendations that we just discussed to you all that would leave that individual feeling validated in that space?

[00:43:44]

ELENA RENKEN:  Thank you. I have a question here from the New London Day, that’s based in Connecticut. What stories do the panelists wish journalists would tell to, A, help prevent suicide among college students, and B, help support students whose friends have taken their lives? Is anyone able to jump in on that one?

[00:44:07]

CHRISTINE YU MOUTIER: I can certainly kick us off here and then turn to my colleagues. When covering the topic of suicide, there are actually a multitude of opportunities to allow people who are at risk to feel more seen, heard, and part of a community. The lived experience movement, as it’s called, is very strong, and there are any number of people who’ve experienced loss, their own struggles or having supported a loved one through mental health crisis or suicidal struggles, who are available to help tell their stories.

And it’s already been highlighted that, try to think about suicide as a public health matter so that you’re not only covering it after a death has occurred. Now, after a death has occurred, that is a moment where the public’s attention is already on the topic, as mentioned by Dr. Brooks Stephens and Dr. Horwitz, where that opportunity is to actually get some of the facts out, the correct language, not using, commit suicide, but died by suicide, not using judgment- laden language like failed or successful attempt, but rather just plain language, like an attempt means that they didn’t die by suicide.

Again, even after a suicide has occurred, there could be space in a story to talk about the movement that’s going on through organizations like Black People Die by Suicide Too, or Black Girl Therapy, or other culturally-attuned resources, or Out of the Darkness Walks, tell an incredible story of a quarter of a million people coming out to walk and speak about their experiences of loss or lived experiences.

So there are a number of ways to allow college students to feel a sense of hope through stories about suicide. Then, as for the loss experience, again, part of the lived experience community includes suicide loss. That is a very strong powerful group within the suicide prevention movement where connection, healing, making meaning, the grief journey, being a focus, actually, and a part of our research portfolio at AFSP and part of suicide prevention.

Something I will just point out is that when we say the phrase suicide prevention, to some people, especially loss survivors, that may land on their ears like we’re saying every instance of suicide could be and should have been prevented, when other leading causes of death that are complex health outcomes, we would not misinterpret the word prevention to mean every instance can be prevented.

Think of it as, I always ground myself with heart disease or diabetes, other complex health outcomes that will hold you in good stead. So prevention, we even say things like suicide can often be prevented or can be preventable, just so that, to the loss survivor, it’s not landing in that way that just reams even more coals of shame and guilt and self-blame.

[00:47:37]

JASMIN BROOKS STEPHENS:  Yeah, I think that was a fantastic answer. I think, one thing to add, going on that thread, when you’re thinking about these groups, interview people who have overcome these thoughts. I mean, where can we tell stories of overcoming? I think that that will be very important when this is happening, or thinking about, speaking of survivors, as well, is how do we tell those stories of tools that, if we are thinking about, how can we be helpful, making sure that, after reading your article, would individuals who are experiencing this themselves, would that trigger, then, just all that I have learned is that this is happening to more people and that there’s nowhere to turn and that the people that I look up to are choosing to die by suicide. So then, why would I have hope?

Like, that is what you want to ask of just what are ways that I can prevent that? How can I provide resources? How can I provide stories of overcoming? How can I also, while reporting on these factors, make sure that I’m leaving individuals with a way to seek help that is, again, either culturally informed or informed based on their age group, or both. I think that those could be things to really be mindful of, taking a step back from what we are saying to you all, but just really thinking about it on that person level of just, how are people leaving your article? What do you think you are leaving those individuals with? Like I said, taking that step back from the research talk, really quickly, I think that’s just really important to me, to highlight here.

[00:49:18]

ELENA RENKEN:  I have a question here from the New York Times. How easy or difficult is it for families, teachers, or medical providers to predict a suicide? What are the most common screening tools? How accurate are they? And what steps can be taken if risk is deemed high? Is anyone able to start us off there?

[00:49:39]

CHRISTINE YU MOUTIER:  I mean, there’s a whole section of the scientific field that has been pursuing suicide risk prediction. It’s been one of our RFPs for the last 10 or 12 years, and we’re getting closer, from a large health system, lots of clinical data perspective. But I just want to tease apart that, with prevention, you can identify those whose risk is present, just like we do with heart disease, without getting into this sense of, in order to prevent, I have to be able to predict, because that is not the case, and that’s not what cardiologists do around heart disease. They see the risk factors and they go after them, any modifiable risk factors, reduce them, any protective factors, enhance them.

