Sunday, January 29, 2017

Strange World: Two Perplexing Trends in College Mental Health

In its most recent annual report, The Center for Collegiate Mental Health highlighted two disorienting facts from their trend data over six years:
"1. Lifetime prevalence rates of “threat-to-self” characteristics (nonsuicidal self-injury and serious suicidal ideation) increased for the sixth year in a row (page 5). This persistent trend, combined with dramatic increases in demand for mental health services documented in last year’s report, confirm that counseling centers are evaluating and managing increasing numbers of students who may also represent “threat-to-self". 
2. Despite increasing demand marked by risk, lifetime prevalence rates for prior mental health treatment remain stable for the sixth year in a row (page 4). One in two students that sought treatment has had prior counseling, one in three has taken prior medications, and one in ten has been hospitalized. The six-year stability of these trends suggests that students referred for counseling, do not have increasing rates of preexisting mental health concerns. 
4. Anxiety and depression continue to be the most common presenting concerns for college students as identified by counseling center staff (page 9). In addition, students’ self-reported distress levels for depression, generalized anxiety, and social anxiety continue to evidence slight but persistent increases each year for the past six years (page 6). Other areas of self-reported distress (academic, eating concerns, hostility, substance abuse, and family distress) have remained relatively flat or decreasing. Thus, anxiety and depression are not only the most common concerns, but students’ distress in these areas appears to be growing slowly while other areas of distress are flat or decreasing.  These findings highlight the fact that not all aspects of mental health are worsening and that it will be important to better understand the role of depression and anxiety in college students."

The latter lifetime prevalence rate data are consistent with what has been reported in epidemiological studies both in America and Canada. It strongly suggests that the cause of the increasing rates of "threat-to-self" is not due to rates of pre-existing mental health issues. The report goes on to say that "growth" in mental health concerns is actually slowing but persistent in a few areas, and flat or subsiding in others, over six years. Taken together all of this suggests that other factors are at work in terms of self harm.

Threat to self or self harm, broadly defined, is the turning inward of distress. Key questions are 1) what is causing the increase in this distress if it is not pre-existing mental health concerns, and 2) why are students focusing inwardly in manifesting their distress? Clues are available in the "list of top concerns" data from the same report (page 10). First, suicidality is ranked 18th of 44 items by counselors choosing the top concern, while self-injurious thoughts or behavior is 24th. Thus, while these appear to be increasing, they are NOT anywhere near the top-most concerns, suggesting that actual risk is low and that other concerns need more attention. Looking at those top 24 rankings then, we find that 14 of them have an external or environmental influence, such as stress, family, trauma, and relationship problems. Stress is ranked number three among all items.

A hypothesis is that something is happening to students after they arrive on campus which exceeds their ability to cope, and they are unable to articulate this in language. As previous posts have communicated, some believe it is the emergence of serious mental illness conditions that often appear in that age range (which so happens to benefit an industry). Some believe that higher education itself is too taxing and with diminishing benefit (which offers a scapegoat to the guilty). Others point to parents and families who fail to prepare their children for independence (which provides an easy target that exculpates the rest of us).

While each factor may account for some portion of the variance, I think each misses the big picture: modern life is becoming intolerably psychologically stressful. Yes I know that other generations faced dire circumstances and death and got through them with grit. There is no doubt that, at least for many, we have more resources and conveniences than ever. But that is not the point.

Today's youth do not have a clear path or ritual into independence and adulthood, and they are struggling to find meaning and define what success is for them while it seems so easily attainable by others. And the world is an increasingly confusing and frightening place. What we are seeing are reactions to an extreme form of impotence and frustration among our youth.

More on these subjects later so stay tuned.