Because we all experience some of the symptoms of depression at one time or another, we all have some personal knowledge of what the depressed student is going through. A depressed student is likely to be experiencing some of the following:
Signs and Symptoms
- Deep feelings of sadness and hopelessness.
- Difficulty performing simple daily activities like getting out of bed and getting dressed.
- Loss of interest in usual activities, even pleasurable activities (e.g., good student stops attending class).
- Insomnia or hypersomnia.
- Overeating/weight gain or loss of appetite/weight loss.
- Difficulty concentrating and remembering.
- Decreased energy (everything is an effort).
- Feelings of worthlessness or inadequacy.
- Guilt or anger at him/herself.
- Thoughts or comments about death/suicide.
- Let the student know you're aware s/he is feeling down and that you would like to help.
- Reach out more than halfway and encourage the student to talk about her/his feelings.
- Tell the student of your concerns.
- Talk about suicide if that's on the student's mind.
- Refer if suicidal (CAPS: 509-359-2366; Spokane Mental Health: 509-838-4651).
- Daily contact, even for a few minutes, may relieve feelings of isolation (encourage the student to be in contact with family, friends, counselor).
Less Helpful Responses
- Saying "don't worry," "crying won't help," or "everything will be better tomorrow," may only make the student feel worse (and unheard).
- Becoming overwhelmed by the student's problems, may only provide evidence that s/he should feel helpless.
- Assuming too much responsibility for the student and his/her problems.
- Trying to ignore or minimize his/her feelings.
- Being afraid to ask whether the person is feeling suicidal (if you believe s/he may be).
Suicide Risk Factors
- History of suicidal behavior.
- Family history of suicide.
- Specific plan for harming self (the more developed the plan, the greater likelihood of an attempt).
- Means to carry out plan (lethality of implement increases risk).
- Drug or alcohol abuse.
- History of impulsive behavior.
- Lack of interpersonal/social resources.
- Lack of intrapersonal/coping resources.
Facts About Suicide
It is important to take all suicidal comments seriously and to make appropriate referrals. Below are a few facts about suicide:
- College students actually have lower suicide rates than non-college peers of the same age.
- More men commit suicide; more women attempt suicide.
- There are more attempts at the beginning and end of semesters/quarters.
- People committing suicide rarely want to die, but want to end the pain they experience; most reveal ambivalence about living versus dying.
- Not all suicidal persons are depressed or mentally ill-however their typical coping mechanisms have broken down or are unavailable.
- Individuals who commit suicide typically give many clues or warnings of their intent.
- Asking a person directly about suicidal intent does not lead to an attempt (in fact, it may minimize the anxiety and tension surrounding the feeling and, thereby, act as a deterrent to suicidal behavior).
Suicide is the second leading cause of death among college students. The suicidal person is typically intensely ambivalent about killing himself or herself, and usually responds to help. Suicidal states are definitely time-limited and most who commit suicide are neither crazy nor psychotic. High risk indicators include: feelings of hopelessness and futility; a severe loss or threat of loss; a detailed suicide plan; history of prior attempts; history of alcohol or other drug abuse; and feelings of alienation and isolation from others. Suicidal students usually want to communicate their feelings and any opportunity to do so should be encouraged.
- Taking the person seriously; 80% of suicides give warning of their intent.
- Acknowledging that a threat of suicide (or attempt) is a plea for help.
- Asking the individual directly whether s/he is considering harming her/himself (e.g., "You seem so upset and discouraged that I'm wondering if you are thinking of suicide?").
- Being available to listen, to talk, to be concerned; but refer to Counseling & Psychological Services (509-359-2366), the Student Health Clinic (509-235-6151), and/or Frontier Behavioral Health (509-838-4651).
- Consulting with the above resources as necessary.
- Contacting the Dean of Students' Office (509-359-7924) to initiate appropriate university responses (see Suicide Prevention section).
- If the situation is believed imminent, call 9-1-1 or the Regional Behavioral Health Crisis Line (877-266-1818).
- Administering to yourself. Helping someone who is feeling suicidal is hard, demanding, and draining work.
Less Helpful Responses
- Minimizing the situation or depth of feeling (e.g., "Oh, it will be much better tomorrow").
- Being afraid to ask the person if they are so depressed or sad that they want to hurt themselves.
- Overcommitting yourself and, therefore, being unable to deliver on what you promise.
- Ignoring your limitations (i.e., not consulting with available resources).
If you observe any of these warning signs that indicate suicidal risk, particularly in combination, communicate with a mental health professional as soon as possible:
- Expression of desire to kill him/herself or wishing to be dead.
- Presence of a plan to harm self.
- Means are available to carry out plan to harm self.
- Suicide plan is specific as to time, place; notes already written.
- High stress due to grief, illness, loss of new job, academic difficulty, etc.
- Symptoms of depression are present, such as loss of appetite, sleep, severe hopelessness or agitation, feelings of exhaustion, guilt/shame, loss of interest in school, work or sexual activities, change or deterioration in hygiene.
