Depression in College Students

Abstract

A majority of college students report experiencing feelings of depression at some point in their schooling. On occasion, depression may become chronic or develop into full-blown disorder, a major risk factor for suicide. In fact, one in ten college students have considered suicide, according to some studies. Depression is expressed as feelings of sadness, loss of pleasure and interest in formerly enjoyable activities, ruminating thoughts, hopelessness, anxiety, and difficulty sleeping. Modern research has found significant factors of differentiation in depression across students from a diversity of backgrounds. This knowledge is useful to counselors and other health services professionals.

Overview

Depression is a serious mental illness that affects many college students. There are various triggers for depression among college students, including homesickness, feelings of inadequacy, lack of sleep and exercise, poor eating habits, financial and relationship issues, a dysfunctional background, belonging to a minority group, mental health problems, and others. Any of these factors may affect academic performance and acculturation to campus life. In fact, depression is cited as the top reason for students to drop out of college. Some troubling studies report that more than 40 percent of American college students report symptoms of depression, yet up to 75 percent fail to seek help. Among these are students who need it the most: 25 percent of college students suffer mental illness, including depression. Moreover, according to some studies, as many as 4 out of 5 students consider or attempt suicide every year. Suicide is among the top 5 leading causes of death among college students (Kerr, 2012).

Depression is often undiagnosed. Educators are at the forefront of student interaction, yet most are untrained in identifying symptoms of depression. This situation is exacerbated in large universities, where educators often teach classes with hundreds of students and can offer little personalized attention. Modern students are also at greater risk of suffering from anxiety and depression than in generations past. Issues such as fewer job prospects and higher debt is generally daunting to many students, affecting college attrition.

Depression is also sometimes triggered by a romantic breakup or conflicts with peers. In such cases, gender matters. Depression affects both men and women and more than 40 percent of college students report suffering from insomnia in the months after a relationship ends. Young women, however, report higher rates of sadness, distress, and insomnia than men. They also report dwelling on problems for longer periods of time.

Depression is a serious problem. It is linked to suicide, substance abuse, mental illness, stressful life events, and self-destructive and self-harming behaviors. According to the World Health Organization, the risk for mental health concerns rises up to 25 percent for young people who have experienced poverty and stressful life situations such as having been exposed to violence or drug abuse. In other words, it can be worsened by inequality and other socioeconomic phenomena.

Depression is a global phenomenon, affecting college students worldwide. It is important to understand and address it, because it presents obstacles to successful achievement of academic and life goals. Numerous studies report that depression affects college students more than it does the general population; these studies have been performed in more than twenty countries in Asia, Africa, Australia, Europe, and the United States. Depression affects college students in low-income as well as in high-income countries. There are some interesting variations. For example, lower levels of depression are more prevalent in the Americas, and southern and western Europe. Higher levels are reported in eastern Europe and Pacific Asian countries.

The American Psychological Association has advised that depression can be experienced as feelings of depression as well as lack of interest and pleasure in regular activities. Parents, teachers, and counselors should also be on the lookout for other symptoms, such as significant weight fluctuations, insomnia or excessive sleeping, inability to concentrate, feelings of worthlessness, and recurrent thoughts of death. Presence of one of the symptoms may not be indicative of depression. One the other hand, important symptoms may be easy to overlook.

Further Insights

While some students evidence a high level of tolerance for stress, others have a lower threshold and respond with more difficulty to the demands of academic expectations, work and family, and their own goals. Studies show that women, for example, tend to develop unrealistic expectations for themselves in addition to supporting others materially and emotionally in their family and vicinity. These expectations are often based on gendered societal expectations, which position women as nurturers and caretakers, and might be further buttressed by cultural norms and the demands of family and partners.

Perfectionism

Scholars and thinkers have sought for centuries to find the root causes of depression. Besides important developments, such as understanding depression as a mental illness, most recent studies have focused on societal factors such as expectations, socioeconomics, and identity. College students face multiple challenges, including adjusting to new expectations and environments, financial issues, and other stressors such as career choices and competiveness.

