(Graphic: John McCann/M&G)
Preventing suicide among young people is a global public health priority. One-third of all suicides occur among adolescents, and the first onset of suicidal behaviour typically occurs in late adolescence. Suicide is the second leading cause of death among those aged 15-29 and the leading cause of death for females aged 15-19.
Preventing suicide now a global priority
Preventing youth suicides has not always been a worldwide health priority, because in the past there was a greater focus on the infectious diseases that were more likely to claim the lives of young people. The physical health of the youth has improved substantially in the last 30 years due to marked improvements in standards of nutrition and better access to healthcare, vaccines and antibiotics.
Global child and adolescent mortality decreased from 14.18-million deaths in 1990 to 7.26-million deaths in 2015, although some countries in South Asia and sub-Saharan Africa lag behind other regions. Now that comparatively fewer young people die from infectious diseases, the burden of noncommunicable diseases, including accidental injuries and suicide, has become more apparent.
There is growing awareness of the importance of promoting adolescent mental health and considerable advances have been made in the science and practice of suicide prevention over the past 50 years. Improving access to evidence-based treatments for depression, restricting access to lethal means and establishing 24-hour crisis helplines have reduced suicide risk in developed countries.
But the majority (79%) of suicides occur in developing countries, and most of what is known about effective suicide prevention strategies comes from research conducted in developed countries.
Prioritising youth suicide prevention in developing countries may be one of the most effective ways to reduce the global burden of suicides, given that 90% of the world’s adolescents (10-19 years) live in these countries, and one-third of all suicides occur in this age group. Universities could be particularly appropriate sites for targeted suicide prevention programmes, as suicidal thoughts and behaviours are common among students.
Research funded by the South African Medical Research Council (SAMRC), as part of the World Health Organisation’s world mental health surveys international college student initiative, found that almost half of first-year students had thought about suicide at some time in their life, 26.5% had made a suicide plan, and 8.6% had attempted suicide. Campus-based suicide prevention efforts at universities in developing countries are, however, hampered by a lack of reliable and meaningful epidemiological data and the absence of evidence-based context-sensitive interventions for students.
Elevated rates of suicide among students are attributed to psychosocial stressors, including difficulty adapting to the increased academic workload, substance use, bullying, gender-based violence, inadequate skills for resolving interpersonal conflicts, financial stress and stigma about accessing psychosocial support. Suicidal behaviour among students is also strongly associated with common mental disorders, principally anxiety and mood disorders.
Increasing access to culturally appropriate evidence-based treatments for common mental disorders and promoting students’ ability to cope with stressors and solve problems is integral to campus suicide prevention. Indeed, research conducted at Stellenbosch University (SU) and University of Cape Town, funded by the Ithemba Foundation, suggests that treating common mental disorders among students could yield absolute reductions in the prevalence of suicide ideation, plans and attempts of 17%, 55% and 73.8%, respectively.Â
Barriers to seeking treatment
Resource constraints in developing countries impede the provision of accessible campus counselling services, creating a significant treatment gap. This is further exacerbated because young people are often reluctant to seek professional help for psychosocial problems, even when free counselling services are provided.
Other barriers to accessing campus counselling services include students’ inability to recognise when they need help, insufficient knowledge of where to get help, too little time to attend formal treatment, reluctance to receive help from mental health professionals, logistical impediments such as scheduling problems, and attitudinal factors such as stigma and perceptions regarding the ineffectiveness of therapy.
Technology could help overcome some of these barriers and improve students’ access to mental healthcare services, especially if digital interventions promote students’ autonomy and expand the range of treatment options available to them.
Digital interventions such as apps and other forms of internet-based therapy have been shown to be effective and acceptable to students, and help to reduce their risk of suicide. Psychologists and researchers from SU’s centre for student counselling and development and the Institute for Life Course Health Research are working with international digital health experts to develop and test scalable digital mental health solutions for students.Â
This SAMRC-funded research has, among other things, led to the development, implementation and evaluation of internet-based group interventions to promote the mental health of students and reduce suicidal behaviour. This research is the first of its kind in the world, putting South Africa at the forefront of suicide prevention on university campuses.
World Suicide Prevention Day (10 September) provides a good opportunity for us to celebrate the advances that are being made in youth suicide prevention and to recommit ourselves to this essential task.Â
It is also a chance to improve young people’s access to affordable and effective mental healthcare, and to create the social and educational conditions that promote optimal development. If we can sustain a focus on youth suicide prevention and promote research in this area, particularly in developing countries, we can ensure that future advances in child and adolescent mental health match the improvements seen in the physical health of young people over the past three decades.
Suicide is preventable. If you are struggling with thoughts of suicide, reach out and ask for help. Help is available from: