Graduate school is a stressful time. Between papers, labs, presentations, and trying to keep work and life ducks in a row, the pursuit of a master’s can take its toll. According to a study from Harvard University, graduate students are six times more likely to experience anxiety and depression than the general population. Even worse, just 36% of those students seek help.
When left unchecked, anxiety and depression in graduate school can lead to far more serious mental health concerns, including suicide. Suicide is the second-leading cause of death among people ages 15 to 24, and an estimated 1,100 deaths by suicide occur on college campuses each year. This makes it critical to learn how to recognize the risk factors of suicide and how to address them should one or more emerge in a friend, a family member, or yourself.
The following guidebook is a starting point. It examines stressors, risk factors, and warning signs, and then breaks down the steps you can take if you or someone you know needs help. It also includes an interview with a university counselor who specializes in mental health in college. Suicide awareness and prevention begins with education.
Common Grad School Stressors
When discussing suicide, it’s important to focus some of that discussion on stressors. For example, finances, deadlines, and success measures (e.g. grades) can lead anyone — grad student or not — to feel anxious or worse. Let’s review some of the common stressors grad students face as they navigate toward graduation.
Many graduate students have multiple responsibilities to tackle in a limited amount of time, sometimes weeks or days. This means long hours, overnighters, and over-caffeinating to get quality work done before D-Day. As a deadline looms — especially a critical one — anxiety, hopelessness, and a fear of failure can emerge. These feelings can exacerbate when career goals and expectations are on the line.
Competition and Toxicity
In many cohort-based programs, diverse personalities, internal alliances, and competition for roles and recognition can breed an unhealthy and sometimes even toxic environment. You can feel exhausted trying to excel, learn, and grow in this fraught interpersonal environment. Beyond these dynamics, students often compete for resources (e.g. grant funding) and faculty support for their projects and other pursuits. With so much competition, it can often feel like you spend more time and energy navigating these dynamics than you do studying which can eventually take its toll on your mental health.
Like medical residents at a hospital, graduate assistants sometimes make up a large portion of the instructional workforce, especially at large institutions. They also often pick up the slack for overloaded faculty members. While some graduate assistants enjoy teaching, others find the prospect exhausting as they also try to balance their academic duties and work responsibilities, particularly if they intend to enter industry rather than academia after graduation. The demands of an assistantship aren’t for everyone, and can contribute to poor mental health if the fit isn’t right.
The reporting structure for any type of conflict as a graduate student is not always straightforward. While there may be a student code of conduct in place, but that doesn’t always stop students for breaking the rules or sometimes the conflict falls into a gray area. An example of this might be everyday microaggressions from a classmate that, though subtle, can add up over time. There are also often stigmas surrounding the person who calls out the bad behavior. This can lead to someone continuing to put up with a behavior that they shouldn’t or lack of accountability on the part of the aggressor. Over time, these problems can fester and impact student mental health.
Major Academic Milestones
Many graduate programs either include comprehensive exams and thesis defense or prepare you for a licensing exam. The pressure of these milestones is immense given they can seem to define your ability, your dedication, and your career trajectory. Some students handle these challenges better than those who may learn differently or struggle with test-taking. The resulting stress can be too much for some, particularly if they don’t do as well as they expected.
College Suicide: Key Risk Factors
The Life Change Index can help you understand the risk factors of suicide for college students, including graduate students. By adding some objectivity to the impact of change in a person’s life, this scale reminds you that change is tough and can exacerbate other mental health issues. Pay attention to these signs in yourself or someone you love as it may be an indicator of a larger mental health problem that needs to be addressed.
- A history of depression or previous suicide attempts: Previous suicide attempts increase the likelihood of future attempts, especially when combined with periods of clinical or sub-clinical depression, dysthymia, or other mood disorders. If you notice yourself or a loved one losing interest in daily activities and experiencing depression more days than not, engage mental health resources as soon as possible.
- Being a victim of bullying or cyberbullying: Bullying (e.g. name-calling, insults, physical harm) in a romantic relationship or a parent/child relationship is a sign of abuse. Bullying and cyberbullying are also serious, and a victim’s mental health needs to be supported with the same concern and trauma-informed care as any individual experiencing emotional or physical abuse.
- Many life changes all at once: Change can exacerbate already existing or underlying mental health issues. When beginning a new graduate school program, you might be moving to a new town or state or away from friends and family for the first time. This can have you questioning your choices or cause mental health issues that should be addressed.
- Career or academic setbacks: If a student is on a tight deadline or struggles with poor performance in their course of study, these circumstances certainly affect their mental health and sense of self-worth. Students often identify with their chosen course of graduate study, and not meeting expectations is stressful and devastating. Students who are particularly encouraged by good grades or accolades struggle even more when they experience academic issues.
- Isolation and little/no social interaction: Isolation is a risk factor for suicide because connectedness reminds us of the possibility for change, and encouragement from others can counteract our own negativity. Some graduate students who commute or are completing their studies part-time while working may be juggling too many responsibilities, leaving little time for socializing. Others self-isolate in response to reduced self-esteem or mental health challenges. If you notice an uptick in social isolation, consider getting help right away.
- Homesickness, culture shock, or language barriers: Any student who feels substantially different from their peers, whether because of nationality, ability, gender, race, socioeconomic status/background, or language barriers may struggle to find a sense of belonging, a protective factor against suicide. In its absence, students can feel increasingly isolated, especially if they cannot recharge in an environment that feels authentic to them for months or years at a time.
- A recent loss: Losing a loved one is stressful and tragic all on its own. Coping with a loss in addition to managing the pressure of graduate school can lead to intense sadness exacerbated by grief. Master’s students dealing with the loss of a loved one may struggle to focus or complete assignments, signs that grief counseling or other mental health supports may be necessary.
- Untreated mental health issues: A struggle with mental health is often the direct result of a concrete issue, like the loss of a loved one or academic stress. This isn’t always the case, though, as the origin of some mental health issues illudes identification. Additionally, some students feel uncomfortable accessing mental health support and instead leave their mental health issues untreated with room to worsen. Regardless of the cause, utilizing mental health resources for support is often necessary for overcoming them. Consider sharing your concern with a friend whose needs appear to be worsening and are untreated, offering a listening ear and gentle encouragement to seek professional help.
- History of abuse or assault: Post-traumatic stress, no matter when it happened, can affect how you function. Whether a survivor of emotional or physical abuse or physical or sexual assault, mental health challenges are exacerbated by the intense demands of coping with trauma or any added stress. Graduate students who also have a history of abuse or were victims of assault may experience disruptions to their studies as they cope with the physiological and emotional effects of trauma.
- Poverty or financial issues: Financial stress intensifies other stresses, leading some students to make decisions for financial gain at the expense of their studies. A student whose family is funding their education likely will experience less stress than one working to maintain a scholarship or taking out loans to pay for grad school. Additionally, with the low stipends awarded to graduate students that have not kept pace with inflation, many funded graduate students are living below the poverty line.
Warning Signs of Suicide
If you see any risk factors for suicide emerging in yourself or a friend, stay on the lookout for these warning signs of suicide. Any combination of a suicide plan, intent, and means to enact a plan indicates that a suicide attempt may be imminent. If you notice any of these warning signs detailed below, seek help immediately.
- Unhealthy relationships: If instead of being marked by compassion, positive regard, and support, your relationships are fraught with criticism and disdain, they will detract from a healthy mental health state. Look for ways to protect yourself from any unhealthy relationships.
- Dramatic mood changes: Any sharp mood change is usually noticeable to friends and loved ones and can indicate a worsening mental state and need for intervention.
- Increased alcohol, substance use, or use of medication not as prescribed: Anything that impairs judgment affects decision-making ability, especially in conjunction with any of the other risk factors touched on in this guide.
- Insomnia or sleeping all the time: Sleep resets our bodies, and a disruption in sleep makes us more susceptible to stress and other impairments. Sleeping too much or not enough can indicate a mental health issue.
- Suicidal ideation or expressing feelings of not wanting to live anymore: Suicidal ideation can be more passive (e.g., “I don’t want to live anymore,”) or more active (e.g., “I want to die.”) If someone expresses them, sit in the discomfort of the sentiment and allow them to express themselves before seeking immediate help.
- Being in a dark place and then suddenly showing signs of coming out of it: If an individual has decided to commit suicide after a period of grappling with their stress, they may suddenly seem improved. This mood change, seemingly for the better, can be a warning sign for suicide.
- Reckless or risky behavior: While some individuals may create and execute a suicide plan, some engage in risky behavior to invite a lethal outcome rather than enacting a plan themselves. If you notice behaviors that are inconsistent with someone’s typical sensibilities, take note and ask for help.
Immediate Signs: Time to Take Action
- If a loved one threatens to hurt or kill themselves, talks about self-harm, or announces a plan to kill themselves, consider this an imminent sign of danger.
- Obtaining a weapon or other items (e.g. prescription medication) they could use to hurt themselves represents a means to execute a suicide plan and should be taken very seriously.
- Talking or writing about death, dying, or suicide can take place if suicide is dominant in a person’s thoughts.
