Experts and researchers use terms like "epidemic" and "crisis" to characterize the mental health challenges currently facing American college students.
Statistics back up these claims. According to 2018 and 2019 student surveys from the American College Health Association (ACHA), about 60% of respondents felt "overwhelming" anxiety, while 40% experienced depression so severe they had difficulty functioning. A 2019 Pennsylvania State University study noted that demand for campus mental health services spiked by 30-40% during a period that saw only a 5% increase in enrollment.
Mood disturbances represent only some of the prevalent mental health issues experienced by college students. Others include serious problems like suicide, eating disorders, and addiction. Mental health professionals stress the importance of talking about such issues, but students tend to consider these stresses a normal part of college life. In other cases, they may lack the time, energy, will, and/or money to seek the support they need. This guide contains information to help students identify potential mental health issues and locate valuable community resources.
Depression is a mood disorder that involves persistent feelings of sadness, hopelessness, and loss of interest in previously enjoyable activities. People experiencing depressive episodes may also experience mood swings, sleep disturbances, appetite changes, and headaches and body pains that have no apparent physical cause.
ACHA's 2018 survey indicated that 40% of American college students experienced at least one major depressive episode that year. Referencing data from two comprehensive surveys, a Reuters article published in August 2019 reported that severe depression rates among U.S. college students doubled from 2007-2018.
Symptoms for depression differ from person to person. Ultimately, depression is a result of a chemical imbalance in our brains. The way one person displays signs of depression is not necessarily the way symptoms emerge in others. According to the American Psychological Association, symptoms of depression include (but are not limited to) the following:
- Physical Well-being Symptoms
Changes in sleep habits and appetite changes.
- Emotional Symptoms
Sadness, feelings of being overwhelmed, feelings of hopelessness, and feelings of powerlessness.
- Thinking Symptoms
Seeing a glass "half-empty," having trouble concentrating and paying attention, difficulty reading and completing work tasks.
Displaying some of these symptoms does not necessarily mean that you are depressed. However, if you begin to experience these symptoms with some regularity, you should seek assistance, if only to be on the safe side.
Identifying these issues in others can be tricky, as students often downplay or simply never talk about things deeply bothering them. Students often stay quiet due to insecurity, fear of standing out, or embarrassment. Furthermore, peers can easily misdiagnose one another, sometimes making matters worse.
As such, if you experience these symptoms, seeing a mental health professional is this best course of action.
Recognizing the Signs
Recognizing signs of depression in yourself and others can be difficult. Everyone has off days or times when they become overwhelmed with life. However, when days become weeks and simply getting out of bed becomes a struggle, this is cause for concern.
What Should You Do If You Start to Notice Signs of Depression in Your Friend?
Here are some signs of depression to look for in friends:
- They are not enjoying activities they once loved
- They no longer attend classes or social outings
- They are experiencing extreme anger or sadness over a relationship in their life
- They react negatively or with apathy to most things
- They often talk about death or suicide
Words of encouragement show your friend you are a source of support. Avoid telling your friends to "cheer up" or "snap out of it." Many people experiencing depression are aware of their condition, and telling them to get over it is not helpful.
If you feel your friend is at risk, gently encourage them to seek help and offer to accompany them to a student health center or a doctor's appointment. While talking through their issues with you may be helpful, it is not a substitute for treatment.
How Do You Know If You're Depressed?
Ask yourself the following questions:
- Have you experienced extreme sadness or hopelessness?
- Does your family have a history of depression?
- Have you turned to heavy drinking or drug use to relieve feelings of hopelessness?
- Have you experienced invasive thoughts of death or suicide?
If you answered yes to any of the above questions, consider contacting your primary healthcare provider or your student health center for a mental health assessment.
Support groups can also make a big difference. The Depression and Bipolar Support Alliance offers a geographical locator for support groups. The Anxiety and Depression Association of America (ADAA) also offers support groups.
People who have depression often feel as if they are alone and have no one to turn to. But it's important to understand that isn't the case, as people care and want to help. People with depression also have resources at their disposal that they may not know about. For example, the following organizations are dedicated to providing resources for those living with depression:
This organization promotes the prevention, treatment, and cure of anxiety, depression, and related disorders. Its website offers insight into understanding depressive mental illnesses, provides links for those seeking help, and identifies mobile apps designed to help people living with depressive illnesses.
A division of the U.S. Department of Health and Human Services, NIMH works to transform the public and scientific understanding and treatment of mental illnesses through clinical research, paving the way for prevention, recovery, and cures. NIMH offers information on pinpointing signs and symptoms of mental illnesses, resources for seeking help, and opportunities to participate in clinical trials to further research.
