College Students Vulnerability to Mental Health Problems: A Review of the Research
Author: Xie, Songying, Stony Brook University
Chief Editor: Nadine Wilches
Overview
College can be a challenging and complex experience for young adults to navigate: the demands of developing their independence and identity, managing finances for the first time, taking on new and varied responsibilities, as well as the general stress of meeting academic standards, presents many difficulties that college students must overcome (Sukup and Clayton, 2021). During this transition period where young adults become full-fledged adults, a student’s success can be dependent on their mental wellbeing and the support they receive from those around them.
Research suggests that the modern student faces more stress than ever before, but their ability to cope has not kept pace with this increasing pressure (Galatzer-Levy et al., 2012, as cited in Sukup and Clayton, 2021). Being unable to effectively deal with stress can lead to both poor academic outcomes as well as poor mental and physical health (Jenkins et al, 2021). Rates of anxiety and depression in college students have also been on the rise. According to an international report, as many as half of all college students currently struggle with anxiety, while over 40% struggle with some form of depression (AUCCCD, as cited in Palesh et al, 2022).
Encouragingly, while there is an abundance of research that highlights this crisis, there is also a plethora of research that shows action can be taken to address these difficulties. Being able to incorporate preventative measures and better identify and understand the nuances of mental health can be beneficial towards the campus as a whole (Palesh et al, 2022). Prominent issues such as stress, when framed in encouraging, instead of debilitating, ways that promote healthy coping and achievement, have been shown to increase resiliency and mental wellbeing in affected students (Sukup and Clayton, 2021; Jenkins et al, 2021). A fascinating 2020 study by Seppälä et al. also suggests that cost-effective preventative wellbeing programs can help bolster students’ ability to fight off depression and stress, as well as enhance their social connectedness, and more. Such interventions are promising, as they can not only reduce rates of mental health issues in larger populations, but also allow the population to thrive and grow in a holistic manner.
In short, the potential of a preventative approach that focuses on developing effective coping habits and further building up the naturally present strengths in students can serve as a powerful counter to the challenges of modern day college life. To help us better understand the needs and unique circumstances of the college population, MindArch Health has identified nine vulnerabilities that increase the risk of developing mental health or behavioral disorders, which will guide efforts to work towards a healthier student body.
Vulnerabilities
The following 9 vulnerability categories were identified by Nadine Wilches, LCSW at MindArch Health Inc. from an examination of existing literature, sourcing well-known national and international organizations such as the World Health Organization (WHO), the National Alliance on Mental Illness (NAMI), and the Center for Disease Control (CDC) among others. The categories are not in any particular order nor priority ranking. In this review, these vulnerabilities are examined to better understand their impact on college student populations and the greater campus community in order to examine their needs to consider ways to address those risks proactively and preventatively.
1. Risky Behavior
Students who engage in risky behavior are a demographic often vulnerable to various negative outcomes. These outcomes do not always directly result in struggles with mental health, but risk taking can have long-term consequences on students’ academic success and career prospects, which in turn can serve as a heavy influence on their mental wellbeing.
For example, over half of students report engaging in some form of academic dishonesty, with younger students and students involved in Greek Life being more likely to do so (Stiles, B. L., 2018). Greek Life students engage in risky behavior more often than the average student, increasing their vulnerability to mental and behavioral health problems that may follow. Studies have shown that they are more likely than their peers to engage in risky alcohol-related, drug-related, or sex-related activities (Hopmeyer and Medovoy, 2017; Chinopfukutwa and Hektner, 2020). This is of concern, as frequent usage of drugs such as marijuana can delay graduation, lower GPA, and increase the likelihood of dropping out (Suerken, et al, 2016), all of which could impact a student emotionally.
Risky sexual behaviors may also lead to poor health outcomes such as transmitted STIs and unwanted pregnancies, as well as increasing the likelihood of similar future behavior (Scull, et al, 2020), serving as stressors and challenges to a student’s wellbeing. Overall, engaging in risky behavior can heavily impact a student’s future and possibility of success, which then serves to impact their state of mind.
