There are many exciting things about entering college: possibly living apart from parents for the first time, new classes and friends, more freedom. But there's a dark side to all of that new opportunity: U.S. college students are experiencing emotionally and physically harmful levels of college depression and anxiety. More than 41 percent of college students stated they felt so depressed that it was “difficult to function” in the past year, according to the 2018 study from the American College Health Association (ACHA). Another 63 percent said they had “felt overwhelming anxiety” within the last 12 months.
Specific biological, psychological, and environmental factors contribute to depressive symptoms in college students, the Journal of Affective Disorders notes. Signs that a student might be experiencing depression during college include sadness, hopelessness, irritability or frustration, loss of interest or pleasure in things, sleeping too little or too much, lack of energy, changes in appetite, anxiety, feelings of worthlessness, trouble concentrating or making decisions, suicidal ideation or attempts, and unexplained physical problems.
Be aware of the symptoms, and keep an eye out for these five common causes of college-age depression and anxiety.
Moving and acclimating to a new environment or academic system can be disruptive and stressful. “Many teens might be at a genetic risk of developing depression, but the disorder isn’t actually triggered until the individual experiences some sort of significant environmental stressor, such as college,” says A.J. Marsden, Ph.D., assistant professor of psychology at Beacon College in Leesburg, FL. She notes our brains aren't fully developed until the mid- to late-20s. “Student decisions aren’t always the best as their frontal lobe — the lobe responsibility for higher order processing such as critical thinking and decision making — is not yet fully formed,” she says. New surroundings, overwhelming classes, and bad decisions made in the wake of newfound freedom can be what pushes students past the breaking point.
Although there’s no failsafe way to prevent depression during college, “helping your student become accustomed to his or her campus before the start of the school year might prevent them from feeling overwhelmed by the transition,” says Nicole Beurkens, Ph.D., C.N.S., a clinical psychologist of Caledonia, MI. "Encourage your child to visit the campus and talk to students, peer counselors, or faculty about what to expect and where to turn for support. Also consider finding a doctor or therapist closer to campus to provide therapy or monitor medication.”
Jack J. Springer, M.D., assistant professor of emergency medicine at the Zucker School of Medicine at Hofstra-Northwell, says students can't wait until things are at a crisis before they find help. “Mitigation needs to start far before college," he notes. "Mental health awareness programs need to be readily visible to all, and be in a form that makes it minimally threatening for students to express their overwhelmed feelings and readily obtain counseling. Orientation at schools should involve education about these resources, and education should be ongoing.”
Student stressors can take countless forms including grades, deadlines, work, and finances. Moreover, if a student could arrive at college with unmet or unaddressed mental health issues, they could find themselves struggling with a lack of a support system.
“The most important issue is whether or not one is prone to depression — and usually anxiety, as the two are inherited together," Mark D. Rego, M.D. of the Yale School of Medicine. "If you are prone, then many stressors may push you past a threshold. These may be things like lack of sleep, drug abuse, overwork, and interpersonal conflict.” Getting screened for the potential for Major Depressive Disorder at the start of school has been shown to be a promising strategy for identifying students who may be at risk, and can improve targeted preventive interventions. (Mental Health America offers a screening online.)
There's also the issue of some students getting their first taste of the "real world" after living with parents who have paved their way. “In my work with clients in therapy, I've noticed that emerging adults who have parents whose level of involvement is overbearing are more prone to depression," says Heather Z. Lyons, Ph.D., psychologist and owner of the Baltimore Therapy Group. "These college-aged individuals might have been protected from past failure, and hence haven't developed the skills needed to self-soothe or persevere amid failure."
“Students should learn to reframe setbacks or difficulties as problems that are solvable," says Dr. Beurkens. "Then they can see themselves as capable of solving them on their own, so they develop better resilience and confidence.”
Uncertainty and Fear of the Future
Anxiety thrives in unknowns. Not knowing if they'll have a job after school, where they will live, and how they'll pay the bills can be a weight on students as they go through school. “In my experience working with college students, one of the biggest triggers for depression is the fear of unsuccessfully transitioning to the adult world of work and responsibilities," Dr. Beurkens says. "We focus on personal strengths and capabilities to reframe their automatic negative thoughts about themselves and their perceived inability to handle the future."
“The sense of uncertainty surrounding choosing a major or feeling without direction or inspiration, especially when the student’s friends all seem like they found their calling, can certainly lead to depression,” says Bryan Bruno, M.D. psychiatrist founder/medical director at Mid City TMS. But he offers this advice: “Remind them that finding your calling is what college is for. It’s also important tell them not to compare their experience with their peers’ because there is no wrong path when it comes to finding your calling.”
Navigating relationships in college — platonic or romantic — can lead to problems for a generation that relies heavily on technology as a means of communicating. Social media proliferates a compare-and-despair dilemma. We are curious, so we look, and then we feel badly.
But, as we all know, social media isn't real life. "College students benefit from seeking out peers with whom they can share vulnerability and have fun — fully in person and not mediated by technology," says Deborah J. Cohan, Ph.D., sociology professor at the University of South Carolina Beaufort.
Here's the hard part: To get around this hazard, students have to limit the amount of social media they take in each day; they should use it even less if they notice a mood decrease afterward, which is true for most people. Students who put a lot of effort into portraying themselves a certain way online are more vulnerable and would benefit more profoundly from regular breaks. Encourage them to try a one-week break and take it from there — offline is the new luxury.
Multiple recent studies show there's a significant association between physical activity levels and sleep quality in regulating mental health and reducing anxiety and depressive symptoms. “A regular sleep schedule, healthy diet, and regular exercise have all been shown to decrease symptoms of depression," says Dr. Marsden. But college life, with its late nights, parties, cramming sessions, and cafeteria food can make keeping a healthy lifestyle a challenge.
Depression is also strongly associated with substance use and abuse. “While the college atmosphere often encourages partying, students who do so excessively can be led to high-risk behaviors, mental health problems and depression,” says Jeff Nalin, Psy.D., executive director of the Paradigm Malibu Treatment Center. “For those wanting help, contacting student support services can be a step in the right direction. The key to managing any kind of anxiety or depression is to integrate self-care into our lives.”
What you can do if you think you need help:
Since 75% of all lifetime cases of mental illness begin developing by age 24, it’s imperative to seek help for mental health symptoms early, so college depression doesn’t become a lifetime disorder. The average delay between onset and intervention is eight to ten years, according to the National Alliance on Mental Illness and Centers for Disease Control and Prevention. If you find you're struggling:
- Call the campus counseling center or health center and ask about counseling sessions with graduate students.
- Alternatively, reach-out to your school’s chaplains or religious/spiritual leaders for help or guidance.
- Confide in a friend, RA, professor, or mentor, and ask him or her to go with you to seek professional help.
- Call the number for the National Suicide Prevention Lifeline: 1-800-273-8255.
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