Abstract
Researchers have found that nursing students are experiencing stress and mental health issues at higher rates than the general college student population. Emphasis should be placed on assessing nursing student stress, with increased efforts toward early detection of depression, before these students experience academic failure. Nurse educators must be the first line in addressing students ‘mental health problems, being the “eyes and ears” in the classroom as they advocate for students. Faculty have a responsibility to be aware of warning signs of and risk factors for suicide in nursing students, and how to locate resources for at-risk students. Suicide is a preventable public health concern, and nurse educators can make a difference.
Suicide, a global public health concern, has become a significant problem in the United States. According to the Centers for Disease Control and Prevention (CDC, 2019), suicide is the second leading cause of death among persons 10–34 years of age. Nearly 45,000 lives were lost to suicide in 2017, with an estimated 10.6 million adults reporting suicidal thoughts that same year (CDC, 2019).
Suicidal ideation and behaviors are closely linked with depressive mood (World Health Organization [WHO], 2020). According to the WHO (2020), depression affects an estimated 264 million people worldwide. Elevated stress that is unsuccessfully managed may also result in depressive symptoms (Labrague et al., 2017; Smith et al., 2014). Concern is escalating in particular about depression among American college students (D'Amico et al., 2016; Sandra, 2019). More and more students are seeking professional assistance to cope with depression (Sandra, 2019); however, campus counseling centers report inadequate staff to deal with the increased demand for services, which has resulted in waiting lists and session limits (Sandra, 2019; Xiao et al., 2017). Priority consideration must be given to the psychosocial needs of students as campus life becomes increasingly complex, with rapid changes in education, the workplace, and everyday life.
Bartlett et al. (2016) found that nursing students reported higher stress levels, higher stress levels affecting academics, and more stress-related symptoms such as anxiety, migraines, and illnesses, than the general college student population. Nursing students are subject to the same stress-provoking components experienced by all college students, regardless of the institutional climate. However, nursing students are faced with the added demands of assuming responsibility and liability for the safety and well-being of patients (Bartlett et al., 2016). In addition, nursing students must often maintain a required grade point average to remain in nursing programs that are highly competitive. Today's nursing students also routinely work while in school, and some have their own families (Labrague et al., 2017).
Recent studies have reported that nurses are at greater risk for suicide than others in the general population (Cheung et al., 2015; Davidson et al., 2020). Preparing nursing's future workforce requires nurse educators to respond to emerging practice concerns. Identifying key traits and manifestations of excessive stress, depression, and suicidal ideation are critical, and nursing faculty must have the ability and knowledge to identify when student stress is overwhelming before it manifests itself in unhealthy symptoms.
Emphasis should be placed on assessing student stress, with increased efforts toward early detection of depression before these students experience academic failure. Students must be provided the necessary support to improve functioning and resiliency skills, as the experience of excessive stress and depression have the potential to lead to suicidal behavior in this population. The provision of effective stress management training for undergraduate nursing students in managing the stressors they are likely to encounter could be an important requirement for avoiding long-term maladaptive effects of emotional stress in the nursing profession (Dwyer & Hunter Revell, 2015).
Nurse educators must be the first line in addressing mental health problems in nursing students. Faculty have a responsibility to be aware of warning signs of and risk factors for suicide, and how to locate resources for at-risk students. A combination of individual, relationship, community, and societal factors contribute to the risk of suicide (CDC, 2019). Protective factors buffer individuals from suicidal thoughts and behavior. Access to clinical interventions, support for help seeking, community connectedness, and assistance with problem-solving skills are protective factors that nursing educators can implement to assist students (CDC, 2019).
Students can also be coached regarding how to talk to friends and family about their depression (D'Amico et al., 2016). Peer support may be found in campus chapters of the National Alliance on Mental Illness (NAMI, 2020) and Active Minds (D'Amico et al., 2016). Self-help strategies such as physical exercise and yoga can be beneficial in reducing depressive symptoms as well as in improving overall health (D'Amico et al., 2016). All nursing faculty can be involved in advocating for increased on-campus and community resources for treatment of student depression.
Most nurses have little or no training in how to assess, evaluate, or refer a suicidal patient (Bolster et al., 2015). Education and training can help to change values and improve nurses ‘detection skills. Although suicide is a global health concern, assessment and prevention of suicide are also not in the curricula of most colleges and universities (Bolster et al., 2015). Agencies known for suicide prevention training include the American Association of Suicidology (AAS), the QPR Institute, and Suicide Prevention Resource Center (SPRC); these agencies have developed evidence-based competencies as well as both in-person seminars and online programs for suicide assessments (AAS, 2020; QPR Institute, 2020; SPRC, 2020). This data-driven instruction, which helps the learner recognize warning symptoms and communicate effectively, must be incorporated into the curricula of every college and university, as well as in the form of workshops and in-services for nursing faculty. Nurses who have received training show increased knowledge of and confidence in the ability to assess and intervene appropriately (Bolster et al., 2015).
Nursing students are subject to the same stress-provoking components experienced by all college students, but face the added demands of responsibility and liability for the safety and well-being of patients, and often must maintain a required grade point average to remain in highly competitive programs.
It is important to understand suicidal ideation in nursing students when planning prevention programs to acquire better outcomes. More qualitative and quantitative research is needed about depression and suicidal ideation among undergraduate nursing students so that screening tools can be developed and educational strategies implemented to assist students through this global public health crisis. Nurse educators need to be the “eyes and ears” in the classroom as they advocate for students, asking questions and observing body language. Suicide is a preventable public health concern, and nurse educators can make a difference.
Footnotes
Catherine A. Stubin, PhD, RN, CNE, CCRN, has been a registered nurse for over three decades in various areas of nursing practice and education. Her program of scholarship and research centers on stress and emotional strain in nursing, mental health of nursing students, transitioning students to professional practice, and medication administration safety.
Disclosure. The authors have no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.
Funding. The author(s) received no specific grant or financial support for the research, authorship, and/or publication of this article.