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In brief

Last year, Scripps Research Institute California graduate student Anna Owensby killed herself. Graduate school is hard at the best of times, and it can become overwhelming when students are faced with situations such as having a dispute with an adviser or not passing a milestone such as a qualifying exam. One recent study found that 7.3% of graduate students had suicidal thoughts. But there are practices that advisers, departments, and schools can put in place to support their students mental health.

In the spring of 2016, Scripps Research Institute California graduate student Anna Owensby texted a friend: I have this feeling right now that there isnt really a place for me ... People like me arent supposed to get a Ph.D., we are addicts or homeless or in jail.

Owensby, 26, was a fourth-year graduate student. In her first years at Scripps, she was briefly hospitalized to evaluate her mental health, and she changed lab groups. Her new adviser, Scripps molecular medicine professor Dennis W. Wolan, had assisted in finding her a therapy group that seemed to be helping her. The group was not in Owensbys insurance network, but Scripps was paying for the sessions. She passed her Ph.D. candidacy exam at the end of 2015, at which time her committee members indicated that she was progressing appropriately and that they had no nonacademic concerns about her.

Then, in the space of just a few weeks in spring 2016, Owensby was banned from Wolans lab and told not to contact him or her lab mates. She was encouraged to resign from Scripps and informed that Wolan would not give her a job recommendation.

On April 14, 2016, Owensby died by suicide.

There is no one situation or event that makes a person suicidal, experts in suicide risk and prevention emphasize. We always want to come up with one cause, but it doesnt work that way, says Jill Harkavy-Friedman, vice president of research at the American Foundation for Suicide Prevention. People end their lives when a number of conditions and factors come together to make someone feel overwhelmed and unable to cope.

Nonetheless, there are concrete steps that academic advisers, departments, and schools can take to better support their graduate students mental health and reduce the risk of losing people like Owensby.

In 2015, the rate of death by suicide for people ages 20 to 34 in the U.S. was between 15 and 16 people per 100,000, according to the Centers for Disease Control & Prevention. Suicide is one of the five most common causes of death for people ages 15 to 44 years.

Long-term factors that increase the risk that someone might attempt suicide include a psychiatric diagnosis, substance use disorder, childhood trauma, and family history of suicide.

Few studies have investigated mental health problems and suicide in Ph.D. students specifically. One survey of 3,659 students in Belgium suggests that 32% of Ph.D. students are at risk of having or developing a psychiatric disorder such as depression (Res. Policy 2017, DOI: 10.1016/j.respol.2017.02.008). A separate survey of 301 graduate students at Emory University determined that more than 34% likely had moderate to severe depression, while 7.3% reported suicidal thoughts, and 2.3% reported having plans for suicide (Acad. Psychiatry 2014, DOI: 10.1007/s40596-014-0041-y). The rates of mental health issues in this population are elevated pretty significantly above the general population, says Nathan L. Vanderford, assistant dean for academic development in the University of Kentucky College of Medicine.

In addition to the long-term factors that increase suicide risk, short-term issues such as life transitions and stress also play a role, experts say. Not unlike starting college, the transition to graduate school can involve significant life upheavalbut without the large number of support staff and peers that undergraduates encounter when moving to campus.

Graduate students instead might move to a new location to live in an apartment alone or with a rarely seen roommate and then interact mostly with a relatively small set of classmates and lab mates in one or two buildings. As time goes on, other events can disrupt a students world: An adviser loses a grant, doesnt get tenure, or chooses to move, or a student fails to pass a milestone such as an oral exam. Meanwhile, family and friends might not understand the unique experience of graduate school.

And the stakes are high. Students are putting so much effort and energy into pursuing the degree that every single step can carry a lot of weight. Certainly theres fear of failure or perception of failure, says Christa Labouliere, a clinical psychology professor and administrator for a suicide prevention program at New York State Psychiatric Institute, which is part of Columbia University Medical Center.

A year after Anna Owensby died, her mother, Victoria Owensby, sobs when she tries to talk about her. She was so funny, her heart was so kind, and she was beautiful and brilliant, Victoria says.

