Running head: SUICIDE AND SELF-HARM

Suicide and Self-Harm Among University Students

Paige Barcant, Abigail Cragin, Breanna Hutson, Kristina Youngson

University of Florida
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Abstract

Suicide and self-harm is an increasingly prominent factor characterizing universities. Students

may feel pressures from outside forces to succeed in college, and when accompanied by new

feelings of isolation and loneliness that comes with this unfamiliarity, students can face

deterioration in their mental health. There are many social and economic factors that play a role

in why a student may resort to self-harm or suicide, and the effect that it has on the community

can be detrimental. At the University of Florida, the Counseling and Wellness Center is a

resource that students can access for mental health care, counseling, and for check-ins on their

overall well-being. Programs like the Counseling and Wellness Center seek to reduce the

number of students suffering from mental health issues and/or suicidal ideation by implementing

the structural functionalist theoretical perspective into their programs. This paper will discuss the

issue of suicide as a whole, the population it affects and how the community-level factors

influence the population and problem, while also discussing the ways the CWC is endorsing their

chosen theoretical perspective.

Keywords: s​ uicide, self-harm, mental health, college students, structural functionalism

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Suicide and Self-Harm Among University Students

Organizational Overview

The University of Florida’s Counseling and Wellness Center (CWC) is a short term

counseling center for university students. The facility is located on the university campus,

making it easily accessible to students. Their mission statement, ​to foster human development in

all of its diversity through compassion, empowerment, advocacy, hope, and heart, i​ llustrates

their goal in taking care of the Gator Nation (UF CWC). They offer a broad array of student

services, including individual counseling, group therapy and workshops, psychiatry, and crisis

services. In order to determine which services will best fit the needs of the individual, students

attend an initial triage appointment to discuss the details of their problem and to provide

additional background. Students are seen for an average of one to six appointments, but the

organization also provides assistance to individuals looking for a more long term therapy. The

CWC acknowledges the changes that students experience upon entering college and aim to

provide them with the tools to cope with these changes.

In order to learn more about this organization, a student manager, Bianca Cegatte, was

interviewed. Bianca works as a liaison between the Counseling and Wellness Center and U

Matter We Care. She is well versed in recommending the services offered by the CWC to

students and ensuring that students do not encounter additional stress when pursuing these

services. Bianca provided information on the organization’s outreach and advocacy programs

that reduce students’ feelings of isolation and the stigma associated with seeking help.

Problem
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In recent years, suicide rates have been on a steep incline, especially among teenagers

and young adults. In addition to this, self harm is on the rise. These two issues mentioned are of

extreme urgency in today’s society, which is why this group has chosen to discuss them and the

effects they can have on a community. While suicide and self harm begin as individual-level

problems, they can have a heavy impact on both the household and community in which they

occur.

When an individual commits suicide, this can have a tremendous impact on his or her

microsystem; the people they interacted with on a regular basis feel the effects of it the most.

According to Elana Premack Sandler, this can include the individual’s parents, siblings, friends,

classmates, coworkers, teachers, and anyone else who is close to the victim (Sandler, 2018).

Sandler explains that not only do these people miss the physical presence of the person, but the

loss can also have an immense effect on their mental health as possible feelings of guilt, anger,

and shame can arise due to the stigma surrounding the topic, as well as the lasting question of

“why?”. Furthermore, this tragedy can strongly affect this person’s wider community, their

mesosystem, such as: students in their school, acquaintances, religious group members, and

family friends to name a few.

According to Jackie Burrell, some primary risk factors for suicide among adolescents are

“major depression, traumatic or stressful life events, a prior suicide attempt, a sense of isolation

and lack of support, and poor coping skills” (Burrell, 2019). The main reasons mentioned in the

interview for students engaging in self-harm or feeling suicidal are academic stress, roommate

problems, and the isolation of being away from home and family. In addition to this, Bianca
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stated that students also suffer as they feel overwhelmed by the size of the university and its

student body, thus causing them to feel lonely and often self-destructive.

In the United States, suicide is the tenth leading cause of death as of 2019 (Nichols,

2019). According to the Florida Department of Health, in the year 2018, 42 people took their

own lives here in Alachua county (Florida Department of Health, 2018). The Florida Department

of Health also highlighted that in 2018, 3,552 persons committed suicide in the state of Florida.

It should also be noted that the American Foundation for Suicide Prevention reported that a total

of 47,173 persons died of suicide in the United States in 2017. Lastly, every year, one in five

females as well as one in seven males engage in self harm in the United States (Gluck, 2019).

