FOR IMMEDIATE RELEASE July 30, 2009

As millions of college students graduate college this year, mtvU, MTV’s 24-hour college network and The Associated Press today revealed the results of a new poll examining the emotional health of college students as they face a global recession and a receding job market, finding that more than half of college seniors are worried they won’t be able to secure a job after graduation.

The study finds that although financial pressures are a major source of daily stress, they do not surpass worries about academic performance. The economy has definitely taken a toll with concerns about finding a job ranking high among stressors, and intensified struggles reported by the almost one in five students whose parents have experienced job loss. Additionally, an alarming number of college students are struggling with mental health issues, but many are not actively seeking out the help that they need. Despite all of this, young people are generally happier than they were last year, are adapting to their environment by switching their majors, going to graduate school or making other proactive changes in their lives, and maintain positive attitudes about the value of their college experience.

The mtvU and Associated Press study follows a month of on-air and online mtvU programming exploring how college students are impacted by increasing financial pressures as part of mtvU and The Jed Foundation’s ongoing “Half of Us” campaign. A similar study examining the impact of stress, mental health struggles, the economy, and other issues facing college students was conducted in 2008 by mtvU / AP in conjunction with “Half of Us.”

Detailed findings from the 2009 study include:

STRESS ON CAMPUS

With 85 percent of students reporting that they experience stress on a daily basis, up from 80 percent last year, it’s clear that stress is a prevalent factor on college campuses today. However, even in light of larger national issues, academic concerns like school work and grades, with 77 percent and 74 percent respectively, maintain their positions as the top drivers of student stress. Financial woes followed close behind, with 67 percent stating that money matters accounted for a lot or some of their daily stress.

In the face of stress and uncertainty, 82 percent maintain positive attitudes surrounding their college education, feeling that it has been worth the time and financial investment.

At the same time, the study shows that stress is taking a serious toll on the everyday lives of college students, affecting them academically and socially:

• Six out of 10 students report having felt so stressed they couldn’t get their work done on one or more occasions.
• 53 percent of students report feeling so stressed they didn’t want to hang out with friends on one or more occasions.

DEPRESSION, SUICIDAL THOUGHTS AND GENERAL MENTAL HEALTH

The mtvU/AP polls from 2008 and 2009 confirm that mental health struggles are common among the college audience and continued efforts are needed to educate students on avenues for seeking support. When stress becomes excessive and impacts a student’s ability to function, it can have severe consequences, especially for students with a mental health condition. Low energy levels, sleep troubles and appetite issues are among the most common indicators of emotional health problems experienced by students, and nearly one out of every 10 students are reporting signs of moderate to severe depression, and an alarming number of students have reached crisis mode:

• 17 percent of students overall report that their friends have talked about wanting to end their lives.
• 10 percent report having a friend who has made a suicide attempt.
• Seven percent report that they have seriously thought about ending their own lives in the past year.

84 percent of students know where they would go for help if they were coping with emotional distress, with 77 percent turning to friends and 67 percent reaching out to their parents for help. Only half of students report that they are familiar with counseling resources available on their campus, and even fewer students actively seek them out. Among students reporting symptoms of moderate to severe depression, 47 percent of state that they are not familiar with the counseling resources available on their campuses, and only 32 percent received any support or treatment from a counselor or mental health professional since beginning college.

Additional findings from this poll can be found at http://www.halfofus.com/press.aspx.

Official press release

A new report will better position government and its partners to help Nova Scotians at risk of attempting suicide.

The report, Suicide and Attempted Suicide in Nova Scotia, was released today, July 15. Its purpose is to help those who work in the areas of suicide prevention, intervention and support.

“Suicide is a very complex and sensitive public health issue,” said Dr. Robert Strang, Nova Scotia’s chief public health officer. “We need to talk about it more and better understand it to ensure the right programs and supports are in place to help Nova Scotians.”

