Stressed for Success

Ashli Haggard saw her future collapsing with her first ‘F’.She wasn’t just afraid the failing grade would keep her from going to nursing school. The then-sophomore wondered if she was smart enough to be in college at all.

Haggard ’15, who had a history of anxiety and depression since elementary school, spiraled into a deep funk. She holed up in her room on the fifth floor of LaPlata Hall and began thinking about suicide.

“I felt like everything I’d worked for was gone,” she says. “I just didn’t want to exist anymore.”

Haggard called the university’s Counseling Center to say she had been thinking about harming herself. “They said, ‘Be here in 20 minutes. We’ll see you right away,’” she remembers. She asked her dorm’s resident adviser to walk her over; otherwise, she feared she would chicken out.

As they walked the 15 minutes across campus, Haggard thought, “I just have to get there. If I get there, I can get fixed.”

She’s one of about 3.5 to 4 million college students nationwide who are struggling with serious anxiety, depression or other mental health issues, according to a 2013 survey by the American College Counseling Association. It also strongly suggested the problem is growing: 95 percent of counseling directors at four-year colleges think that more students than ever before are dealing with these issues.

The University of Maryland is spending $5 million over 10 years to boost its counseling staff to respond to an increase in students’ requests for help. Nearly 2,000 students sought treatment at the Counseling Center in the 2013–14 academic year, a 12 percent jump from a year earlier.

Psychologist Sharon Kirkland-Gordon, director of Maryland’s Counseling Center, says the number of UMD students who consider suicide has increased, as has the overall severity of mental illness among patients and the number who say they have previously attempted suicide.

“The situation is definitely more serious now,” she says.

It’s hard to say definitively that college students are more stressed than ever, as mental illness remains complex and poorly understood. But many researchers, educators and counselors point to mounting academic pressure, the uncertain economy, a decline in coping skills and increased social alienation for a generation that grew up online. Others see the rising numbers as the result of reduced stigma surrounding mental illness, as well as improved efforts to diagnose and treat children—who then bring those diagnoses with them to college.

Overwhelmed and Underprepared

No one wants to wait tables after spending four years and tens of thousands of dollars earning a degree. That kind of fear about the shaky economy and their career prospects ignites anxiety, say researchers, educators and students.

“College students are definitely aware of the economic climate,” says Haggard. “There is really a lot of pressure from that.”

The data back up this angst: Among recent college graduates, unemployment and underemployment (a category that includes people who are working part-time because they can’t find a full-time job, or have given up searching) remain nearly twice as high as before the 2008 crash, at 8.5 percent and 16.8 percent, respectively, according to the Economic Policy Institute.

At the same time, students face mounting school costs. In 2012, the average college graduate faced $29,000 in student debt—$10,000 more than just eight years earlier, according to the nonprofit Institute for College Access & Success. (For UMD students, this amount is lower: $21,000, on average, in 2013.)

Beyond unease about jobs and career, many college students feel more academic pressure than previous generations. “These institutions are clearly becoming more competitive places,” says psychiatrist Victor Schwartz, medical director of the Jed Foundation, a nonprofit based in New York City that promotes emotional health among college students. This year, for example, Stanford University accepted 5 percent of its applicants, perhaps the lowest rate ever recorded at a U.S. university.

In this competitive context, many millennials simply rev too high, says Kirkland-Gordon. “We have a very bright, very talented, very ambitious group of students,” she says. “With that comes a lot of stress.”

Dance major Nicole Turchi is familiar with this trajectory. She received a full scholarship to Maryland, has done well academically here and is on pace to graduate in December. But she has wrestled with depression, anxiety and eating disorders. Fear about staying thin enough drove her to binge-eating, and when she felt out of control, she sometimes went to the Stamp Student Union to eat “four or five lunches.” A bad breakup, as well as a series of chronic injuries that kept her from dancing, led her to consider suicide.

“When you’re a student, there are so many hats you have to wear and so many balls you have to keep in the air,” Turchi says. She has gotten help at the Counseling Center, and praises the therapists there for helping to improve her outlook.

Some observers say some students are ill equipped to withstand the slings and arrows of breakups, bad grades and loneliness. “It’s clear that young adults have fewer coping skills, and less resilience than past generations,” says pediatrician Sarah Van Orman, incoming president of the American College Health Association as well as director of health services at the University of Wisconsin-Madison.

She puts some of the responsibility on the increase on overprotective, overinvolved parenting. Kids brought up this way may not learn self-reliance, and when they become undergraduates, may lack the psychological tools to handle the adversity that is an inevitable part of independent adulthood.

Students’ pervasive use of social media may also increase their vulnerability. Kirkland-Gordon calls this “artificial connectedness,” and says many Maryland students tell counselors that their constant texting and posting sometimes replaces more meaningful relationships. Recent studies have found that social media such as Facebook and Instagram often instill a sense of inadequacy among frequent users.

“Facebook can be depressing,” says Van Orman. “You don’t see posts where people say, ‘I’m an average person and I’m having an average day.’ No. On Facebook everyone is having a wonderful time and doing amazing things. For some, constantly being exposed to that can be psychologically damaging.”

Turchi has experienced this. Two years ago, she realized she was spending too much time on Facebook, and was judging herself harshly against others’ digital personae. She stopped using the social media site, and says, “It was one of the happiest periods of my life.” After six months she went back, and has since been more disciplined about limiting her use and recognizing when she needs a break.