Suicide and self harm often go hand in hand as “deliberate self-harm is the strongest risk

factor for future suicide” (Hawton, Zahl & Weatherall, 2018). According to the Centre for

Suicide Prevention, self harm can lead to suicide when it is “no longer an effective coping

method” and it “ceases to offset the feelings caused by stress or trauma” (Centre for Suicide

Prevention, 2018, para. 6). Often times when persons engage in self harm or commit suicide,

their environment is one of the primary aspects under investigation. Questions about the state of

their households, neighbourhoods, and schools are asked to determine the causes. In other words,

the community in which the individual resides is analyzed. This is how a community plays such

a crucial role in the health of its members and why suicide and self harm have lasting effects on

the community.

Population

Every year 800,000 people around the world attempt to take their own life (Suicide

Statistics, 2019). According to the American Foundation for Suicide Prevention, suicide is the
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tenth leading cause of death in the United States (Suicide Statistics, 2019). Suicide affects

families and communities alike. Bianca described the Counseling and Wellness Center’s

involvement in the community as they work one-on-one with the student, as well as with their

family members and friends. She stated that the CWC is aware of the impact that suicide and

self-harm has on the people in the individual’s life and ensure that they are taken care of as well.

Suicide is common in both high income communities and vulnerable communities. These

vulnerable communities include those that experience discrimination or economic difficulties,

such as immigrants, the LGBTQ community, and other minority groups.

Gender seems to be a factor in societal rates of self-harm and suicide. When comparing

rates of suicide over generations, the number of male suicides outnumber that of females. In

2017, the rate of suicide in men was 3.54 times higher than females (Suicide Statistics,2019).

This increased rate of suicide could be linked to the more violent suicide methods that men tend

to choose (Siversten et al., 2019). While women were four times more likely than men to use

overdosing as a means to committing suicide, men more often resorted to firearms, hanging, and

asphyxiation (Schimelpfening, N., 2019.)

Individuals that suffer from mental illnesses are more vulnerable to suicide and self-

harm. Depression and schizophrenia are the two most common mental illnesses linked to high

rates of suicide (Bird, L., & Faulkner, A., 2000). Individuals with depression struggle with a

chemical imbalance of serotonin and norepinephrine that prohibits the brain from passing

information through neurotransmitters (Bird, L., & Faulkner, A., 2000). While an individual

equipped with a regular balance of serotonin and norepinephrine can regulate their emotions and
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readily consider their options when confronting a hardship, someone with depression has more

difficulty relying on their neurotransmitters to receive those important messages (Bird, L., &

Faulkner, A., 2000). Similarly, someone with schizophrenia may lose touch with reality as their

brain also struggles with receiving the necessary neurotransmitters. The symptoms of both of

these disorders can be very isolating for an individual, especially in cases where they are not able

to receive social and medical support.

According to Dr. Qureshi, immigrants and other ethnic minorities may be at a higher risk

of suicide when compared to the average population of the country (Forte et al, 2018). Migrants

are often exposed to traumatic circumstances, as many of them fled their countries of origin due

to violent and economic instability. Starting a life in a new country can bring many challenges

such as separation from family, language barriers, loss of social networking, job loss, and a lack

of healthcare information (Forte et al, 2018). All of these components combined with

psychological problems such as post-traumatic stress disorder (PTSD), mood and anxiety

disorders make this specific group inclined to experience suicidal thoughts and puts them at a

higher risk of death by suicide (Forte et al, 2018).

The stigma surrounding suicide and self-harm is a major contributor to the low

percentage of individuals that actively seek help when dealing with adverse effects. As

individuals continue to avoid seeking help in these situations, they will be unable to receive

necessary assistance. The general public also lacks knowledge and awareness about suicide as a

whole, including the populations it affects.

