In: Nursing
It’s common. Anxiety in college is very common. According to the American College Health Association Fall 2018 National College Health Assessment, 63% of college students in the US felt overwhelming anxiety in the past year. In the same survey, 23% reported being diagnosed or treated by a mental health professional for anxiety in the past year.
The sharpest increase in anxiety occurs during the initial transition to college. A recent studydemonstrated that psychological distress among college students — that is, their levels of anxiety, depression, and stress — rises steadily during the first semester of college and remains elevated throughout the second semester. This suggests that the first year of college is an especially high-risk time for the onset or worsening of anxiety.
It’s caused by many factors. Many factors contribute to the heightened risk for anxiety among college students. For example, sleep disruption caused by drinking excess caffeine and pulling all-nighters is associated with increased anxiety among college students. Loneliness also predicts mental health problems, including anxiety. Academic factors like school stress and disengagement from studies are also associated with psychological distress among college students.
It may be on the rise. College students today appear to be more stressed and anxious than ever before. A recent study in Sweden showed that anxiety levels have increased in recent years, especially among young adults. In the US, some research shows a decrease in psychological well-being among adolescents over the past several years. It’s not entirely clear what is causing this trend, though research shows a strong association between time spent on electronic communication (social media, smartphones) and reduced well-being among adolescents. Electronic communication might interfere with adjustment to college if it replaces healthy coping behaviors like exercise, face-to-face social interactions, and studying.
Whether you’re a student, a parent, or an administrator, our tips on coping with anxiety in college may help. Even if you haven’t yet started college, it can be useful to think ahead.
For students:
Approach, don’t avoid. College is challenging and many students
cope by avoiding stressors (skipping class, staying in bed all
day). However, we know that avoidance tends to make anxiety worse
over time. Instead, practice taking small steps to approach
anxiety-provoking situations. If you’re struggling in a class, try
emailing the professor for help. If you’re feeling lonely, try
introducing yourself to someone in the dining hall. Not at college
yet? Practice this skill by participating in pre-college programs
on campus.
Practice self-care. Many students struggle to maintain healthy
eating habits, consistent exercise, and regular sleep without the
structure of home. But self-care behaviors like these are extremely
important for regulating mood and helping people cope with stress.
Try to establish your own self-care routine — preferably before you
even start college. Good sleep hygiene is key. Set a consistent
bedtime and wake-up time each day. Avoid using your bed for
activities other than sleep, like studying. Limit caffeine in the
evening and limit alcohol altogether, as it interferes with restful
sleep.
Find resources on campus. Many colleges offer resources to help
students navigate the initial transition to campus and cope with
stress. Investigate campus resources for academic advising, study
support, peer counseling, and student mental health. If you’ve been
diagnosed with a mental health issue, such as an anxiety disorder,
you may also want to find a mental health provider near campus. If
you struggle with anxiety and you’ll be starting college next year,
you may find it helps to establish a relationship with a therapist
beforehand.
For parents: You can help your child navigate the transition to
college by supporting them in trying the tips described above. For
example, you might ask your child about their worries for college
and help them brainstorm an approach plan. You can also assist in
researching campus resources and finding local mental health
providers.
For administrators: College administrators can support students by raising awareness on campus about stress and anxiety. The message that anxiety is common and treatable can reduce stigma for those who are struggling, and increase the likelihood that they will reach out for help. Administrators can also work on reducing barriers for students who need mental health resources. For example, colleges can offer mental health support to students via phone, online chat, and drop-in sessions, to make it as easy as possible to receive treatment.
Depression and suicide are of increasing concern on college
campuses. This article presents data from the College Health
Intervention Projects on the frequency of depression and suicide
ideation among 1,622 college students who accessed primary care
services in 4 university clinics in the Midwest, Northwest, and
Canada. Students completed the Beck Depression Inventory and other
measures related to exercise patterns, alcohol use, sensation
seeking, and violence. The frequency of depression was similar for
men (25%) and women (26%). Thought of suicide was higher for men
(13%) than women (10%). Tobacco use, emotional abuse, and unwanted
sexual encounters were all associated with screening positive for
depression. “Days of exercise per week” was inversely associated
with screening positive for depression. Because the majority of
students access campus-based student health centers, medical
providers can serve a key role in early identification and
intervention. With every 4th student reporting symptoms of
depression and every 10th student having suicidal thoughts, such
interventions are needed. Depression and other mental health
disorders are a significant public health problem on college
campuses. Many students experience their first psychiatric episode
while at college, and 12 to 18% of students have a diagnosable
mental illness (Mowbray, Megivern & Mandiberg, 2006).