The report describes the conditions surrounding suicide and attempted suicide in Nova Scotia. The data is based on hospital and vital statistics records of suicides and suicide attempts from 1995 to 2004. It examines demographic factors, how people attempt suicide and complete suicide, and the types of health-care services used by Nova Scotians at risk.

“This report is a baseline we can use to evaluate future efforts on this important issue, and we’ve made good progress since 2004,” said Dr. Strang. “We’ve developed a suicide prevention framework to reduce suicides and attempted suicides, we’re doing additional research with the medical examiner’s office, and we fund our community partners who work with Nova Scotians.”

Dr. Stan Kutcher, Sun Life Financial Chair in Adolescent Mental Health, a partnership with the IWK Health Centre and Dalhousie University, said that even though suicide and suicide attempt rates are decreasing, and Nova Scotia is experiencing lower suicide rates than most Canadian provinces, there is more to be done.

“Improving care for people with mental disorders, enhancing the capability of health care and education professionals to identify people at risk, promoting overall good health and resiliency, and improving access to good mental health care, can all help further reduce Nova Scotia’s suicide rates.”

Highlights of the report include:

• The rate of hospitalizations for suicide attempts declined by 30 per cent over the 10-year period
• 55 per cent of those hospitalized were female
• Lower income was associated with higher rates of both hospitalizations for suicide attempts and suicide deaths
• The rate of suicide death declined from 11 to nine individuals per 100,000
• Nova Scotia’s suicide rate was lower than the national average, nine out of 100,000 individuals compared to 11 out of 100,000
• 84 per cent of suicide deaths were male
• 55 per cent of suicide deaths were previously diagnosed with a mental disorder

The report is available online at www.gov.ns.ca/hpp.

Thanks to Mr. Steve Snider the CEO of the Halifax-Dartmouth Bridge Commission for finally moving to install a barrier that will substantially increase the difficulty of completing suicide from the MacDonald Bridge.

Many large cities have a “favoured” location to which individuals contemplating suicide congregate. In Halifax-Dartmouth, the MacDonald Bridge is one of those places. The fact that it is conveniently close to a major mental health facility only serves to accentuate its importance in this problem.

Since the impetus to complete suicide often waxes and wanes, actions that can substantially delay the final act leading to suicide may deter the suicidal individual from acting and may increase the probability of choosing life instead. Indeed, many people who have decided not to complete suicide or who have survived a suicide attempt go on to live positive and productive lives and when reflecting on their suicide considerations are very pleased that they did not go through with their plans.

Restriction of lethal means is one of the few public health measures that have been associated with decreasing suicide rates. Although method substitution is technically possible, research studies have not been able to demonstrate a clear pattern of this occurring when a bridge barrier is erected. So is it likely that putting up a barrier on the MacDonald Bridge will save lives? Probably. Will it send a clear message of concern for this important health issue? Totally! Is it about time this happened? Absolutely!

Actually, important as the role that Mr. Snider had in moving this agenda forward, the true heroes of the story are Carol Cashen and a concerned group of citizens and mental health advocates. As many residents of Halifax-Darthmouth Ms. Cashen is a public health nurse and the mother of a young man who took his life by jumping from the MacDonald Bridge. Together with other members of the community , with the input of the Canadian Mental Health Association and with responsible print and electronic media reporting Carol and the citizens of Halifax-Dartmouth were able to accomplish what the professionals and government were not able to do. They have made the difference. They are the people we all have to be thankful to.

Further Reading:
AJA Award winner: Adam’s Fall, by Matthieu Aikins
Mother calls for screen to stop bridge jumpers

~ Dr. Stan Kutcher

(photo credit)

Great post on Teens Who Self-Harm by Marie Hartwell-Walker, Ed.D. over at Psych Central.

In the blog Marie Hartwell-Walker encourages that “Self-harmers need to be understood, not scolded. They need to unlearn the idea that their feelings are “wrong” and learn that it’s okay to feel them. Most important, they need to learn new ways to manage stress and emotions that they find overwhelming.”