Community-Level Factors Affecting the Problem

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Risk and protective factors both play a critical role in the prevention of suicide and

self-harm in individuals and communities; this section will focus mainly on the community-level

factors that play a role in this process. Suicide is the second leading cause of death among

college students in the United States (National Institute of Mental Health, 2017), which means

that universities have a responsibility for providing access to resources to help students suffering

from suicidal ideation and self-harm. Suicide prevention programs are an example of a

community factor that attempts to mitigate the issue of suicide, as they were created to reduce

factors that increase suicidal thoughts and actions while increasing the factors that protect people

from suicide and self-harm. Suicide prevention programs on college campuses seek to mitigate

the problem by identifying high-risk students, encourage help-seeking by eliminating stigma,

training mental health staff to address risk factors, and have crisis management plans (Suicide

Prevention Resource Center, 2013). The CWC has programs in place for mitigating these issues;

as learned in the interview, friends, family, and professors of students can call UMatter or the

CWC on behalf of a student they think is in need of mental health support services. Another

protective factor is community access to effective behavioral healthcare. Communities with

multiple levels of care for patients with suicide risk tend to be effective when they include

treatment for mental and/or substance use disorders, non-restrictive settings, and

follow-up/referral services that happen in a timely manner (Suicide Prevention Resource Center,

2013). Based on the interview with Bianca, we learned that the CWC has no time-limit on when

they stop checking in on a student after the student seeks counseling. The counselor uses their

professional judgement to determine if the student is in need of further counseling, and of course,

if the student feels they need more help, they will receive it.
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Overall connectedness in the community and school is an important protective factor

since social isolation can contribute to anxiety and depression, which can increase the risk of

suicide and self-harm. A 2017 survey of nearly 48,000 college students showed that 64% felt

“very lonely” in the previous 12 months, with 12% saying they contemplated suicide (Art and

Healing, 2017). Minority, first-generation, and international students are most likely to

experience these feelings of loneliness, and this could be considered a community problem

because of the lack of resources available to these groups. Research has shown that feelings of

loneliness and, more specifically, feeling like “a burden on others” are signs that an individual

may have suicidal ideations (Hollingsworth et al., 2016) Community-based efforts in schools can

combat these feelings of loneliness to vulnerable groups by raising awareness and encouraging

openness about feelings of loneliness and hopelessness. Combined with access to behavioral

healthcare and mental health services mentioned above, these initiatives can be great resources

for helping students suffering from suicidal ideation due to isolation and loneliness (Nobel,

2018).

Having access to basic physical needs and overall psychological safety is another

protective factor, and this can be achieved by living in an area that is not exposed to school and

community violence. Poverty and community-level traumatic events would contribute to the

problem of suicide; globally, suicide rates have fallen as living conditions improve, and the

reverse is also true (American Psychological Association, 2019). Access to firearms is a key risk

factor for suicide since firearms were the leading mechanism for suicide death in 2016

(American Public Health Association, 2018). Restricted access to firearms, especially on college

campuses, is a protective factor that the community has a direct influence on.
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Especially in adolescents attending a college or university, a sense of isolation and lack

of support is a major risk factor for suicide. Stigma surrounding seeking help for mental health

issues and suicidal ideations can easily be considered a community-level issue, especially in a

college environment that promotes professionalism and perfectionism. This stigma has

manifested into a lack of campus mental health services across the country. Only 7% of two-year

institutions and 58% of four-year colleges have on-campus psychiatric consultation (Gallagher,

2015). Many of these resources may have wait times that are inefficient for patients who may

urgently need psychiatric help, which only increases the likelihood of a suicide attempt or

self-harm. Referrals to off-campus psychiatric clinics are also an inefficient solution because of

financial issues/minimal mental health insurance, transportation issues, and lack of availability of

these types of psychiatric clinics in the community as a whole. Students with the highest risk of

suicide ideation and attempts are those who already have some pre-existing mental health

problems and those who develop mental health problems when enrolled, which is why it is so

important that college campuses have the adequate counseling centers and suicide prevention

resources (Illinois Department of Public Health, 2014).

Our interview with Bianca gave us insight on what the CWC identifies as being important

community-level factors that were relevant to the topic of suicide and self-harm on campus. We

learned from her that people who had a pre-existing mental health issue were more likely to seek

out counseling than others, which was something we also initially found in our research.

Isolation and feelings of loneliness were also cited as the biggest contributors to suicidal ideation

among college students, especially if they are farther from home, like an out of state or

international student. Bianca told us that the end of the semester corresponds with the highest
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influx of students seeking support services, and this can be for a variety of reasons including

stress from final exams, feelings of sadness from students who cannot go home for the holidays,

and students who are graduating who have fears about the future. Students being unsure about

their plans after graduating is something we did not account for in our research, but this is

something that the CWC sees a lot.

Community-Level Factors Affecting the Population

Incidences of suicide and self-harm at the University of Florida are increasing at an

alarming rate ​(Remington, 2019).​ While there is a stigma around mental health, some students

who might seek help are unaware of the resources free to students on campus, such as the

Counseling and Wellness Center and U Matter We Care. Instead, students tend to struggle

silently until someone notices that they are struggling, or until a mental break occurs

(Remington, 2019).