Epidemiological studies suggest that the 15 to 21 age category
(typical college years) has the highest past-year prevalence rate
of mental illness at 39%. Eisenberg (2007)reported that the general
prevalence of depression and anxiety is 16% among undergraduate
students and 13% among graduate students. Based on findings from
the American College Health Association (ACHA) National College
Health Assessment (NCHA), the rates of students reporting having
been diagnosed with depression has increased from 10% in 2000 to
18% in 2008 (2000, 2008). A number of factors contribute to the
initial presentation of depression during college. The transition
itself from home to college places additional life stressors on
young adults as they explore their identity, strive to master new
skills, are away from established social support systems, and have
increased time demands (Dyson & Renk, 2006). The consequences
of depression are significant. Depression has long been associated
with academic impairment (Heiligenstein, Guenther, Hsu, &
Herman, 1996). Depression and anxiety are consistently listed among
the top 10 factors impairing academic performance in the past 12
months on the NCHA (ACHA, 2008). Diagnosed depression was
associated with a 0.49 decrease in student GPA, and treatment was
associated with a 0.44 protective effect (Hysenbegasi, Hass, &
Rowland, 2005). Depression may also lead to increased risk of
self-injury, dropping out or failing college, attempting or
committing suicide, and other risky behaviors (Gollust, Eisenberg,
& Golberstein, 2008; Kisch, Leino, & Silverman, 2005). In
addition, there is an association between feeling functionally
impaired by depression in the past 12 months and accumulation of
credit card debt among students (Adams & Moore, 2007).
Psychiatric disorders and depressive symptoms have been associated
with tobacco use, alcohol consumption, physical inactivity, and
partner violence (physical, psychological, or sexual victimization)
(Sabina & Straus, 2008; Strine et al, 2006; Strine et al,
2008).
Suicide is the third leading cause of death among teenagers and
young adults (Centers for Disease Control and Prevention, 2004).
Depression has consistently been considered a risk factor in
suicide, along with substance abuse, adverse life events, family
history, a history of sexual abuse, troubled relationships, and
difficulties with sexual identity (Agerbo, Nordentoft, &
Mortensen, 2002; Cooper, Appleby, & Amos, 2002; Garlow, 2002;
Nemeroff, Comptom, & Berger, 2001). The NCHA reveals that 6.1%
of female and 6.4% of male respondents have seriously considered
suicide in the past year, and 1.2% of female and 1.5% of male
respondents have seriously considered suicide in the past 2 weeks
(ACHA, 2008). A study by Garlow, Roesenberg, and Moore (2008) of
suicidal ideation and depression among college students found that
11% of students endorsed current (past 4 weeks) suicidal ideation.
The same study found suicidal ideation to be associated with
screening positive for depression on the Patient
Health.Identification and referral to treatment earlier in the
course of a depression may reduce the serious consequences of
depression and prevent suicide (Wang et al., 2007). Yet, in general
U.S. populations, the median delay between onset of mental health
symptoms and accessing services is 11 years (Wang, Berglund,
Olfson, & Kessler, 2004). Despite access to health services on
campuses, Eisenberg, Gollust, Golberstein, and Hefner (2007) showed
that 37 % to 84% of students who screened positive for depression
or anxiety did not receive services. An analysis of the Spring 2000
NCHA data revealed that less than 20% of students reporting
suicidal ideation or attempts were receiving treatment (Kisch,
Leino, & Silverman, 2000). Similarly, the study by Garlow,
Rosenberg, and Moore (2008) found that 16% of students endorsing
current suicidal ideation and 14 % of students screening positive
for depression were in treatment. In community based primary care
settings, the point prevalence of major depression ranges from 4.8%
– 8.6%. This is higher than the prevalence rates from community
surveys, where the range tends to be 1.8% – 3.3%. Good evidence
exists that screening for depression in clinical settings improves
identification of patients with depression and decreases clinical
mortality (U.S. Department of Health and Human Services, 2002).
However, a search of the literature failed to find any studies that
looked at the prevalence of depression among the sub-population of
students who access student health facilities. This information
would be particularly useful to practitioners who provide medical
care to students in these clinical settings. The purpose of our
study is to determine the prevalence of depressive symptoms and
suicide ideation among students seeking routine care at four
college health primary care clinics. We expected the rate for
depression among students accessing campus health facilities would
be higher than in the general student population (Henk, Katzelnick,
Koback, Greist, & Jefferson, 1996). In addition, we
investigated the statistical relationships among depression,
self-reported health behaviors, and other potential risk factors.
Loneliness, substance abuse, dating violence, and hopelessness, are
just some of the risk factors for suicide, which remains the second
leading cause of death for college students. Many factors
contribute to the heightened risk for anxiety among college
students. For example, sleep disruption caused by drinking excess
caffeine and pulling all nighters is associated with increased
anxiety among college students. Loneliness also predicts mental
health problems, including anxiety.