Anna Owensby was valedictorian of her high school class and a talented cellist who enjoyed playing music composed by Johann Sebastian Bach. After high school, she initially attended Cleveland Institute of Music. Students at the institute take nonmusic electives at nearby Case Western Reserve University. After a general chemistry class, Owensby reconsidered her career pathshe didnt think she could make money playing the cello, her mother saysand Owensby wound up switching to a chemistry major at Case.

32%

Percentage of Ph.D. students who are at risk of having or developing a psychiatric disorder such as depression, according to a 2017 study. Source: Res. Policy 2017, DOI: 10.1016/j.respol.2017.02.008

2.3%

Percentage of surveyed graduate students who reported having plans to attempt suicide, according to a 2014 study. Source: Acad. Psychiatry 2014, DOI: 10.1007/s40596-014-0041-y

15 to 16

People ages 2034 per 100,000 who died by suicide in the U.S. in 2015. Source: Centers for Disease Control & Prevention

25

People who attempt suicide for every person who dies by suicide. Source: American Foundation for Suicide Prevention

As an undergraduate, Owensby stood out for her enthusiasm and work ethic, says Case chemistry professor Gregory Tochtrop, who taught Owensby organic chemistry before recruiting her to do research in his lab. She was incredibly smart, Tochtrop says. After discussing a research idea, she would track down and read all the same papers a more seasoned scientist would look up. She had the mind-set of Im going to learn something about this so that I can contribute to it, he says.

But Owensby had difficulties as well. Growing up in Greenville, S.C., she was a tough child to parent, often losing emotional control when faced with even minor setbacks, her family says. One of Owensbys aunts, Amy Forton, is a mental health counselor and says Owensby exhibited severe anxiety. She wasnt depressed, though, Forton believes. She was happy and interested in things in life.

Nevertheless, Owensbys difficulty regulating her emotions was significant enough that her mother sought psychological help for her daughter. The therapists just said she was really, really smart and overly perfectionist and sensitive, her mother says. They never said anything about any mental illness, ever.

There were mental health issues in Owensbys family. Her father had alcoholism and died of liver disease while she was in college. Tochtrop believes that the challenges of growing up with her fathers alcoholism and then losing him led Owensby to look for father figures. Owensby tried to push for a more personal connection in an otherwise professional relationship with him, Tochtrop says. Early in college, Owensby would turn to Tochtrop to talk for hours about her life history and problems. It wasnt anything inappropriate, but I think she was looking for things she didnt have, Tochtrop says.

When Owensby was a junior, Tochtropat the time an assistant professor who had a wife in law school, a baby, and an approaching tenure decisionfelt he had to draw a line. He told Owensby that he couldnt help her with personal matters, but he was happy to support her career. Owensby seemed to take the message well, and after the conversation we still had a really good professional relationship, he says.

Owensby used Case counseling services, Tochtrop says, but he doesnt know further details. Once, he noticed that she had been cutting herself. Despite her personal challenges, Owensby graduated from Case having earned several university awards, including one for best thesis in undergraduate chemistry research.

Owensby started at Scripps in 2012. Details of her time there are based on materials provided by and interviews with her family and Tochtrop, who stayed in close touch after she left Case. Scripps refused C&ENs request to interview institute personnel about Owensby and the schools programs to support students mental health. In a statement, Vice President for Communications and Development Cara Miller said, All universities are faced with the challenge of wanting to provide the utmost support for members of their community who may be in need of assistance, while also maintaining their privacy and adhering to legal requirements. Owensbys mother has filed a complaint with Scrippss accrediting commission because although the institute has given her Owensbys educational records, it has withheld disciplinary records.

Anna Owensby (center) with her mother, Victoria Owensby, and her brother, Adam Owensby.

Credit: Courtesy of Anna Owensbys family

During her first years at graduate school, Owensby diagnosed herself with borderline personality disorder (BPD). In January 2015, she began a form of cognitive behavioral therapy with the support of her adviser, Wolan, and Scripps. The director of the therapy center that Owensby used, Milton Z. Brown of the Dialectical Behavior Therapy Center of San Diego, did not respond to voice mail messages left by C&EN.

The National Institute of Mental Health describes BPD as a serious mental disorder marked by a pattern of ongoing instability in moods, behavior, self-image, and functioning. People with BPD often exhibit impulsive actions and have unstable relationships. They go through episodes of anger, depression, and anxiety that can last only a few hours or as long as days. Because Brown did not return C&ENs calls, C&EN was unable to determine whether Owensbys therapists agreed with her self-diagnosis.

