Q&A: Lecturer Megan Spokas Explains Rising Suicide Rates

Editor’s note: If you or someone you know may have suicidal thoughts, you can call the 988 Suicide and Crisis Lifeline or chat online at 988lifeline.org.

Suicide continues to be a leading cause of death in the United States. At Princeton, at least four students and one staff member have died by suicide since May 2022. This is a public health issue, and there are practical steps we can all take to support individuals in crisis, says Megan Spokas, a trained clinical psychologist whose areas of focus include suicide prevention. In recognition of Suicide Prevention Month in September, Spokas, who is also a lecturer in Princeton’s psychology department, spoke with PAW about warning signs, risk factors unique to college students, and what steps individuals can take to help. 

Why are suicide rates rising?

They have been on the rise since the late ’90s, despite efforts in the United States to prevent suicide. There are so many factors that could be at play, but I’ll name a few. There are similar trends: Our rates of depression and problematic alcohol use are also on the rise across the same period, and those conditions are associated with increased suicide risk. Access to opioid use has also increased, and that could increase preexisting suicide risk factors like depression or chronic pain. It could also leave people with easier access to something that could be used as the method of suicide. There are also documented increases in depression and anxiety among college students compared to the rates a decade ago. We all know the toll that this epidemic has taken on certain communities, and so a lot of people have been impacted by loss, grief, and trauma, which might also be part of the picture. 

You mentioned the impact on certain communities. What’s happening?

In the United States, certain groups have been showing steeper increases than others. So people of color come to mind. Discrimination, racial trauma, and structural barriers to accessing good mental health care are factors that can explain increases in this group. Adolescents are another group where we see steeper suicide rates, and social media use may be one of the causes. In the next few years, we’ll likely start to see how the COVID pandemic impacted different communities. I’d also highlight rural communities as another group where suicide deaths have increased at a higher rate. Some of this might be due to access to firearms and a shortage of mental health workers in rural areas. 

What factors are unique to college students? 

The latest statistics indicate that about 15% of college students have serious thoughts about suicide. Many of the risk factors we were talking about apply to this group, and we can understand how they might be heightened during this particular stage of life. Depression, anxiety, the stressors of being in school, financial burdens, social isolation, and heavy alcohol use are some examples. 

There are some interpersonal factors that can increase risk as well. Feeling isolated, lonely, not belonging, or like a burden to others — all are factors that can be associated with suicidal thinking. We can think about this in college communities where, for example, a student has moved away from a social support system and they’re not quite integrating into their new community. Folks who identify as LGBTQ+ or students who are from religious or racial groups that aren’t well represented on campus are other examples of people we can look out for at the community level and areas where we should consider creating spaces to allow more connection. 

What are some warning signs and risk factors to look out for?

Great question, because I think this is part of what we can all do, regardless of our background or our professional training, to help contribute to prevention efforts. Warning signs can include changes in mood — particularly when a person is feeling depressed, hopeless, and worthless — excessive drinking or use of drugs, changes in their general demeanor, someone suddenly becoming withdrawn, and sleep disturbances. Oftentimes people do talk about feeling like they would be better off dead. So those are things to take seriously and to follow up on. 

About one in four adults will experience a diagnosable psychiatric condition. I think sharing goes a long way so people see that there’s actually a lot of strength that comes from seeking out help.

— Megan Spokas

What’s tricky about all of this is that many people who experience all of those things that I just highlighted will not die by suicide. So it can be really hard to know who exactly is high-risk. 

But going back to what we can do, express your concern to the person. It’s a myth to think that asking a person about suicide will somehow worsen the situation. It’s actually an opportunity to show a person that you care about them. You can say: “I’m worried about you. I’m concerned. Have you been having thoughts of hurting yourself or thoughts of killing yourself?” 

What advice would you offer to someone who is having suicidal thoughts? 

While I understand that it’s really hard when a person’s feeling that low to have hope in the future, I would encourage the person to think about some things they can look forward to. It can help to imagine a future where you could feel less depressed and what that would free you up to do. Also, know that there are effective treatments available for people who are struggling.

You’ve touched on the idea that there is still a lot of stigma around suicide. Why does it continue to be a taboo topic?

There’s many reasons for that. In certain communities, it might be seen as a weakness or a personal failure. Some communities believe it’s more appropriate to turn to religious or spiritual traditions, as opposed to the mental-health-care field. I do think we’re in agreement that the more a person can feel supported and have as many options available to them as possible, the better. As a community, we should think about how we can each personally dispel some of these stigmas. I think people who speak up and share their personal struggles with mental health and seeking treatment are doing a great service to normalize these experiences, which are quite common. About one in four adults will experience a diagnosable psychiatric condition. I think sharing goes a long way, so people see that there’s actually a lot of strength that comes from seeking out help. 

Are there specific actions people can take during Suicide Prevention Month, like we do for other awareness months? 

I often talk on campus about the resources that are available through Counseling and Psychological Services (CPS). I’d encourage alumni to be familiar with the national Suicide and Crisis Lifeline, 988. You never really know when you might find yourself in a position to offer some support and encouragement, and you could have that on the tip of your tongue, to say, “Let’s call 988 together, and figure out what to do together.” 

The other thing that comes to mind is advocating for causes that have a direct impact on suicide. That could be advocating for better insurance coverage for preventative services and risk screenings, for more trained professionals in your area, for increased funding, and for extreme risk protection laws, which allow for a mechanism to temporarily reduce access to firearms when a person is in crisis. 

Interview conducted and condensed by C.S.