Some experts have suggested that high levels of anxiety and depression among college students often correlate with high levels of perfectionism. It is important to note that perfectionism has both negative and positive aspects. Regular perfectionists hold high standards but are flexible and able to feel satisfied even if their goals are not achieved as expected. Neurotic or maladaptive perfectionists, on the other hand, hold unrealistically high standards for themselves, are inflexible in their goals and feel that they have failed when unable to meet them. They also may fall prey to depression when they fail.

People manage tension by way of coping, and different coping styles exist. Experts have examined how perfectionists cope with unsatisfactory outcomes and the relationship of their coping style to depression. Maladaptive perfectionists tend to cope with stress by engaging in both obsessive thoughts and avoidance, which in turn contributes to distress and depression. In other words, avoiding challenging academic situations is self-defeating, because the more an individual avoids these stressors, the more he or she becomes stressed (Noble, Ashby & Gnilka, 2014).

Both normal and maladaptive perfectionists are usually task-oriented. However, normal perfectionists tend to see obstacles as part of a process and are not prone to internalizing failure. Maladaptive perfectionists, on the other hand, are likelier to avoid difficulties as soon as they arise, fearing failure. Their distress may rapidly become depression. These are important issues to address with students who exhibit perfectionist traits or come from perfectionist environments (Noble et al., 2014).

First Generation College Students

Socioeconomic class is also linked to college depression. First generation college students, for example, usually face greater difficulties than those who come from families with high levels of education. According to surveys, first generation college students come from low income environments, exhibit lower academic expectations and goals than their higher income peers, and are less familiar with higher education in general. They also are likelier to come from ethnic and racial minorities. Low income students overall are more vulnerable to difficulties related to inequality, such as discrimination and violence. They tend to have suffered more stress and alienation during high school, be the first generation in their family to attend college, and feel more pessimistic about the future (Jenkins, Belanger, Conally, Boals & Duron, 2013).

First generation students often bring these stressors to college and evidence a higher incidence of difficulties in critical thinking and other skills related to academic success. These issues place first generation students at greater risk for depression and attrition. In fact, finances are one of the most important stressors for low income and first generation students (Jenkins et al., 2013). Studies indicate that close to 50 percent of colleges report a spike in the number of students dropping out—permanently or temporarily—due to financial reasons. Close to 70 percent of students work longer hours than before and 36 percent take fewer credits, both due to financial need. Close to 50 percent of surveyed colleges report increases in the numbers of student who live at home for financial reasons, which curtails their ability to participate fully in college life.

Trauma

Another crucial factor for college depression is a traumatic family background. This is of particular relevance to female students, given that date rape and other instances of sexual violence are more prevalent on college campuses. Experts also call attention to issues of Post-Traumatic Stress Disorder (PTSD) not only for victims of violence, but also for thousands of former war-deployed veterans who pursue higher education (Jenkins et al., 2013). As with maladaptive perfectionism, avoidance often becomes a coping strategy for individuals suffering from PTSD as a way to avoid events that might trigger traumatic feelings, adding to factors that cause academic stress. Cultural factors related to sexuality, nationality, ethnicity, and race may also contribute to instances of depression among college students (Balis & Postolache, 2008).

Treatment

Depression is treatable, especially if it is situational. Nevertheless, depression and other mental illnesses have long suffered a social stigma; therefore, students may be hesitant or decline to seek help. It is important, then, for parents, faculty, peers, and counselors to be aware and become involved when there is reason to believe a student may be suffering from depression.

College mental health counselors often run an evaluation in order to determine if a student suffers from depression. There are many instruments that help counselors determine depression and the level of depression suffered by a student, which may run from mild to severe. A mental health evaluation usually includes factors such as a student’s family history, developmental trajectory, history of school performance, past instances of depression, and self-harm or addictions. A treatment plan is then developed based on the outcome.

