Author:   Mark Pettus, MD,    Chief Medical Officer, Preventia, Inc.

As a new fall season approaches many parents and students are transitioning to another exciting academic year on college and university campuses around the US. For all returning students and especially incoming freshman, this transition can pose challenges as one adapts to new environments, academic rigor, and a greater need for self-efficacy.

There is a mental health crisis on college campus across the United States. During the 2020-2021 school year, more than 60% of students met the criteria for at least one mental health issue. This was a 50% increase from 2013. Mental health worsened among all groups over the study period. American Indian/Alaskan Native students experienced the largest increases in depression, anxiety, suicidal ideation, and meeting criteria for one or more mental health problem. Students of color had the lowest rates of mental health service utilization. The highest annual rate of past-year treatment for Asian, Black, and Latinx students was at or below the lowest rate for White students.

The National College Health Assessment by the American College Health Association found that almost three-quarters of students report moderate or severe psychological distress.

While these trends were well established prior to the covid-19 pandemic, the added stressors of unrelenting pandemic fear, social isolation and disruption from familiar routine further exacerbated these concerns. Today, 1 in 4 collegiate adults have a diagnosable mental illness, and over 10% of students are being treated for anxiety & depression.  In an American College Health Association report, students cited anxiety & depression as the top impediment to academic performance, and 7% of students have “seriously considered suicide.

College and student mental health has become a top priority for Student Affair Administrators in Higher Education (NASPA). NASPA and Uwill (Student Mental Health and Wellness) surveyed NASPA members to gain perspective on the current state of mental health on college campuses for the 2021-2022 academic year. The results provide a concerning look at the state of campus mental health, as assessed by campus leaders representing more than 150,000 college students at 100+ institutions. Highlights of that survey reveal:

Campus mental health continues to decline.

  • 72% said overall trajectory of campus mental health (students, faculty, staff) worsened during past year.
  • 70% said staff mental health worsened during past year.
  • 65% said student mental health worsened during past year.

Top causes of student distress during the 2021-2022 academic year

  • 76% personal or family life
  • 76% financial or debt-related concerns
  • 70% diagnosed or reported mental health concerns 66% academic concerns.

Single greatest challenge related to campus mental health.

  • 43% increased severity of mental health issues
  • 20% inability to meet student demand.
  • 12% lack of funding to expand mental health services.

The two greatest needs suggested by this leadership forum were more funding for mental health services and expansion of telehealth services.

Telehealth as an engagement option accelerated during the pandemic as the logistics and safety of traditional face-face encounters was discouraged. The rapidly growing body of research suggests a telehealth option, from a consumer perspective, to be good or even better than a traditional visit, particularly for non-acute, less complex interactions. In a national survey of 1,100 students by a virtual health service company 81% of students responded they want their college or university to provide a virtual health care option; 64% responded they had used a virtual care solution; and 86% rated their virtual health care as same or better than in-person care. (TimelyMD 2022)

Wellbeing among university students has been shown to correlate strongly with academic performance and reduced risk from mental illness. A systematic review and meta-analysis of longitudinal studies of the antecedents and consequences of wellbeing among university students (Toit A. et al.) identified self-relationship, emotion regulation and interventions to enhance mental health resiliency as important considerations. For example, Universities might make it easier to establish and maintain groups e.g., study cohorts, interest groups). Proactive engagement with general health and mental health coaches can serve as a critical model for ongoing support, development of relationship-trust capital and co-creation of mitigation strategies to improve early mental health challenges before they escalate. Because these strategies leverage lifestyle interventions, motivational interviewing techniques and personalized support, students can address challenges at the root cause level. This might change the trajectory of performance, health, and the capacity to thrive in one’s environment long after academic matriculation. More research is demonstrating the efficacy of mental health coaching as compared with more expensive and limited capacity from therapists and prescribing mental health clinicians.

Regular interaction with a general health and mental health coach makes more likely a health promoting behavior will emerge in a sustained manner. These behavioral changes are at the foundation of mental health and have robust wellness science to support them. Examples include:

  • Simple mind-body stress reduction techniques such as breathwork and guided imagery.
  • Whole foods nutritional options that better serve brain and mental health e.g., reducing sugar and high glycemic processed carbs.
  • More efficient time management
  • More time outdoors each day, even for short periods of time
  • Peer-peer social supports
  • Improved sleep hygiene and circadian entrainment practices
  • Gratitude journaling
  • Developing emotional-social intelligence skills and practices

References:

  • Lipson, SK, et all, Journal of Affective Disorders, Vol 306, 2021.
  • National College Health Assessment, American College Health Association, 2021.
  • National Association on Mental Illness: https://nami.org
  • du Toit, A., Thomson, R. & Page, A. (2022). A systematic review and meta-analysis of longitudinal studies of the antecedents and consequences of wellbeing among university students. International Journal of Wellbeing, 12(2), 163-206. https://doi.org/10.5502/ijw.v12i2.1897
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