- Intoxication or drug abuse (including alcohol).
- Previous suicide attempt by the individual, a friend or family member.
- Isolation, loneliness, or lack of support.
- Withdrawal or agitation.
- Preparation to leave, giving away possessions, packing belongings.
- Secretive behavior.
- Major mood changes (e.g., elation of person who has been depressed).
- Indirect comments implying death is an option (e.g., person implies he/she may not be around in the future).
Aggression can take many forms, from very subtle, passive acts to violent outbursts. It often results when a student perceives a threat, feels frustrated and/or out of control. Some aggressive people express hostility immediately without regard for their circumstances or the people around them. Others deny their anger and frustration until their hostility builds to the point of an explosive outburst. Many times, persons who are verbally or physically aggressive feel inadequate and use hostile behavior as a way to build up their self-esteem. Often these individuals feel that you will reject them so they become hostile and reject you first to protect themselves from being hurt. They may see you as attempting to control them and lash out to try to gain a sense of control.
It is important to remember that the student is generally not angry at you personally, but is angry at his/her world and you are the handy target of pent-up frustrations.
Overall, dealing with an aggressive student will be facilitated if you set up your environment to be as safe as possible (e.g., a physical barrier, etc.) and maintain firm, consistent and calm control in the situation (i.e., know what you are doing and what your goals are).
- Acknowledge their anger and frustration (e.g., "I hear how angry you are").
- Rephrase what the individual is saying and identify his/her emotions.
- Allow the student to ventilate, get the feelings out (within limits), and tell you what is upsetting them.
- Tell the student that you are not willing to accept abusive behavior (e.g., "When you yell and scream at me, I find it difficult to listen"). If you need to, explicitly state what behaviors are acceptable.
- Stick to the limits you set.
- If the person begins to get too close to you, tell them to please move back.
- Reduce stimulation. If you are comfortable doing so, invite them to your office or another quiet place. If you sense some threat, arrange for a colleague to be nearby.
- Help the person problem-solve and deal with the real issues when he/she becomes calmer.
- If necessary, get help (your supervisor, CAPS, University Police).
Less Helpful Responses
- Getting into an argument or shouting match.
- Becoming hostile or punitive yourself (e.g., "You can't talk to me that way!").
- Pressing for explanations about his/her behavior.
- Looking away and not dealing with the situation.
- Physically restraining or grabbing the individual.
- Giving away your own rights as a person.
We have all experienced anxiety in response to a perceived stressful situation. Anxiety becomes heightened as the situation becomes more vague and less familiar.
A panic attack is an overwhelming sense of dread and fear, and is the extreme result of feeling anxious. Some of the physiological components of general anxiety and a panic attack are rapid heart palpitations, chest pain or discomfort, choking, dizziness, sweating, trembling or shaking, and cold, clammy hands. The student may experience feelings of worry or fear and may anticipate some misfortune. S/he may complain of poor concentration, being on edge, being easily distracted, memory problems and/or fitful sleep. The student may also indicate unreasonably high self- expectations, and be very critical of her/his performance. This student may constantly think about and discuss her/his problems and possible solutions, but be too fearful to take action.
- Inability to relax.
- Unrealistic or excessive worry.
- Difficulty falling asleep.
- Rapid heart rate.
- Shortness of breath.
- Excessive sweating.
- Feelings of dread or fear of losing control.
- Feelings of detachment.
- Let them discuss their feelings and thoughts. Often this alone relieves a great deal of pressure.
- Help them if possible to define their stressors and their ineffective and effective coping strategies.
- Encourage them to break down tasks into workable steps in order to feel less overwhelmed.
- Relaxation techniques, deep breathing, meditation and enjoyable exercise (e.g., walking) can all be helpful in reducing anxiety. Encourage them to engage in these behaviors or to seek professional help to learn these and other coping strategies. They can also consult self-help documents located on this website.
- Be clear and explicit about what you are expecting from them, and what you are willing to do. It may be helpful to have them repeat what you have said to ensure that they understand.
- Be calm and reassure him/her as appropriate.
Less Helpful Responses
- Taking responsibility for her/his emotional state.
- Trying to solve her/his problems as if they were your own.
- Becoming anxious or overwhelmed along with them.
- Overwhelming the student with more information or ideas (instead, keeps things 'bite size').
Any amount of time and energy may simply not be enough for some students. Such students often seek to control your time and unconsciously believe that the amount of time received is a reflection of personal worth. In many situations, these individuals feel incompetent to handle their own lives. Usually they are immature and very self-absorbed.
- Set clear and precise limits with the student.
- Stick to the limits no matter how much s/he protests.
- Let the individual make his/her own choices and decisions, clarifying the logical consequences of such choices.
- Refer the student to other students in class, their friends or campus/community resources.
Less Helpful Responses
- Taking responsibility for the individual.
- Letting the student "trap" you into solving his/her life problems.
- Allowing him/her to use you as a sole source of support.
