Irfan Akbani was worried about one of his newly pledged fraternity brothers at St. Louis University this past spring.
The student seemed "off" -- not like his usual self. Akbani, then a junior, didn't think the younger student would confide in him, but he wanted someone to check in with him. Akbani approached the newly appointed mental health chair in his frat.
"There's something going on," he said. His fraternity brother promised to look into it.
Akbani has been on high alert with a heightened awareness about mental health issues.
Many on the campus have been.
Four male students died at SLU during the previous school year, with three confirmed as suicides.
"If you asked a lot of men, 'Who would you call if you needed help?' a lot of them would say, 'Nobody,'" Akbani said. He is convinced that a far greater number of his peers think about harming themselves than anyone is willing to admit.
Akbani's hunch is reflected in the most recent data available through the Missouri Assessment of College Health Behaviors, an annual survey of 8,000 to 11,000 students from 24 college campuses in the state. According to the 2021 data, 1 in 4 students said they had thought about suicide in the past year. That's an increase from 17% in 2016.
Nationally reported data about the years preceding the pandemic reveal a crisis that's been building for years: Suicides among children and young people aged 10 to 24 rose 57% from 2007 to 2018, according to the U.S. Centers for Disease Control and Prevention. There's also a documented spike in rates of mental health disorders among young people. Prescriptions for antidepressants rose 38% for teenagers from 2015 to 2019, according to data from the mail-order pharmacy Express Scripts.
Suicide is not a single cause-and-effect phenomenon. Researchers have been studying why young people are feeling more anxious and depressed, with factors including a decline in sleep, decreasing amounts of physical activity, increased loneliness and the use of social media. For marginalized groups, such as LGBTQ students and Black students, contributing factors may also include discrimination, exposure to racialized violence, prior trauma and lack of access to resources. Missouri's survey also suggests correlations between suicidality and substance abuse and experiences with abuse in intimate relationships.
Katie Heiden-Rootes, a professor of family and community medicine at SLU's School of Medicine, is a principal investigator of a major grant focused on improving behavioral health services for children and adolescents.
"I think about suicidal behavior and ideation as the intersection of being hopeless and feeling helpless," she said. When young people feel unable to meet the challenges ahead of them, they can feel overwhelmed. Students may appear as though they have it all together, she said, while feeling tremendous self-doubt and fear internally.
Students who have struggled with anxiety from trauma experienced prior to arriving on campus may find it exacerbated by increased isolation and loneliness in college. In fact, persistent and unhealthy levels of loneliness are reported by college students nationally.
As a leader in several campus organizations, Akbani has heard several reasons why students, especially young men, are unwilling to seek help. Some are afraid of being seen differently or judged by their peers; others worry that a diagnosis might prevent them from pursuing a career in a certain field. And he said that some are scared of losing their rights and being hospitalized if they talk to a school counselor about suicidal feelings.
Findings from Missouri's College Health Behavior Survey found similar concerns from students. Of the students who reported having suicidal thoughts or having attempted suicide in the past year, only 38% sought assistance. Among those who did not, the greatest barriers were feeling shame, being afraid of judgment, lacking insurance or ability to pay for treatment, and fear of hospitalization. Another 40% reported that they didn't seek help because they didn't think they needed it.
Akbani said that demanding coursework is a top stressor for him, along with his other responsibilities: Last semester, as a pre-med student taking 18 hours of classes, he also served as an officer in three student organizations, belonged to a fraternity, volunteered at a soup kitchen and did extra science research outside of his classes.
"It does take a toll on me," he said. But he knows how hard it is to get into medical school, and feels he has to maintain this pace to have a competitive application.
"Suffering in silence is kind of the norm around men's mental health," he said.
That's something he is hoping will change.