Concerns about student mental health and risk of suicide have been widely documented, with recent attention and focus on self-harm and suicidality in Higher Education (American Foundation for Suicide Prevention, 2019; Universities UK, 2018). Literature has included a focus on the increasing pressures young adults face at university and the potential impact on their mental wellbeing (Burns, 2017; Vaughan, 2018; Coughlan, 2018).
Suicide is the leading cause of death in young people in the UK and has been reported as the second leading cause of death among 15-29 year olds globally (WHO, 2018). In 2018, 759 young people died by suicide in the UK and the Republic of Ireland; suicide rates have increased for young people in the UK, with a 30% increase for men aged 20-24 (Samaritans, 2019). However, this was based on the general population and does not specify students.
To date, there have been no national studies carried out into student deaths by suicide in UK universities over a sustained period of time. Historic data documented between the 1950s-1990s was only available for research conducted at single institutions, therefore not at aggregate level. Prof David Gunnell et al.’s work investigates trends in the incidence and characteristics of suicides in England and Wales between 2000 and 2017. Their study provides a comprehensive and up to date overview of trends in the characteristics and prevalence of university student suicides and highlights the ongoing need for “a whole university approach to mental health”.
Student mental health is a growing concern for universities.
Methods
University students were categorised as undergraduates, postgraduates or higher degree. The authors recorded linkage between mortality rates and data gathered by the Office for National Statistics (ONS) and Higher Education Statistics Agency (HESA) for England and Wales. They coded student deaths according to the International Classification of Disease-10 (ICD-10) and the same for the general population. As accurate data for the period of time was only available for England and Wales, other parts of the United Kingdom were excluded. Suicides registered with occupation as “student” recorded on the death certificate were included, while students in secondary school or further education institutes were excluded. Sensitivity analysis was carried out based on HESA records for ‘past student’.
Poisson regression was used when comparing suicide risk for each year and level of study for age, gender and ethnicity, in order to determine whether there was statistical evidence of a rise in student suicide deaths. Methods of suicide and monthly distribution were compared with the general public using chi square tests. Due to limitations of HESA data, student suicide methods and “seasonal distribution” compared to the general public were restricted to 18-29 years (78% of total student population).
Results
The study identified 1,330 students who died by suicide between 2000/01 and 2016/17, with statistical evidence of an increase between 2001 and 2016; student suicides almost doubled from 52 confirmed deaths in 2000/01 to 102 in 2013/14. However, the rate of suicide in students was comparatively lower than the age-matched rate in the general population.
Student suicide rates increased with age and were higher in males than females (66% vs. 34%), in keeping with trends in the general population. However, the age-specific incidence of suicide was comparatively lower amongst students. Risk of suicide was found to be lower amongst black students compared to other ethnic groups. There was some evidence suggesting higher risk from the second year of undergraduate study onwards, however a lower risk was identified in postgraduate study.
Statistical evidence identified a small difference in methods used between students and the general population aged 18-29, except for jumping, which was relatively more prevalent in the former group (8.2% vs 4.2%). The highest number of suicide deaths was recorded in January and the lowest during the summer holidays (July to September).
This study found that the annual incidence of student suicide in England & Wales was less than half that recorded in the general population of a similar age.
Conclusions
This is a robust, comprehensive study that provides a detailed picture of incidence and characteristics of student suicides across a sustained period of time. Although a rise in student suicide and attempted suicide has been well documented and has gained much press attention over the last couple of years, analysis of UK news reporting has identified a “bias towards youth suicides…reflected in students/pupils” (Marzano et al., 2018), showing that student deaths by suicide are disproportionately reported. The findings confirm that this increase was proportional to that in the general population (15-19 year olds) since 2009/10 and suggests that rates for students are considerably lower.
The research substantiates the latest guidance provided by Universities UK, which focuses on opportunities within universities for suicide prevention and encourages a whole-university approach to mental health, building resilience, support structures and suicide prevention in an empowered way (Universities UK, 2018).
In keeping with trends in suicide amongst young people in the general population, this study found evidence of a rise in incidence of suicides amongst students since 2009/10.
Strengths and limitations
This study makes an important contribution to literature in the field of student suicidality. It is the first of its kind in England and Wales, providing a comprehensive overview of student deaths, methods of suicide used and seasonal distribution, compared to the general population of the same age over a sustained period of time. The size of the data gathered and methods used ensure that conclusions drawn have a high rate of statistical reliability.
Furthermore, it evidences comparative risk according to year of study. By substantiating and recognising the prevalence of suicidality in the context of students and non-students, it raises important questions about how we can better understand risk and protective factors in both students and non-students and provide appropriate, accessible support.