Usually these students complain about something other than their psychological difficulties. They are tense, cautious, mistrustful, and have few friends. These students tend to interpret a minor oversight as significant personal rejection and often overreact to insignificant occurrences. They see themselves as the focal point of others' behaviors and everything that happens may seem to be interpreted in a suspicious light. Usually they are over-concerned with fairness and being treated equally. They project blame onto others and may express anger in indirect ways. Many times they feel worthless and inadequate.
- It is important to send clear, consistent messages regarding what you are willing to do and what you expect.
- Express "reserved compassion," mindful that a suspicious student may have trouble with closeness and warmth.
- Be firm, steady, punctual and consistent.
- Be aware that humor may be interpreted as rejection.
Less Helpful Responses
- Being overly warm or nurturing, or assuring the person that you are his/her friend. Let the student know that you can still be concerned without being intimate.
- Trying to flatter him/her, or to be cute or humorous to try to relieve your own anxiety. This will probably distance the student from you.
- Challenging or agreeing with any mistaken or illogical beliefs.
- Being ambiguous in your response.
This student may have trouble distinguishing fantasy from reality. To some extent, this person will appear confused or illogical. As you talk to this student, you may notice that his/her speech jumps from one topic to another with little or no logical connection between the topics. The individual may also pay a great deal of attention to some unimportant detail that is being discussed or may be generally scattered and incoherent. The student may coin new words and expect others to understand their meaning or may put words together because they rhyme, not because they make grammatical sense.
Such individuals may make inappropriate emotional responses. For example, s/he may overreact to her/his feelings, or be very "flat" emotionally. Many times the person knows that her/his emotions are inappropriate, but just feels overwhelmed and cannot control them.
Persons in poor contact with reality may experience themselves as especially powerful or important, or may believe that people are attempting to harm or control them in some way. S/he may also feel that certain actions have special meaning for them (e.g., when people in a small group begin to laugh, they are laughing at him/her). Such students may experience hallucinations, usually auditory, although hallucinations can be experienced through any sensory modality. Generally, these individuals are not dangerous, but are scared, frightened and overwhelmed.
- Respond to them with warmth and kindness, but with firmness.
- If you are comfortable in doing so, remove extra stimulation from the environment and see them in a quiet atmosphere.
- Acknowledge their concerns and state that you can see they need help (e.g., "It seems very hard for you to integrate all these things that are happening and I am concerned about you; I'd like to help").
- Acknowledge their feelings or fears without supporting the misperceptions (e.g., "I understand how you think they are trying to hurt you and I know how real it seems to you, but I don't hear the voices").
- Reveal your difficulty in understanding them, as appropriate ("I'm sorry, but I don't understand. Could you repeat that or say it in a different way?").
- Focus on the 'here and now.'
- Switch topics and divert the focus from the irrational to the rational or real.
- Speak to their healthy side, which they have. It is okay to joke, laugh, or smile when appropriate.
Less Helpful Responses
- Arguing, disputing their illusions, or trying to convince them of the irrationality of their thinking. This typically just makes them defend their position (false perceptions) more ardently.
- Playing along (e.g., "Oh yeah, I hear the voices").
- Encouraging further revelations of delusional thinking. It would be more helpful to switch topics and divert focus from delusions to reality.
- Demanding, commanding, or ordering them to do something to change themselves.
- Expecting customary emotional responses.
Violence related to emotional distress is very rare and typically occurs only when the student is completely frustrated, feels powerless, and is unable to exert sufficient self-control. The adage, "An ounce of prevention is worth a pound of cure," best applies here. Also consult section on 'defusing anger in others.'
- Prevent total frustration and helplessness by quickly and calmly acknowledging the intensity of the situation (e.g., "I can see you're really upset and really mean business, and have some critical concerns on your mind").
- Explain clearly and directly what behaviors are acceptable (e.g., "You certainly have the right to be angry, but hitting (breaking things) is not okay").
- Stay in open area.
- Divert attention when all else fails (e.g., "If you hit me, I can't be of help").
- Get necessary help (other staff, University Police, Health Clinic, Psychological Services).
- Remember that student discipline is implemented by the Dean of Students Office.
Less Helpful Responses
- Ignoring warning signs that the person is about to explode (e.g., raised voice, quickened speech, clenched fists, statements like, "You're leaving me no choice").
- Threatening or taunting behaviors.
- Physically cornering the person.
- Touching the student.
Given the stresses of university life, students are especially susceptible to drug abuse. A variety of substances are available that provide escape from pressing demands. These drugs soon create their own set of problems in the form of addiction, accident proneness, and poor health. The most abused substance is alcohol. Alcohol and other drug-related accidents remain the greatest single cause of preventable death among college students.
- Be on the alert for signs of drug abuse: preoccupation with drugs; inability to participate in class activities; deteriorating performance in class; periods of memory loss.
- Share your honest concern for the person.
- Encourage him/her to seek help.
- Get necessary help in instances of intoxication.
Less Helpful Responses
- Ignoring the problem.
- Chastising the person; lecturing.
- Subtlely encouraging the behavior.