Suicide is a severe and multifaceted issue affecting individuals at any stage, including PhD students. Adults aged 25-34 in the United States have one of the highest suicide rates, with 18.35 deaths per 100,000 people, according to the Centers for Disease Control and Prevention.
The journey to doctoral-level study is an exceptional accomplishment, requiring years of dedicated effort to secure admission to a PhD program. While you might dream of the vibrant exchanges and discussions with peers depicted in graduate school guidebooks, the reality can often involve weeks of isolation in a lab or extensive hours spent reading. These experiences can exacerbate the risk of suicide.
The pressure to excel academically, combined with the isolation inherent in independent research and study, uncertainty about the future, and interpersonal challenges, can contribute to feelings of despair and hopelessness among PhD students. Experts estimate that for each suicide death, many more individuals are profoundly affected as survivors of that loss. It is essential to provide information and resources to support PhD students, their peers, and their loved ones in recognizing the warning signs of suicidal thoughts, accessing assistance, and promoting mental health and overall well-being.
“Suicide can be a difficult topic, but it’s important to know that help is there. If you or someone you know is struggling with thoughts of suicide, contact the 988 Suicide & Crisis Lifeline at 988 or 1-800-273-TALK (8255). It is available 24 hours a day, seven days a week, and all calls are confidential.”
Suicide & Self-Harm on the Rise?
Data supports that doctoral students have a higher risk of mental health challenges because of the stressors that come with graduate study. The mindset of having to “suffer for your PhD” can be worn as a badge of honor, and as a result, others may disregard indirect verbal or behavioral clues that a student is seriously considering suicide. A myth is that only experts can prevent suicide, but anyone can help prevent the tragedy of suicide.
Common Mental Health Issues Among PhD Students
While each student comes into PhD programs with their own particular set of experiences, strengths, and hardships, there are some common mental health challenges that PhD students experience during their studies.
Two of the most common mental health challenges among PhD students are anxiety and depression. Depression is especially a risk factor for suicidal ideation, intent, or actions. When students experience elevated and simultaneous combination of feelings like they are burdensome and like they don’t belong or “fit in”, suicide risk may escalate precipitously. These factors, including the ones below, may cause disruptions in the wellbeing of you and your peers.
Factors That Put You at Most Risk for Suicide
As a PhD student, you will experience some of the same stressors as students in other stages of education; however, these stressors will be more intense to match the level of your degree. Some of these specific circumstances are fundamental risk factors, which form the basis for proximal risk factors, or “final straws,” to increase suicidal thinking and actions.
Academic Stress
Doctoral study is unlike any other type of learning. It carries a specific set of academic demands, including increased output, publishing, research, and experiments. The length and depth of assignments increase, as do reading materials that are demanded for research or to “stay current” in your respective field. Additionally, you may be collaborating with your adviser towards publication, which is crucial for their academic appointment and your program completion. You may also reach a point with your research topic where your experiments are not successful and feel stuck, unsure of how to proceed productively. You may even be feeling “burned out” after a few years of graduate school.
Chronic or Serious Health Issues
Many adults experience acute or chronic health issues, and they can be exacerbated by the stress of a PhD program. Whether you are grappling with an existing condition or remarking the evolution of an acute condition like a substance use disorder, these health issues can affect your ability to be present with your studies and begin to feel like you are falling insurmountably behind. Additionally, frequent or excessive maladaptive substance use can melt some of the protective factors against suicide like connecting with friends and loved ones, seeking psychotherapy, or a sense of hope.
Financial Concerns
Earning a place in a funded PhD program is a difficult feat; however, it presents an extremely challenging lifestyle. While your tuition is supported by the institution, you may encounter low stipends on which you and your family may struggle to meet basic needs. You may have to access student loans to support your tuition or living expenses while you study, and be limited in how you can access other work opportunities while in your program. You may also have to secure grants for ongoing funds to continue your research and complete your degree.
History of Mental Health Issues
For those who have previously experienced mental health challenges, the increased stress of a PhD program can exacerbate your current circumstances and chip away at your established coping skills. The depleted resources, lack of time for positive activities that support mental health recovery, and unprecedented stress can aggravate the history of mental health challenges and =contribute to increased suicide risk.
Isolation and Loneliness
Doctoral study is often more isolating than what students expect. First, you may have needed to relocate to attend your program, disrupting your existing social support system more than you anticipated and leaving you feeling vulnerable and lonely in a new place. Additionally, tasks associated with PhD programs, like lab experiments or in-depth reading and research, are often solitary activities, leaving you alone or isolated for many hours a day.
