The first two decades of the 21st century have witnessed a steady rise in rates of mental health problems among college-aged youth. Scientific publications, popular press and social media accounts have documented what many view as an epidemic of anxiety, depression, suicide and substance use disorders in this age group. Annual surveys of college administrators, counseling center directors, and student health directors document a dramatic increase in the demand for mental health services by college students, often to the point of straining available resources. Yet much of this information is drawn from clinical samples, and population-based studies have been very scant. The authors of this study are principal investigators of the Health Minds Study (HMS), a large on-line Web-based survey that annually polls college and university students on mental health, service usage and related factors. This report analyzes survey responses over the decade 2007-2017 of 155,026 students from 196 U.S. campuses.
The headlines from their results include the following:
- Rates of depression increased from 24.8% in 2009 to 29.9% in 2017.
- Rates of suicidal ideation went up from 5.8% in 2007 to 10.8% in 2017.
- Rates of past-year treatment increased from 18.7% in 2007 to 33.8% in 2017.
- The proportion of students with a diagnosed mental health condition increased from 21.9% in 2007 to 35.5% in 2017.
- Among students with depression, rates of past-year treatment went from 42.5% in 2009 to 53.3% in 2017.
- Personal stigma regarding receiving mental health treatment declined from 8.2% to 5.1% over the decade of the study.
There is both bad news and good news in these numbers. On the negative side, more students are depressed and feeling suicidal than ever before, and almost half of students with depression are not getting treatment. On the positive side, more students are going for help – rates have almost doubled in a decade. Along with this, personal stigma has decreased considerably (which may partly explain the rise in service utilization). While there are limitations to the results reported – including a relatively low response rate to the survey (23-29% in recent years), a lack of quality measures of mental health treatment, a reliance on simple measures of stigma, and the absence of items regarding anxiety, substance abuse and PTSD – this is an impressive survey study.
Repeat: I am not a short-order cook. "It's a child's job to learn to eat what the parents eat," says Ellyn Satter, a registered dietitian and the author of Secrets of Feeding a Healthy Family. Instead of the all-or-nothing scenario, offer a variety of foods at mealtime: the main course, plus rice or pasta, a fruit or vegetable, and milk. This way, your child can eat just the pasta and the peas and get protein from the milk. "What a child eats over the course of a day or a week is more important than a balanced meal at one sitting," says Stephen Daniels, the chairman of the department of pediatrics at the University of Colorado School of Medicine, in Aurora.
What are the implications of the findings? To begin with, it validates the concerns of many that mental health problems among college and university students are rising steadily. Next, it explains the growing demand for services that college mental health programs are facing. And it demonstrates that there is an important change taking place in the culture – namely, young people are less afraid of seeking help when they need it, although a substantial percentage are still avoiding treatment.
The authors of this study recommend increasing campus resources to respond to the growing demand for services, along with implementing universal prevention programs and improving referrals to community resources. They also point to the expanding evidence base and the overall acceptability of digital mental health programs among young people – new resources that might enable more students in distress to receive assistance. One can hardly argue against increasing campus resources for mental health prevention and treatment. Yet important questions remain. Who should pay the costs for these services? How should the quality of care be measured and improved? How can we make care more acceptable to those who need it most? And how can we engage families and peers in providing social support when a young person is in crisis?
Beyond these are a myriad of policy questions barely discussed in the U.S., including the lack of parity for mental health treatment in most health insurance plans, the shortage of mental health providers in many communities, and the absence of a national policy for promoting the health and well-being of transitional age youth. Most other developed societies consider adolescence and young adulthood to be developmental stages worthy of pubic investment in higher education and vocational training for all citizens. When will we face the truth that our market-driven, individualistic and fragmented approach is simply not up to the enormity of the challenges ahead?
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