- Giving away prized possessions can be a sign of “final benevolence” before a suicide attempt and should motivate friends and loved ones to seek help.
- Neglecting appearance and hygiene may indicate an attitude that “those things don’t matter anymore” and can signal worsening depression.
How to Help: When Someone Talks Suicide
You are likely nota mental health professional and cannot be expected to engage as such. Suicide is a serious mental health concern, and a mental health professional is often the only person who can safely manage someone who is suicidal. However, using the mental health first aid suggestions below can be useful in the moment while transitioning to appropriate professional care.
- Pay close attention. Watching your mood and the moods of your loved ones to notice manifestation or worsening risk factors. Err on the side of extreme caution when engaging support rather than hoping the depression will end when an assignment is finished, an exam is complete, or a dissertation is defended. Symptoms are often not circumstantial.
- Take suicidal statements seriously. Social conversation has regrettably become quite casual about referencing suicide as a hyperbolic way to address feelings of stress. Notice this tendency in yourself and change how you express yourself. Quietly ask others about their suicidal statements, even ones made in jest, to let them know that you take talk of suicide very seriously.
- Get involved and use active listening when talking with someone who is suicidal. Learn more about active listening and how to implement it, especially when a person is expressing suicidal thoughts. This is not the time to try to reassure them, challenge their experience, or talk about your own experiences. Being a good listener can make you a better support in all your relationships.
- Encourage the person to get professional help. Therapy is an evidence-based way to improve one’s mental health, and there are strategies you can implement to have a productive conversation about the benefits of therapy, express your concern, and encourage someone to take the next step.
- Don’t be afraid to ask if a person is thinking about suicide. Sometimes, making a person feel seen and understood can be the first step in their healing. If we allow our own anxiety about suicide to interfere with our ability to have honest, open, and challenging conversations, we risk missing someone talking about their feelings. Being open to tough conversations lets your loved one know your support is unconditional.
- If someone says they are suicidal, ask more questions to assess their current risk. Be aware of your limitations and operating under Good Samaritan Laws. Assess whether the person has a plan for suicide, the means to execute that plan, and intends to follow through. If the answer is yes to any three of these areas, seek help immediately.
- Do not leave a person alone if they are high risk until they get help. If you cannot attend to them until help arrives, find another supportive individual who can. You may have to be assertive and remind the at-risk person you are doing so for their safety.
- If a person has taken some life-threatening action already, get help immediately. Your knowledge of an attempt in progress could save a person’s life. Remember, though, that you cannot change what has already taken place. You are not at fault if someone completes an attempt or dies because of their suicidal actions.
How to Help: When a Suicide Attempt Feels Imminent
Get help immediately. Period. This is challenging if you are concerned about the impact of your relationship with a friend or loved one who is actively suicidal. However, whenever there is a valid safety concern, always air on the side of caution. You can repair a damaged relationship following a thwarted suicide attempt or suicidal episode, but you cannot do anything if your loved one dies. While challenging, tolerate the anger of your friend in favor of the impact of losing them.
What to Do:
- Dial 988 – National Suicide & Crisis Lifeline: Call immediately for crisis or emotional support 24/7 if you or a loved one needs help.
- Dial 911 or go to the nearest Crisis Response Center: You or a loved one may need immediate medical attention or hospitalization to protect your/their safety. If you are not with your loved one but know their location, you can dispatch an ambulance on their behalf to assess for suicide risk. Medical professionals can determine if there is a necessity for involuntary commitment for safety risk.
- If these resources are not available, stay with your loved one or request a friend stay with you until suitable help can be engaged. This is not a long-term solution, but one-to-one support should be used for up to several hours until appropriate medical care can be engaged and a warm handoff can take place.
Interview with Dr. Shawn Blue, PsyD
Shawn Blue, Psy.D., is a licensed psychologist and Clinical Associate Professor at Thomas Jefferson University. She is a staff psychologist in the Student Counseling Center as well as the Outreach Coordinator overseeing all workshops and programs offered by the Counseling Center.
Dr. Blue is the author of several published scholarly works including Grief and Romantic Relationship Dissolution in 2017 and The Psychology of Modern Dating: Websites, Apps, and Relationships in 2020.
If a graduate student is experiencing suicidal thoughts or struggling with their mental health, how should they go about addressing this with faculty or altering their academic load while they receive appropriate care?
