College students exhibiting more severe mental illness, study finds

"In the last 10 years, a shift in the needs of students seeking counseling services is becoming apparent," said John Guthman, PhD, author of the study and director of student counseling services at Hofstra University in Hempstead, NY. "University and college counseling services around the country are reporting that the needs of students seeking services are escalating toward more severe psychological problems. While the condition of students seeking counseling doesn't necessarily reflect the experience of the average college student, our findings may suggest that students with severe emotional stress are getting better education, outreach and support during childhood that makes them more likely to attend college than in the past."

Guthman and his co-authors looked at the records of 3,256 college students who accessed college counseling support between September 1997 and August 2009 at a mid-sized private university. Students, both undergraduate and graduate, were screened for mental disorders, suicidal thoughts and self-injurious behavior. Several tools were employed to make a diagnosis, including clinical evaluations, structured interviews, and two widely used tests of mood -- the Beck Depression Inventory and the Beck Anxiety Inventory.

In 1998, 93 percent of the students coming into the clinic were diagnosed with one mental disorder, said Guthman. That number rose to 96 percent in 2009. In 2009, 96 percent of students seeking treatment met criteria for diagnosis with at least one mental disorder. Most students were diagnosed with mood and anxiety disorders as well as adjustment disorders or problems associated with significant impairment in functioning. There were no significant class or age differences.

"Overall, the average quality of depression and anxiety experienced by students in counseling has remained constant and relatively mild during the last decade," Guthman said. "However, the percentage of students with moderate to severe depression has gone up from 34 to 41 percent. "These outliers often require significantly more resources and may contribute greatly to the misperception that the average student is in distress."

The rise in the more severe cases of depression and anxiety in college students may be because more students are coming to college with pre-existing mental health difficulties, said Guthman. "There are also more students who are not socially connected. The average college student is not having this problem, but the students who are seeking help are frequently socially isolated, depressed and may be on medication."

The study also found that the number of students on psychiatric medicines increased more than 10 percentage points. In 1998, 11 percent of the clinical sample reported using psychiatric medications, mostly for depression, anxiety and ADHD. In 2009, 24 percent of those attending counseling reported using psychiatric medications.

On a more positive note, Guthman found that the number of students who acknowledged that they had thought about suicide within two weeks of counseling intake declined from 26 percent in 1998 to 11 percent in 2009. This decrease may reflect general improvements in suicide prevention education and outreach and greater awareness of available assistance, he said.

"It used to be that students would come to university counseling centers because they broke up with their partner or failed a test," Guthman said. "Now, they are coming with emotional distress and requesting mental health treatment for the same reasons that other adult populations seeks out treatment."