Special Report Mental Health Matters

Anxiety and Depression

Anxiety the most common mental health diagnosis in college students

When it was announced in spring 2014 that a Penn State study had found that anxiety had surpassed depression as the leading mental health issue facing college students, the story made national headlines. According to the study of more than 100,000 students by Penn’s Center for Collegiate Mental Health, more than half of the students visiting campus health clinics listed anxiety as a concern. That finding was borne out by the American College Health Association (ACHA) 2015 National College Health Assessment survey, which reported that nearly one in six college students (15.8 percent) had been diagnosed with, or treated for, anxiety.

The same survey found that 21.9 percent of students said that within the last 12 months, anxiety had affected their academic performance, defined as receiving a lower grade on an exam or important project, receiving an incomplete, or dropping a course. That’s up from 18.2 percent in the ACHA’s 2008 survey. Meanwhile, 13.8 percent reported that in the last 12 months, depression had affected their academic performance, up from 11.2 percent in 2008.

These findings don’t surprise mental health clinicians at BU.

“We have all become less able to tolerate ambiguity and the unknown due to the incredible technological advances we have seen,” says Carrie Landa, director of Behavioral Medicine at Student Health Services. “Immediacy is sometimes the antidote to anxiety: having to wait for anything—a text, an exam grade, ‘How am I going to do?’—all create anticipatory anxiety. Unfortunately, there are many things in life that aren’t quickly resolved and waiting is necessary.”

In the 2015 Healthy Minds study, an annual web-based survey examining mental health on college campuses, the number of BU students who score positive on a measure of depression was larger, at 23 percent, than the number who scored positive on a measure of anxiety, 17 percent. In fact, depression and anxiety are two sides of the same coin, says Dori Hutchinson (SAR’85,’96), director of services at BU’s Center for Psychiatric Rehabilitation and a Sargent College clinical associate professor. Both are treatable with therapy, lifestyle changes, and medication when indicated—and sometimes a combination of all three.

What’s normal and when to seek help

Every student feels stressed out at one time or another, especially during midterms and finals. And it’s normal for students to feel blue on occasion, too. So when do those feelings become reason for more concern?

“When your mood state interferes with your ability to function at school,” Hutchinson says, “like when you’re finding you can’t get to class, and you don’t want to hang out with your friends or teammates, and you’re having difficulty concentrating because you’re feeling so distressed—that’s when we want to reach out and help you.”

“Often it is more important to manage your emotional reaction to stress than to try to change the stressful situation, which may not be fully under your control.”

—Lisa Smith

Other warning signs are prolonged feelings of sadness or despair, excessive anxiety or panic, isolation or withdrawal from typical daily activities, thoughts of self-harm or suicide, giving away possessions, changes in personal hygiene, and excessive use of alcohol or other drugs, which are often used by students experiencing social anxiety to self-medicate.

“When any emotions or behaviors are a big change from your regular, day-to-day functioning, it’s important to stop and ask yourself what’s going on,” says Landa. “We see normal anxiety morph into distress when a student is having panic attacks, can’t sleep or slow themselves down, persistently worries or obsesses about what’s next, or is having other physical symptoms consistent with anxiety. When day-to-day functioning is affected, but before it’s impaired, that’s when to get help. Similarly, with depression, everyone experiences a low mood day or a disappointment they just can’t shake off, whether that’s because of a bad grade, a relationship ending, or a fight with a friend. But when feelings of sadness, loneliness, or low self-worth become the norm, reaching out is really important.”

“We know that stress can be a trigger of psychological conditions, especially in the context of unpredictability and uncontrollability. This seems to be inherent in the transition to college,” says Lisa Smith, director of BU’s Center for Anxiety & Related Disorders and a College of Arts & Sciences clinical associate professor of psychological and brain sciences. “At the point where your emotions are interfering with your life or are causing significant distress is when you would want to take action to adjust your emotional functioning in response to stress.

“Often it is more important to manage your emotional reaction to stress than to try to change the stressful situation, which may not be fully under your control,” she says. “I often think that if students were given an Emotions 101 course in high school or college, they would be much better equipped to know how emotions work well versus what emotional coping strategies only serve to heighten anxiety and depression. It’s often surprisingly counterintuitive.”

For many students, Smith says, a brief program of cognitive-behavioral treatment can help them shift to more effective emotion management.

Despite the fact that depression and anxiety are treatable, many students are reluctant to admit they have a problem and to seek help.

Case in point: Victoria Pae (CAS’16). During freshman year, she says, she felt overwhelmed by stress and anxiety, but she was afraid to seek help. “Everyone was doing so much, everyone was so on top of their games, it seemed like they had it all together,” says Pae, a double major in neuroscience and psychology, who as a high school student had done very well academically and in extracurricular activities. “You’re seeing everyone excelling above you. And even though you have the ability to excel too, you’re too scared of making a fool of yourself to actually try to do it.”

Pae found it hard to admit she had a problem. She kept her feelings of anxiety and being overwhelmed to herself. “I didn’t want to tell myself that I needed to get help, so I didn’t,” she says. “I just told myself, it’s all in my head, get over it.”

