The Dallas Morning News
Sunday, March 23, 2003
By KAREN PATTERSON
The Dallas Morning News
DALLAS - Depression, suicidal thoughts and other worrisome conditions appear to have increased dramatically among college students seeking on-campus counseling, a new study suggests.
The study examined 13 years' worth of problems addressed in a university counseling center. Among other findings, the percentage of students seen with depression nearly doubled, as did that of students seen with suicidal thoughts.
The surge in potentially suicidal students is "huge," said psychologist Sherry Benton, who led the research, at Kansas State University. "In the early years, we were talking in the high 20s per year," she said. "Now it's closer to 100" students. Suicides on the main campus and its satellites have ranged annually from zero to four in recent years.
The study, released this month, appears in Professional Psychology: Research and Practice.
"I don't know if problem levels are higher in the age group overall, or if this is just unique to the students who actually seek services," said Benton, of Kansas State's Counseling Services. The services aided about 1,000 students a year on a campus enrolling some 19,000 to 21,000.
Troubles with dating and other relationships were the most frequently reported issue among students seeking counseling until 1994, when stress and anxiety problems surpassed them. From 1988 to 1992, about 36 percent had stress or anxiety issues, compared with almost 47 percent who had relationship problems. But from 1996 to 2001, almost 63 percent of the students had stress and anxiety problems, and about 56 percent relationship problems.
While it's not surprising that 18- to 24-year-olds would struggle with relationships, Benton said, "you don't really expect stress and anxiety."
Therapists at colleges have for some time perceived an escalation in the problems students present to them. Yet studies have shown no long-term rise in levels of distress that students report when they first seek therapy.
The new findings are based on a standardized questionnaire completed by the therapist when each case was closed. To better discern trends, the researchers consolidated data into three multiyear periods: from mid-1988 to mid-1992, 1992 to 1996, and 1996 to 2001.
Of 19 types of problems examined, significant increases were found in 14, the researchers reported. Troubles such as grief and depression, as well as developmental problems (severe homesickness, for instance), struggles with academic skills, and problems for which medication was prescribed increased across the three blocks of time.
For other issues - such as family problems, stress/anxiety, personality disorders and suicidal thoughts - percentages increased during the second time period and then leveled off at the higher rates.
While the research offers a helpful long-term look at problems among students seeking counseling, it doesn't truly address whether these problems have grown more severe in recent years, said Bruce Sharkin, a staff psychologist for counseling services at Kutztown University in Pennsylvania. For instance, "it's not that unusual for a student to present with suicidal thoughts, but if you don't get an assessment of degree of it, it may not be that meaningful," said Sharkin, who has reviewed research examining on-campus counseling. He would like to see a more detailed study of the topic, with multiple, ongoing measures of a student's condition by both student and therapist.
Despite this criticism, he said, it may well be true that students' troubles have become weightier. "My own impression is that, yeah, we see students with what we would consider more severe problems."
Counselors still assist students who get depressed and struggle after, say, a relationship breakup. "But there are also these cases of students who are obsessed, become suicidal, can't stay at school because it becomes such a problem," Dr. Sharkin said. Such complicated cases can leave a therapist feeling overwhelmed, he adds.
At the University of Texas at Austin, therapists have a similar impression, notes David Drum, director of the Counseling & Mental Health Center there.
However, that doesn't mean the problems are rising in all college students, he said. "That just means that it's (in) the population we're actually working with."
In fact, students seeking psychological counseling at college - about 15 percent of general student populations - differ markedly from those who don't seek help, said Drum, whose center is part of a national research effort involving some 40 college mental health centers. Results of the work have been presented at conferences of the American Psychological Association and the Association for University and College Counseling Center Directors.
The group has examined severity of problems in "help-seekers" during two time periods in the 1990s and is finishing a second round of data-gathering among students who didn't seek help.
Based on the amount of distress students reported and the duration of the problems brought to the counseling centers, anxiety and fears emerged as the most severe problem among women and second among men. (Academic worries such as grades ranked first for men, and second for women.) Third for both sexes was depression.
In students who hadn't visited counseling centers, the biggest difficulties were almost exclusively what would be expected in college populations, Drum said - academics, career decisions and finances. Anxiety, along with procrastination/motivation issues, ranked fifth, and depression 20th, in this group.
"That tells you that we're seeing who we should be seeing," Drum said. While he believes life is growing more complicated for most young people, "I'm not sure it's as dramatic as the change in the people we actually see."
At college counseling centers, "there's not what I would call a rational relationship between the magnitude of the task - the needs of students in mental health services - and the amount of services available to them," Drum said. "What happens is, without that rational relationship, you have to determine who you can see and what's the priority. You have to deal more and more with the urgent population, because they're the people more at risk of hurting themselves or failing out of school."
Other factors, too, could help explain the changing picture in college counseling centers, the experts say - for instance, campus outreach efforts.
Also, the psychologists note, U.S. depression rates are increasing overall. Families are under greater stress. Choosing a career has grown more difficult as the job market becomes more complex. And, as college costs spiral, monetary pressures mount.
It's not as if these problems didn't exist before, said Sharkin, "but there's more openness or certainly less stigma, so there are more students willing to seek help." That might in part explain one striking finding, Benton said - that the number of students pursuing counseling after a sexual assault quadrupled over the 13 years.
And treatments for children with psychiatric or learning difficulties have improved greatly in recent years, Benton said - "which means that a whole lot of those pretty troubled kids end up in college who didn't get here a decade ago."
In addition, the national research found, about 50 percent of students seeking counseling at college have previously received psychological care, Drum said. That compares with only 30 percent of students who haven't sought on-campus counseling.
"I think it means that this generation of students has been more exposed to mental health care," Drum said. "And they continue to seek it when things aren't going right."
A study by psychologists at Kansas State University examined trends among students seeking psychological help from 1988 to 2001, a time frame divided into three smaller periods. Among the findings:
The percentages of counseling clients seen with depression and of those seen with suicidal thoughts almost doubled from the first to third time period.
Four times as many students sought counseling after a sexual assault. (The dramatic change may be attributable in part to a growing willingness to seek help after such an assault, researchers note.)
The percentage of students coping with physical health problems, such as cancer, the AIDS virus and sexually transmitted diseases, more than doubled over the course of the study, from 6.6 percent to 13.5 percent.
Problems with substance abuse and eating disorders held steady, each at around 6 percent. Trouble with chronic mental illness also held steady, at about 3 percent.
Students needing help with academic skills increased from 8.5 percent of those counseled in the first time period to almost 35 percent in the third.
"Situational" problems - where some immediate event triggered the students' troubles - jumped from about 22 percent in the first time frame to 58 percent in the third. (In response to increasing demands, therapists have been pressed to limit sessions - and perhaps have shifted focus from long-term, underlying problems to simpler, more immediate events, the study's authors suggest.)
Students with A and B averages were more likely to seek counseling than those with C averages or below.
In an average year, about 27 percent of those seen at the counseling center were seniors; 23 percent juniors; 18 percent sophomores; and 16 percent freshmen. About 15 percent were graduate students.
Sources: Professional Psychology: Research and Practice; Sherry Benton/Kansas State University
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