Treatment often includes a recommendation for more exercise, a healthy diet, and plentiful rest as crucial to dealing with anxiety and depression. Counselors may also include other assessments and strategies, depending on specific issues faced by some students, such as assessments related to academic performance, learning disabilities, life satisfaction, and past trauma.

For students suffering difficulties acculturating to college, counselors can provide access to tutoring and peer counseling, for example. Some assessments may be more gender-specific, such as those that relate to sexual risk or trauma, physical safety, family responsibilities, and self-regard. Ethnicity, for example, may compound gender in many ways, including cultural issues of identity, family and social roles, and language barriers.

Finally, some students may have physiological or inheritable traits that cause them to suffer depression, regardless of life circumstances. For many of these cases, coaching in problem-solving strategies are often effective measures, as well as modeling healthier forms of coping with goals and the challenges and demands of campus life. Experts also recommend teaching students critical thinking skills, encouraging them to develop social skills and healthful routines, and participating in extracurricular activities. These are effective ways to help students cope with college challenges and expectations and fully enjoy their education.

Other cases may require more of a college counselor. For cases related to trauma, such as PTSD, counselors may screen students for feelings of depression, in addition to other tests. These should be carefully assessed to differentiate between cases that can be worked between the college counselor and student, and those that may require more expertise. PTSD sufferers often experience episodes of anxiety and reliving trauma, making it hard to focus fully on academics. Counselors may refer such cases to further assessment and treatment.

Viewpoints

The causes, numbers and treatment for college depression have long been up for debate. Moreover, some countries report higher incidences than others. Spain reports an extraordinarily high rate of depression among its female students, both within Spain and among students studying abroad. A 2006 study found that 52 percent of Spanish female students in the United States were affected by depression, anxiety, and sleeplessness. The numbers were higher in Spain (Field et al., 2012).

Other experts, however, argue that a higher level of depression among female students is common; in fact, the overall ratio for depression for females versus males is of 2 to 1. Still other experts argue against the Spanish findings, stating that some of the measuring instruments used—anxiety and depression scales—lacked specificity and were not the most appropriate to differentiate among various types of anxiety. In other words, feelings of anxiety do not necessarily mean that individuals suffer from significant depression; some may even be normal. Anxiety, depression, and sleep disorders at some point in life are not necessarily cause for serious concern. Moreover, higher levels of anxiety—and even some depression—may actually be common in some disciplines. Science and law careers, for example, are disciplines in which research has found a prevalence of anxiety among students (Hope & Henderson, 2014).

Experts have debated whether working students suffer more levels of depression than those who do not work at a job. Older studies showed a higher incidence of depression among working students. Based on more recent studies, however, some experts have argued that these reflect no significant differences in depression rates between working and non-working students (although working students tend to report more feelings of anxiety). One of the reasons for this difference is that, decades ago, the majority of college students—both working and non-working—tended to be much younger, between the ages of 18 and 22, and full-time students.

In the twenty-first century, less than 30 percent of college students are among those aged 18 to 22. In fact, a majority of college students are non-traditional students. Most non-traditional students are older, tend to be individuals who postponed college, work full time, are self-supporting, often enroll in college part time, are financially responsible for others, come from a two-year program, are parents (many times single parents), female, and may have left high school with a General Education Development (GED) High School Equivalency Test certificate rather than a traditional diploma. In consequence, older students might appear at first glance to be more at-risk of suffering anxiety, fatigue, and poor campus acculturation.

Much depends, however, on how an individual handles stress. Many older and experienced non-traditional students handle stress better; they know better what to expect. Non-traditional students less experienced at coping with multiple life demands, seem less able to handle stress and more prone to anxiety in the beginning of their college years. But in time, they become better at it (Jenkins et al., 2013). These findings, then, complicate reports on the anxiety and depression risks of low income and first generation students, providing a more nuanced view of depression among college students.