2. Serious Life Events
As a source of great stress and challenges, serious life events such as the death of a loved one or being involved in a car accident can affect students’ mental health in a profoundly negative manner, serving as powerful stressors or even as a source of trauma. According to one study, 21% of the students in their sample had experienced some sort of traumatic or serious life event during their time enrolled at their college (Frazie, 2009). In another sample of college students who had experienced some sort of traumatic life event, just over half (50.9%) reported suicidal ideation or behavior. A notable amount of students (15.9%) also expressed the possibility of continued suicidal ideation or behavior in the future (Shannonhouse, 2022).
Both studies placed sexual assault as a prominent and commonly defined example of a serious life event due to its prevalence on many college campuses. Experiencing sexual assault has a strong influence on lowering students’ GPA and increasing their drop-out rates (Molstad, 2021), highlighting how difficult it is to continue healthy functioning afterwards. Whether serious life events occur during students’ time on campus or earlier in life, they are likely to have a negative influence on both physical and mental wellbeing.
3. Household Dysfunction and Family Mental Illness/Substance Abuse:
Although more research needs to be conducted in regards to college students from dysfunctional families, estimates put the number of students from a dysfunctional or substance abusing household at anywhere between 16% to 43% of the campus population (Fischer et al, 2000). Dysfunctional households are often correlated with emotional abuse and the potential of trauma, which can be difficult to cope with and hurt mental wellbeing (Mphaphuli, 2023). Various negative mental health outcomes such as general anxiety and low self esteem are commonly developed within this demographic, with the most notable of these being stress that results from a heightened perception towards potential threats encountered in daily life (Fischer et al, 2000).
Using the 1984 College Adjustment Inventory developed by Baker and Siryk, which measures personal, academic, and social adjustment for newly arrived freshmen, Buelow (1995) found that students from a dysfunctional household, on average, do not adapt as well to the college environment as their peers. This is supported by results from Fischer et al (2000) which suggest that college-age students from alcohol-abusing households score lower on evaluations designed to measure general wellbeing and coping resources. Furthermore, dysfunction in the family may also contribute to other various negative mental health outcomes: most notably stress, but also general anxiety and a lowered sense of self esteem (Fischer et al, 2000).
Finally, in regards to family mental illness, a meta-analysis by Rasic et al in 2013 found that having at least one parent with a severe mental health condition (defined here as bipolar, major depression, or schizophrenia) drastically increased the likelihood of their children developing a psychiatric condition themselves, increasing from previous estimates of one in ten to one in three. Certain genetic predispositions to mental illness may also cause further vulnerabilities, as suggested by Peyrot et al’s 2014 study, where they found that those who had a higher genetic risk for major depression were more likely to develop symptoms following adverse childhood events compared to those without the genetic factors.
4. Learning and Development Problems
As a result of the difficulties they face, the rate of graduation for students with learning disabilities is approximately 10% lower than those without one, which in turn may also be affected by or contribute to the lack of social supports and higher rate of anxiety observed in this population (Feldman et al., 2016, and Cortiella and Horowitz, as cited in Wen Zeng et al., 2018). Modern research and insight into learning and development problems has made our understanding of the subject better, but there are still many barriers left to overcome in this sector: for example, many mental health professionals at colleges may still portray a negative view of learning disabilities and development problems or carry harmful biases that make it difficult for those affected to navigate their experiences (May and Lamont, 2014).
This is supplemented by other studies, such as one where they found that only 24% of students who disclosed their disability in prior educational institutions did the same for college, suggesting that there is still much work to be done in terms of improving ease of access and opportunity for support (Cortiella and Horowitz, as cited in Wen Zeng et al., 2018). Out of those who disclose their disability, only 33% seek and receive accommodations (McGregor et al., 2016), but intervention has been proven to be helpful to many, increasing academic performance, feelings of control over their lives, and decreasing anxiety (Wen Zeng et al., 2018). There is much room for improvement here as well, though, as Wen Zeng et al’s study suggests that comprehensive support programs may be more effective than purely academic ones in providing long term skills and mental health benefits to disabled individuals (2018).
5. Abuse, Neglect, Violence, and Post-Traumatic Stress
The mental health challenges presented by abusive events in childhood can manifest in many ways, such as anxiety, depression, insomnia, aggression, and poor interpersonal skills, all of which may deeply affect a student’s life (Marmion and Lundberg-Love, 2008). Studies estimate that around 30% of college students have received emotional, physical, or sexual abuse or some form of neglect in their childhood (Welsh et al., 2017). It is difficult to say how much of a campus population may struggle with the long-lasting consequences of this maltreatment due to the inherent sensitivity of the subject matter.