This online resource is for college students seeking mental health wellness. It provides tips on how to help friends in crisis and ideas for developing better wellness habits.
ACHA promotes healthy campus communities and is a principal leadership organization for advancing the health of college students. The organization's website provides helplines, brochures on different types of depression, and external links.
This foundation offers online resources designed to promote emotional health and prevent suicide among college students.
This initiative identifies warning signs through social media. The Half of Us campaign promotes mental health awareness nationally through on-air and live events and connects students with healthcare providers.
Everyone experiences anxiety from time to time. However, mounting, ongoing feelings of worry, tension, and panic can interfere with daily life. When your daily life is disrupted, anxiety crosses the line to become a medical condition.
In a Pennsylvania State University study published in 2016, 61% of survey respondents identified anxiety as a leading student mental health issue.
- Generalized Anxiety Disorder (GAD)
Constant, severe anxiety that interferes with day-to-day activities.
- Obsessive-compulsive Disorder (OCD)
Unreasonable thoughts, fears, and obsessions that lead to repetitive behaviors or compulsions.
- Panic Disorder
Characterized by frequent sudden attacks of terror, panic, and constant fearfulness.
- Post-traumatic Stress Disorder (PTSD)
A condition triggered by experiencing or witnessing a terrifying event.
- Social Anxiety Disorder (SAD)
A disorder in which everyday interactions cause irrational anxiety, fear, self-consciousness, and embarrassment.
Symptoms of anxiety disorders may sometimes be mistaken for everyday stress or simply written off as someone worrying too much. Depending on how your body responds to increased levels of certain chemicals, panic attacks may be mistaken as a physical ailment, such as a heart attack or a tension headache. Symptoms manifest differently in each person, so what is true for you won't necessarily be true for a friend.
Symptoms for anxiety disorders include the following:
|Feelings of stress and apprehension||Shortness of breath|
|Trouble concentrating||Muscle pain and tension|
|Sweating and dizziness||Frequent upset stomach or diarrhea|
The exact causes of anxiety disorders aren't fully understood, but they may include a combination of genetics, naturally occurring brain chemicals, life experiences, and stress. Comparatively affordable treatment options are available to students on campus, and ADAA provides a list of affordable treatment plans and resources.
Recognizing the Signs
Brief and occasional flashes of anxious feelings or behavior do not automatically indicate a mental illness. However, if anxious feelings persist, or if they begin to manifest in obsessive behavior or an overwhelming sense of fear, then it's time to seek help.
What Should You Do If You Start to Notice Signs of an Anxiety Disorder in a Friend?
Your friend may have an anxiety disorder if they display these behaviors:
- Have experienced a tragic event and do not develop healthy coping habits
- Appear to live in constant fear of failure — academically or socially
- Are uncomfortable and extremely anxious in social atmospheres
- Have trouble concentrating or seem to have a blank mind
- Seem plagued with guilt or stress
- Have visible panic attacks
Avoid criticizing or belittling the severity of your friend's symptoms and encourage them to try coping strategies that avoid causing further anxiety (such as those recommended by ADAA). Encourage your friend to visit a campus healthcare center and discuss their troubles with a professional.
How Do You Know If You Have an Anxiety Disorder?
If you suspect you have an anxiety disorder, here are some questions to ask yourself:
- Are you experiencing anxious or worrisome thoughts on a daily basis?
- Are you plagued by fears others perceive as unfounded or irrational?
- Do you avoid everyday social activities because they cause you anxiety?
- Do you experience sudden, heart-pounding panic attacks?
- Is your anxiety interfering with your school work, social life, or family?
If you answered yes to any of the above questions, consider consulting your primary healthcare provider (or your student health center) for a mental health assessment. An assessment can help determine if you are experiencing an anxiety disorder.
The following organizations are excellent resources for students with anxiety disorders.
ADAA promotes the prevention, treatment, and cure of anxiety, depression, and related disorders. The association's website offers insight into how to better understand depressive mental illnesses. Additionally, it suggests several mobile apps that cater to users with depressive illnesses.
APA is dedicated to advancing the creation, communication, and application of psychological knowledge to benefit society. Its website offers insight into the differences between anxiety disorders and depression, as well as tools to help you locate a psychologist.
ARC is a nonprofit dedicated to offering assistance to those who have anxiety disorders. Its website features a lengthy list of education materials, a newsletter, and a blog to help visitors stay updated on breakthroughs in research and trends.
This nonprofit maintains resources for people with social anxiety. Its website provides links to support groups, information on how to find health professionals, news and updates on the disorder, and extensive information on treatment options.
