Depression and Anxiety in College Students: A True Epidemic?
Unsplash, Christian Erfurt
Adjusting to college can be a challenge that catches many students and their families by surprise. Successfully navigating adult-like responsibilities, increased academic stress and social pressure require cognitive maturity and life skills that many in this age group are still mastering.
At a time when mental health experts, advocacy groups and public health organizations describe the incidence of anxiety and depression among college students and college-age young adults as an epidemic1, it’s worth pointing out that many common disorders including depression, anxiety, schizophrenia, mood disorders, and personality disorders emerge during young adulthood.2 In a review of the literature regarding the age of onset of mental health disorders, researchers noted that by the age of 25, 75% of those who will have a mental health disorder have had their first onset.3
Many, if not most, colleges and universities report a rising number of students seeking help at counseling centers, sometimes resulting in difficulty keeping up with the need for these services. What’s behind this increase in demand, and does it stem from an actual rise in mental health problems or from societal shifts that encourage and enable students to talk about something that used to be much more taboo?
The answer, of course, is complicated.
No two students are exactly alike, and people arrive on campus with a wide variety of experiences, beliefs, and fears that influence their emotional state as well as their likelihood of seeking help. Sometimes students enter college having been diagnosed with anxiety in their early teens or even younger. Sometimes a specific event during the college years sets off a cycle of anxious thinking that didn’t exist in high school. Sometimes the cause is not immediately apparent.
How a Traumatic Event Can Trigger a Problem
In high school, Jasmine Williams considered herself someone people leaned on. “I was always seen as the strong friend and the ‘big sister,’” says the Virginia-based 24-year-old digital media specialist and public speaker who says she had no experience of anxiety. However, shortly into her freshman year at High Point University in High Point, North Carolina, Jasmine’s older brother died suddenly. This tragedy sent her into a whirlwind of anxiety that left her bewildered and drained, just as she needed to navigate her entry into young adulthood.
But after her brother’s abrupt passing, Jasmine found herself unable to deal with change of any kind. It got so bad that if the due date for a paper was moved, she would find herself with a racing heart. “I could feel myself kind of spiraling,” she recalls. “Because the loss was so unexpected, I think that pushed me as I grieved to fear change, to fear the unexpected. There were years of my life where I didn’t even know that anxiety was what I had. I just knew I felt different.”
High Point connected Jasmine with the school’s emotional-support services which included counseling sessions (at no additional cost) at the campus health center. During this difficult time, Jasmine formed a kinship with other students who were struggling. The key? Opening up and sharing her feelings with her peers instead of going through her day pretending everything was fine.
Once she began talking about her emotions, her email inbox and cellphone became “flooded” with messages from others who were also dealing with anxiety and stress. “People can’t help you if they don’t know what’s going on,” she explains. “The sooner you let other people in, whether it’s a counselor or friend, the sooner you can get not only empathy but relief.”
As for why so many young people seem to be suffering from anxiety, stress, and depression even in the absence of acute traumatic events like the one she suffered, Jasmine thinks it has to do with fear. “[It’s] this overriding concept around control, I think—a feeling that everything is out of your control,” she says adding that, “many students are unnerved by a feeling that they can’t control what’s coming next.”
More Seeking Help
At least one expert hesitates to label the increase of college students asking for help as a true mental health crisis on campus. Ben Locke, PhD, senior director of counseling and psychological services at the Pennsylvania State University in University Park, Pennsylvania, as well as the executive director of the university’s Center for Collegiate Mental Health (CCMH)4,5 points out that as institutions confront the cumulative impact from years of rising demand for mental health services it’s important to remember that academic institutions actively worked to create the very demand they are seeing now.
(The Center for Collegiate Mental Health at Penn State is an international practice-research network of nearly 550 colleges and universities that works to understand college student mental health. CCMH collects and analyses data on college students seeking mental health treatment at their academic institutions in the US and internationally and publishes an annual report. The 2018 report, the CCMH’s 10th, describes the experiences of 179,964 college students seeking mental health treatment; 3,723 clinicians; and more than 1,384,712 appointments from the 2017-18 academic year.)
“Over the last 15 years, the culture of society has dramatically changed,” says Dr. Locke explaining that enormous sums of money have been spent over the past decade and a half on suicide awareness starting with the youngest students—children in elementary school. “[These efforts] dramatically increase the rate at which people seek mental health services,” he says.
In other words, people who in the past were feeling anxious or depressed might have suffered in silence or talked it out with friends and family, whereas now—thanks to less stigma surrounding mental health conditions and better-trained “gatekeepers” such as teachers, parents, and coaches—it’s become much more acceptable and even desirable to actively seek counseling.
“Students today are far more willing to acknowledge any kind of mental health concern than at any time in history,” explains Dr. Locke. “This creates a perception of demand and crisis that may not be wholly accurate.” As an example, he notes that 35% of the students seeking counseling help at Penn State agree with the statement: “I have thoughts of ending my life,” at any level on a scale of 0 to 4. After seeing a counselor just once, that agreement drops to 9.5% of students who visit the counseling center.
Dr. Locke says suicide rates in the higher-education setting have remained steady or even declined slightly over the past few years while the suicide rate for the population as a whole has skyrocketed. Similarly, rates of students on anti-anxiety medication or antidepressants have remained flat.
What to make of surveys that indicate extremely high rates of anxiety and depression among the college student population? Dr. Locke asserts that they may lead people to believe the incidence of these conditions is higher than it is because survey response rates overall are low, and those students who do respond are likely to be “emotionally connected to the topic.” This self-selecting group of responders could possibly be skewing results in some cases.
Meeting a Need
That said, Dr. Locke acknowledged that mental health needs are real for a substantial number of young adults. The all-pervasive reach of social media, hyper-competition among younger students, and over-involved parents can definitely increase stress and contribute to anxiety and depression.
Like other schools, Penn State is rising to meet the increased demand for services by hiring more mental health practitioners, keeping a 24/7 hotline staffed, and offering a crisis text service that links students with community resources, among other initiatives. Although the more unfiltered language students use today to describe their emotional state may heighten and even exaggerate the sense of urgency at times, he explained, no one wants to deny help to a truly struggling student: “Institutions have to respond every time. The new demand we’re seeing is not going away.”
by Laurie Saloman