The adjustment to college life transitioning from public high school to a top 10 university

is a significant difference. Students go from having classes from seven in the morning, Monday

through Friday, to having the ability to create their own schedule, the way they like it. While it

sounds nice, there are already stressors that are taking place due to full classes and overlapping

lectures. After the initial excitement of college wears off, loneliness, depression, and

homesickness usually arrive. In our interview, Bianca reiterated the fact that having a large

campus like the University of Florida makes individuals feel alone. According to College Stats,

50% of students rated their mental health below average or poor (Mental Health Guide, 2019).

In order to still be able to achieve both academically and mentally, students need to understand

the importance of taking a mental health day in order to avoid pent up stress.
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College students typically put a lot of pressure on themselves. According to American

Psychological Association, anxiety is the top concern for 41.6% of students (College Students’

Mental Health is a Growing Concern, Survey Finds). They sign up for twelve to seventeen credit

hours a semester, going in with the expectation of receiving an A in every class and make sure

everything is done perfectly to maintain or achieve an honorable grade-point-average. 30% of

students reported they had problems with schoolwork due to a mental health issue (Mental

Health Guide, 2019). Parents also tend to put pressure on the students as well. Parents understand

that students are going to be stressed and do not expect their children to be perfect but projecting

their thoughts and disapproval upon certain ideas and activities affects the student. It is reported

that 80% of students feel overwhelmed by their responsibilities as a student (Mental Health

Guide, 2019). The student is already aware that they are spending thousands of dollars to attend a

university and do not need the additional reminders that there is a lot of weight hanging on their

shoulders to succeed.

It is not surprising that there is a stigma about mental health services around the

University of Florida campus when it is reported that 40% of students fail to seek help (Mental

Health Guide, 2019). In the interview, Bianca mentioned the stigma saying that students are

scared to go because it is attached to the school (Cegatte). While it is attached to the school and

the CWC is aware of the stigma, Bianca also stated that they pride themselves on the

confidentiality and anonymity, and that reaching out to seek help is a low pressure process, and

that they are there to be a resource. She also mentioned that in addition to the CWC, U Matter

We Care is another great resource for students as they also provide additional assistance, as well

as have ambassadors on campus. While GatorWell is a prominent and trusted resource, it also
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has its flaws. A very distinctive flaw is that during times where students are typically most

stressed and suicidal, like exam season or the end of the semester, there are no available

appointments. GatorWell is known for turning students away in a time of crisis in the end of the

semester, saying that they are booked, and instead offer to make an appointment for the

following semester. This is lamentable as students may experience additional distress after being

turned away from GatorWell, and do not know where to go. These students are typically

unaware of the remarkable resources that the Counseling and Wellness Center provides,

including crisis services that are offered both in person and via telephone (“Crisis Services- UF

Counseling and Wellness Center (CWC)”).

A community level factor that mitigates the problem of suicide and self-harm is campus

involvement and having a vital support system in Gainesville that is available when presenting

signs of distress. Additionally, spending time with peers in a setting not involving academia that

allows for a relaxed, enjoyable environment is also likely to reduce thoughts of self-harm and

suicide. As previously mentioned, the Counseling and Wellness Center and You Matter We Care

are essential resources for students that may be struggling with mental health issues on the

University of Florida Campus.

Theoretical Perspective

The theoretical perspective believed to be used by the organization to interpret the

problem of suicide and self harm among college students is structural functionalism. The basic

premise of structural functionalism is that every part of society serves a purpose to help that

society function properly (Moore, 2019). The CWC is a structure whose function is to provide an

array of services to students suffering from mental health illnesses or suicidal thoughts.
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Structural functionalism aims to maintain the status quo within society, which in this case would

look like students having equal access to resources on campus that would prevent them from

engaging in self-harm and/or having suicidal thoughts. As stated in the interview, the CWC

attempts to maintain the status quo through outreach to students, confidential counseling sessions

with certified professionals, advocating for students with mental health issues, as well as

follow-up sessions with students (Bianca Cegatte, personal communication, 2019)