An unfortunate consequence of Wolans support in the face of Owensbys mental health challenges may have been that Owensby again sought personal fulfillment in a professional relationship. Looking back, I am just so incredibly grateful for the times you gave me when I felt valued and wanted, as they were the happiest moments of my life, she wrote to Wolan in a letter she last edited a few days before she died. I slowly came to love you like the family I had always wanted.

On Sunday, March 13, 2016, Owensby seemed to be doing well at Scripps. Wolan had texted Owensby, You are working harder than you likely ever have in your life. Andmore importantlyholding it together. Youve come an incredibly long way. Very proud of you! according to a document Owensby later prepared for attorneys.

Then Owensbys life quickly derailed. According to Owensbys notes, on Wednesday, March 16, Wolan called her into his office to ask if shed gone through the drawers of a lab mate with whom Owensby had had a contentious relationship. (Six months earlier, Owensby had suspected the lab mate of sabotaging her research materials.)

On Thursday, March 17, Owensby was unexpectedly escorted from her lab to meet with James R. Williamson, then dean of graduate studies at Scripps and now executive vice president for research and academic affairs. According to Owensbys notes about the meeting, Williamson told her that Wolan had requested her removal because she was disruptive and had gone through other lab members personal property. Williamson told Owensby not to return to the lab and had her identification badge and keys confiscated. Then she was escorted to her car.

On Friday, March 18, Scripps director of graduate studies, Dawn Eastmond, contacted Owensby to ask about laboratory materials needed to continue experiments. Eastmond also told her not to contact Wolan or any of her lab mates.

Owensby considered hiring an attorney to challenge Scrippss actions but decided she couldnt afford one. At a meeting on Thursday, March 31, 2016, with Williamson and Eastmond, Owensby learned more details of why shed been shut out of Scripps. In addition to the accusation about going through lab mates property, Wolan had discovered that in 2014 Owensby and another lab member had accessed Wolans computer and gone through his web browser history.

In her notes for possible attorneys, Owensby maintained that the other, more senior, lab member was the instigator and she was a bystander. She felt an enormous amount of social pressure to laugh along with the other lab member when they were searching Wolans computer because of a fear of harassment from that person, Owensby wrote. Owensby also alleged that the other lab member had a history of inappropriate behavior, including using lab resources without Wolans knowledge to generate materials for a project the lab member planned to undertake elsewhere.

In texts to a friend after the meeting, Owensby wrote about the next steps Scripps planned to take: They say they have conflicting testimony. They will basically feel it out and [Eastmond], [Williamson], and a [Scripps] lawyer will make a decision. [Eastmond] told me she envisions that either I resign or get terminated.

Over the next couple of weeks, Owensby continued to text the same friend, expressing concern about how long Scripps would continue to pay her and whether she would have enough money for rent. She also said that she was applying for jobs, but even McDonalds wants to talk to your previous supervisor, she wrote. I dont know what Im gonna do.

Owensby also met with Brown, one of her therapists. He later told her family that he tried to help her problem solve throughout the entire course of events. Around Tuesday, April 5, Owensby called Eastmond from Browns office to ask about getting a recommendation from Wolan. Owensby texted a friend that Eastmond said Wolan didnt want anything to do with her.

On Wednesday, April 13, 2016, Eastmond called Owensby to suggest that she resign from Scripps. Owensbys texts to a friend say that Scripps would pay her until the end of April. After Owensby died, Forton, her aunt, spoke with Wolan and Eastmond. According to Fortons notes about the meeting, Eastmond says she informed Owensby that Scripps would continue to pay for her health insurance through June.

On Wednesday and Thursday, April 13 and 14, Owensby tried several times to contact Wolan. She also spoke for the last time with Tochtrop, who says he thinks about the conversation nearly every day. She was worried about her career and what she could do, Tochtrop recalls. I really tried to emphasize how incredibly smart and talented she was. I said that I would do anything I could to make sure she had a safe landing and found a position.

