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Graduate Students’ Interdisciplinary Work Informs Suicide Prevention and Recovery Efforts

Graduate students at the University of North Carolina at Chapel Hill are working to destigmatize and to support suicide prevention awareness to provide better training for the next generation of educators and clinicians in North Carolina and beyond. September is National Suicide Prevention Awareness Month; for families whose child experiences suicidal behaviors—the need for prevention and care goes beyond the month of awareness.

Often a taboo topic, three Ph.D. students at the UNC School of Education came to study suicide prevention and recovery. Cari Pittleman, Katherine Ingram, and Karen Hall work with Marisa Marraccini, an assistant professor at the school, on research and clinical initiatives which span from counseling provided in school settings to both outpatient and inpatient care. Ingram recently received a $100,000 National Institute of Justice dissertation award.

Headshot of Marisa Marraccini, who is wearing a blue shirt and standing in front of greenery.
Marisa Marraccini, Ph.D. Photo credit: Michael Hobbs

“In both research and clinical practice, my primary lens into suicide and mental health is through relationships,” Ingram said. “There are many paths to contemplating suicide, and I am primarily focused on the powerful role, both supportive and traumatic, of interpersonal relationships in shaping mental health.” … “It’s a very special research-practice cycle, where I have the honor of learning collaboratively with colleagues and patients alike.”

The graduate student trio—whose professional backgrounds range from classroom teaching to working with students with disabilities—saw the School of Education’s school psychology Ph.D. program as a pathway to support children beyond the classroom. Their trajectory at Carolina as doctoral students has broadened their understanding of the role schools play before, during, and after a child or adolescent has a suicide-related crisis.

“I have benefitted from their backgrounds in terms of different experiences and perspectives both Katie and Karen bring,” Pittleman said. “Suicide is a very scary and uncomfortable issue; we want to study the different ways that school professionals support students but also the ways in which the professionals themselves are treated.” … “Having that comfort level goes a long way in terms of how school professionals interact with students.”

Cari Pittleman headshot
Cari Pittleman

UNC School of Education’s Marisa Marraccini at Forefront of Suicide Prevention in Schools

Marraccini, who is funded by a prestigious $625,000 career-development grant from the National Institute for Mental Health (NIMH), is focused on supporting children who are in crisis—and how schools, hospitals, and support systems respond if a child has a suicide-related crisis. The grant supports development of a mixed-reality supplement for suicide prevention treatment that incorporates both virtual and augmented reality.

“Suicide can impact all people—kids, grown adults—not just one particular category of person,” Marraccini said. “At any given point, people who you may not expect to have a mental health crisis might be struggling, but, fortunately, effective treatments are available to those facing suicide-related risk.” Marraccini said school-based services for supporting children in crisis vary widely around the country—and her research aims to better show how school connectedness and other school-related supports can play a role in both prevention and recovery.

“Fundamentally, at the core of all of the work that I and my students are doing, is this notion that these less-formal interactions with teachers and supportive adults throughout students’ lives can cumulatively play a protective role against health risk behaviors,” Marraccini explained. If a student does have a suicide-related crisis, she hopes to improve guidance to some of the school professionals who might be the first to notice or respond, like a school nurse, school psychologist, or counselor.

“The thing that’s so incredible about the field of school psychology is that we’re experts in mental health, and we can support and consult in the context of where students really are: In the classroom,” she said. “For most kids, schools are their world.”

As she explained, much of the existing research and current guidelines regarding suicide prevention are based on white, heteronormative populations that typically exclude students from underrepresented minorities, including LGBTQ+ students, who are often more at risk for suicidal behaviors.

“These particular populations may be less likely to feel connected to their school; it can spin in another direction,” Marraccini said. “There’s a lot to be done.”

Graduate Students Bring Varied Experiences and Expertise to Shape School Systems and Clinical Care

Katie Ingram, wearing a denim jacket and standing in front of greenery
Katie Ingram; photo credit Michael Hobbs

Marraccini said that Ingram, Hall, and Pittleman each bring expertise in different disciplines in a way that amplifies the potential for this work to drive change. For Pittleman, who works most closely with Marraccini on her research, the graduate student experience has provided her with insight.

“We’re grad students, instructors, doing dissertations, shaping research—and we have these practical skills and knowledge of factors that contribute to suicide risk,” Pittleman said. “What are the threats to mental health, and why do people become suicidal? A lot of that is system-level practices and structure.”

Ingram, whose primary mentor is Dorothy Espelage, a William C. Friday Distinguished Professor of Education, said she appreciates the opportunity to provide psychological services in a a variety of clinical settings, from schools to crisis stabilization units within UNC Hospitals. She strives to bring this knowledge base to all of her other roles as a graduate student and contribute to the policies, practices, and norms that facilitate mental health for everyone.

As a graduate student currently involved in research, and mentoring undergraduates, in addition to clinical hours and coursework, Ingram is aware of how the systems and demands of academia can adversely affect mental health, for graduate students and for all community members.

Karen Hall, wearing a teal shirt and standing in front of a tree
Karen Hall

“There are a lot of opportunities to not only talk about wellness and struggling with mental health, but also to do our best to contribute to fostering safer and healthier environments for ourselves and those around us,” Ingram said.

Part of that work at Carolina has included The Graduate School’s I4 Boundary Spanners project, which supported Master of Public Health then-graduate student Cason Whitcomb, who worked with Marraccini on supporting adolescents with suicidal thoughts and behaviors during the COVID-19 pandemic. Marraccini served as principal investigator on the North Carolina Policy Collaboratory project, and she and her team have been disseminating findings about the creative ways in which school professionals have approached suicide prevention during the pandemic.

Across her research, Marraccini said conversations with teens who have shown suicidal behavior, as well as their parents, underscore the importance of developing guidelines that support children both in the school and hospital environment following a suicide-related crisis.

And with school systems serving as a pathway to higher education, Marraccini and her graduate students keep the cumulative effect of school-based support systems in mind as a mechanism for fostering resiliency and other protective factors in children.

Suzanne Barbour, dean of The Graduate School, wants to make certain that UNC-Chapel Hill graduate students to know about resources that are available to them at the University, especially if they find themselves to be less energetic, happy, or confident than usual.

“We are living in a time of uncertainty, and many of us are fatigued,” Barbour said. “I want you to know that you’re not alone.”

Resources at UNC-Chapel Hill

From the American Foundation of Suicide Prevention

Warning Signs

  • Talking about wanting to die
  • Looking for a way to kill oneself
  • Talking about feeling hopeless or having no purpose
  • Talking about feeling trapped or in unbearable pain
  • Talking about being a burden to others
  • Increasing the use of alcohol or drugs
  • Acting anxious, agitated or recklessly
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings

The more of these signs a person shows, the greater the risk. Warning signs are associated with suicide but may not be what causes a suicide.

If someone you know exhibits warning signs of suicide:

  • Do not leave the person alone
  • Remove any firearms, alcohol, drugs or sharp objects that could be used in a suicide attempt
  • Call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255)
  • Take the person to an emergency room or seek help from a medical or mental health professional
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