Also we just linked up with Dr. Mary Kay Nixon and her team of the Interdisciplinary National Self-Injury in Youth Network Canada (INSYNC). Lots of great info for youth, families and professionals.

For some interesting and powerful reading on self-harm I recommend the books Cut by Patricia Mccormick and Skin Game: A Memoir by Caroline Kettlewell

Carol Marquis has written a touching and highly personal story about her brother Donnie and his tragic suicide at age 27 years. While Carol’s personal journey led her to feel life more deeply, my professional journey is more focused on what we can do to prevent others, who like Donnie are living with a mental disorder (in his case bipolar illness), from death by suicide.

We know that unfortunately suicide is a mode of death for people who suffer from and live with mental illnesses, much like a heart attack is a mode of death for those who suffer from and live with heart disease. Thus, it is no surprise that in Canada, the highest rates of suicide are found in people who live with a major mental illness – in particular: major depression; bipolar disorder; schizophrenia. Study after study has demonstrated that these mental disorders are the greatest risk factors for suicide. Study after study has demonstrated that there are effective interventions for individuals living with mental illness that can decrease this risk for suicide.

Some of these interventions are: the continued application of effective treatments (medications and psychological interventions); easy access to emergency/crisis mental health care; unique programs that address a variety of factors that can lead to or trigger a suicide act. We know that the majority of individuals who die by suicide visit a health provider prior to the event.

The difficult questions we need to ask are as follows. Why is it that with so much knowledge about what can be helpful that so many people living with mental illness still die by suicide? Why is it that with so much knowledge about what we can do we still invest in programs and activities for which there is little or no evidence of effectiveness? Why is it that we do not widely distribute and ensure that evidence based standards of care for suicide prevention are available in every location where health care is provided? Why is it that we spend little or no time in educating the large legion of health providers to identify and intervene when their patients are or could be suicidal?

Are there many other areas in medicine where we know what to do to make things better and we still persist in doing things that we either know do not work or do not know if they work? If not, what is it about the field of mental health that encourages us to act this way?

~ Dr. Stan Kutcher

One of the goals of this blog is to provide evidence-based information about adolescent mental health. Scientific evidence helps us confirm truths and debunk myths.

A recent BBC article looked at some Christmas myths debunked by the British Medical Journal. One of the myths the BMJ busted is the belief that suicides are more common during the holiday season and winter months.

“The combined stresses of family dysfunction, exacerbations in loneliness, and more depression over the cold dark winter months are commonly thought to increase the number of suicides,” said Dr Vreeman.

But, although the holidays may be difficult for some, there is no good evidence to suggest a peak in suicides.

Also people are not more likely to commit suicide in the dark winter months - around the world suicides peak in warmer months, the researchers said.

Some of the other myths debunked in the article were: there’s no cure for a hangover, eating late does not make you gain weight, and sugar doesn’t make you hyperactive.

~ D. Venn

There’s a lot of misinformation out there about youth suicide. Suicide rates in young people nationally have decreased by about 20% from the mid 1990’s to 2004. Nova Scotia is a good case study. It is difficult to determine trends in youth suicide in Nova Scotia because of the small numbers involved, but total suicide rates as well as total suicide attempts in this province have decreased substantially between 1995 and 2004.

Suicide in Canada, 1950 to 1992

Suicide in Canada, 1979-2003

Why this has occurred is not clear.

One explanation is that effective treatment of depression in young people may be an important factor. Studies have demonstrated a strong relationship between increased use of antidepressant medications and decreased suicide rates in youth. Evidence shows that both medications and psychological therapies decrease rates of suicide attempts in depressed youth. Recent research reports in both Canada and the USA indicate that when anti- depressant medication treatment in young people has decreased, suicide rates have increased. Treatment of depression in young people may effectively reduce suicide rates.