No Shame in Admitting Pain 

Schwartz says decreased shame and embarrassment about mental illness has allowed more students to face their anguish. “We have done a pretty good job of destigmatizing these problems,” he says. “It’s now more okay for many students to go for treatment.”

Sarah Polus ’14 exemplifies this shift. Throughout her years at Maryland, she suffered from anxiety disorder and panic attacks. Both are now under better control, thanks to therapy and medication. Polus has no problem sharing her struggles, whether making a point in class or talking to a stressed-out friend. “I try to bring it up as much as I can,” she says with a laugh.

Haggard shares this view. “It’s not the end of the world if you need help,” she says. “If you have a toothache, you go to a dentist. If your mind hurts, you go to a therapist or a psychiatrist. It’s the same thing. Pain is pain.”

Still, men, minority students and international students are much less likely to use mental health services on campus. “We’ve made great progress on this. But we have a long way to go,” says Alison Malmon, executive director of Active Minds, a Washington, D.C.-based nonprofit devoted to raising awareness about mental health among college students. The group has 9,000 members spread across 400 campus chapters, including one at Maryland.

Adam Ziegel ’14, a physiology and neurobiology major, understands this reluctance to get help. In high school and in his freshman year, he suffered from depression, stemming mainly from the fact that he was gay but not ready to come out. “I was hiding myself,” he says. “It got worse and worse and worse, until I just couldn’t take it anymore.”

In his sophomore year at Maryland, he sought help, and his parents agreed to pay for him to see a psychiatrist. Ziegel decided to come out, and he began taking antidepressants. Today, he is still getting comfortable talking about his illness.

“I hate to say it, but it’s the old stereotype,” he says. “Men just have this weird block about talking about their feelings.”

What progress has been made is on display in the waiting rooms of university counseling centers. Experts say that more secondary school students are receiving mental health treatment. (Haggard is among this group: She first saw a therapist in elementary school, for anxiety.) In the past, some of these students might not have made it to college because they didn’t have the grades or couldn’t handle the demands of being away from home. Today, with the help of therapy and more effective medications, they often do well. But once they’re on campus, they may be more likely to seek help for a relapse or a crisis.

Psychiatrist Marta Hopkinson, director of mental health at Maryland’s Health Center, sees this regularly. She says its seven psychiatrists frequently must help students who arrive at school with prescriptions, and now need adjustments in dosage or different medication.

She says much of this is due to changes in how kids are raised. “Parents today are much more likely to get mental health treatment when they see problems with their kids,” she says. “They’re much more aware of their kids’ emotional state.”

A Stronger Prescription for Pain

The decision to add counselors at Maryland was brought into sharp focus by the case of UMD graduate student Dayvon Green, who in February 2013 shot two undergraduates, one fatally, then killed himself at their off-campus house.

Green suffered from schizophrenia and bipolar disorder, police said. He had never sought treatment at the Counseling Center, but after the murder-suicide, critics said the university had a relatively low number of psychologists and psychiatrists available to treat students.

Maryland’s Counseling Center used the $5 million in new funding to add three psychologists, bringing the total to 17. The center also has four interns (doctoral students in psychology) who see clients, with supervision from staff psychologists. It’s also adding a care manager who will oversee treatment and work with students who want to extend treatment beyond their allotted eight free sessions.

In addition, the Health Center has added two psychiatrists to its existing five. These practitioners don’t provide therapy, but work with students who need psychotropic medications. The Health Center also has five psychotherapists, who offer services similar to Counseling Center psychologists.

With the additional hires, Maryland has reduced its ratio from one counselor for every 1,608 students to 1 for every 1,423 students. The International Association of Counseling Services recommends that universities maintain a ratio of 1 to 1,500.

Maryland is using other strategies to raise awareness and reach students, including widespread screening; training for students, staff and faculty; and involving counselors in dorms, fraternities and other student institutions.

This year, the Counseling Center will also expand the number of “mindfulness meditation” groups for students. This approach, which teaches participants to consciously regulate their response to stressful experiences, has been shown to treat conditions including depression and anxiety.

Providing Health, No Matter the Cause

Van Orman and others see the growing use of services as a sign that colleges are doing more to find and help troubled students. “This is a testament to what colleges are doing,” Van Orman says. “In many ways, this is a success story.”

Because college counseling centers are more likely to help those who are in real trouble, this creates the perception that the problem is worsening, says University of Rochester clinical psychiatry Associate Professor Allan Schwartz (no relation to Victor), who has studied the issue for more than a decade. He points to studies in which students report they’re not more stressed, and to the fact that the suicide rate among college students has held steady for the past 30 years, at around 7 per 100,000 annually. In fact, the rate for college students is about half that of people in the same age bracket who aren’t in school; Schwartz says being in college actually reduces suicide risk.

Victor Schwartz says even if that’s true, colleges must continue to focus on helping students in distress. “We have to make sure we remember how important it is to give these students the support they need,” he says. “If we want them to do well, as students and as people, colleges have to make sure they get treatment.”

These days, Haggard is doing much better. She joined one of the Counseling Center’s therapy groups, where she realized that it’s common for students to worry about measuring up academically. She switched her major to behavioral and community health and plans to become a social worker, and she joined the UMD chapter of Active Minds. She sees a private therapist in Rockville, takes antidepressants and relies on coping strategies such as running and writing in a journal.

Even so, she still has hard days, when everything—school, friends, the future—feels overwhelming.

“I know this is a long-term process,” she says. “It’s like diabetes or any other chronic disease. It won’t magically disappear. You just have to stay on top of it.” TERP