She was in her sophomore year, her mother back in Seoul was ill, her father had lost his job and she was depressed and having panic attacks so severe that she went to the emergency room for chest pains.
“I was hesitating right in front of the door,” said Kim, 20. But she went through because, “I was desperate for help.”
It is not new that the number of college students who say they are facing mental- and emotional-health troubles has been steadily growing. What is new is that colleges and universities are increasingly focused on trying to understand, through rigorous research, what interventions work best and for the broadest swath of students.
“The fact that students are struggling with anxiety and depression is real,” said Thomas C. Shandley, dean of students for Davidson College. “It took a while to reach college campuses, and now it’s here.”
In addition, the Center for Collegiate Mental Health at Penn State, which annually reports on college students receiving mental health services, found that the number who have purposely injured themselves (for instance, by cutting themselves) rose steadily to almost 26 percent in the 2015-16 school year, from 21.8 percent in 2010-11. The same upward trend was true of those who seriously considered attempting suicide — rising to 33.2 percent, up from 23.8 percent, over the same period.
A common narrative is that too many students, especially those at elite universities, are coddled products of helicopter parents who run to counselors at the first obstacle. Particularly in affluent areas, said Julie Lythcott-Haims, author of “How to Raise an Adult,” too many parents have tried to ensure that their children never run up against failure or obstacles.
“We’ve enriched the hell out of them,” she said. “They’re hardworking, but their childhood has not helped them build coping skills.”
But the overprotected child is only one small part of the overall story. Many universities’ mental health and wellness centers are strained for many other reasons.
Part of the equation is that doctors have a greater ability to diagnose and treat mental illness than in the past; 30 years ago, students who acted strangely or cut themselves might just be ignored or kicked out of school.
And life (along with college) is different now.
“There are more international students, more students of color, family lives are more complex,” said Larry Moneta, vice president for student affairs at Duke University. “Students today have older parents, and so we’re dealing with parent deaths far more often.”
In the past, many of the students on campuses today “would have been weeded out before they got to college,” Moneta said. “Therapies and treatments have enabled kids who have never been to college to be there. Once there, it’s about maintaining their ability to stay.”
In addition, economic anxiety about the future and the high cost of college now (which can top $70,000 a year at private schools) puts great stress on students who worry that a grade of B may ruin their career chances or disappoint their parents who are paying hundreds of thousands of dollars.
Calling these students coddled “is an uninformed response,” said Dori Hutchinson, director of services at the Boston University Center for Psychiatric Rehabilitation. Some people are born more resilient, but it is a skill that can be taught. Hutchinson defines it as emotional agility, “the capacity as an adult to be responsible and flexible to all life throws at you. And to respond to yourself and others with empathy.”
One groundbreaking effort to drill down into the complex causes of student stress — and to understand the best ways universities can help students cope — is funded by the nonprofit Duke Endowment.
Four higher education institutions — Duke, Davidson, Johnson C. Smith University, all in North Carolina, and Furman University in South Carolina — are part of the five-year $3.4 million project, which follows the class of 2018 from freshman through senior year.
All of the institutions asked for volunteers at the beginning of the freshman year; these students must complete a 400-question survey four times as freshmen and a minimum of twice a year after that. The questions cover a range of topics, including family and academic background, eating behavior, sense of purpose and physical activity.
It must be done in one sitting, and the students are compensated for their time.
The data are still being collected and interpreted, but some of the participating colleges are already using what they’ve learned so far. For example, at Furman, “we were surprised at the number of our students who had experienced a loss in their young lives,” like the death of a parent, sibling or close friend, said Connie Carson, the university’s vice president for student life. “It was high enough that it raised an alert.”
So this spring, Furman began a six-week grief group, bringing in outside counselors. “We weren’t sure if the students would show, but 10 have consistently participated,” Carson said.
