What parents need to know about college students and depression

By Mayo Clinic Health System staff

As college students returned or entered college this fall, the important issue of anxiety and depression is a discussion that parents, college students and professionals who work with students do not want to forget.

Depression and anxiety

Symptoms of depression and anxiety can include:

• Difficulty handling schoolwork
• Loss of interest in activities, such as clubs, sports or other social commitments
• Changes in eating or sleeping patterns
• Emotional outbursts, such as tearfulness or anger
• Sense of being overwhelmed
• Panic
• Faulty self-assessments
• Lack of energy

Up to 44% of college students reported having symptoms of depression and anxiety.

Other startling statistics regarding college students and mental health include:

• Suicide is the third leading cause of death for college students.
• Of those who have been diagnosed with a mental health disorder, 75% have their first episode by 24.
• 30% of students reported feeling depressed in the past year.
• Half of students reported feeling overwhelmingly anxious in the past year.
• Nearly two-thirds of students who developed substance abuse problems also were found to suffer from mental health disorders, such as anxiety and depression.

Social pressure and skill deficits

But why our young adults struggling so much?

A few factors are the increased societal pressure to achieve success and students not being equipped with necessary life skills.

Julie Scelfco, writing for The New York Times, described that young adults are increasingly faced with negotiating "America's culture of hyperachievement" and "the pressure to be effortlessly perfect." As a result, their mental health and well-being are suffering.

These students arrive for their first day of classes and are increasingly less prepared to function as adults. The rising cost of education has placed pressure on students and their families that youth are being pushed to their limits as early as their elementary school years by parents who are focused on their children's future potential successes.

Julie Lythcott-Haims, an author and former dean of students at Stanford University, wrote that "Children deserve to be strengthened, not strangled, by the fierceness of a parent's love."

In my practice, most middle and high school students have schedules that rival top corporate executives, with an average day beginning at 6 a.m. and ending at 10 p.m. or later. This punishing schedule leaves them sleep-deprived with little time to develop basic independent living skills, such as laundry, cooking meals, being an employee, managing money and accessing services to meet their needs ― all while figuring out "Who am I?"

These skill deficits compound as young adults go to college and face relationship challenges, heavy class schedules and, for some, living separate from parents for the first time.

The positive mental health of college students begins with good preparation and adequate support at a young age. Young people need to learn basic survival and coping skills, practiced and honed from elementary school to high school graduation ― not just the ability to make the grade.

Here's what parents can do:

• Set a realistic view of the educational big picture.
• Manage their fears for their children's future.
• Build independent living skills at a young age. Online resources are available to find age-appropriate chores for children to help you start the process.
• Protect downtime or unstructured time for middle and high school students. This is when students start exploring and answering "Who am I?"

Additional risk factors

Unfortunately, up to 75% of struggling students are reluctant to seek help. This increases the risk of harmful outcomes, such as dropping out of college, poor academic performance, suicide and substance abuse.

Here are some situations or risk factors that could trigger a bout of depression or anxiety for college students:

• Relationship breakup
• Sexual assault
• Peer relationship difficulties
• Sexual identity adjustment difficulties
• Drug or alcohol use
• Family history of depression
• Stressful life events
• Comparison of academic, athletic or social performance to one's peers
• Fears of disappointing parents because of grades or career path choice

Warning signs of suicide

Young people with a mental health diagnosis, including depression, are five times more likely to attempt suicide than adults.

Four out of 5 college students who consider or attempt suicide have shown clear warning signs prior to the attempt, such as:

• Ignoring class work or skipping classes
• Withdrawal from friends and wanting to be left alone
• Giving away possessions
• Talking about suicide
• Doing risky or self-destructive things, such as using drugs or driving recklessly
• Increasing use of alcohol or drugs
• Saying goodbye to people as if they won't be seeing them again

This is not an exhaustive list. Be alert to behavior and personality changes that can provide clues into a student's state of well-being.

It is important if any of these signs or symptoms are present that a college student is referred for a mental health evaluation. Many universities have mental health services on campus for student access. Students also can seek assistance at their local clinic through their primary care physician or behavioral health staff for a thorough evaluation of symptoms and history.

A combination of cognitive behavioral therapy and interpersonal therapy, along with medications, has been shown to effectively treat anxiety, depression and suicidal thoughts. Family therapy may be indicated if students are struggling to separate from their parents or take charge of their lives if parents are overinvolved.

There is a good deal of hope for those students who receive the appropriate support from a well-informed and skilled treatment team that includes professionals, friends and family.