Stress, Mental Illness and Substance Abuse are Increasing Demand for Psychiatric Service in College Health Centers

The annual college report is a comprehensive and collaborative assessment of collegiate mental health involving approximately 500 university and college counseling centers with the overarching goal to identify anxiety, depression, and overall mental health issues and needs for this high risk age cohort. This report is not a survey. The data summarized in this report were obtained during clinical interactions with students who visited hundreds of college counseling centers in the U.S. during the 2016-2017 school year and not the general student population.

Our College Students Have Problems and Need Help

Increasing Demand
There is an increasing disparity between the need for mental health care and availability. Between 2010 and 2015, counseling center utilization increased by an average of 30-40%, while college enrollment in participating school increased by only 5%.

Students in Crisis
Suicide and mental health crisis counseling has become a core and necessary service. In 2016, counseling programs devoted to “rapid access” e.g., crisis intervention services increased by an average of 28%, whereas resources devoted to “routine treatment” decreased slightly by 7.6%.

Depression and Anxiety
In 2017, half of college students who sought out counseling said they felt depressed, but anxiety was even more common, affecting 62 percent of students who came in for counseling, as assessed by their clinicians. This trend has been observed and growing over the past four years.

Other trends include students reporting a past traumatic life experience.

Suicidality and Self Injury
Self-threatening and suicidal behaviors are becoming more common among college students seeking treatment. It’s important to note, that colleges and university health systems do not report suicides on campus or among their student population. However, the prevalence and proportion of students who had self-injured, thought seriously about suicide, or attempted suicide, rose for the seventh consecutive year.

Marijuana Use and Abuse
The percentage of students seeking mental health counseling who reported using marijuana during the previous two weeks increased by 3.6 percent (21 to over 24 percent) from the previous school year. These students are also likely to binge drink, smoke cigarettes, and report learning problems.

During the assessment process, students are asked how many times they have smoked marijuana during the previous 2 weeks. Overall 5.5 percent reported over 10 times in the previous 2 weeks (8.4% males; 4.0 % females) N=96,700

Figure 1: Specific Mental Health Concern / Diagnosis and Prevalence Between School Year 2013-14 and 2016-17

Research You Can Use Mark Gold, MD RiverMend Health


Why Does This Matter?

These data and trends are a wake-up call. We have students leaving home for college who are already abusing or are dependent on marijuana or other illicit drugs and alcohol. Many have been treated by local clinicians for ADD, ADHD, depression, bipolar or eating disorders, and even schizophrenia.

College students are representative of adolescents who survived the perils of high school and persevered well enough to graduate and earn a high enough score on the SAT or ACT to enter college. Many have done this with the help of psychologists, psychiatrists, and/or psychotropic medications.

Moreover, college students who voluntarily seek help for various mental health conditions or for an acute stressor, are among those with the highest distress, but they also possess the willingness to shrug off the stigma and get the help they need. In other words, they are the self-selectors, which present a valid reliability concern, if one was making comparisons to the non-college world or generalizing these data with non-college persons in the same age cohort. Therefore, these data very likely under report the severity of mental health and substance use disorders among this age demographic.

Because anxiety disorder and depression are increasing each year and utilizing the vast majority of clinical time and resources, the days of the Student Health Centers giving antibiotics, flu shots and condoms are long gone. Most of the care requests are psychiatric in nature. High school students who were previously treated in their community who now attend college are a viable concern and one that skews these data. Adjusting to college life is stressful, but even more so for those already suffering with mental illness. Sleep problems, learning problems, social anxiety, sexually transmitted diseases, drug and alcohol abuse, trauma, depression and suicidality are all increasing on college campuses.

Given these extraordinary data and the likelihood of availability and proximity to academic medical centers among the 500 colleges and universities represented, it makes good sense to pursue well-powered research to develop effective interventions aimed at the broader age cohort, which is at greater risk for morbidity and mortality from mental health, stress and substance abuse.

Center for Collegiate Mental Health. (2018, January). 2017 Annual Report (Publication No. STA 18-166).

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