One study found that as much as 20% of the college students in their sample reported experiences and emotions that could be indicative of PTSD (Fasciano et al., 2021). Furthermore, post-traumatic stress is heavily linked to poor coping behaviors such as risky drinking practices (which can be even more prominent in a college setting due to its unique social environment), as well as prescription drug misuse (Paltell et al., 2022, and Aarstad-Martin and Boyraz, 2017).
6. Economic Disadvantage and Homelessness
An economically disadvantaged household presents the possibility of many stressors for college age students. Common issues faced by those in poverty include food insecurity and heavy debts, with the former being linked to depression and anxiety, while the latter is linked to significantly higher rates of substance abuse (Marbin et al, 2022). Having a background of economic disadvantage also presents a notable association with suicide risk (Page et al., 2013) and the development of various mental health conditions throughout life, often comorbid, in individuals (Salom et al., 2014).
In order to better support students from economically disadvantaged households, assistance in different areas affecting wellbeing are necessary. One study by Clotfelter, Hemelet, and Ladd in 2018 showed that college students were much more likely to experience all around success when support such as advising, career counseling, and peer connection programs were implemented alongside financial assistance, highlighting the need for wellness in both academic and social spheres.
Although more research needs to be done with homeless college students in particular, existing research suggests a similar pattern of poor mental health to students who are economically disadvantaged. 1 in 8 homeless individuals have a psychiatric condition, and it is suggested that mental illness and homelessness are strongly interrelated, each contributing to the other (Gutwinski et al., 2021).
7. Chronic Illness and Toxin Exposure
In terms of mental health, those with a chronic illness experience increased anxiety and loneliness compared to their peers (Mullins et al., 2017). This may contribute to further challenges this population faces, such as a lowered likelihood of graduation or gaining future employment (Mullins et al., 2017). The number of chronically ill students was estimated in 2015 to be 5.7% of the college population, according to the National College Health Assessment, an increase from a previous estimate of 3.7% in 2008 (Ravert, Russell, and O’Guin, 2017).
As a minority that often go unnoticed, students with chronic illnesses possess their own unique challenges and circumstances that pose a unique challenge for campus health promotion. Chronically ill individuals must cope with traditional college-related stressors while also balancing their personal health, something that can be difficult for many (Mullins et al., 2017). Though there is not much research on college students with chronic conditions due to the small portion of the population they make up, studies still show that interventions such as increasing social support can help these individuals with both their mental and physical health (Feldman et al., 2020).
Living in an environment with toxins, which may contribute to the development of chronic illness in itself, also presents itself as a risk factor for developing mental health conditions. (Gao et al., 2023). Long-term exposure to environmental toxins such as air pollutants has been associated with an increased likelihood of depression and anxiety within individuals (Gao et al., 2023).
8. Poor Access to and Quality of Supportive Relationships
A lack of connection to others in the community can be prevalent in college settings, especially for freshmen who have little experience with their new environment. Approximately 30% of college students reported feeling loneliness, with 6% believing it was a noteworthy problem (McWhirter, as cited in Al Khatib, 2012). In one study, 40% of a freshman cohort reported having no friends even ten weeks into their college experience (Paul and Brier, 2001). This can have many mental health implications: lowered self esteem, lowered self efficacy, feelings of loneliness and isolation, and depression can all result from this lack of supportive social relationships (Al Khatib, 2012, and Knox et al., 2007). Men are especially at risk for experiencing this deficiency (Knox et al., 2007), possibly attributed to sociological factors regarding how masculinity and vulnerability are viewed.
9. Discrimination, Bullying, Peer Pressure, and Stigma
In academic institutions, bullying can be a vicious cycle: the likelihood for a student to become a bully is strongly predicted by having been a victim of bullying themselves (Chapell, 2004). Victims of bullying often experience a lower quality of mental health characterized by lowered self esteem, anxiety, and loneliness alongside a multitude of other possible symptoms (Guo, 2022). In regards to preventing these symptoms, high social support from the victim’s peers can be a strong protective factor (Guo, 2022), suggesting that interventions focusing on creating a sympathetic environment and student body may be helpful.
