Anxiety 101

College students love freebies—a fact amply displayed in virtually any dormitory room, where a great deal of the décor comes courtesy of Anheuser–Busch. Noting this fondness for free T-shirts, shampoo samples, and other giveaways, a group of student health advocates at the University of Minnesota figured a bag of free swag would be just the thing to relieve the tension of finals week last year. The bag contained a brain-shaped stress ball (perfect for squeezing during the physics exam), soothing herbal tea, some serotonin-triggering chocolate, a list of relaxation tips, and a minifridge magnet listing places to call if the pressure proved too much to handle.

“It was full of cool stuff—but no one would take one,” recalls Erica Hynes, a psychology major and a leader of Active Minds, the student-run advocacy group providing the antistress kits. “People would come toward the table, but as soon as they saw the words mental health on the bag, they were, like, ‘No thanks.’ ‘I don’t need it.’ ‘Not for me.’ ”

That’s ironic because last year a nationwide survey of nearly 72,000 college students conducted for the American College Health Association found that nine out of ten felt “overwhelmed by all they had to do” and almost half said they’d felt so depressed in the past year they found it difficult to function. One in ten had seriously contemplated suicide—the second-leading cause of death among college students (after traffic accidents). Between those extremes can lie everything from trouble sleeping to more serious problems such as bipolar disorder and schizophrenia, with symptoms that often don’t surface until young adulthood.

Colleges and universities are responding to the mental health needs of their students as never before—especially since the tragedies at Virginia Tech and Northern Illinois raised public awareness of the risks of leaving problems untreated. Whether students are aware of these resources and are willing to use them is another matter.

“When you’re in college, paying attention to your health is probably one of your last priorities,” says Hynes. Which is why mental health advocates are working hard to educate incoming students about the stresses and challenges that await them. Parents sending their children off to college this month should also take notes.

Considering how much thought, planning, and money go into a college education these days, it’s depressing to learn that these four (or more) essential years in a young person’s life may not be very happy. What’s getting them down? Many of the same issues you may recall from your own college days—stress, incompatible roommates, romantic breakups, peer pressure, dealing with failure, deciding on a major.

“Those are the typical concerns,” says Harriett Copher Haynes, senior psychologist at the University of Minnesota Counseling and Consulting Services. “But what we’ve been observing in recent years is students who are coming in with issues that they’ve been dealing with since high school or longer”—problems such as eating disorders, depression, panic attacks, and performance anxiety.

A 2007 College Student Health Survey developed by the U of M’s Boynton Health Services found that more than 27 percent of students responding from fourteen Minnesota colleges and universities had been diagnosed with a mental illness in their short lifetime—almost 16 percent within the previous year. It’s a trend that college counselors say they’re seeing on campuses large and small.

One explanation: As a college education becomes more accessible—or at least more widely expected—student health is more closely reflecting the health of the general population.An estimated one of four Americans between the ages of eighteen and twenty-four has a diagnosable form of mental illness—the highest prevalence among any age group. One in four adults of all ages suffers from a mental disorder in any given year.

“Another explanation is that the improvement in psychiatric medications and the Americans with Disabilities Act laws have made it possible for a whole group of students who might not have attended college a generation ago to succeed in college now,” says psychologist Ted Rueff, associate director of health services at Macalester College in St. Paul. Indeed, in a 2005 survey, 95 percent of the directors of college counseling centers queried nationwide reported an increase in the number of students taking medication for psychiatric problems before they came in for help.

“College is not like it was even fifteen years ago,” says Marit Lysne, a clinical psychologist and coordinator of counseling services at Carleton College in Northfield. “It’s very different in terms of the amount of pressure students feel, the expectations from parents and employers about what you should be involved in, what you should have demonstrated in your time there, and what you should get out of the cost of tuition”—which now averages well over $40,000 at private schools such as Carleton and has increased by double-digit percentages at the U of M and other public institutions. (Every source interviewed for this column mentioned rising-tuition-related debt as a major source of stress for students.)

“And it’s not just extremely driven students who are stressed and anxious,” Lysne continues. She says nearly half of all Carleton students will visit the campus counseling center between freshman week and commencement four years later. On the U of M Twin Cities campus, nearly three of ten students say they’re unable to manage their stress levels without help; antidepressants are the second most-prescribed student medication, right behind contraceptives.

Such statistics seem to suggest that today’s students are not as bothered as past generations by the perceived stigma of mental illness. But Erica Hynes of Active Minds believes the numbers may tell only half the story. “There’s probably more awareness, but I’m not sure there’s the understanding to go with it,” says Hynes, who lost her father to depression-related suicide during her sophomore year. “I was really stunned by how many bright, smart, brilliant people came up to me after he died and said, ‘How selfish of him. How could he do that to you?’ You wouldn’t say that if he’d died of cancer or a heart attack, but mental illness is a disease.”

Changing those attitudes is one reason Hynes became a member of Active Minds, a nationwide movement started in 2001 at the University of Pennsylvania by a student whose brother had committed suicide. The group now comprises 144 chapters across the country, including one at the U of M and another at the College of St. Catherine in St. Paul. Hynes has also been involved in Stamp Out Stigma, a faculty- and administration-led campaign at the U of M to encourage students to seek mental health care as they would any other kind of health care.

“I would say we’re at the beginning of a revolution in how we talk about these issues,” says Hynes, who plans to study clinical psychology in grad school. “But there’s still a long way to go.”

Like many colleges across the country, Macalester has nearly doubled the staff of its counseling center in recent years—a fact incoming freshmen are unlikely to appreciate during New Student Orientation, but one the college makes sure their parents understand. “Many students just aren’t in a place where they think they’re ever going to need those resources,” says Ted Rueff. “But parents are more attuned to the possible pitfalls.”

It may seem paradoxical for colleges to provide mental health information to parents when privacy laws prohibit them from telling parents if their children are using those services. “It’s a balancing act,” Rueff concedes. “But parents can be really important partners in helping their students through hard times.”

“Truly the biggest danger we face is when students come to campus with a previous diagnosis, but want to leave it behind and look at college as a fresh start,” says Marjorie Savage, director of the U of M’s Parent Program, a fifteen-year-old outreach initiative designed to help parents understand and support their children’s collegiate experience. “Consequently, they may not tell anyone [about their condition] and may stop taking their medications. But, because starting college is such a huge transition, it’s the worst time to stop that support. That’s why we tell parents, ‘You know your child best. You will be able to tell, in many cases, if something’s going wrong.’ ”

That’s also why the U of M recently consolidated its mental health resources at a single website: mentalhealth.umn.edu. The site includes a selection of online workshops where the university’s experts explain to parents how to tell if a student is merely feeling a little blue or truly depressed or is suffering from typical test anxiety or a more troubling anxiety disorder.

Though no one expects parents to diagnose their own kids, the experts say parents could give students a potentially life-saving lesson before they get to campus. “I would tell parents to sit down with their students before there’s a problem and say, ‘You know, if you have a sore throat, I expect you to go see a doctor, and if you have a hard time, I hope you know I want you to see someone who can help,’ ” says Harriett Copher Haynes. “Students are often able to put on happy faces and say what they think their parents want to hear. But parents can get through that by asking really pointed questions—‘How bad do you feel?’ ‘How disappointed do you get?’—so when their student does run into a problem, they can help steer them toward the help they need.”

And given students’ fondness for free stuff, parents should also mention that mental health care is often included in the cost of tuition.

You can reach columnist Laura Billings at edit@mspmag.com.