Depression in the Dorms: What You Need to Know About Mental Health and College

Patient Expert

Expert patient Deborah Gray explains why depression is common in college and what you can do about it.

While I won't go so far as to say that my college years were the best of my life, it's a period I remember fondly. Except for the two dark holes of depression I that I recall all too well. One occurred when I was expelled for one semester and the other reared its ugly head in my last semester of college. At that point, in the early 1980s, there was very little discussion of depression, and no one at my college knew what was happening in my life.

Depression has been on the rise among college students in the past two decades. One factor is very likely earlier diagnosis and improvements in antidepressants that enable young people with mental illness to function at a higher level. In the past, those young people might not have made it to college at all. The passage of the Americans with Disabilities Act (ADA) in 1990 prompted educational institutions to become more accessible to students with mental illness. As long as students can meet the school's academic standards, colleges, especially ones that accept federal aid, must provide accommodations for students who battle mental illness, which might include lighter courseloads or extra time to finish assignments and take exams.

College brings with it many different types of stress - and many that a student has not encountered before. The freedom that young adults find in college can be exhilarating, but it can also be terrifying. For the first time, young people don't have a parental safety net to protect them from making poor decisions, and they alone bear responsibility for the consequences. For some this is a positive step towards adulthood, but for others it brings an enormous amount of stress.

The increased academic pressure weighs heavily on many students, not only because courses tend to be tougher than high school, but also because failure is much more expensive, and the consequences much greater. When I failed two courses and was expelled, it ended up costing my parents thousands of dollars. I got back into my college and subsequently made Dean's List, but I was very much aware of the price of failing my courses after that.

Other stressors include social challenges (meeting new people, navigating a different type of social scene than high school) and anxiety about the future. The job market is much more uncertain than it was twenty or thirty years ago, and a college diploma is no guarantee of a career. Choosing a major is more than just deciding what you prefer to study in college; it could decide the course of your life and how successful you will be. Pretty serious stuff for an 18 or 19 year old to consider.

And then there's the partying. For many students, drinking is the method of choice for blowing off some steam, with four in five college students drinking and half of those doing what qualifies as binge drinking. The consequences this high a prevalence of drinking include 1,700 deaths of college students per year from alcohol-related unintentional injuries as well as hundreds of thousands of assaults, injuries and sexual assaults. College drinking is obviously nothing new, but some experts are concerned that some of this drinking is due to self-medication by students with depression and little support or education about the illness.

In addition, lack of sleep, a constant for most college students, can exacerbate unipolar depression and trigger mania in someone predisposed to bipolar depression.

The good news about depression among college students is that, for some, symptoms of depression may be a short-term reaction to one or more of the aforementioned stressors as opposed to full-blown clinical depression. In many cases, short-term therapy will be all that is needed things back on track. It is essential that it be treated, though, since short-term depression can evolve into a more permanent state if left untreated.

What are colleges doing about mental health on campus?

Colleges and universities are on the horns of a dilemma when it comes to students with mental illness issues, due to some new developments in the past few years.

While many schools have become more accessible to mentally ill students since the passage of the ADA, the high profile suicide of an Massachusetts Institute of Technology student and the subsequent lawsuit by her parents seems to have caused many schools to rethink that accessibility and accommodation. In April 2000 Elizabeth Shin committed suicide by setting herself on fire in her M.I.T. dorm room. Her parents filed a wrongful death lawsuit two years later claiming that M.I.T. was more concerned with Elizabeth's privacy than her wellbeing in failing to inform them of her deteriorating mental health and did not provide coordinated mental health care.

Although the case was settled before trial, it, along with other recent suicides and lawsuits, seems to have made schools very nervous. Many of them are now responding to suicidal thoughts in students by either suspending any student who expresses them or forcing the student to choose between psychiatric treatment or expulsion. Some schools, such as New York University, revamped the medical questionnaire they send to the entering freshman class to include questions about psychiatric history.

As a consequence, a rash of lawsuits have cropped up, brought by students who claim that they are being discriminated against for being mentally ill. Including questions about psychiatric history on medical questionnaires could cause serious problems for the school if they either expel the student in the future with the knowledge that he or she was protected under the ADA, or get sued by the parents of a child who committed suicide because they didn't reach out the the student and provide mental health services. Many schools are floundering around in terms of deciding how to respond to students with emotional or mental illness issues.

What can parents do?

Since most colleges consider students adults, as they indeed are after the age of 18, parents may find it difficult to get any information about their child's treatment directly from the college. Schools consider it a violation of the child's privacy, and this is supported by the Health Insurance Portability and Accountability Act of 1996. However, some schools are becoming more flexible in the wake of the Shin case. It might be possible to have your child sign a waiver that will allow the school to contact you if they are concerned about your child's welfare.

It's also important to know what the school's policy on students who express suicidal thoughts is. Will your child be expelled or forced into treatment if they confide in a counselor? Or does the school make a commitment to helping the student stay in school and get counseling or treatment?

The most important thing parents can do is remain in contact with their students to watch out for changes in mood, stress levels, and challenges, and to make sure students understand their mental health support options on campus.

What can friends and roommates do?

As a friend or roommate, you're on the front line when it comes to offering support, which can feel like a lot of responsibility, but it also means you can make a big difference in helping another student. You can encourage person to seek support. Sometimes that nudge is all someone needs to make an appointment. You can ask an older students or resident advisor to step in. And yes, you can contact the student's parents if it feels appropriate. If you happen to know that he or she comes from a particularly toxic household, you might want to make that the last resort, but if the student refuses to get help, you need to alert someone in authority.

And if you, as a college student, feel overwhelmed, hopeless or emotionally exhausted, remember that this is not the way it's supposed to be. Get some help for your depression and it's likely that you'll find college is an immensely satisfying experience.

Mental Health Resources

Dramatic increases shown in college students' mental health problems over last 13 years

College Initiative at the NIMH

NAMI On Campus

The Jed Foundation

College mental health information at American Psychiatric Association

Active Minds on Campus