And that’s part of the suicide prevention effort. So there are validated screening tools, for sure, that should be used in clinical settings. Now, outside of clinical settings, like Dr. Jasmin Brooks Stephens was mentioning, and maybe Dr. Horwitz, as well, there are safe community- based screening tools, but they have to be used with care so that the community does not feel that they’re being used to weed out students. That can be an issue if you haven’t built up the trust and the infrastructure to handle those positive screens with care.

[00:51:11]

ELENA RENKEN:  Anyone else want to add to that?

[00:51:15]

ADAM HORWITZ: Echoing that main aspect. I think we all get caught into the trap, and I’m definitely part of that group that has been involved in that research of trying to get that prediction and very much agree that you can start to identify groupings in terms of risk classification. But within that, particularly not just the who but also the when is also an aspect that makes it even more challenging because you could identify someone who writes the same way as a heart attack of, a lot of times those things are structured.

This is someone who’s percentage of a heart attack in the next ten years might be X percent, and so we’re going to recommend this thing. When it comes to preventing suicide, you can’t just admit someone into an inpatient hospital for ten years because of a particular percentage, and so it’s this very dynamic challenge of not just who is at risk, but also when are they at risk and can you appropriately tailor the approach or treatment or support around those times.

And it’s never going to be a perfect indicator because suicide itself is a very low base-rate event, you’re always going to have this false positive ratio where, for every person who does die by suicide, there may be however many other people who have a similar profile who do not die by suicide. And so just from a mathematical standpoint, it is a very challenging thing to do at any individual person level, but again, at more group-based levels, public health- type approaches to try to put those supports in place to reduce the overall outcome.

[00:53:06]

JASMIN BROOKS STEPHENS:  Yeah, I was just going to very quickly add that I did a fellowship with some folks at Harvard that were leading some of this work on prediction. I’m going to advocate, as well, for the algorithmic bias that occurs here that has the potential to fuel disparities, even more for persons of color, when they’re developing these clinical prediction tools, which was part of the reason I stayed on, to try to push this in a better direction.

These tools are being developed with samples sometimes less than 5%, that are just non-white, not even specific groups. And so when we’re thinking about some of the racial and ethnic disparities, some of the disparities for gender and sexual minorities that I mentioned, these individuals are extremely underrepresented when we’re developing these clinical tools.

And so on top of what Dr. Horwitz and Dr. Moutier just said, we also are just extremely under-representing minority communities when we are moving this needle and prediction tools. And again, some of my work has done algorithmic bias broadly when it comes to health prediction tools, but that is something to really keep in mind, as well, is are we accurately representing all lived experience and all perspectives when we’re moving this needle towards prediction?

[00:54:23]

CHRISTINE YU MOUTIER:  I do just want to drill down on one really important thing I heard Dr. Horwitz say about the timing, and that one thing that can be done by parents and college administrators and teachers and peers is looking for those moments of transition where anyone can be a little bit destabilized by the start of college, where identity formation is already in play, by humiliating or challenging disciplinary events. That is a moment where most people will get through it, but people with suicide risk factors, it’s going to land in a more accentuated, more stressful way because of those cognitive features of perfectionism and sometimes very rigid cognitive distortions.

So we can all just become a little bit more savvy about recognizing those moments of vulnerability. And I know it’s a really broad one, but life transitions. If you think about veterans, with higher suicide rate, one of the peaks is when they’re transitioning out of active duty into civilian veteran status. And similarly, for college students, there’s all these sort of different transitions they go through.

[00:55:39]

ELENA RENKEN:  Thank you. Now, we’ve gotten a few related questions from reporters on the line about terminology. I’m going to share a few elements of them and see if any of you is able to give some context or response. So one reporter added that, we’re seeing a rise in the use of terms like un-alived among young people, which originated as a way to bypass social media filters. How does the use of such euphemisms affect how public and specifically youth perceive the reality of this health crisis?

Another reporter mentioned that Dr. Moutier brought up how being careful about phrases like committing suicide versus dying by suicide and avoiding judgment terms like failed or successful attempts could be useful. Are there any other phrases that reporters need to consider? Is anyone able to give some more context?

[00:56:33]

CHRISTINE YU MOUTIER:  I don’t like the term un-alive, mainly because I think, by getting around those social media filters and barriers, in a way, it may have normalized suicidal behavior in this colloquial use of a term that became coined and more commonplace. One of the tricky aspects of suicide prevention and the public health efforts is, while we want to raise awareness, we never want to normalize suicide. We want to normalize everything leading up to it in terms of distress. It’s human to face challenges, and it’s courageous to seek help. But going beyond suicidal thoughts into action is a bridge we don’t want people to cross. We don’t want stigma, but we do not want acceptability with suicidal behavior as an outcome to distress.

