Suicide Prevention: University Students’ Narratives on Their Reasons for Living and for Dying

Article in Review: Testoni, I., Piol, S. & De Leo, D. (2021). Suicide Prevention: University Students’ Narratives on Their Reasons for Living and for Dying. International Journal of Environmental Research and Public Health. DOI: 10.3390/ijerph18158029

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Summary
Social workers may encounter suicidal young people during their professional practice. This study was conducted through the University of Padua, Italy and sought to determine how social work students consider the factors that may increase suicide risk and behaviours. A group of social work students were asked to explore what university students might state as their reasons for living or dying. Following this activity, the students were asked to develop potential suicide prevention interventions.

Young people and suicide
Suicide is the second leading cause of death for young people in Italy, of both sexes aged 15 and 29. Universal school suicide prevention programs can raise awareness about warning signs and risk factors for young people, enabling peers to assist in recognising and seeking help for peers who may be suicide. The Death Education (DeED) program is an example cited in the study, a suicide prevention tool used in schools. It aims to create appropriate language about death-related topics, enabling students to think about and discuss death, share emotions directed from thinking about death and create a safe space for questions and learning.

Study aim and method
This study aimed to answer the questions:
• How do social work university students understand the suicidal choices of adolescents and young adults
• In the opinions of the students, what are the main reasons driving young people to either live or die?
• How can social work students employ their creativity, age and professional skills to create suicide intervention strategies?

A total of 62 social work students in their third year of study (mean age 21.6 years) at the University of Padua, in Northern Italy, were involved. The study involved two main activities.

In the first activity, students were invited to participate in semi-structured written interviews. They were guided by a professional to respond to the question “Why life refusal is considered a solution by some young people?” and then subsequently “Which are the reasons driving young people to choose life?”

Responses to these questions were grouped into four main categories:
• Internet and social media
• Social isolation and loneness
• The importance of proximal relationships
• The importance of networking between proximal relationships, educational intuitions and mental health services

Many of the social work students identified loneliness as a potential risk factor. Chronic loneliness is in accordance with the interpersonal theory of suicide, isolation may be considered a suicide risk factor. In contrast, the students recognised that close proximal relationships were protective factors. The students also indicated they believe:
• Social and new media may be responsible for the weakening of social bonds, alienation from relations and cyberbullying as well as imitative effects of the media.
• Social isolation and loneliness were perceived to be closely linked to the use of social media, and loneliness has a strong impact when it is a result of non-acceptance by peers.
• Importance of proximal relationships – the importance of family and friends we discussed and described as “valuable and precious”.
• Strong community and social networks, with high degrees of social can be considered to be a protective factor.
• It is perceived to be critical that there are networking people and agencies involved in the life of the young person- and that there be coordinated support from teachers, professionals, other important figures as well as family and friends.
• Moreover, participants acknowledged the role of schools and universities in suicide prevention and the importance to create networks between young people’s most proximal relationships, academic institutions and mental health services in order to support young people in times of crisis.

In the second stage of the research, students worked on designing suicide prevention programs for young people that might address the reasons a young person might attempt suicide, or reinforce these reasons identified as protective factors. The resulting projects focused on three different settings for their suicide prevention programs:
• Suicide Prevention through Community and Networking between Services
• Academic Institutions: High schools and Universities
• Suicide Prevention through New Technologies

The projects related to particular target groups including young people who were:
• Struggling with gambling
• Experiencing an eating disorder
• Using substances
• Interested in using new technologies to communicate and connect with other young people

This study explored how social work students understand the reasons that drive young people to suicide, and the factors that may prevent it. Most commonly they considered loneliness the main risk factor, and close family and friends bonds as the most protective factor. The students understood the complex and interwoven nature of risk factors and the importance of coordinated care for young people at risk. The suicide intervention programs they designed showed a good level of understanding related to the personal challenges that young people face, with a focus on addressing the perceived reasons for suicide, and building upon the recognised reasons for life.