Sadly, many times students are reluctant to go to their faculty and acknowledge that they are struggling or need help. My recommendations for encouraging students to seek out assistance is directed both toward students and faculty. It is important for students to recognize that resources are available on campus for their support. Universities ultimately want to retain their student body and therefore resources are available for that purpose. Reminding students that it is their right (and that they are paying for these services) can be helpful in providing the permission to seek out these relevant resources. Students can utilize office hours or schedule a meeting to discuss their concerns with faculty. If a student is worried about how to verbalize their needs, I would suggest they consider writing out what they would say before the meeting which would provide a practice run of what they would say in the actual meeting.
Faculty need to be ready to provide a safe and non-judgmental environment for students to feel comfortable seeking them out and acknowledging needing help. Mandating training for faculty regarding how to support students by increasing supportive listening skills is highly recommended. Having faculty normalize the students’ experience and validating their ability to seek out help can also be very beneficial and will reflect support to students who come in for help.
Have you observed any distinct or unique signs of suicidality in graduate students that are different from the population at large?
Graduate students experience a great deal of stress to be successful academically. This stress is both generated internally as well as externally with family, friends, romantic partners, professors, and the university community. Although imposter syndrome impacts individuals of all ages, I see it especially in the college and graduate population. Interpersonal relating is also influential during this period when most students experience feelings of loneliness or trying to find their “people” to navigating romantic relationships and managing conflict within their families.
Social media can impact individuals in other age groups, but within college and graduate students, social media can play a large part in how students feel about themselves and their perceptions of others. Unfortunately, we have seen how social media impacts students’ comparison with others and at its most tragic consequences we have seen how it has resulted in deaths by suicide. Students also experience feelings of loneliness and at times are subject to disillusionment as they perceive others as having better lives than their own. Because social media is so ingrained in modern culture, its vast impact can often have negative outcomes on students’ self-esteem, well-being, and coping skills.
What special considerations might exist for students who are completing their graduate coursework virtually and may not be as connected to on-the-ground campus resources?
Virtual coursework can have both positive and negative consequences for students. Some students find that they can focus and study better with virtual work. However, concerns about recent behaviors of “zoom fatigue” have created difficulties related to virtual coursework. One of the major considerations we need to consider involves the social influence of virtual courses and programs. Universities and students both should find ways to try and stay connected to campus life and resources. Universities should continue to disseminate information to students, especially so for virtual students, who might need valuable information about campus resources, just for the sheer fact that they are not physically on campus.
Universities should also consider ways to build community for and create opportunities for students to enrich their social relationships but also gain knowledge about campus resources and services. Providing this information in a user-friendly manner and making it easily accessible are important. Equally important is to embrace the technological culture that many college and graduate students utilize which might require training or outsourcing in order to meet student needs.
Students, on the other hand, would benefit from intentionally joining student organizations that will allow them to feel connected. Related to this suggestion, student organizations should allow virtual options for students who are not physically on campus. Students should also seek out information during orientation and on their university websites for the resources that might be useful to them.
For students who experience racial, gender, or ability bias or discrimination, or any health disparity as a result of being a member of a marginalized group, how might their pursuit of and experiences utilizing mental health resources differ from some of their peers? What should they keep in mind as a part of this process?
It is especially important to support students who identify as being part of marginalized groups. Especially at PWI (Predominantly White Institutions), marginalized students will most likely experience situations that make it difficult for them to be as successful as their counterparts. Marginalized students experience not only the general stressors that all college and graduate students experience, but they also experience stress related to their marginalized status. Due to a history of systemic barriers and historical racism, many marginalized students have a difficult time trusting mental health services. The lack of diversity among faculty and mental health professionals also can make seeking out services difficult for students. It is important for universities and mental health services to be knowledgeable of these challenges and put effort into creating services that will support marginalized students.
Marginalized students should reach out to the available mental health services on their campuses when they need support. If the university is not able to itself provide services that will be culturally sensitive to the marginalized students’ identity, then students should request referrals to community resources that will be. Until we make the concerted efforts to increase the diversity at colleges and universities, the priority will be to ensure that we can direct students in finding the help that they need.
Many students fear the consequences for their degree trajectory/timing if they take steps to preserve their mental health during a challenging episode, including experiencing suicidal thoughts. What should these students keep in mind when seeking help?
Societally, we need to do a better job of sending the message that mental health and self-care are important. I appreciate the impact that athletes and other individuals in the public eye are role modeling the importance of taking time off to devote to one’s mental health. If we can continue working on sending these types of messages, it will change our overall culture to a new one that provides permission and encourages prioritizing oneself and one’s mental health needs.
Continued work around suicide prevention is needed. It is why prevention programs like Mental Health First Aid and QPR and other training programs such as Safe Zone training are so important, especially during college and graduate school. Universities should devote money and time to offering these types of prevention and training to help support students’ matriculation and ultimately avoid deaths by suicide.