Bullying also affects minority students disproportionately. LGBTQ+ and POC students experience much more anxiety over the possibility of being bullied, and that these anxieties were associated with depression as well (Grinshteyn, 2021). LGBTQ+ students are four times more likely to experience depression than their straight, cisgender peers, which research suggests could flare up during the college years (Gnan et al., 2019, as cited in Thacker Darrow et al., 2023). Women of color reported higher levels of discrimination compared to their peers, as well as increased feelings of anxiety and depression (Daftary, Devereux, and Elliot, 2020).
Black students in particular have also been shown to struggle mentally with the stress of the systemic discrimination that affects their everyday lives (Priest and Williams, 2018, as cited in Neukrug et al., 2022). In general, racism and discrimination manifests on several levels including individual, institutional, and systemic, all of which causes significant stress for minority groups (Ingram and Wallace, 2019).
College can be a challenging time for students, and many factors can put them at risk for negative experiences. From social pressures to academic difficulties, students may engage in risky behaviors, struggle with mental health issues, or face challenges due to their background or identity. Understanding these vulnerabilities is important to create a supportive campus environment that helps students succeed and thrive.
Discussion and Implications
This transitory period between teenage, young adult, and adult life is a critical time in terms of mental health. Students who may have struggled in the past with mental health issues may find their struggles exacerbated, and students who did not have any history of mental health issues may find them beginning to arise during the stressful years of college (Downs et al., 2019). Present and future generations of students have much at stake, especially as rates of psychiatric diagnoses and mental disorders continue to climb. From 2007 to 2017 alone, the number of college students diagnosed with a mental health condition jumped from 22% to 36% (Lipson, Lattie, and Eisenberg, 2019), attributed to changing factors in the modern world such as shifting lifestyles, higher levels of economic competition, and the proliferation of substance usage (Jaisoorya, 2021).
Yet despite the mounting gravity of the situation, there has also been ample research to suggest hope. In Azmitia et al.’s 2013 study, as well as many of the previously cited research works (Clotfelter, Hemelt, and Ladd, 2018; Feldman et al., 2020; Neukrug et al., 2022), one of the key components for study participants, (whether they be adequately privileged, economically disadvantaged, struggling with a disability, or part of a minority group) that allowed them to more successfully navigate their situation, was the role of support. Support, be it in the form of assistance from institutions and authority figures within the school, to financial aid and resources, to an environment that simply fosters greater peer to peer connection, was shown time and time again to improve the coping and resilience of students. Such measures that are both preventative and can reinforce the existing strengths we have as both individuals and as a community.
The EQUIP Model, an evidence-based approach designed by Nadine Wilches, LCSW at MindArch Health, is an example of a framework that can assist in the implementation of supportive measures. It applies a 5 phase socioecological approach which seeks to address the ‘root cause of mental wellness’ and evaluate protective factors in campus communities holistically to design solutions that are not only applicable and feasible, but also one that is sustainable in terms of long term growth. Preventative interventions have shown much promise. Past and existing programs such as “Headspace” from Australia have been able to reduce both the possibility of at-risk individuals developing conditions as well as the time those conditions spend untreated once manifested (Colizzi, Lasalvia, and Ruggeri, 2020). Beyond simply stemming the growth of malignancy, prevention based strategies also promote better psychosocial adjustment overall (Colizzi, Lasalvia, and Ruggeri, 2020). Such practices will optimize resource usage, lower long term costs and stressors placed on our healthcare systems, and overall improve the quality of life for the wider community.
The diverse setting of a college campus creates an intersection of different factors that can lead to a myriad of risks to mental wellbeing (Worsley, 2022), but also many chances to overcome and to achieve personal growth. The research demonstrates the importance of exploring these opportunities and fully realizing them to reduce rates of mental health issues at colleges and universities. Going forward, there must be work done to design and implement solutions that will positively impact the growing college population and its changing culture to provide a mentally healthier future (Worsley, 2022).
It will be important to work alongside community stakeholders to design and implement solutions that will positively impact the growing college population and provide a mentally healthier future.
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