Need to Be Perfect
Many students feel the pressure of perfection in their PhD program because they know how much work was required to earn their place in a competitive application cycle. You may also be feeling guilty about those who “lost a spot” because of you. These thoughts can lead to perfectionistic tendencies, which are an unsustainable set of personal directives that often lead to feelings of inadequacy and ultimately, failure.
Previous Suicide Attempts
Any previous suicidal attempt is a risk factor for further attempts, including attempts by using more lethal means, like a firearm. While you may not know the history of your peer, if they have hinted, suggested, or stated that they attempted suicide previously, even if you are unsure of the seriousness of their attempt, take all signs and risk factors seriously.
Relationship Problems
Connectedness is one of the most successful aspects of suicide prevention, and so disruption to a student’s relationships for any reason can exacerbate suicidal thinking. This disruption may take the form of a break-up, loss of relationships, abusive or conflict-heavy relationships, experiencing bullying, or death of a loved one, particularly by suicide. Relationship crises or problems often act as a proximal risk factor for suicide, and they can be one of the last observed changes prior to an attempt.
Support Systems are Shaky
When the systems that exist to provide support and reassurance are flimsy or not meaningful to the individual, it can increase suicide risk. Whether this takes the form of strife in a student’s program, conflict with an adviser, challenges with peers or being ostracized by a cohort, any tears in a “safety net” of support systems can contribute to increased suicide risk.
10 Warning Signs to Look For
As you are considering possible warning signs for a peer or loved one, it is first crucial to understand the context in which these signs are manifesting. For example, a heart attack and a panic attack share a series of signs and symptoms, and require knowledge to distinguish between them to move forward with thoughtful treatment. However, with each condition, we should take each sign or clue seriously and act swiftly to identify support.
Some behavioral warning signs may be direct while others may be indirect. Some clues may be verbal, some may be non-verbal while other warning signs may be situational. Noticing each of these warning signs, as well as environmentally relevant ones to your peer or loved one, can help determine if someone is considering suicide. Attending early warning signs could save a life.
1. Talk about suicide or express thoughts of dying
This may be the most explicit warning sign and should be taken seriously. Some people engage hyperbolic language that includes references to suicide (“I’m so stressed I could kill myself!”), and you should address this earnestly and seriously with your peer to communicate your concern and willingness to engage if necessary.
2. Extreme mood changes or behavior changes
Any drastic personality or mood change is important and warrants further exploration. Examples include not going to social events, increased irritability, or sudden mood swings. A steep decline in mood may signify worsening depression, or a suddenly improved mood may indicate that a person has now created a plan to die by suicide.
3. Changes in academic performance
If a student has struggled to keep up with their studies, has uncharacteristically been turning in assignments late, and seem disengaged and full of apathy, they may be trying to send signals with their behavior. Additionally, if you notice that someone is experiencing anhedonia, an inability to experience pleasure in things that they typically find pleasurable, like socializing with friends, attending a sporting event or concert, or even a meal at their favorite restaurant, seek attention promptly.
4. Acquiring means of suicide
This may include purchasing a firearm, stockpiling pills, or making other plans to attempt suicide. If someone discloses to you that they have been engaging in this behavior, engage emergency services immediately.
5. Intermittent success with recovery or substance use
Individuals who may have previously been maintaining sobriety from drugs and alcohol experience a relapse, they may be feeling hopeless and frustrated with themselves, putting them at very high risk for suicide. They also may be unsure about how to address this with their recovery support community. They may fear being ostracized by their peers because they are using again. Whether this is the result of a history of substance use disorder or uncharacteristically consuming alcohol or drugs more, use of alcohol or other drugs increases the risk of suicide exponentially.
6. Humor
Paradoxically, someone who is trying to emit clues about their suicidal ideation may do so through humor. They may make quips, hyperbolic statements, or joke about suicide to see if anyone picks up on it and perceives their pain. If no one does, they can laugh along with the joke, feeling even more isolated. It’s important to remind others that suicide is never a joke and that we must take all mention of it seriously.
7. Culture shock/shift
A sudden change in culture or environment, even if it’s for the better, can erode someone’s sense of belonging and increase isolation and suicide risk. Relocating for school or immigrating are examples of “positive” changes, which may happen simultaneously for PhD students. If you notice someone disconnecting socially or feeling like they can’t keep up with changing social groups and are becoming increasingly isolated, consider building connections with them before their isolation escalates.
8. Dismissal, expulsion, or firing
Another example of a proximal warning sign, losing a coveted place in a program, school, or job can disorient the person and leave them feeling hopeless. If the dismissal was the result of disciplinary action for some other warning signs like substance use or depression, this compounds suicide risk.