Meanwhile, Owensby also spoke with and texted friends. Can you watch Curie for a little bit tonight, she texted one on Wednesday, referring to her beloved dog. I need to have some time alone.

The friend wasnt able to take Curie that evening, and Owensby repeated the request on Thursday. Wolan and Eastmond each contacted Owensbys therapist that day, concerned about Owensbys behavior. No one contacted Owensbys family.

Thursday evening, Owensby killed herself.

We deeply mourn Annas sudden passing, Williamson said in a Scripps obituary. She was extremely bright and truly passionate about science. Our sympathies go out to her family, close friends and colleagues. We are all struggling to come to terms with what has happened, and we are doing our best to come together to generate a support network for those most affected.

Cultivating mental health

Given Owensbys mental health history, she was at high risk for attempting suicide after Scripps personnel barred her from her lab and encouraged her to resign. Ideally, Scripps personnel and Owensbys therapists would have been aware of her risk for suicide.

Generally, however, predicting suicide is hard, says Sidra J. Goldman-Mellor, who studies suicide risk as a professor of public health at the University of California, Merced. For any given person in a program, its going to be really difficult to know if theyre at high risk for suicide, because a lot of people hide it. What that means is that its important to make sure there is support for all students.

That support should go beyond sending an annual e-mail with a list of resources, suicide risk and prevention experts say. Additional steps to take might include holding events such as stress-management workshops or sponsoring thesis-writing support groups. You want to make it a culture in the department to acknowledge that graduate school is hard and there are things you can do to help cope with it, Columbias Labouliere says. Maybe then people wont get to the point of feeling trapped.

Some chemistry departments are making efforts to reduce stress where they can, foster more open discussions about mental health, and encourage students to talk with each other.

When Philippe Buhlmann, a chemistry professor at the University of Minnesota, became his departments director of graduate studies, he made it his mission in that role to promote mental health. He started by working with UMNs mental health services to develop a survey of chemistry graduate students to figure out their primary stressors. The most intense ones turned out to be the interrelated needs to publish and to find a job upon graduation. We cant eliminate those, Buhlmann says. We want 100% of our students to get a job.

But Buhlmann and colleagues did identify some measures that the department could take to reduce students stress. For example, the department reconsidered annual student progress reports and self-evaluations. Without guidance, some students are harder on themselves than they should be. They come up with their own scale that by all objective assessment is twisted, Buhlmann says. Now, after the students self-evaluate, their advisers must also weigh in to concur or correct the students assessment, clarifying expectations and improving communication in the process.

The department also now requires that fourth-year students meet with their thesis committee members to talk about research progress and career aspirations. Students were worried that this would be just another hoop to jump through, Buhlmann says. But Im getting very positive feedback. It gives students other perspectives and pushes them to think more realistically about how to reach their postgraduation goals.

Buhlmann also formed a student-run group called the Community of Chemistry Graduate Students (CCGS) that has a $3,000 budget to plan events promoting physical, mental, and social health. Activities so far have included hosting weekly runs and biweekly social hours, creating videos about depression, and holding panel discussions on topics such as stress reduction or how to write a rsum. If we have too many things that are too strongly focused on mental health, then we dont get good turnout, says third-year chemistry graduate student and CCGS chair Evan Anderson. If we mix things up, then we get better attendance overall. A recent picnic had 150 attendees, which included more than half of the graduate students in the department.

Similar efforts are afoot in the department of chemistry and chemical biology at Harvard University. That department tried to implement changes after graduate student Jason Altom died by suicide in 1988at the time, the departments fourth suicide death in eight years. Some of those efforts, such as a biweekly catered dinner, didnt stick.

A switch to multiprofessor doctoral committees did lastbut different faculty approached committee responsibilities differently, such as how often they met with students. Starting with this falls incoming class, however, there will be some standardization: To alleviate the stress of having to choose committee members and corral them for meetings, those tasks will fall to the departments director of graduate studies. Starting in their second year, students will have annual meetings with their committee in April, and the department has developed some basic guidelines about what those meetings should cover.

