Most graduates remember university as one of the best times of their lives filled with new experiences and challenges both inside and outside the classroom. Indeed, media depictions of college life would suggest it is entirely fun-packed and fancy-free.
Yet, few accounts of college life look at the ever more relevant issue of student mental health. The sobering reality is that students are among the highest risk groups for many short and long-term mental health problems.
Student Mental Health deserves attention not only for the sake of the individuals who may be affected but also for its impact on the graduate workforce. A young person affected by even short-term mental health problems may not reach their full potential at university or worse, may drop out entirely.
Clearly this impacts the young person’s longer term career opportunities. Moreover, if the aim of university is to develop a highly skilled workforce for society, then the issue of student drop out and underachievement is of relevance to us all.
A range of issues affects students’ mental health
Students are affected by a range of mental health issues including, in some cases, full mental illnesses such as schizophrenia and bipolar disorder. Among the broader student population, however, the most common problems are from anxiety, depression and eating disorders.
Data from the UK in 2007 have suggested around 15 per cent of students may be suffering from anxiety or depression. These figures were as high as 40 per cent in surveys from Lebanon (2006) and Pakistan (2008) looking specifically at medical students. Indeed, medical students affected by mental health issues is of particular concern as they will themselves be caring for and in contact with vulnerable individuals as part of their programme.
Eating disorders are also widely prevalent among university students. A large self-report survey of US college students in 2011 showed 13.5 per cent of women and 3.6% of men met criteria for an eating disorder. Estimates by national agencies generally put rates as high as 25 per cent among US college students. Of the two main forms of clinical eating disorders, the more prevalent is the binge-purge (through vomiting or laxative use) behaviours of ‘bulimia’.
Anorexia, involving severe food intake restriction to the point of starvation, is less common but a majority of female students still habitually restrict food intake to lose weight. Both bulimia and anorexia have significant impact on physical health and will affect ability to focus on studies.
Finally, the problematic level of substance use among university student populations is widely acknowledged. While this mainly affects campuses in ‘western’ countries, it is likely that this age group have a relatively higher exposure to substance use than other age groups in all populations.
Given these data, it is important to consider what may be causing the high rates of mental health problems among university students. Perhaps the type of person who goes to university is simply more vulnerable.
For example, being higher intellect, more achievement-focused, or perfectionist among other characteristics, are correlated with instances of anxiety and eating disorders. Furthermore, university students are often away from home and family for the first time which puts them at unique risk for depression and emotional instability.
University enrolment itself can cause anxiety
However, a 2004 longitudinal study following healthy young people before and during university found 9% developed symptoms of depression and 20% anxiety following the start of university. This suggests there may be something about the university environment itself which causes disturbance.
Certainly, there are unique pressures not just to achieve academically but also personal pressures to grow up, look after yourself and make decisions independently. These may be increased by the expectations of family and the financial sacrifices that may have been made.
These high expectations can mean instances of low grades or negative feedback can have an exaggerated impact on new students and may affect motivation and self esteem. Beyond the academic challenges, many students experience a sense of isolation from their first few weeks and months away from home.
A 2013 article by the UK National Union of Students (NUS) states the most cited factors for distress being deadlines, exam pressures, financial issues and general homesickness. Unfortunately these factors may well be on the rise as costs of attending university increase and the numbers travelling further abroad to international institutions grows.
Finally, emotional instability can be exacerbated by the claustrophobic nature of university – all aspects of daily life are contained and controlled within one location and setting. Work, accommodation, social life and hobbies all happen with many of the same faces day in and day out. Particularly within dormitories this means any disturbance between individuals or affecting a single person, may be felt by the whole social ‘system’ and all those living in it.
Why many students don’t seek help
Of particular concern is the mismatch between the evidence of real distress among university populations and the number seeking help from support services. For example, a 2011 report from the Royal College of Psychiatrists states that only 0.5 per cent of students declare a mental health disability yet studies using diagnostic tools measuring broader signs of distress suggest up to 70 per cent of students show some signs of disturbance.
In another study of 4 UK universities in 2008, 29 per cent of students reported what would be considered clinically significant distress and 38% have experienced at least one episode of panic (NUS data).
In direct contrast to this reports from the NUS suggest only 3-10 per cent of UK students suffering difficulties will actually visit the (free) university counselling services and 26 per cent of those with problems will not seek any form of treatment at all.
Of great concern is the suggestion that students with distress who do not receive help may be at risk for self harm and suicide: 14 per cent and 13 per cent respectively in NUS data and 10% seriously considered suicide in a 2008 US college survey.
It appears then that many students are suffering alone either because they are unaware of support services or because they fear stigma and repercussions from seeking help.