At Davidson, the findings from the project encouraged the school to begin a pilot project with Therapy Assistance Online counseling, said Shandley, the dean of students. The program, used at other universities, requires students seeking help to have an initial assessment with a counselor, to determine how acute the issue is. If the problem seems less severe, students are referred to the interactive web-based program, which helps them cope with minor levels of depression and other common concerns.
“The plight of every counseling center on every campus is that they’re way overworked, Shandley said. “This is not a substitute for serious issues’ interventions, but it frees up a counselor.”
Administrators at Johnson C. Smith, a historically black university, see part of their efforts in the initiative as reducing the shame around mental illness that can be more prevalent among African-Americans.
“African-American college students may have an unwillingness to seek any type of psychological help,” said Tierra Parsons, a campus counselor and adjunct professor at the university. “There is a stigma attached to mental illness.”
On a lighter note, Davidson now also offers art carts, which volunteers roll around the campus. Students can take a break from studying to finger-paint or do a craft to calm down. And last year, on reading day (the day between classes and finals), the school brought dogs from a local animal shelter to the student union for students to play with; research has shown dogs can have a calming effect. The dogs were a big hit, Shandley said.
For some students, a break to paint or pet a puppy is all that’s needed to calm normal anxiety about an upcoming final or test. But for others, fear of failing, of letting down a parent or professor, can quickly spin out of control.
Michelle Craske, a professor of psychology, psychiatry and biobehavioral sciences and the director of the Anxiety and Depression Research Center at U.C.L.A., knows this. She is helping spearhead the U.C.L.A. Depressions Grand Challenge, which will monitor 100,000 people to identify genetic and environmental causes of depression. The study, the largest of its kind to date, will follow students over four years, and staff, faculty and community members for a decade.
Although the project has been under development for two years, it began in earnest about five months ago when students began receiving emails, fliers and newsletters asking for participants in a novel treatment study. Students are invited to complete an online depression and anxiety assessment, then receive individual feedback on their responses.
Of the 520 students who completed the online screening and reported symptoms, 197 were deemed eligible; these are students with mild to moderate depression or moderate to severe anxiety, Professor Craske said. They were referred to an Australian interactive web program called This Way Up, and could also choose to have trained peer support. All are closely monitored throughout the study.
Eight percent (or 44 students of those who completed the screening) were considered severely depressed, and 20 were considered at risk for suicide; they received immediate follow-up and were offered clinical help.
Ensuring that faculty and staff are on board is part of the equation. But professors and staff members face a constant balancing act — trying to ensure a seriously disturbed student doesn’t slip through the cracks without lowering the expectation that most students will meet deadlines or be prepared for tests.
“Trying to sort that out is challenging,” said Diane Dalton, a professor of physical therapy at Boston University. As a professor for more than 20 years, she is now more aware of the need to really know students in the course, notice if their behavior has altered and consult with other faculty to see if they also have observed changes.
Where once, for example, she may simply have been annoyed if someone fell asleep in class, now she checks in to find out if it’s because of late-night partying or something more worrisome.
“We have a student whose father is on the West Coast and dying, and he’s doing graduate work,” she said. “Some are dealing with domestic violence.”
Rutgers University at New Brunswick has long been at the forefront of some of these issues; it has the first Recovery House in the nation (now emulated by a handful of other campuses) where students who are recovering from alcohol or drug addiction (or both) can live.
In another initiative started about six months ago, Rutgers is embedding counselors at campus cultural centers that cater to specific students, like African-Americans, Latinos and Asian-Americans.
“This is an effort to get students who would not walk to the counseling center,” said Jill Richards, director of the RutgersCAPS center, which stands for counseling, ADAP (alcohol and drug assistance program) and psychiatric services.
For Kim, who also suffered from post-traumatic stress disorder after an experience she chose not to disclose, the 12-week one-on-one counseling she received through Rutgers counseling and psychiatric center helped her cope with her cycle of anxious thoughts and panic attacks.
“The therapy basically changed the way I think about myself and the world around me,” she said.