Depression and College Students (Part 1)

Many people experience the first symptoms of depression during their college years. Unfortunately, many college students who have depression aren't getting the help they need. They may not know where to go for help, or they may believe that treatment won't help. Others don't get help because they think their symptoms are just part of the typical stress of college, or they worry about being judged if they seek mental health care.¹

In reality, most colleges offer free or low-cost mental health services to students. Depression is a medical illness, and treatments can be very effective. Early diagnosis and treatment of depression can relieve depression symptoms, prevent depression from returning, and help students succeed in college and after graduation. This article addresses common questions about depression and how it can affect students attending college.

What is depression?

Depression is a common but serious mental illness typically marked by sad or anxious feelings. Most college students occasionally feel sad or anxious, but these emotions usually pass quickly—within a couple of days. Untreated depression lasts for a long time, interferes with day-to-day activities, and is much more than just being "a little down" or "feeling blue."

How does depression affect college students?

In 2011, the American College Health Association–National College Health Assessment (ACHA–NCHA)—a nationwide survey of college students at 2- and 4-year institutions—found that about 30% of college students reported feeling "so depressed that it was difficult to function" at some time in the past year.²

Depression can affect your academic performance in college.³ Studies suggest that college students who have depression are more likely to smoke.⁴ Research suggests that students with depression do not necessarily drink alcohol more heavily than other college students, but students with depression, especially women, are more likely to drink to get drunk and experience problems related to alcohol abuse, such as engaging in unsafe sex.⁵ Depression and other mental disorders often co-occur with substance abuse, which can complicate treatment.^6,7

Depression is also a major risk factor for suicide.⁸ Better diagnosis and treatment of depression can help reduce suicide rates among college students. In the Fall 2011 ACHA–NCHA survey, more than 6% of college students reported seriously considering suicide, and about 1% reported attempting suicide in the previous year.² Suicide is the third leading cause of death for teens and young adults ages 15 to 24.^{9, 10} Students should also be aware that the warning signs can be different in men versus women.

Are there different types of depression?

Yes. These are the most common depressive disorders:

• Major depressive disorder is also called major depression. The symptoms of major depression are disabling and interfere with everyday activities such as studying, eating, and sleeping. People with this disorder may have only one episode of major depression in their lifetimes, but more often, depression comes back repeatedly.
• Dysthymic disorder is also called dysthymia. Dysthymia is mild, chronic depression. The symptoms of dysthymia last for a long time—2 years or more. Dysthymia is less severe than major depression, but it can still interfere with everyday activities. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.
• Minor depression is similar to major depression and dysthymia. Symptoms of minor depression are less severe and are usually shorter term. Without treatment, however, people with minor depression are at high risk for developing major depressive disorder.

Other types of depression include these:

• Psychotic depression is severe depression accompanied by some form of psychosis, such as hallucinations and delusions.
• Seasonal affective disorder is depression that begins during the winter months and lifts during spring and summer.

Bipolar disorder, also called manic-depressive illness, is not as common as major depression or dysthymia but often develops in a person's late teens or early adult years. At least half of all cases start before age 25. People with bipolar disorder may show symptoms of depression and are more likely to seek help when they are depressed than when experiencing mania or hypomania. Bipolar disorder requires different treatment than major depression, so a careful and complete medical exam is needed to assure a person receives the right diagnosis.

What are the signs and symptoms of depression?

The symptoms of depression vary. If you are depressed, you may feel

• Sad
• Anxious
• Empty
• Hopeless
• Guilty
• Worthless
• Helpless
• Irritable
• Restless

You may also experience one or more of the following:

• Loss of interest in activities you used to enjoy
• Lack of energy
• Problems concentrating, remembering information, or making decisions
• Problems falling asleep, staying asleep, or sleeping too much
• Loss of appetite or eating too much
• Thoughts of suicide or suicide attempts
• Aches, pains, headaches, cramps, or digestive problems that do not go away

What causes depression?

Depression does not have a single cause. Several factors can lead to depression. Some people carry genes that increase their risk of depression, but not all people with depression have these genes, and not all people with these genes have depression. Environment—your surroundings and life experiences, such as stress—also affects your risk for depression. Stresses of college may include^11,12

• Living away from family for the first time
• Missing family or friends
• Feeling alone or isolated
• Experiencing conflict in relationships
• Facing new and sometimes difficult school work
• Worrying about finances

References

1. Eisenberg, D., Golberstein, E., & Gollust, S. E. (2007, July). Help-seeking and access to mental health care in a university student population. Medical Care, 45(7), 594–601.
2. American College Health Association. (2012). American College Health Association-National College Health Assessment II: Reference group executive summary fall 2011. Hanover, MD: American College Health Association.
3. Eisenberg, D., Gollust, S. E., Golberstein, E., & Hefner, J. L. (2007, October). Prevalence and correlates of depression, anxiety, and suicidality among university students. American Journal of Orthopsychiatry, 77(4), 534–542.
4. Cranford, J. A, Eisenberg, D., & Serras, M. (2009, February; epub 2008, September 17). Substance use behaviors, mental health problems, and use of mental health services in a probability sample of college students. Addictive Behavior, 34(2), 134–145.
5. Weitzman, E. R. (2004, April). Poor mental health, depression, and associations with alcohol consumption, harm, and abuse in a national sample of young adults in college. Journal of Nervous and Mental Disease, 192(4), 269–277.
6. Griswold, K. S., Aronoff, H., Kernan, J. B., & Kahn, L. S. (2008, February 1). Adolescent substance use and abuse: Recognition and management. American Family Physician, 77(3), 331–336.
7. Glantz, M. D., Anthony, J. C., Berglund, P. A., Degenhardt, L., Dierker, L., Kalaydjian, A., et al. (2009, August; epub 2008 Dec 2). Mental disorders as risk factors for later substance dependence: Estimates of optimal prevention and treatment benefits. Psychological Medicine, 39(8), 1365–1377.
8. Garlow, S. J., Rosenberg, J., Moore, J. D., Haas, P., Koestner, B., Hendin, H., et al. (2008). Depression, desperation, and suicidal ideation in college students: Results from the American Foundation for Suicide Prevention College Screening Project at Emory University. Depression and Anxiety, 25(6), 482–488.
9. National Center for Health Statistics. (2012). Health, United States, 2011: With special feature on socioeconomic status and health. Hyattsville, MD.
10. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005, June). Lifetime prevalence and age of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602.
11. Mowbray, C. T., Megivern, D., Mandiberg, J. M., Strauss, S., Stein, C. H., Collins, K., et al. (2006, April). Campus mental health services: Recommendations for change. American Journal of Orthopsychiatry, 76(2), 226–237.
12. Hefner, J., & Eisenberg, D. (2009, October). Social support and mental health among college students. American Journal of Orthopsychiatry, 79(4), 491–499.