College students are the focus of negative headlines about everything from binge drinking to campus crime. Now a new concern may dwarf the earlier crises: an alarming increase in cases of mental illness on college campuses.
Two new studies shed light on the phenomenon — an overview in a special report from the publishers of Psychology Today and the latest research presented Tuesday at the Philadelphia conference of the American Psychiatric Association (APA).
"Mental illness is absolutely going off the charts on college campuses," says Hara Marano, who prepared the report for a May newsletter published in association with Psychology Today. "College counseling centers used to be the backwaters of the mental health care system. Now they are the front line."
A March report in Psychiatric News from the American Psychiatric Association reported similar concerns.
Psychiatrist Shamsah Sonawalla of Massachusetts General Hospital says "there is not just an increase in prevalence" of psychological problems in college students, but "an identification of problems earlier. That we recognize it more is a good thing. But we have opened up Pandora's box."
Sonawalla found that 14% of 701 students who filled out a survey at a college in the Boston area showed significant depressive symptoms, and half of them could qualify as having major depression. The psychiatrist presented her research Tuesday to the APA.
North America's college counseling centers report an increase in troubled students, according to psychologist Robert Gallagher of the University of Pittsburgh. His 2001 survey of counseling centers shows that 85% of colleges report an increase during the past five years in students with severe psychological problems.
About 30% report at least one suicide in the previous year. Such incidents include the much-publicized case of a girl who killed herself two years ago in a fire in her dorm room at the Massachusetts Institute of Technology.
Other sources document an alarming trend. A study from the American College Health Association in 2000 said 10% of college students have been diagnosed with depression. And the National Mental Health Association quotes a study saying 30% of college freshmen report feeling overwhelmed a great deal of the time; 38% of college women do.
The National Institute of Mental Health (NIMH) pays special attention to college students and mental illness on its Web site, www.nimh.nih.gov. The site highlights the common stressors that are part of normal college life, including greater academic demands; new financial responsibilities; changes in social life; exposure to new people, ideas and temptations; greater awareness of sexual identity issues; and anxiety about life after graduation.
Marano, whose study appears in the May issue of Blues Buster, a lengthy newsletter about depression, says the college population is not suddenly losing its moorings. For the deeply troubled, problems began before bags were ever packed for that first trip to school.
Many students show up already on antidepressants, thanks to earlier diagnoses in the young. "I call it the Prozac payoff," Marano says.
"We find that students arrive at our doors with these severe problems, rather than developing them while on campus," Gallagher says.
Students may run into trouble, Marano says, if they attempt to go off their medication. "They think once they are out of the house that made them go crazy, they will be fine." Or, she says, they stop their pills in favor of alcohol or drugs, both of which can be associated with depression.
In the past, unmedicated students with dramatic problems would not have made it into college or could not have stayed there, Gallagher notes.
Other factors experts say are increasingly at play:
- Family dysfunction at home. "Parental drug and alcohol use and the reduced presence of adults in the home" contribute, Gallagher says. Sexual and physical abuse "definitely predisposes the likelihood of depression," Marano says. Students also may lack the social and emotional skills that a supportive family base provides.
- A college population that now parallels the general population. "College is no longer an elite place," Marano says. "College populations are more like real life."
- A group vulnerable to mental illnesses from depression to anxiety disorders. The ages of 18-25 are the prime time for serious conditions to emerge, Gallagher says.
- An increasingly complex and competitive world. "In the very high-pressure schools, there seem to be more student suicides," says Gallagher, although they are still quite rare.
- The increasing availability of psychiatric services at colleges. Counseling may be free. "It is a good place to get diagnosed and treated," Marano says, and the stigma against mental illness, while still strong, is weakening a bit.
Marano notes that going home for the summer can be another traumatic time for students. They return to the place they perceive to be causing them problems. Often before leaving school they will have stopped for a tune-up. "They will first go to a counseling center to get taken care of."