[00:57:48]

ELENA RENKEN:  Any other thoughts on terms?

[00:57:54]

ADAM HORWITZ: Yeah, I was just going to add, in terms of the specific questions on the committed suicide piece being one that I think is still fairly commonly used and just a little rationale around that being related to thinking of, and we’ve been talking a lot during this panel about suicide as a health issue, public health, in that medical field and for any other medical condition.

That commit term is really not in play. I think most people connect commit with crimes, and commit murder or a felony or this or that. And so, you know, died by suicide being the preferred term, describing it the same way, say, died of a heart attack or died of a stroke or whatever else, keeping it in that same public health mindset when we’re talking about it.

[00:58:55]

ELENA RENKEN:  Thank you. Now, I’m going to ask our final question, which will give our panelists here a chance to offer some concise takeaway messages. But I want to mention to reporters here that you’re going to get a quick email survey after you leave this briefing and if you have even 30 seconds to fill it out, your answers would really help us design our free services so that they’re helpful to you going forward. Our last question, in about 30 seconds, if you can, what is one take-home message for the reporters here? Dr. Horwitz, do you have anything they can leave with?

[00:59:28]

ADAM HORWITZ: I would emphasize what folks have been sharing in terms of Papagino stories, that there is a great opportunity in reporting. I know that it can raise those fears because no one wants to put something out there that has that potential for risk, but just emphasizing that there’s a lot of potential for good.There may be individuals out there who are struggling, who have not disclosed anything or are not in an environment where they have safe spaces to talk about their feelings, and being able to see an article, but have one that includes information and resources or where and how to seek help, that might be their point of contact into the system of help-seeking and being able to have that opportunity to be a really positive force for good in that way is key. The other aspect that I was just going to throw out there, too, is that, don’t be shy about asking professional mental health clinicians or suicide researchers or things like that. If you’re writing something and you’re not positive about framing or anything like that, I’m very confident there will be many folks who are dedicated to this topic who will be more than willing and happy to look anything over or answer questions that you might have.

[01:00:47]

ELENA RENKEN:  Thank you. Dr. Stephens?

[01:00:50]

JASMIN BROOKS STEPHENS:  I think Dr. Horwitz answered that perfectly. I mean, I have to echo that, I think, referring to the resources that we talked about, about how to report on suicide, I think that reaching out to us, if you all do have questions or want more specific information, but really the biggest point I that can be said here is that, particularly when we talk about the barriers to care and the barriers to understanding mental health, that one thing is certain is that you all have some of the highest in terms of teens and young adults that have access to learning from you all. It is just so much higher than what we have in academia and publishing and these other spaces where you have to pay to receive articles. All these barriers that we have to getting our research out there, you all are the way to do that. And so really thinking about how can I be mindful of reporting solutions, as well, and following those guidelines and reaching out to some of the experts that do this work to ask if there is anything else I should consider. So again, really echoing what Dr. Horwitz said there, but just highlighting the importance of that latter piece.

[01:02:04]

ELENA RENKEN:  And Dr. Moutier?

[01:02:06]

CHRISTINE YU MOUTIER:  Yeah. You all just took the words right out of my mouth, as well, and just really want to thank the journalists for attending today and echo that you are a powerful part of the public health approach to suicide prevention because your work reaches so many. If this is an area of interest for you, a couple little things you could do. The fall is approaching, and so that is our AFSP, Out of the Darkness, community walk season, where 600 of these walks occur in most communities. If you attend, it’s a morning or an afternoon. It’s not a huge time commitment. You’ll be immersed in what it looks like to be surrounded by people who are speaking about mental health experiences, treatment, loss, and other lived experience struggles with no stigma in a way that we hope and we believe is safe and is actually uplifting towards healing and hope and sense of connection. That’s both for the loss community as well as for all aspects of these personal experiences that bring our volunteers to be involved with AFSP. And again, I’ll just remind you of our safe storytelling studio where you can access our help and our review and interviews, and we have a media advisory as well. So we really value the relationship with media experts like yourself. So thank you.

[01:03:40]

ELENA RENKEN:  Thank you all so much for taking the time to explain the research here, especially on such an important topic where understanding the evidence can make all the difference. And to reporters, thank you all for showing up to gather more evidence and expertise for your coverage. I hope I will see you all at SciLine’s next briefing. Thank you.