This website features suggestions and resources to help students cope with and conquer OCD in college. The organization also helps people find support groups in their area.
Remember: If you feel that someone's life is in danger, immediately call 911. It's important that anyone who may be suicidal receives the help they need as soon as possible. A majority of college students who take their lives have a diagnosable and treatable mental illness.
Mental health professionals define suicidal ideations as a prevalent pattern of thinking about or planning one's own death by one's own hand. Generally, experts consider overwhelming or highly detailed suicidal thoughts a mental health crisis.
The Association of American Universities reports that 20% of American college students reported suicidal ideations in 2018. News articles from 2019 revealed that suicide rates among young Americans were at their highest-ever levels, speaking to a crisis that extends beyond campus into society as a whole.
Recognizing the Signs
Many students experience frustration and doubt, but sometimes those thoughts gain an intense momentum, bringing students to a place where they seriously consider ending their lives. Signs of suicidal ideation differ from person to person. According to ADAA, common warning signs can appear in a person's speech, mood, and behavior.
Suicidal people may talk about feeling trapped, feeling as if they are a burden to others, feeling like they have no reason to go on, and ending their lives.
Individuals experiencing suicidal ideation often display a variety of moods, including anxiety, irritability, loss of interest in activities they enjoyed before, humiliation, rage, and depression.
People considering suicide may exhibit specific behaviors, including giving away possessions they once prized, withdrawing from friends and family, inexplicably visiting people to tell them goodbye, and searching online for means of committing suicide. They may also sleep poorly or too often, behave recklessly, display aggression, and increase their use of drugs and alcohol.
If you see any of the behaviors listed above in a friend, it's important to talk to them about your concerns as soon as possible. They could be in a fragile state, so approach them with patience and help them seek out a mental health professional. If you're unsure how to approach your friend, you can consult online suicide prevention programs like Crisis Clinic for specific advice
What Should You Do If You Start to Notice Suicidal Behavior in Your Friend?
If you are concerned that a roommate, friend, or peer is suicidal, contact your campus counseling center immediately. Students who are suicidal often communicate their intent to those around them, so beware of signs of depression and do not take their actions lightly.
ADAA recommends five steps to take if you suspect someone you know is suicidal:
- Ask them directly, "Are you considering killing yourself?" This may seem blunt. However, according to ADAA, studies show that this question does not increase the likelihood of suicidal thoughts, and it's an important foundation for the next steps.
- Make safety a priority. If they answer positively to step one, ask them if they have a plan. While it may not be easy, removing lethal objects and items in the dorm or home, such as guns, can also make a big difference.
- Be there for them. Sometimes the most you can do for someone is simply to be there for them when they need you. Listen to what they have to say. Acknowledge and talk to them about the realities of suicide. According to ADAA, this can reduce suicidal thoughts.
- Give them the tools to help themselves. Save the National Suicide Prevention Lifeline's number — (800) 273-8255 — in your phone. If possible, also save this number in your friend's phone.
- Remain in contact. Staying in contact makes a big difference and can potentially save the life of an at-risk person.
How Do You Know If You Are Suicidal?
Suicidal thoughts often stem from a preexisting mental condition. Depression, which causes distorted thinking, can sometimes lead to suicidal thoughts. Feeling completely overwhelmed and helpless from anxiety may also lead you down this path. Mental illnesses left untreated can have dire conclusions.
If you are thinking about ending your life, tell a friend or call your mental health center as soon as possible. Suicide is a preventable tragedy, and if you're feeling alone or hopeless, it's crucial that you understand that there are people out there who care.
Suicide Prevention Resources
There are many resources available to you through your on-campus student health center or through the following organizations, which are dedicated to preventing suicide.
Active Minds is an organization dedicated to educating and changing the conversation about mental health on college campuses. The organization administers over 400 chapters on campuses across the U.S. that teach suicide prevention techniques for students and faculty. The organization's website offers a list of resources for students in crisis and features a therapist/counseling search tool.
Dedicated to improving the lives of Americans affected by mental illness, NAMI provides information on suicide prevention, a link to a 24-hour suicide lifeline crisis chat, a text support line, and social networking groups that help more people join the conversation.
AFSP works to end and prevent suicide through research, education, and advocacy. The organization's website provides a wealth of information on suicide statistics in America. Visitors can also read about prevention techniques and peruse a list of available resources. The foundation hosts Out of the Darkness walks on campuses across America to raise funds for youth suicide prevention, to reach out to students, and to help create safer environments.
Calling the toll-free number (800) 273-8255 connects those in need to compassionate people who are there to provide the emotional support some can't find anywhere else. Counselors help family and friends of at-risk individuals find ways to help their loved ones. All calls are confidential.