Terms & Concepts

Anxiety: A condition in which an individual experiences feelings of tension, nervousness, and unsettlement.

Assessment: An estimation of the level, quality, or intensity of something.

Depression: A mental health condition in which an individual experiences sadness, despondency, hopelessness, and disinterestedness.

PTSD: A mental health condition that includes severe anxiety, reliving stressful events or flashbacks, and other uncontrollable emotions or thoughts related to specific traumas.

Stressor: An external stimulus or trigger that causes stress.

Trauma: An injury or distressing experience.

Bibliography

Balis, T., & Postolache, T. T. (2008). Ethnic differences in adolescent suicide in the United States. International Journal of Child Health and Human Development, 1(3), 281–296.

Beck, A. T. (2014). Depression: Causes and treatment. Philadelphia, PA: University of Pennsylvania Press.

Degges-White, S., & Borzumato-Gainey, C. (Eds.). (2013). College student mental health counseling: A developmental approach. New York, NY: Springer.

Field, T., Diego, M., Pelaez, M., Deeds, O. Delgado, J. (2012). Depression and related problems in university students. College Student Journal, 46(1), 193–202. Retrieved November 30, 2015 from EBSCO Online Database Education Research Complete http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=73951031&site=ehost-live

Hope, V., & Henderson, M. (2014) Medical student depression, anxiety and distress outside North America: A systematic review. Medical Education in Review, 48(10), 963–979. Retrieved November 30, 2015 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=97982899&site=ehost-live

Irovici, D. (2014). Mental health issues and the university student. Baltimore, MD: John Hopkins University Press.

Jenkins, S. R., Belanger, A., Conally, M. L., Boals, A., & Duron, K. M. (2013). First-generation undergraduate students’ social support, depression, and life satisfaction. Journal of College Counseling, 16(2), 129–142. Retrieved November 30, 2015 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=88823961&site=ehost-live

Kerr, M. (2012). Depression and college students. Healthline. Retrieved November 30, 2015, from http://www.healthline.com/health/depression/college-students

Kadison, R., & DiGeronimo, T. F. (2005). College of the overwhelmed: The campus mental health crisis and what to do about it. San Francisco, CA: Jossey-Bass.

Levine, A., & Dean, D. R. (2012). Generation tightrope: A portrait of today’s college student. San Francisco, CA: Jossey Bass.

Noble, C. L., Ashby, J. S., & Gnilka, P. B. (2014). Multidimensional perfectionism, coping and depression: Differential prediction of depression symptoms by perfectionism type. Journal of College Counseling, 17, 80–94. Retrieved November 30, 2015 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=95322459&site=ehost-live

Quaye, S. J., & Harper, S. R. (Eds.). (2014). Student engagement in higher education: Theoretical perspectives and practical approaches for diverse populations. London, UK: Routledge.

Renn, K. A., & Reason, R. D. (2012). College students in the united states: Characteristics, experiences, and outcomes. San Francisco, CA: Jossey-Bass.

Suggested Reading

Field, T., Diego, M., Pelaez, M., Deeds, O., & Delgado, J. (2012). Depression and related problems in university students. College Student Journal, 48(1), 193–202. Retrieved November 30, 2015 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=73951031&site=ehost-live

Hamamura, T., & Laird, P. G. (2012). The effect of perfectionism and acculturative stress on levels of depression experienced by East Asian international students. Annual of Multicultural Counseling and Development, 42, 205–219. Retrieved November 30, 2015 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=102201115&site=ehost-live

Mounsey, R., Vandehey, M. A., & Diekhoff, G. M. (2013). Working and non-working university students: Anxiety, depression, and grade point average. College Student Journal, 47(2), 379–389. Retrieved November 13, 2005 from EBSCO Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=88413468&site=ehost-live

Yenpasook, M. (2013). One, two, three, go: Aiding teachers in assessing students for depression. National Teacher Education Journal, 6(3), 17–21. Retrieved November 30, 2015 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=110268104&site=ehost-live