Starting college can be a time of fun, new experiences and growth. Yet it can also be a rough transition for many students who struggle with mental health issues.
A new study from researchers in the United Kingdom and Canada found about one-third of first-year students have or develop moderate to severe anxiety or depression.
When these young adults had increasing use of illicit drugs, they had greater odds of developing high levels of anxiety or depression. Yet if they were more socially active, their mental health tended to be better.
While the research involved college freshmen in Canada, experts say the findings also apply to college students in the United States.
“We've been seeing that the mental health of college students has been deteriorating,” said Dr. Rachel Conrad, director of young adult mental health at Brigham and Women’s Hospital in Boston. She was not involved in the study.
“Prior to the [COVID-19] pandemic, alcohol use had been decreasing, but stress, depression, anxiety, trauma and suicidal thoughts had been increasing. And then during the pandemic, alcohol use increased significantly in the college-age population as well,” Conrad said.
Teens are experiencing an increasing number of suicides, as well as a rise in anxiety, specifically social anxiety, Conrad said.
The study was led by Kiera Louise Adams, a doctoral student at the University of Oxford in England. She and her colleagues analyzed nearly 1,700 responses from a survey of first-year undergraduates at a public Canadian university taken in September 2018 and in March 2019.
Participants answered questions about parental education, early life adversity and lifetime occurrence of mood and anxiety disorders. The researchers assessed the amount and frequency of alcohol use, sleeping pills and stimulants that had not been prescribed, cannabis, painkillers, opiates, psychedelics and other recreational drugs the students were using. These measures were rated on a scale.
About 32% of respondents had anxiety at the start of the academic year and 27% had depressive symptoms. Six months later, 37% of students had anxiety symptoms and 33% experienced depressive symptoms.
Social engagement helps
Students who had a history of internalizing disorders, such as anxiety and depression, when they began were almost four times as likely not to recover from significant levels of anxiety/depressive symptoms as those without that history, according to the research. Conversely, students who felt connected to university life and their peers had greater odds of recovering.
For every one point in connectedness students had, they had 10% to 6% lower odds of developing anxiety or depression. Every 1-point increase in drug use meant 16% higher odds of developing clinically significant depressive or anxiety symptoms.
Loneliness is a significant risk factor, both for physical and mental health, and some studies show that loneliness is actually more dangerous to a person’s physical well-being than obesity, Conrad said.
“The authors point out that substance use and mental health symptoms can be a two-way street. Many people turn to substances to help them manage unpleasant feelings, sometimes referred to as ‘self-medication,’” said Eric Endlich, clinical psychologist and founder of Top College Consultants in San Francisco. He was not involved in the study.
“Depression and anxiety disorders can lead to alcohol and drug abuse. But the causality can run in the other direction, too,” Endlich continued. “Alcohol, for example, is a central nervous system depressant, and chronic overuse can raise one's risk of depression. Likewise, if you use stimulants, they can make you jittery and anxious, and the withdrawal symptoms can include feelings of depression and even suicidality.”
The authors noted that biological, psychological and social factors contribute to mental health issues.
“Many factors contribute to high rates of anxiety and depression at this age, including being away from home and facing higher demands in terms of the academic rigor of college coursework,” Endlich said.
When they enter college, students are starting from scratch with new social networks, which is what makes connectedness so important, Endlich said.
Falling between the cracks
This is an underserved field because it is so fragmented in terms of clinical services and research, Conrad said.
“These students fall between the cracks. It doesn't clearly fall in the pediatrics or child realm and they aren't equivalent to adults, even though they're over the age of 18. There's a big gap in the research to understand the stressors driving the increasing anxiety, depression, stress and suicidality,” Conrad said.
The findings were published Nov. 30 in BMJ Open. The authors suggested the findings have important implications for university mental health policies and practices, as well as for the availability of clubs, societies and sports to promote student well-being.
“Not all students realize how life-changing it can be to go the extra mile to become more connected via clubs, resident assistants (RAs), mentors and other means,” Endlich said. “I'd really like to see parents and universities systematically encourage students to become more connected through seeking out their professors during office hours, going to the career center for guidance, playing a club sport or any one of a number of strategies.
"It would cost next to nothing to take this step, and the payoff could be huge,” he added.