Additionally, the department has formed a Community Committee composed of faculty, staff, students, and postdocs who are charged with promoting department cohesiveness and communication. It has sponsored a Thanksgiving dinner for people remaining in the Cambridge, Mass., area during the holiday; sessions on mindfulness; chair massages; and Fruitful Wednesdays during nutritional awareness month, when students can gather and chat while picking up free fruit to eat. The committee does not yet have a budget because it is new, but money is not a constraint; we will do things as they make sense, says Elizabeth A. Lennox, director of laboratories and codirector of graduate studies in the department.

Meanwhile, the departments Graduate Student & Postdoc Council has a $19,000 annual budget for social gatherings and what Lennox calls fun but academically constructive events. For example, the committee organized faculty to give talks about their experiences applying for academic jobs, running a lab, and rising from junior to senior faculty.

The increased efforts toward supporting mental health and building community were a priority set by professor Charles M. Lieber when he became department chair in 2015. A culture survey had shown that morale was down across the board in the department, something that Lieber attributes to a lack of transparency. Lieber emphasizes that expectations remain high for Harvard students, postdocs, and faculty. But promoting openness helps alleviate some of the issues created when people stay in their labs and offices and dont talk with each other, he adds.

Although general programs to promote mental, physical, and social health are important, it is also critical for people to know how to respond when someone is in acute distress. Owensby was already connected with therapists when her life upended. But most people who are depressed or suicidal dont make it to a counseling center, says Julie Cerel, a psychologist and professor at the University of Kentucky College of Social Work and president of the American Association of Suicidology. She says training people who are naturally part of students environmentgatekeepers such as lab managers, faculty, and other departmental staffcan help identify those in need of intervention. In departments in which people arent used to discussing mental health, training can also provide scripts they can use to begin conversations.

Anna Owensby with her dog, Curie.

Credit: Courtesy of Anna Owensbys family

Such training, however, doesnt mean that faculty or other department members become therapists. There are professional limitations and personal boundaries that should not be crossed, UMNs Buhlmann emphasizes. He was a pilot trainee in a now-expanding effort at UMN to train mental health advocates within each academic unit. The advocates are taught a 4R approach: recognize when people are in trouble, assume the role of listener, respond by giving them options, and direct them to appropriate resources.

Additionally, Buhlmann brought in UMN mental health services staff to train graduate student teaching assistants to recognize the signs of stress and mental health problems in chemistry undergraduates and how to direct them to appropriate help. These skills could also transfer to interactions with peers.

At Harvard, Lennox arranged for the schools mental health services to conduct mental health awareness training this spring for the lab group administrators within her department. These administrators might be physically present in labs and see members in person more often than faculty do, Lennox says.

Lennox is also working with mental health services to develop a mental health curriculum to add to the departments routine training for students and postdocs. Shed like to include topics such as signs of mental distress, suicide risk awareness, and campus resources.

As part of an overall campus approach, schools should also ensure that on-campus clinicians are trained in suicide prevention response and how to implement measures that can quickly ensure someones safety, Labouliere says. Those interventions include determining how to restrict access to whatever method someone has chosen to use to attempt suicide. One of the reasons someone is suicidal is an impaired ability to solve problems. Consequently, once someone has a suicide plan, he or she is unlikely to change it when faced with a barrier. Another intervention is safety planning, which involves talking through and writing down what actions to take when suicidal thoughts take over.

Suicidal thinking does not last forever, Labouliere notes. In the moment, people might find their pain unbearable, but if they can get through that crisis, then they likely can engage in therapy, consider their options, and work to address whatever factors led to the situation. She adds that its important to tell people in crisis that effective, research-supported treatments are available. A lot of folks that feel suicidal are so hopeless and feel that their problems are so intractable that the message that there are treatments can be very powerful, she says.

If someone does die by suicide, its important for the department and school to step up actions to pay attention to their community. Cerels research suggests that after someone dies by suicide, as many as 30 people might have their lives majorly disrupted. Its not just a handful of close family members whose lives are changed, she says. Also, I think that suicides can really hit science departments hard because theyre not used to talking about feelings, she says.

Since Buhlmann has started bringing up the topic of mental health in his department, theres been tremendously positive feedback from other faculty, he says. Anyone whos been a chemistry professor long enough knows students in their group or department who have severely struggled, he adds. There are so many good people out there who want to help but dont know how. When you start to talk about it, everyone engages.

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Grappling with graduate student mental health and suicide - The Biological SCENE