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.

When reproductive freedom was recently struck down by the Supreme Court, one of the first things I discussed with my teenagers was our religious beliefs about abortion.

My husband and I are Muslims and have raised our two kids in our Islamic faith. While there is a diversity of Islamic opinions on the issue, there’s a general consensus that the soul enters a fetus at 120 days. There are several conditions prior to this point at which abortion is permitted -- and even after this point, abortion is permissible if the mother’s life is in danger.

The complete abortion ban in Missouri, based on a minority religious view within Christianity, is in direct conflict with our own beliefs.

We are hardly alone in this situation. Clergy from across faiths are mobilizing to fight for their congregants’ religious freedom.

“For years, evangelical Christian voices were dominant in Jefferson City as legislators reduced access and finally banned abortion in Missouri. They imposed their narrow theology on the state, threatening the religious freedoms of the rest of us,” said Stacey Newman, who served as a state representative for nine years. “Prior to the legalization of abortion in 1973, Missouri clergy of all faiths were part of an underground network to protect women, and many are vowing to do the same today.”

Newman recently helped bring together Missouri religious leaders who support reproductive rights in an informal network of communication and support.

Jeffrey Stiffman, rabbi emeritus at Congregation Shaare Emeth, was among that group. Prior to the legal protections offered by Roe v. Wade, there was a local clergy advisory council, he said. When women in Missouri needed an abortion, these Christian and Jewish faith leaders would help coordinate flights to New York or Colorado and arrange transportation to clinics.

In the Jewish faith, preserving the mother’s life is paramount.

“The imposition of a ban on abortion restricts not only women’s rights, but also the rights of all religious minorities,” Stiffman said.

Several faith leaders pointed out the hypocrisy of politicians claiming to be pro-life but refusing to expand health care access for mothers and children. Why aren’t the politicians who fought to ban abortion working just as hard to lower Missouri’s high infant and maternal mortality rates?

“For me, that is theologically an injustice,” said Sonya Vann, an associate minister at Christ the King United Church of Christ. The state’s abortion ban tells her “that if I am outside this very narrow interpretation of Christianity, then I have no rights within my own religious freedom to think about what life even is. I very much have a problem with that.”

Two-thirds of states that limit abortion access, or that soon will, also have Religious Freedom Restoration Act laws, which limit when the government can restrict someone’s religious liberty. One such state is Florida, and religious leaders there -- including two Christians, three Jews, one Unitarian Universalist and a Buddhist -- have sued the state over its abortion ban. According to the lawsuits filed in Miami-Dade County, the law violates clergy members’ religious freedom because it prohibits them from counseling congregants about abortion in ways that align with their faiths.

Rev. Deb Krause, president of Eden Seminary, a Presbyterian minister and professor of the New Testament, says her study of the Bible does not find it to restrict access to abortion.

“I’m a New Testament scholar; it matters to me tremendously what the Bible says,” she said. But when it comes to the legal right to abortion, “it doesn’t matter what the Bible says because we are not a theocracy.”

Rabbi Andrea Goldstein, of Shaare Emeth, said she doesn’t understand how the state can impose a singular religious value when there is no conclusive proof of when life begins.

Her congregation has a monthly collection for the Missouri Abortion Fund. She said there is a groundswell of people of faith who want to give of their time, in addition to donating money.

“Everyone is trying to figure out the best way to mobilize direct service,” she said. “They want to show people who are scared (that) there are others who care about them.”

Religious scholars have drawn connections between the current fight for women’s bodily autonomy and the role clergy once played in guiding enslaved people toward freedom. They point out that proposals to ban travel for abortion care harken to fugitive slave laws.

“Much like the Underground Railroad, religious denominations and leaders took actions against the law at the time,” Vann said.

Rev. Rebecca Turner, of the United Church of Christ in Maplewood, points out that there has always been religious support for a woman’s right to choose an abortion. It is the duty of the clergy to help those in distress.

“I’m not afraid of standing up against unjust laws,” Turner said. “I think a lot of clergy may well have to do that to challenge the state on its treatment of women.”

Amen, sister.

The conservative “pro-life” movement managed to do something that abortion-rights activists have been trying to do for decades: They have destroyed the stigma around abortion.

When the same Supreme Court justices who had testified during congressional confirmation hearings that Roe v. Wade was settled law overturned abortion rights soon after, the house of cards began to fall. Women started speaking about abortion in ways I had never heard before.

Mothers bought Plan B pills for their college-aged daughters. Grandmothers shared stories about botched, illegal abortions performed before Roe. Gen Z, the least religiously affiliated generation in this country’s history, was galvanized to speak out on social media and raise eye-popping amounts of money in support of reproductive rights.

Olivia Julianna, a 19-year-old political activist from Texas, responded to Rep. Matt Gaetz’s tweet targeting her by raising more than $2 million for abortion funds.

A young Army medic went viral on TikTok for her emotional post in the aftermath of the Supreme Court decision. She said in her video: “I just extended my contract to continue serving this country a week ago. How am I supposed to swear to support and defend the Constitution and a country that treats its women like second-class citizens?”

These voices stood in stark contrast to the Republicans who said, publicly, that a raped 10-year-old should be forced to give birth to the rapist’s child. Missouri State Rep. Mary Elizabeth Coleman proposed allowing private citizens to sue anyone they suspect of helping a Missouri resident get an abortion in another state -- effectively trying to ban women from traveling to get the medical care they need.

This rising Republican extremism, including stripping rights away from half the country’s citizens, was bound to provoke a backlash. What may have been less expected was the significant and rapid change in people’s private conversations and behavior.

I spoke to my teenage children about abortion rights for the first time after Roe was overturned. Close friends I have known for decades revealed, for the first time, their own experiences with needing abortion care. I saw male politicians -- in Missouri -- wearing T-shirts supporting reproductive rights while campaigning.

The era of secrecy and shame around abortion is over. Ironically, Republicans ended it.

Voters in Kansas showed the country on Tuesday that the issue of reproductive freedom is really about freedom -- period. They voted overwhelmingly to reject changes to the state’s constitution, which protects the right to an abortion. In the referendum, 59% of voters in Kansas -- a deep-red state -- cast a ballot in support of abortion rights.

That’s a significant majority. It highlights just how out-of-touch extremist judges and politicians are with the majority of the country. It also suggests a path to freedom in the most oppressive states for women.

Missouri is a prime state to make reproductive rights a ballot initiative. While the state votes heavily Republican, progressive ballot initiatives such as Medicaid expansion and increasing the minimum wage have won at the polls. In Kansas, at least 20% of Republicans voted for abortion rights, and national polling shows that a third of Republicans opposed overturning Roe. A ballot initiative securing abortion rights would be a way for Missouri Republicans to support human rights without compromising a political identity.

You may convince people to believe conspiracy theories about things removed from their daily lives, like rigged voting machines, but it’s much harder to gaslight them about their own bodies and lived experiences. A tiny minority of people believe a single-cell zygote is the exact same as their daughter or mother standing in front of them. The majority of us know that prioritizing the potential of a life over a real, living, breathing human being could destroy the life of someone we know -- or our own.

The vote in Kansas was a primal scream for women.

Across the country, we heard it loud and clear.