“A colleague of mine has started calling it the ‘game face’ that students put on, that tells everybody else in the world, ‘I’m just fine, I’m handling it, look at me juggling school, extracurricular activities, and work,’” says Katharine Mooney (SPH’12), director of Wellness & Prevention Services at Student Health Services. “But that’s not how they’re feeling…they feel really alone, isolated, that no one else feels like they do. And that’s just not the case.”

Rather than confront her feelings, Pae says, she would party with friends. Her grades began to suffer as well. But at the beginning of her sophomore year, she started working with the BU chapter of the student mental-health group Active Minds, which works to make people more aware of mental health issues, reduce prejudice against those with mental health challenges, and direct students to behavioral health resources on campus.

“I was teaching students that it’s OK to receive support, but here I was with a mental health disorder and not seeking help. I thought that was very hypocritical,” Pae says. The spring after she joined Active Minds, she began to see an off-campus therapist to help treat her anxiety.

“I won’t say I’m 100 percent OK now, as I still have my moments of self-doubt and of neglecting self-care,” Pae says, “but I’m definitely doing better than I was a couple of years ago.”

A chance for everyone to be screened

Tomorrow, October 5, all students, as well as faculty and staff, can receive free, confidential screenings for depression and anxiety as part of National Depression Screening Day.

The screenings, brief anonymous questionnaires with multiple choice answers, are being offered on both the Charles River and Medical Campuses and take only two to three minutes to complete. The questionnaire asks about eating and sleeping habits and having feelings of hopelessness, suicidal thoughts, or an inability to stop worrying. The results can help determine if someone is experiencing depression, anxiety, a mood disorder, or even post-traumatic stress.

A clinician will review the answers on site and discuss what the proper next steps might be and provide referral cards directing students to Behavioral Medicine, the Center for Anxiety & Related Disorders, or the Center for Psychiatric Rehabilitation. Everyone who is screened receives information about counseling and other services, regardless of whether they show symptoms of anxiety and depression. No appointment is needed.

“Sometimes a screening can be lifesaving, while other times it helps facilitate the small change that allows someone to go from feeling okay to feeling good.”

—Carrie Landa

“If your score is high, we say, ‘What can we do to help?’ and direct them toward resources on campus,” Hutchinson says.

The screenings will be held at three locations on the Charles River Campus: at both the George Sherman Union Link and the Yawkey Center for Student Services dining room, from noon to 3 p.m. and in the FitRec lobby, from 3:30 to 6:30 p.m. Screenings on the Medical Campus will be in the School of Medicine L-Instructional Building lobby, from 4 to 6:30 p.m. At each site, clinicians will be on hand for confidential feedback and there free chocolate will be given out.

During last year’s National Depression Screening Day event at BU, 445 people came for checkups, Hutchinson says, and 19 percent were referred to Behavioral Medicine for appointments or other follow-ups. Six students received urgent care after noting that they were in extreme distress. The first year BU held the screenings, in 2008, one person was hospitalized after the questionnaire revealed suicidal impulses.

“That may have helped save his life and put him on the path to wellness,” says Hutchinson.

The screenings coincide with the semester kicking into high gear. “The honeymoon is over, the schoolwork is hard—it might be growing,” Hutchinson says. “Midterms are right around the corner, and if someone is living with depression, it can worsen. The screenings are really a way for our community to say, we care about you.”

Landa urges everyone to avail themselves of the opportunity to be screened Wednesday. “National Depression Screening Day is a great opportunity to check in with yourself, be able to quickly look at some key behaviors and feelings that are markers for wellness. Sometimes a screening can be lifesaving, while other times it helps facilitate the small change that allows someone to go from feeling okay to feeling good.”

Pae says her experience with anxiety made her realize the benefits of getting help. “I think a lot of students…are scared to admit that they’re stressed and worried their life might be crumbling before their eyes,” she says. The former president of BU’s Active Minds chapter, Pae says the group emphasizes that “whether the difficulties you’re going through are major or minor, it’s OK to seek help.”

Those seeking free, confidential mental health counseling can contact Student Health Services Behavioral Medicine (617-353-3569) (available 24 hours for psychiatric emergencies), the Center for Psychiatric Rehabilitation (617-353-3549), the Danielsen Institute (617-353-3047), and the Center for Anxiety & Related Disorders (617-353-9610). Faculty and staff with mental health issues can contact BU’s Faculty & Staff Assistance office (617-353-5381). The Samaritans of Boston suicide prevention hotline is 877-870-4673. The Active Minds student support group is best reached through its Facebook page. For crises related to crime and interpersonal or sexual violence, BU’s Sexual Assault Response & Prevention Center crisis counselors are available 24 hours a day, 7 days a week (617-353-SARP) (7277). If you, or someone you know, have questions about their drug or alcohol use, Wellness & Prevention Services can help (617-358-0485). Students who require academic or other accommodations for a psychological disability can also consult BU’s Disability Services (617-353-3658). Accommodations and services could include testing modifications, reduced course load, developing skills in self-advocating with faculty, executive functioning coaching, and more. Services are free and confidential.

Next, in the final installment of our series “Mental Health Matters,” we’ll look at healthy ways of coping with stress and where to seek help at BU.