The Trevor Project provides LGBTQ individuals of any age a safe space to talk and find support. Individuals can call the toll-free Trevor Lifeline — (866) 488-7386 — for 24/7 intervention and suicide prevention help.
Eating disorders cover a variety of conditions marked by major irregularities in individual eating habits and an intense preoccupation with one's body image or shape. Disorders can involve both food deprivation and binge eating, which may be followed by purging.
2018 statistics from the National Eating Disorders Association reported that 10-20% of female college students have an eating disorder, and that rates continue to rise. Male students experience lower incidences of 4-10%.
As defined by the National Association of Anorexia Nervosa and Associated Disorders (ANAD), examples of common eating disorders include the following:
- Anorexia Nervosa
Characterized by an unhealthy fixation on thinness, a distorted body image, and fears of gaining weight, this disorder commonly results in emaciation.
- Bulimia Nervosa
Bulimia nervosa is a binge eating disorder, involving recurrent and frequent episodes of eating unusually large amounts of food, followed by behavior that compensates for binging, like purging, fasting, or over-exercising.
- Binge Eating Disorder
Binge eating disorder is characterized by constant cravings that occur any time of day and result in binge eating. This disorder is often associated with poor body image and low self-esteem.
The signs and symptoms of eating disorders vary by person and condition, and many depend on the mental state of the individual with the disorder. However, there are several red flags that are common factors for anorexia, bulimia, and binging, including the following:
|Distorted or poor body image||Excessive exercise|
|Feeling like eating is out of control||Fear of eating in public|
|Constantly making excuses for eating habits|
Many college students do not seek treatment for their eating disorder, nor do they believe they have developed a problem. Eating disorders can be life-threatening issues and can contribute to the following serious health issues if not treated properly.
|Kidney failure||Failure in the reproductive system|
|Stunted growth||Heart problems|
|Loss of menstruation|
Recognizing the Signs
We all have days where our self-image isn't the best. Remember that experiencing a few negative episodes does not necessarily mean someone is at risk.
However, when random complaints about weight become all a friend can focus on, or when you notice they have started skipping meals or binging on junk food and then feeling guilty, it may be time to act.
What Should You Do If You Think Your Friend Is Developing an Eating Disorder?
Here are some signs to look for:
- Is your friend skipping meals or only eating small portions?
- Is your friend suddenly uninterested in foods they once loved?
- Is your friend limiting their meals to foods very low in calories?
- Is your friend taking diet pills excessively or medication that suppresses hunger, such as Adderall or Ritalin?
- Does your friend disappear suddenly to the restroom after meals?
- Are your friend's teeth noticeably stained?
- Are they using mints after trips to the bathroom or perfume to mask the smell of vomit?
If you answered yes to any of these questions, your friend could be developing an eating disorder. If you need help approaching your friend, consult the National Eating Disorder Association.
How Do You Know If You Have an Eating Disorder?
Here are some questions to ask yourself:
- Do you refuse to eat food or skip meals?
- Do you fear eating in public with others?
- Do you count calories out of a need for control?
- Do you have strict eating habits that you feel guilty and ashamed for breaking?
- Are you obsessed or dissatisfied with your weight or body shape?
- Do you find yourself eating large amounts of food and then purging or making yourself vomit?
- Have you noticed excessive hair growth on your arms and face or loss of your menstrual cycle?
If you answered yes to any of these questions, do not delay seeking treatment. Eating disorders can become life-threatening, and it's important to receive treatment as soon as possible.
Eating Disorder Resources
If you need assistance helping a friend through an eating disorder, or if you need to understand more about them before you come to terms with the fact that you may have one, the following list of resources are a good place to start.
NEDA is dedicated to improving the understanding of eating disorders in America. Its website provides a list of information regarding support groups, treatment referrals, and research studies.
ANAD is dedicated to the prevention and alleviation of eating disorders. The organization maintains a helpline and email address to provide information and answer questions. ANAD also hosts an annual conference that connects patients with healthcare providers and support.
This global network is dedicated to the research, education, prevention, and treatment of eating disorders. AED is a great resource for learning about the differences between eating disorders, identifying signs and symptoms, and finding professionals in your area.
Eating Disorder Hope provides information on education and awareness, recovery tools, and access to treatment and support. The organization also maintains a blog to help college students with eating disorders.
ACHA promotes healthy campus communities and works to advance the health of college students. The association's website provides helplines, resources related to eating disorders, and external links to seek help.
College students frequently use alcohol and recreational drugs, which can become problematic. Addiction describes a tangible pattern of physical and/or psychological dependence on one or more substances, including strong cravings and indulgence in substance abuse despite known risks and harms.
