March 9th, 2009
11:59 AM ET

Stigma still hindering campus mental health care

By Jamie Guzzardo
CNN Medical Intern

As I sift through my final semester of college, I realize what an exhilarating, yet incredibly stressful, experience the last four years have been. Students’ lives are jam-packed with papers, exams, hectic schedules, conflicts with roommates, and newfound sexual and social freedom. Living in an environment filled with all-nighters, parties and alcohol can undermine any student’s focus, but for those with a psychiatric disorder, the challenges can prove exceptionally difficult.

According to the American College Health Association’s 2007 National College Health Assessment, stress is the No. 1 reported impediment to academic performance. Depression and anxiety disorders are among the Top Ten. The survey also found that nearly half of all college students reported feeling so depressed at some point in time that they have trouble functioning, and depression was diagnosed in 24.8 percent of students within the past school year alone.

Depressed students, fearing they will be stigmatized or labeled “crazy,” may further fuel their isolation by not sharing their feelings with a friend, roommate or an on-call clinician. They may also hesitate to speak with a professor, fearing a negative impact on their grades. It often becomes easier for a student to retreat further into his or her depression, rather than turning to parents and siblings who are often far away. The results can be tragic. According to the American College Health Association, suicide remains the second leading cause of death for college students.

The good news for students is that many colleges are keenly aware of the health impacts of stress and depression, and the majority of schools around the country provide free and confidential mental health counseling services. But according to a 2008 survey conducted by the National Epidemiologic Survey on Alcohol and Related Conditions, getting students to actually use these resources can be a problem. They found that while almost half of all college-age students meet the criteria for substance abuse, personality disorders or other mental diseases, only one-fourth actually seek treatment. But since counseling services are free and confidential, how can we ensure that students will actually use them?

Reducing the public stigma surrounding mental illness is one place to start, and this is something the American Psychiatric Association has long pushed for. A 2006 study published in the journal Social Science and Medicine found that while most Americans believe that mental illness has genetic causes, they are no more tolerant to the disease now than they were 10 years ago. Both Tipper Gore, wife of former vice-president Al Gore, and former first lady Rosalynn Carter, have been a longtime advocates for mental illness, and each has stressed the importance of reducing the mental health stigma. While their work is important and has begun to make a significant impact, it is not enough. Young people need more role models to look up to – they need to know it is OK to talk about mental illness and to ask for help. Seeing a high-profile star speak openly about the issue could show young people that open dialogue is nothing to be ashamed of.

Another way to impact college mental health is through early preventive measures. According to a new report from the National Research Council and Institute of Medicine, the weight of research is currently shifted towards treatment programs. However, since the first symptoms of a disorder usually occur two to four years before full-blown onset, these preventive programs could create a window of opportunity and make a long-term difference. With health care costs exploding and, according to this report, mental disorders costing the U.S. an estimated $247 billion annually, preventive measures could help ease the financial burden placed on the health care system by repeated hospital stays, long-term therapy and even some rehab costs.

Some of these preventive programs have already been implemented and have seen some success. The Clarke Cognitive-Behavioral Prevention Intervention helps adolescents at risk for depression learn to deal with stress. In several controlled experiments, this has been beneficial in helping prevent major episodes of depression. Likewise, TeenScreen National Center for Mental Health Checkups at Columbia University works towards early detection and suicide prevention by making evidence-based mental health checkups a more routine part of adolescent health care. These checkups ask teens about common issues in their lives and can identify potential problems, granting teens and their families access to professional services that can improve their prognosis or even save their life.

It is my hope that the next generation of college students will benefit from these types of preventive programs and that the stigma surrounding mental health will be significantly reduced so that they have a happy, healthier college experience.

Have you experienced stress or depression, or do you have a friend or family member who has? How did you manage it?

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