The authors openly identified the limitations of their study including:
- A lack of complete socio-demographic breakdown for the entire period
- HESA data not being stratified by age in males and females separately
- No conclusive data for psychiatric contact with services in the year before death or information on contact made with university mental health services
- The study being limited to England and Wales
Another consideration is that we do not know whether some of the general population deaths were young people too unwell and therefore not accessing, or excluded from, education.
This research paves the way for many further studies and highlights implications for practice in research, education and health.
Implications for practice
Focus on policy and public health
The need for further research into risk factors and preventative mechanisms among students is highlighted. Even though the first year of study was not identified as a particular peak in suicides, moving away from support networks may lead young people to loneliness and therefore increased risk (Lasgaard et. al, 2011; Samaritans, 2019).
The first ever cross-government suicide prevention plan was published with “a greater focus on addressing the increase in suicide and self-harm among young people”. The scale of this study provides notable evidence identifying a need to explore opportunities within education for suicide prevention. It also emphasises the need for a review of service provision within universities and the NHS. To ensure a joined-up approach, it may be helpful to investigate access to and uptake of services and any potential barriers that may exist within organisations or individuals themselves, based on lived experiences.
Focus on research
Although Gunnell et al. focused their research on Higher Education, their findings refer to the onset of certain mental health conditions in late adolescence to early adulthood and additional research suggests that this could increase risk (Eskin, et.al. 2016). Therefore, research bridging Further and Higher Education may be beneficial.
The facts presented in Gunnell et al.’s paper provide concrete evidence of a need for ongoing research in suicide and suicide prevention in young adults. However, “suicide remains a whispered word” (Grollman, 2011) and often the individual voice goes unheard. Therefore, finding ways to learn from lived experiences and working collaboratively in research, policy and practice is important. We need to empower individuals to share their experiences, so that we can learn from them and find ways to destigmatise what has become an increasing reality for many young adults. Consequently, we (researchers at Middlesex University) have launched a national survey to learn from Further and Higher Education students’ lived experiences of attempted suicide.
“Mental health research suggests the need to work on suicide prevention and intervention at universities, so that strategies can be developed to prevent suicide, fight against the stigma of seeking help, and promote wellbeing among college students”.
Conflicts of interests
None.
Links
Primary paper
Gunnell, D., Caul, S., Appleby, L., John, A., & Hawton, K. (2019). The incidence of suicide in University students in England and Wales 2000/2001–2016/2017: Record linkage study. Journal of Affective Disorders 261 (2020) 113–120 https://doi.org/10.1016/j.jad.2019.09.079
Other references
American Foundation for Suicide Prevention (2019). Suicide prevention on university campuses. Available at: afsp.org/our-work/advocacy/public-policy-priorities/suicide-prevention-university-college-campuses/ [Accessed August 2019].
Auerback, R., Mortier, P., Bruffaerts, R., Alonso, J., Benjet, C., Cuijpers, p., Demyttenaere, K., Ebert, D., Green, J., Hasking, P., Murray, E., Nick, M., Pinder-Amaker, S., Sampson, N., Stein, D., Vilagut, G., Zaslavsky, A., Kessler, R., WHO WMH-ICS Collaborators. (2018). WHO World Mental Health Surveys International College Student Project: prevalence and distribution ofmental disorders. J. Abnorm. Psychol. 127 (7), 623-638. Epub 2018 Sep 13.
Burns, J. (2017). ‘Sharp rise’ in student mental illness tests universities. BBC News Education, [online] 4 September. Available at: https://www.bbc.co.uk/news/education-41148704 [Accessed 15 May 2018].
Coughlan, S. (2018). Student suicide increase warning. BBC News Education, [online] 13 April.
Grollman, E., in Cholbi, M. (2011). Suicide: The philosophical dimensions. Ontario: Broadview Press.
Lasgaard M, Goossens L, Elklit A. (2011). Loneliness, depressive symptomatology, and suicide ideation in adolescence: Cross-sectional and longitudinal analyses. Journal of abnormal child psychology, 39(1) pp137-50.
Marzano, L., Fraser, L., Scally, M., Farley, S. and Hawton, K. (2018). News coverage of suicidal behaviour in the United Kingdom and the Republic of Ireland. Crisis, Hogrefe Publishing, pp1-11.
Samaritans. (2019). Loneliness, suicide and young people. Available at Samaritans.org. loneliness-suicide-young-people-jan-2019.pdf [Accessed 28 April 2019].
Universities U.K. (2018). A case for action. Available at https://www.universitiesuk.ac.uk/policy-and-analysis [Accessed January 2019]
Vaughan, R. (2018). Mental health crisis among students. i [newspaper] 13 August, p.1,6,7. Available at: https://www.bbc.co.uk/news/education-43739863 [Accessed 15 May 2018].
World Health Organisation. (2018). Suicide. Available at: https://www.who.int/news-room/fact-sheets/detail/suicide[Accessed 28 May 2019]
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