Social pathology is a theory that comes from the structural functionalist perspective

which can provide a clearer understanding of the issue of suicide and self-harm. Social pathology

is a result of institutions or elements of the structure or culture not functioning properly. This can

happen when individuals are not socialized to adopt the norms and values of society. In this case,

this would mean that individuals are not adequately educated about the prevalence of mental

health on college campuses or they are unaware of how to obtain access to resources on campus

that specialize in mental health. The CWC aims to fix this part of society with their outreach

program; this involves getting in touch with students whose family and/or friends have expressed

concerns about their mental health status, as well as ensuring that students remain on track with

their regular appointments. As mentioned in the interview, a deterioration in mental health

among college students can be due to a number of reasons: social isolation, being away from

family/home, academic stress and/or relationship issues. The outreach program at the CWC is a

form of intervention for when students appear to be suffering in silence. Additionally, the CWC

has a variety of suicide prevention resources including access to a 24-hour messaging platform

with a trained professional for those who do not wish to meet in person.
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Structural functionalism assumes that society is a set of interdependent parts that each

serve a function, which is why the CWC not only caters to those who engage in self-harm and/or

have thoughts of suicide, but also those who have been indirectly affected. It was stated in the

interview that the CWC also aims to provide counseling and comfort to individuals who have

been affected by losing someone to suicide. Losing someone to suicide can have adverse effects

on one’s mental health and can affect their academic, personal, and professional life. In the case

of an organization losing a student to suicide, the CWC along with U Matter We Care work

together to provide a representative whose main purpose is to help others make sense of and

process the hardship of losing a loved one. This is another example of how the structural

functionalist perspective is implemented by this organization; the effects of suicide are seen as a

societal issue that can be solved through the services that the CWC provides.

Concluding Remarks

The CWC can improve on certain community-level factors. While it is conveniently

located on campus which allows for easy access for those seeking help at the university, there

can be limited availability for appointments at times. The CWC provides their services mainly

through appointments. As mentioned in the interview, there are certain times of the semester

(example: around finals or closer to graduation) where there is an influx of students seeking help

and they are not always able to accommodate everybody. A possible solution to limited

availability is more funding provided to the CWC by the university which will allow for

expansion of the organization and employment of more counselors.

By including community-level factors in this program, the CWC is able to reach more

students in need. University students are away from home and their primary caregivers, but the
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CWC is an organization that has the ability to ease this process for students. By promoting

counseling and psychiatry services, among others, the university is seen as a source of support.

Rather than being afraid to admit that they are struggling, students will be able to tackle this

adversity, knowing that they have the university on their side.

The organization can integrate community-level factors such as stigma surrounding

seeking mental health help, lack of available mental health services and access to help into their

programs in two different ways. The first idea is attempting to reduce the stigma of mental health

issues by creating a class similar to “First-Year Florida”. This class would be created by the

CWC with the purpose of teaching ways to prevent and overcome stressors that occur during the

college experience in a way that helps prevent suicide and depression before issues begin to

occur, while additionally discussing positive self-care and creating an individualized stress

management plan to use over the course of their college experience. The second

recommendation is to create a satellite location in both Marston and Library West similar to

Peabody Hall as a location student can go in an environment, they are comfortable to relax and

decompress in a place where the feeling of stress and overwhelmingness typically occurs.

While structural functionalism is the theoretical perspective the CWC is most likely to

endorse, symbolic interactionism can also be used to interpret the problem of suicide and

self-harm and the effect it has on the community. The basic premise of symbolic interactionism

is that meaning is created through interactions, and we act in response to the meaning we assign.

Some people may percieve suicide and self-harm as a community-level issue, where as others

may percieve it as a sign of weakness. There is a lot of stigma associated with those who suffer
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from mental illness; they can be seen as weak for not being able to handle the problem in a

different way.

Changing the theoretical perspective from structural functionalism to symbolic

interactionism changes how the organization approaches problems. Using this approach, the best

course of action for the problem would aim towards reducing stigma related to mental health and

topics of suicide, along with acting as advocates for those suffering from mental illness and

suicidal ideations. In our interview with Bianca, she discussed how they advocate and raise

awareness for these individuals. The organization sends representatives to classrooms to talk

about mental health, stigma, and programs for those who want to seek help without a high

amount of pressure. Talking about the subject can be hard to navigate, but doing so is important

in the effort to reduce any lingering stigma. With this approach, it’s important to also consider

the affects that an individual’s cultural, economic, and ethnic background will have on their

perception of mental health and suicide. Some groups may be more understanding of the issue,

whereas other groups may not be as educated about it, and these are the people who often create

negative meanings for mental illnesses.

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