A Systematic Review of Suicide Prevention in Colleges and Universities from a Public Health Perspective

Suicide is a vexing public health problem. It is a leading cause of death in the United States, with over 31,000 people committiug suicide in 2003. It is also a particularly tragic and troubling cause of death because it is a volitional act committed by psychologically and, generally, psychiatrically impaired members of our society. Many key stakeholders in this problem, including the media, health care providers, politicians, and public health officials, have focused much attention on suicide and suicide prevention for many decades. Little progress has been achieved in lowering the suicide rate in this country, however, as it has remained relatively stable over the last 50 years. There are many reasons for this lack of progress in preventing suicide. Although suicide is the eleventh leading cause of death in general in the United States, it is nonetheless a relatively rare event: roughly 11 suicides per 100,000 people in 2003. Moreover, although suicide is more common in certain demographic groups, it is a relatively rare event even in these populations. This makes it exceedingly difficult to study. The definition of what constitutes a suicide has also been inconsistent and the methods used for declaring suicide as the cause of death have varied widely in research and prevention efforts. Many factors interact to cause suicide, making targeted prevention interventions difficult to design. When prevention efforts are implemented, they are difficult to study using well-controlled designs. Stigma surrounding suicide and mental illness has contributed significantly to the poor amount and quality of suicide prevention research as well. In response to these difficulties and the continued lack of progress in decreasing the Nation's suicide rate, key stakeholders in suicide prevention have recently issued recommendations for a new national strategy for suicide research and prevention, based on a public health approach. This strategy seeks to overcome prior difficulties in suicide prevention research by undertaking large, multicenter studies in diverse populations aimed at: 1. determining the true rate of suicide in each demographic population; 2. discerning the many risk and protective factors for suicide; 3. designing, implementing, and evaluating suicide prevention interventions based on these risk and protective factors; 4. combining promising interventions into broad suicide prevention programs; and 5. evaluating the effectiveness of these programs through on-going epidemiological surveillance of suicide in the many distinct populations of this country.Master of Public Healt