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Health & Wellness: ETSU researcher studying ways to lower rates of suicide in rural areas

February 24th, 2010 12:00 am by Leigh Ann Laube

Health & Wellness: ETSU researcher studying ways to lower rates of suicide in rural areas

Dr. Jameson Hirsch

A long-time suicide researcher, Dr. Jameson Hirsch, assistant professor of psychology in the College of Arts and Sciences at East Tennessee State University, wasn’t surprised when he started looking into the rates of risky behaviors and distress among the nearly 14,000 students at ETSU.

Alarmed, he said, but not surprised.

“Some of the research I’ve done in the past and some of the literature points to this time of life being vulnerable,” Hirsch said. “Young adolescents ages 15 to 24, there’s a lot going on — identity issues, social issues — and if you mix that with the college environment, which is potentially stressful, academically, socially, financially, really a lot of students are under pretty significant pressures, and don’t know how to deal with that in an appropriate manner.

“This shows that we have a lot of students on campus in need, experiencing stress or difficult times and there’s a real need for the grant and it’s prevention components. We can try to reach out to these students on campus.”

Hirsch, through ETSU, applied for and received funding by the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop ETSU PEAKS (Prevention through Education, Awareness and Knowledge of Suicide), a campus-wide suicide prevention program.

When gathering preliminary data for the grant-writing process, Hirsch found that 73 percent of students in his sample group reported alcohol use in the past month and 34 percent reported symptoms of depression.  Forty-eight percent of students surveyed reported having suicidal thoughts in the past, 13 percent had planned a suicide attempt, and 2 percent indicated they will make a future suicide attempt.

Suicide rates in Tennessee are consistently at or above national averages, and they are increasing, Hirsch added, noting that college-age young adults have some of the highest suicide rates in the state.

The three-year, $593,000 ETSU PEAKS project, which includes a matching contribution from ETSU, will target vulnerable and at-risk populations on campus, including first-generation students and first-time freshmen; military veterans; minority and international students; members of fraternal and sorority groups; and gay/lesbian/bisexual/transgender students. ETSU PEAKS will also address rural barriers to suicide prevention, including myths and stigma associated with suicide. While there are a number of services and programs at ETSU dedicated to mental health awareness and the support of distressed students, Hirsch said this program will bring everyone to the same table working together to prevent suicide.

Campus partners involved with the grant include the offices of Housing and Residence Life and Public Safety, the Division of Student Affairs, the departments of Psychology and Family Medicine, and the ETSU Counseling Center.

“Like any college campus, we have the ETSU Counseling Center that’s at capacity,” Hirsch said. “People there are seeing an increase in the number of distressed students who need hospitalization or intervention. They're seeing a lot more crisis situations with the students.” 

ETSU currently has 13,700 students. Last fall, there were 14,700 enrolled. Both are record enrollments for the college, said Dr. Steve Brown, director of the ETSU Counseling Center.

“Last semester, we had a 30 percent increase in the number of students seeking assistance from the counseling center, and a pretty significant increase in the number of crisis calls. We had about 10 hospitalizations,” Brown said.

The preliminary data gathered by Hirsch is fairly consistent with national data, Brown said.

“We had no completed suicides last semester. There have been suicides, most of them off-campus. I can’t remember the last time we had one on campus. We had one at a fraternity house three or four years ago, and I think that was the last one near campus. You look at [Middle Tennessee State University], for example. They’ve had four completed this semester that I’m aware of.”

Hirsch doesn’t want the public to dismiss the importance of a suicide prevention program for a university with a low incidence of completed suicide.

“People in our community and in our ETSU community would look at those rates and say, ‘Any suicide is tragic, but we have 15,000 students and we have one every few years.’ I don’t know that that’s the right way to look at it. There’s thoughts of suicide, suicide attempts and those things go unclassified a lot of the time. People don’t think about the co-morbid stuff going along with it, social difficulties, their relationships are in turmoil. It’s all the other stuff that goes along with it.”

Operating with a staff of five, including himself, Brown said the fall semester is when the ETSU Counseling Office sees most crises.

“New students bring their issues with them, especially the freshmen,” he said.

