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?

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

soundoff (31 Responses)
  1. Alex Lickerman

    What is especially amazing and troubling about the stigma that still attaches to anxiety and depression is that some studies have suggested 45-50% of all Americans actually suffer from one or both to some degree! We are still the wealthiest nation on the planet (even in these terrible economic times) but far from the happiest. I completely agree that students are especially sensitive to the stigma that can accompany a formal diagnosis of depression or anxiety and therefore at greater risk not to get the help they need. Interestingly, I just posted an article called "The True Cause Of Depression" that addresses some of the very issues you bring out in this article. For those who might be interested, you can find it at:

    http://happinessinthis world.com

    Alex Lickerman, M.D.

    March 9, 2009 at 13:21 | Report abuse | Reply
  2. ktcasa87

    I had a very difficult time adjusting to life when I first started college, due to family problems and just natural stress from school that was just so different from anything I had ever experienced before. I got help at the campus health center for my problems, and I was able to go through about 6 months of much needed therapy that helped me tremendously. I highly, highly recommend these services to anyone who thinks it might be helpful even in the smallest way. It definitely turned my life around in the best way.

    March 9, 2009 at 15:45 | Report abuse | Reply
  3. Lucy

    This morning, I came across this: http://oas.samhsa.gov/2k9/SPDtx/SPDtx.htm

    Why are these studies conducted door-to-door? Isn't there a more efficient way of getting good information? I hope there is more research going on in this area.

    Mental health treatment for college-age people worries me, too. Wouldn't it be more helpful to assign an academic advisor (who is also a psychologist) to each student that they are required to meet with once a month or at the least once a semester?

    I have issues with stress and depression. My list of antidepressants in my personal history is pretty long, and none of them really helped completely. Side effects outweighed the benefits. What does help are what I think are called "mood stabilizers". The diagnosis is bipolar disorder, and the meds mostly help with the manic part of my nervous system. For depression, I absolutely have to keep busy and stay in touch with people. Exercise helps, but only in a biochemical sense. In my opinion, what is going on with me is so multifaceted that my psychiatrist has no choice but to call me a complicated person. I have a thyroid disorder (Hashimoto's) which shares some symptoms with perimenopause. I have some situations in my life that would trigger situational depression in anyone (recent loss of my only son, for example). Then there are normal biochemical problems that can be alleviated with diet and exercise. Finally, there are the abnormal biochemical problems that I understand have to do with my serotonin level and other stuff that I wish I knew more about.

    A former psychiatrist of mine suggested that the reason scientists don't know much about mental illness is because in order to get the most accurate information, you would have to biopsy the brain, and most people aren't willing to be guinea pigs for that sort of thing. Personally, I think that one's mental health is more dependent on individual body chemistry than generalized symptom lists, and that there are too many variables to pin down the exact right form of treatment for everyone.

    March 9, 2009 at 16:18 | Report abuse | Reply
  4. t

    I was fortunate at one point to attend a University that had a good mental health program. That was in the late '80s early 90's. Since I first encountered treatment for mental health in the early '80s I have experienced bad and good treatments/counselor/doctors. In the end I found that nothing works and apologize for being one who has increased the cost to $247 Billion. The stigma of mental health will not change because we as a society have not been able to change our views. Even in college, and the working world, as an individual with mental health issues I have seen people change their view of who I am once they have found that I have mental health challenges. They want to help me, but no longer feel I have anything to offer.

    March 9, 2009 at 21:35 | Report abuse | Reply
  5. Amy J. Banuchi

    I have experienced panic/anxiety attacks firsthand and it is true that there is such a social stigma attached to these kinds of illnesses. But that's exactly the problem. They aren't viewed by many people as illnesses, but as emotional problems. Having been to the hospital several times for anxiety, I know how hard it is to cope with this kind of this. I hope and pray that people will find freedom from this . It is our responsibility also to educate people about depression/anxiety to foster a greater understanding and sympathy towards those who are in the midst of it.

    March 9, 2009 at 22:23 | Report abuse | Reply
  6. Diane

    Complicating matters is that if a student at a university actually had a serious problem, seeking out counseling services for suicidal thoughts can bring its own set of complications. As much as the universities might want to help their students, they certainly don't want to be liable if they get hurt. So, a student seeking help for severe depression might find themselves expelled from student housing and/or the university (or placed on mandatory "leave".)

    March 10, 2009 at 11:45 | Report abuse | Reply
  7. Cheryl

    When mass murders are committed, the first thing that I want to know is what drug was either started or stopped and when was it done. Please ask for us. The public needs to know that psychiatric drugs are prescribed to people who may not benefit from them, by the “guess” method without a shred of definitive evidence, without a thing to measure that would suggest them to be appropriate. The chemical imbalance theory of psychiatry is a successful marketing tool, not fact. (No, I am not a Scientologist. I am a pharmacist.) People are dying from the use of these drugs, the lives of others are destroyed, but no one is watching because it is always assumed that the patient was a mental patient before the drugs. The evidence is overwhelming that these drugs cause the very conditions that they are marketed to cure. Follow the money!

    States have sued pharmaceutical companies for their marketing practices, while they allow doctors to continue using the drugs, not as single agents, but in untested combinations in non-consenting patients, indeed patients too drugged to give consent. Regulatory bodies and justice departments actually cover up for these doctors. Meanwhile the doctors take kickbacks for providing feedback on their experimental patients to pharmaceutical companies. This is in direct violation of the Nuremberg Code but nothing can be done because law enforcement and the FDA turn away, and tort reform has absolutely slammed the door in the faces of those who would otherwise take the facts to a jury.

    So, please, whenever you need to ask, “What made him do it?” ask also, “What drug made him do it.” and tell us what you learn.

    Jamie, before you write another piece, please read the following books: Psyched Out by O'Meara, Medication Madness by Breggin, and Generation Rx by Critser. I can recommend others but these will make you think a bit more clearly about what is happening.

    March 12, 2009 at 11:19 | Report abuse | Reply
  8. Lucas Parker

    in third world countries, mental health is never a priority.;`'

    June 17, 2010 at 22:50 | Report abuse | Reply
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    mental health is more important than body health yet most people just ignores it.."-

    July 26, 2010 at 12:02 | Report abuse | Reply
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    mental health should always be monitored closely in the same way we monitor the health of our body*;.

    September 12, 2010 at 12:30 | Report abuse | Reply
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    mental health is just as important as your organ's health so always keep your head in check too";:

    October 12, 2010 at 13:21 | Report abuse | Reply
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    mental health is of course very important but most people just ignore it and focus more on their body :–

    December 14, 2010 at 12:59 | Report abuse | Reply
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