9. Feeling burdensome
If someone describes feeling like a burden to their friends or loved ones and begins saying things like “They’d be better off without me,” or “Who cares if I’m dead anyway?” or “Pretty soon you won’t have to worry about me,” these are indirect verbal clues that are warning signs for suicide. A common trait among these statements is they primarily relate to other people’s experiences of them, not the self, as they are considering their burden on others rather than their own agency. If you hear this or adjacent statements, address it with them directly.
10. Putting personal affairs in order
If someone appears to be organizing the end of their life, giving away meaningful possessions or making funeral arrangements, take swift and decisive action to intervene.
How to Talk with a Student
Asking “The Suicide Question” can be overwhelming, and yet, it is an important tool in intervening with someone who is considering suicide. Ultimately, asking the question is more important than how you ask it, and there are some ways for a more productive conversation. If you feel unable to have this tough conversation, find someone who can, as safety is crucial. Remember that suicide is not the problem, it is how the individual is trying to solve what feels like an impossible problem.
Choose a Private and Safe Space
If possible, have the conversation with a person somewhere private and appropriate for the nature of your relationship (like an office or private study area) and give yourself plenty of time. Make sure to make alternate arrangements for teaching, childcare, or other responsibilities so you can be present in your conversation.
Be Direct and Calm
Ask clearly and calmly, “Are you thinking about suicide/killing yourself?” If the person is reluctant, be persistent and consider a less direct approach, like:
- “Have you been very unhappy lately?”
- “Have you been so very unhappy lately that you’ve been thinking about ending your life?”
- “Do you ever wish you could go to sleep and never wake up?”
Be thoughtful about words that may have multiple meanings, like “hurt yourself” or “harm yourself,” being specific is helpful. Whatever their response, remain as neutral as you can and try to allow them to borrow your calm as you work together on identifying help.
Practice Active Listening
Read about active listening and use these skills in the moment. Try to limit alarm towards the person, as well as not engaging in any “problem-solving” now. Listen and be receptive to what they have to say while looking ahead towards next steps. Try not to use a bounded question, like “You’re not thinking of killing yourself, are you?” While it comes from concern, it is signaling the answer that you want to hear rather than listening to how they feel.
Express Your Care and Concern
Very simple phrases are helpful here, like:
- “You are important to me, what do you think you need right now?”
- “You seem to be really struggling, let’s make a plan for the next couple of days together.”
- “Who can we reach out to who would also be helpful right now?”
Being willing to listen and help find hope may make all the difference to someone who is considering suicide.
Encourage Them to Seek Professional Help
The next step is to move towards engaging professionals to assist in this process. The best option is to take the person directly to someone who can help, like a counseling center, crisis center, or emergency room. If you are unsure how to proceed, you can call 988 with the person together and they will advise you with next steps.
Follow Up
Connection is one of the most important suicide prevention tools available, so make sure to follow up with the person regularly by text, call, or visits. Enlist others, with the permission of the affected person, to offer support as well.
How to Get Help
Seeking help for suicidal thoughts is not a sign of weakness. PhD students are accomplished individuals who are hoping to become leaders in their field, and experiencing suicidal thoughts does not change that. Asking for help when you need it, especially when it is for your mental health, is a sign of thoughtful strength. No one has to go through this alone, and getting qualified help immediately can help you find resources and hope.
Seek Emergency Medical Care
If you are in immediate danger, call 988 or go to your nearest crisis center or emergency room. Some areas may have a mobile crisis unit that can come to you, like a “mental health ambulance.” Do not leave a person who is experiencing acute suicidal thoughts by themselves.
Call a Crisis Hotline
Call 988 or text 741-741 to speak with a trained suicide prevention professional. You can also reach The Trevor Helpline 1-866-488-7386 or text 678-678.
Find a Mental Health Professional
Finding a therapist can be challenging, more so when using your health insurance and finding someone with space. Ask for help from peer specialists, case or care managers, or discharge or aftercare planners for help identifying resources that will work for you.
Talk to a Trusted Friend or Family Member
Identify the people in your life who are supportive and with whom you can be candid about your experiences. Some close to you may be too reactive about the prospect of a death by suicide, so look to those who can currently connect with and support you during this time.
Take Advantage of School Resources
Your school community is committed to your safety and wellbeing. Access help through your university’s counseling center, and there are sometimes urgent appointments for people who are experiencing an acute crisis. While university counseling is typically intended to be brief, their staff may be able to connect you with ongoing care.