Statistics from 2019 painted a sobering picture of addiction on American college campuses: alcohol plays a leading role in more than 1,500 annual deaths on college campuses, while 35% of students admit to recent binge drinking and 25% abuse stimulants to enhance studying. College students also abuse drugs like marijuana, ecstasy, benzodiazepines, cocaine, and prescription painkillers at high rates.
Many students who participate in alcohol and drug use in college do not develop an addiction. However, they can still feel the side effects of withdrawal or prolonged use of these substances, including the following:
|Slurred speech, bloodshot eyes, or impaired coordination||Fear, anxiety, or paranoia for no apparent reason|
|Built tolerance for alcohol and drug use; user needs to use more of the substance to obtain the same effects||Deterioration of physical appearance, such as weight loss or gain, and changes in personal grooming habits|
|Prone to suspicious behaviors, frequently get into fights, or trouble with the law||A sudden change in friends, activities, or hobbies|
|A sudden need for money or a financial crisis|
If you experience one or several of the symptoms above, you may be at risk. Genetics can contribute to your likelihood of developing an addiction, especially if there is a history of alcohol or drug abuse in your family. If you find yourself turning to drugs or alcohol more frequently to distract yourself from feelings of stress or sadness, contact your student health center. Addictions need to be taken seriously and treated effectively with the assistance of a professional healthcare provider.
Recognizing the Signs
It's not always clear when alcohol or drug use has turned from recreational to habitual. Friends who don't want to admit they have a problem will use tactics that evade and undermine your concerns.
What Should You Do If You Believe Your Friend Has an Addiction?
Ask yourself the following questions:
- Does your friend drink to relieve stress or suppress issues?
- Has their drinking or drug use interfered with their relationships with others?
- Have they withdrawn from activities or school work?
- Does your friend's life revolve around drug or alcohol use?
- Have they developed a change in personality?
- Have you noticed an unusual smell on their breath, body, or clothing?
Drug and alcohol addicts often conceal their symptoms or downplay their addiction. Therefore, it's important that you express your concerns when you notice warning signs. When they are sober, tell your friend you've noticed their excessive drug or alcohol use. Emphasize the positive sober behaviors you admire and the destructive drunk or high behaviors that concern you.
Don't be accusatory or judgmental, as this might cause your friend to withdraw and further ignore their issues. Offer to go with them to seek treatment at your student health center and help them consult resources online.
How Do You Know If You've Developed a Drug or Alcohol Addiction?
Ask yourself the following questions:
- Do you feel uncomfortable when drugs or alcohol are not available?
- Do you drink heavily when you are disappointed?
- Have you ever been unable to remember part of the previous evening, even though your friends say you did not pass out?
- Has a friend or family member expressed concern about your alcohol or drug use?
- Have any of your blood relatives had an addiction to drugs or alcohol?
- Do you sometimes want to continue your drug and alcohol use when you're by yourself?
If you answered yes to any of these questions, consult your healthcare provider today and find out what your options are for treatment.
Consult these resources to learn more about curbing addiction.
This database provides reports on recent research and prevention programs for alcohol and drug addiction. NIDA offers findings on the latest research projects, clinical trial opportunities, and guidance for those seeking treatment.
SAMHSA is an agency within the Department of Health that works towards advancing and improving behavioral health in the United States. This website provides extensive information on substance abuse and a treatment locator by ZIP code. SAMHSA's national hotline — (800) 662-4357 — is available 24/7, 365 days a year for individuals dealing with substance abuse.
This organization works to support entire families as they address substance use and addiction, from prevention to recovery. Individuals can visit Center on Addiction's website and browse through a library of reports, journals, and books related to addiction.
This famous 12-step program gives alcoholics the opportunity to rebuild their lives and learn to live without alcohol. AA provides members with a support group and sponsor to help them through rough patches. You can find a location for a meeting near your ZIP code on AA's website.
Much like AA, NA administers a 12-step program designed to help those who have developed a dependency on drugs.
Know Your Rights As a Student
In the United States, federal and state laws prohibit colleges and universities from discriminating against students experiencing mental health issues. Institutions must support learners seeking help or treatment by offering academic deferments, leaves of absence, and other accommodations. Privacy laws protecting student confidentiality also apply, while disability laws play a role in cases of pervasive dysfunction.
According to the Americans with Disabilities Act (1990) and Section 504 of the Rehabilitation Act (1973), colleges must make "reasonable accommodations" to students with disabilities, including mental health challenges. Accommodations include policy and procedure modifications regarding issues like coursework and examinations. However, affected individuals must submit authoritative documentation regarding their limitations and the current state of their condition.