Association between suicide rate and SSRI use in youth 5-14 years old (Gibbons, et al. Am J Psychiatry 163:11, November 2006)

Suicide behaviour is complex. Not all self-harm behaviours are suicide attempts. Self-harm behaviour in young people may not be related to suicide, but rather to deficient problem solving strategies, difficulties with emotional control or impulsivity. It is only recently that we have understood the need to differentiate the two in how we collect data. Treatment for young people who demonstrate self-harm behaviours may be different than treatments for youth who attempt suicide.

Self-harm behaviours reflect many mental disturbances and may be an important vehicle by which young people can access emergency care. Thus, increases in self-harm emergency visits may not reflect an increase in suicide as has been erroneously suggested, but may reflect other phenomenon such as: greater parental awareness of the importance of immediately addressing these behaviors; difficulty in access to specialty mental health services; inadequate delivery of child and adolescent mental health care in primary care; inadequacies in the capability to provide early identification and interventions for youth at risk for mental disorders; or others.

Suicide in young people is a complex problem that requires thoughtful, evidence-driven approaches to appropriately address. It is also an emotional issue raising substantial concern amongst parents, youth, care providers, policy makers and the public alike. There are some interventions that we know work to decrease suicide rates in young people.

One of the most important is improving the early identification and effective treatment of depression in youth. This includes enhancing the competencies of primary health care providers (doctors, nurses, social workers, psychologists, etc) in the diagnosis and treatment of adolescent depression. Training programs for school personnel including “gatekeeper” programs for teachers and linkages between schools and health providers to facilitate identification, rapid assessment and effective treatment may also decrease youth suicide. Restriction of access to lethal means (such as bridge barriers) is helpful as is reasonable and informed media reporting.

Youth suicide is an important public health problem. We must work together to better understand it and to apply what we know works. We need to avoid inciting public anxiety through media reports that are not based on a solid understanding of the issue and we need to support the further development of easily accessible and effective mental health care – not just in hospitals but in schools and community settings. We need to do the right thing – not just do something!

~ Dr. Stan Kutcher

Knowledge translation (also known as KT) is one of those important things that has been going on since the dawn of time, but has now been given a name and a scientific grounding. Many things that we have learned have been from knowledge translation - someone who “knows” has taken that knowledge and put it into a format that helped us learn. This is great as long as the knowledge is correct.

But what happens if it is not?

We could learn something that will not be of maximal value to us and may even be unhelpful or harmful. So here is where the science of KT comes in. Over the last few years a methodology for doing KT has been developed and extensively tested. It consists of systematic and reproducible techniques of finding and evaluating all the available knowledge on any particular topic or issue. These techniques are necessary because all information out there is not of equal quality - some is better and some is much better than others. Some may be more likely to be correct and some more likely to be wrong. The techniques used to evaluate the information are very stringent and have been developed to try and ensure that when the information is synthesized the syntheses is more likely to be correct than not correct. So knowledge will have been translated from scientific studies into a common and more certain bundle of information.

Then the next step comes in — taking that bundle of information and putting it into a format that meets the needs of various users. Because what good is KT if it is not used by people to improve what they are doing and to better understand the world around them?

The Sun Life Chair group does both kinds of KT. We conduct systematic literature evaluations and critical analysis to provide the best available evidence on a variety of topics. For example, one recent topic was that of school-based programs designed to prevent suicide. Guess what we found — although there are many such programs (and I think that some people are making quite a bit of money by selling them) there is very shaky evidence that any are effective.

Indeed, we could not find one that clearly demonstrated it decreased suicide rates in young people! So this is very important information for people making health and education policy and for people who want to buy some of these programs. We think that it’s better to use those things that work instead of those things that do not work or that we do not know if they work or those things that may be harmful.

I recently filmed a video with Insider Medicine talking about knowledge translation. Check it out for more info.

Cheers - Dr. Stan Kutcher

In the Spotlight - Dr. Stan Kutcher, MD, FRCPC, Professor of Psychiatry at Dalhousie University, Discusses Knowledge Translation