Treatment Options Available to Doctoral Students
As a PhD student, you have several treatment options to help you manage your symptoms and reduce your risk of death by suicide. Seeking treatment during this vulnerable time is essential, and the best course of treatment will vary depending on the individual. Be wary of individuals on social media platforms promising “healing” or those soliciting unregulated supplements, most of whom are not qualified or trained, as they can exacerbate or worsen your condition. As you consider your treatment options, look for those that are facilitated by a qualified, licensed healthcare professional to develop a treatment plan that is specific to your needs and goals. Some common, safe, proven, and accessible treatment options include:
Psychotherapy
Psychotherapy provides a confidential space to discuss and work on problems and challenges. By evaluating your existing strengths and providing evidence-based tools to grow your internal resource toolbox, a psychotherapist will fortify your efforts for personal wellness and growth.
Medication
Many individuals hold stigma towards mental health medications, however, would not hesitate to adhere to a hypertension or diabetes medication regimen as prescribed by their physician. Medication seeks to correct imbalances that contribute to mood disturbance, and by doing so, allow some of your other healing efforts to go further and become more successful.
Hospitalization
If you are struggling despite working with a psychotherapist regularly and are not improving on medication, you may want to consider a higher level of care, including hospitalization. Taking the time that you need to recalibrate in a structured setting may allow you to return to your life and continue enacting positive changes. You can also consider partial hospitalization and intensive outpatient options, based on your acuity.
Peer Support
Going further than speaking to a loved one, a therapeutic group as peer support can be an excellent tool in mental health treatment and suicide prevention. Seek group therapy options in your area or that take place virtually to gain the benefits of support, thoughtful interactions, and evidence-based content provided by the facilitator to improve your outcome.
Self-care
Beyond cupcakes and pedicures, true self-care begins with how you rest, nourish, and groom your body, and extends to your other routines. Are you comfortable in your environment, in your clothing, and with how you eat? Look to make adjustments in your routines that make your life 5% easier tomorrow, as well as attending to your arousal level and learning when you may need to take a break to self-regulate or engage in a grounding exercise.
Promoting Suicide Awareness and Prevention
Universities and academic institutions continue to prioritize suicide awareness and prevention among all their learners, especially PhD students who carry a specific set of stressors and challenges as a part of earning their degree. Look to your university for how they are providing resources and support for those who are struggling with suicidal thoughts and behaviors, as well as promoting overall wellness and health on their campus for all students, including virtual learners.
Raising Awareness and Reducing Stigma
One of the most obstructive and archaic barriers to suicide awareness is stigma associated with suicidal thoughts and mental health challenges, in addition to the discomfort people experience while discussing suicide. Campuses can begin promoting suicide awareness and prevention measures by hosting events on-campus and fostering campus dialogue about mental health and suicide. Some cultural shifts may include providing routine and ongoing training on suicide prevention to faculty, staff, and students, as well as creating affirming spaces and policies and respecting students’ names and pronouns. By taking some of these steps to reduce stigma, they will work towards creating a more supportive environment in which doctoral students feel empowered to seek help and support.
Creating a Supportive System
Colleges and universities have been working to evolve their mental health support to reflect higher utilization and the needs of different student groups. Your university likely already has a counseling center and community resources and referrals. The counseling center would offer individual and sometimes group therapy, which can be an excellent way to begin your personal support system as a PhD student. However, it is worth thinking in longer-terms, as PhD students are often engaged for longer than an undergraduate student or those seeking a pre-professional degree. Consider suggesting a mentorship program between higher-year students and incoming students, as well as fostering better communication between faculty and students through an ombudsperson or other mediator to improve overall morale and to create a more fruitful learning environment.
Suicide Awareness and Prevention Resources
- Active Minds: Focusing on reducing stigma around mental health and talking about difficult topics like suicide, Active Minds is present on many campuses and has opportunities to get involved.
- David Farber ASPIRE Center: Honoring David Farber, who died by suicide, their center is geared towards innovative research, evidence-based approaches and clinical training for suicide prevention.
- Headspace: Research supports that mindfulness shows promising results in reducing suicide risk, and using an app like Headspace makes it easy and accessible to integrate mindfulness into your daily routine.
- LGBT National Health Center: Call 888-843-4564 for free and confidential peer support by other LGBTQIA+ community members
- Mental Health First Aid: Treating supporting someone during a mental health crisis as crucial as learning basic life support and CPR skills, Mental Health First Aid offers trainings and has additional resources for students.
- Movember: What started as a no-shave challenge has become a prolific hub for information about men’s mental health.
- National Alliance on Mental Illness: Read personal stories and learn more about mental health challenges and suicide prevention, as well as accessing their directory of hundreds of additional resources.
- Suicide Awareness Voices of Education (SAVE): Geared towards education efforts, SAVE provides information for public awareness and education. It also serves as a resource for those who have lost a loved one to suicide.