According to the Tennessee Department of Mental Health and Developmental Disabilities,  suicide is the third-leading cause of death among youth and young adults ages 10 to 24 in this state and throughout the nation. The rate of suicide in Tennessee is 14.4 per 100,000 individuals, higher than the national average of 10.8 per 100,000 individuals, which places Tennessee’s suicide rate 13th in the nation.

Hirsch said data are loud and clear that rates of suicide are often higher in rural areas.

“As for the why, research suggests that social and cultural beliefs, isolation, economic stress, and the acceptance of firearms are contributing factors,” he said.

Hirsch wrote the grant specifically tailored to a rural institution.

“I feel like we have some unique things going on in a rural area that should be addressed. People are strong in their beliefs, their work ethics, their values and these things impact stigma. We want to bring in and work with the campus ministries to get our message out that way in a way that students can relate to. We want to work with some of the ideas that you have to be tough, independent and a rugged individualist because we’re from the South, from Appalachia, which prevents people from seeking help. You have to be tough and suck it up. You’re on your own. We are dealing with a proud and unique set of students here and I think sometimes those things get in the way of trying to help the student. We’re trying to overcome those barriers.”

 For years, Brown said, counseling centers on campuses across the nation have seen an increase in business and in severity.

“We’re seeing the impact of having less parental focus on children, so kids aren’t getting what they need. I can’t tell you how many students we’re seeing where there’s no parental support. The parents may be strung out … and parental issues are tremendously impacting the kids. Then add to that the economy, not being able to support themselves much less their kids wanting to go to college,” Brown said.

Most college students don’t have good coping skills, he said.

“The transition from high school to college is probably more significant than it’s ever been. ... College is a perfect pressure cooker. What other place changes your routine every semester?”

Hirsch and the ETSU PEAKS team will conduct focus groups with students, faculty, staff and administrators to better understand the specific suicide prevention needs of the campus. The SAMHSA grant will provide funding for the development of training programs, workshops and presentations for the ETSU community; specialized suicide prevention curricula for health professions students; an interactive and multimedia prevention Web site; and a social marketing campaign to address suicide and related mental health issues and to promote increased awareness of campus and community resources.

 “The goal is not to educate every employee and student on how to respond to a person in crisis,” Hirsch said. “Yes, there are many on campus who will be trained in this area, but we want the entire ETSU community to understand that suicide can happen on our campus and that certain risk factors and warning signs exist.”

Staff and students who are trained — Hirsch calls them gatekeepers — will not only know the warning signs of suicide and depression, but will know what to do in that situation.

“They will know who [to] call, know where the counseling center is on campus and can walk the student over there. Gatekeepers will be potentially anybody, especially those in contact with the people at risk — faculty, staff, administration, resident assistant’s in the dormitories, people in student government who have a lot of exposure to the student body. … Even janitors and the people who come later at night, the service people. They might be working late, see someone with their head on the desk crying. It could potentially be anybody who has contact with the student. We may not be able to train everybody on campus, but we need to get a good mixture.”

ETSU received the three-year SAMHSA grant in December, so Hirsch has been busy doing baseline assessments to find out what the needs are on campus and working to hire a project coordinator.

“We have started, but the flip side is we really haven’t done anything that the campus can see,” he said.
 He plans to reapply for funding after the initial three years.

“It’s time limited but have we have goals to accomplish ... the ultimate goal to increase service usage on campus and reduce the prevalence rates. That’s a lofty goal. Who are we and how can we make such an impact on each individual student? In the big picture ... hopefully we have a more meaningful impact.


“At the end of this project, we’d like to see on campus a more open and safe environment for students to attempt to deal with their emotional and psychological difficulties. .... We just want an air of safety and comfort on campus. Also we would like to see that we’ve developed a suicide prevention protocol for our campus. What happens from step A to step Z? Another thing I think really has to happen is we have some sustainability on campus for these efforts.”


SAMHSA’s campus suicide prevention program is funded under the Garrett Lee Smith Memorial Act, which was unanimously approved by the U.S. Senate and overwhelmingly supported by the U.S. House of Representatives in 2004.  Smith was the son of former U.S. Senator Gordon Smith from Oregon.  While a college student, he died by suicide the day before his 22nd birthday.

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