Following up on last month's column about psychological stress on college campuses, this month's examines more serious cases of psychological disorder. Alarming headlines have appeared in recent years regarding college students' (and other young persons') mental health:
- "Half of college students consider suicide" headlined an August 2008 article from MSNBC.com. The article reported on a large, multi-campus survey that "defined considering suicide as having at least one episode of suicidal thinking at some point. Slightly more than half of students said they fit that category, which is known as suicide ideation. When researchers asked about more serious episodes, 15 percent said they had 'seriously considered' attempting suicide... More than 5 percent of students said they had actually attempted suicide..."
- "Don't overlook mental health" urged a February 2011 staff editorial in the Duke University Chronicle. This article reported on findings from the previous year's American Psychological Association convention that "of students who sought college counseling, 34 percent had moderate to severe depression in 1997. That number in 2009 was 41 percent. Moreover, 11 percent of students were on medication in 1998 for anxiety, depression and attention deficit hyperactivity disorder, compared to 24 percent in 2009..."
- "Depression on the rise in college students" announced National Public Radio in January 2011, citing the same APA study. Importantly (and unfortunately), this piece noted that college mental health centers were "overwhelmed" and subject to budget cuts.
Traditional clinical diagnosis of such disorders follows the criteria set out in what is known as the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). For each of the numerous recognized disorders (e.g., major depression, generalized anxiety, substance abuse, eating disorders, antisocial personality), DSM-IV specifies criteria for the condition, how many of the criteria must be met, and for what duration.
Major depressive disorder, for example, has nine criteria, including depressed mood; loss of interest or pleasure in activities; changes in appetite or body weight; changes in sleep patterns; feelings of worthlessness; and suicidal thoughts. Five or more of the nine criteria must be present within a two-week period to warrant a clinical diagnosis. For many of the criteria, the specified feelings must be present "most of the day, nearly every day."
The aforementioned APA convention study implies that the prevalence of clinical depression in college students may be rising. The self-selection aspect of who shows up to a university counseling center makes it difficult to know the prevalence rate for students as a whole, but the number certainly appears to be high.
As discussed in last month's column, many aspects of college life seem capable of keeping students' stress levels high, year in and year out. One element that presumably has been worse the last few years than previously is, of course, the country's economic doldrums. The bad economy -- affecting students' and their families' ability to pay tuition, as well as students' job prospects -- may be driving up rates of depression, anxiety, and other disorders, compared to previous years.
APA study author John Guthman, cited in the Duke Chronicle article, suggests another possible reason for the high number of distressed students. As stated in the article, "more students with severe mental illness have been able to attend college, due to increased awareness of childhood mental problems." The NPR piece also notes improvements in the treatment and management of such childhood problems, thus making it possible for some students who could not have attended college in the past to do so now.
According to a 2004 New York Times article on college suicide, university administrators and mental health professionals have increased their awareness of the problem. However, despite different kinds of efforts to combat student suicide (e.g., trying to get students to complete voluntary screening questionnaires; placing counselors in residence halls), the problem remains intractable to a considerable degree. As the article states:
...the best way to reach these students remains unclear, and students do not always welcome the intervention. Some experts fear that forcing students to enter treatment or to take a medical leave can dissuade others from asking for help and discourage their friends from sounding the alarm, even though students who take such leaves generally come back and graduate.
Further increasing the difficulty of treating and managing students' mental health problems is the finding -- based on general-population research and not just college students -- that individuals with conditions such as depression and anxiety wait an average of nine years before seeking treatment, perhaps in the belief that the problem will diminish on its own.
The Times article cites an online/interactive screening program from the American Foundation for Suicide Prevention. According to the organization's website, the AFSP program is currently being used at 30 colleges and universities. Other resources on mental-health issues, including suicide, are the following:
National Institute of Mental Health's "How to Find Help" page.
American Psychological Association's "Help Center."
American College Health Association's Mental Health Resources.