- Suicide Prevention Resource Center: An extensive library of resources, trainings, and prevention tools. Check out the College and University section for information for students.
- Therapy for Black Girls: Working to reduce mental health stigma as well as providing affordable affirming care for Black girls and women.
- Trans Lifeline: Call 877-565-8860 for peer support, as well as connection to economic and community resources.
- Zero Suicide: A hub trainings in suicide prevention for community members, as well as an extensive resource guide
Interview with a Psychologist: Grad School is Marathon, So Care for Yourself
Antonia O’Planick, PsyD, is a clinical health psychologist. She specializes in treating mood disorders, eating disorders, and comorbid medical conditions. She has more than 15 years of experience in the mental health field working in a variety of settings including large hospital systems, inpatient mental health treatment, specialized outpatient centers, and outpatient care. She currently operates a private practice, Align Psychological Health.
1. What piece of mental health advice was most useful to you while you were completing your doctorate?
Although not always easy to prioritize in all the demands, attending to yourself and your basic needs is an absolute necessity. Graduate school isn’t a short-term thing you can muscle through, it’s truly a marathon and you need to pace yourself. A wise professor reminded my cohort, although graduate school is a large part of your life, it’s not your whole life, it’s just your job for the time being. Don’t let it consume you entirely or you won’t make it.
2. Are there any particular periods during a PhD program when students may be at higher risk of suicide, such as during exams or thesis writing?
I would argue that the risk of suicide and overwhelm is possible at any point when someone is working in a high demand, oftentimes competitive situation.
Yes, exam time or other bench-mark moments like competency exams, thesis/dissertation writing are probably more stressful and should receive some special attention. However, I wouldn’t negate the need to prioritize stress-management throughout each stage of the program. It’s not always the last straw that breaks the camel’s back.
3. What might the impact be of a PhD student who needs to take a leave of absence to pursue intensive treatment for mental health challenges?
Using the analogy of a marathon, it is terrifying to entertain the possibility of slowing down or taking a break during a race. The only thing more terrifying is dealing with the consequences of not making that accommodation if it’s needed. Pursuing treatment might very well become a necessity to completing the program. Sometimes we need to consider the larger picture and realize that a detour is needed. Students should have some reasonable faith that their program wants them to succeed, even if that means working on a different timeline.
4. What impact can imposter syndrome have on a PhD student’s mental health, and how can it be addressed or mitigated?
Imposter syndrome is so inherent in the training process. It’s hard to be in a learning situation where you are simultaneously trying to acquire knowledge but also appear knowledgeable. The problem is that it can stoke some more general fears about inadequacy or incompetency (which you may want to discuss further with a therapist). My advice is reminding students that it is in fact a training situation; nothing should be perfect, and mistakes are an essential part of the learning process. If you’re doing everything perfectly, you likely wouldn’t need to be here.
5. Where can PhD students turn for help navigating conflict or challenges in their program, both with their peers and faculty/adviser?
Every good graduate program should include student support. Any accredited program should have policies in place to support students who have questions, are struggling or running into interpersonal difficulties within the program.
Most programs also have a built-in adviser system or a student mentorship program where students can discuss problems. Remember that these programs have invested in you and your success, they want you to do well and typically offer some mechanisms for support.
6. How can PhD students cope with the stress and pressure of conducting original research and producing a dissertation?
The pressure surrounding research and dissertations can be intense. I think sometimes it can take on a larger-than-life persona and suddenly become the most important piece of work a student will ever do that completely dictates their life’s work. That creates immense pressure! Some advice would be to dial back the pressure; listen to your advisers when they say to reduce the scale of the project and remember that it is only one project in the grand scheme of your career. It might be helpful to envision it as your first attempt at an independent project but not your last.
7. How can academic institutions better support PhD students with mental health issues?
It would be great if institutions just assumed that all students are going to struggle mentally and proactively integrated mental health supports. Attention to self and balancing the demands of work with rest should also be something we strive to teach students who are likely entering demanding careers. If ‘wellness support’ became a standardized component of the program, maybe students who are seriously struggling wouldn’t feel so timid to seek support.
8. What are some of the most effective strategies or interventions PhD students can implement in their daily routines to maintain their mental health?
I’m a big proponent of habitually engaging in self-care and think we all underestimate the impact of attending to our own basic needs. The term “self-care” can be a bit flowery but really means doing things that equip your body to meet demands. Nobody can be very successful without being fed, rested, moved, and nourished. Time for self, social engagement, and doing enjoyable activities are also important. Doing these things are essential and actually help us work more effectively.