Why Do College Students Shun Help for MH Problems?

Psychiatric illness, especially substance abuse, is prevalent among college students, but only about 1 in 20 students with a drug or alcohol use disorder report receiving any treatment for their condition in the preceding 12 months.

And a romantic breakup or loss appears to be a high risk factor for psychiatric illness among this population.

Those were two key findings from a national epidemiologic survey of college students and same-age peers not attending college. The report, “Mental Health of College Students and Their Non-College-Attending Peers: Results From the National Epidemiologic Study on Alcohol and Related Conditions,” appeared in the December 2008 Archives of General Psychiatry.

“Clearly, much more needs to be done to make mental health and substance abuse treatment accessible to young people,” co-investigator Marc Olfson, M.D., told Psychiatric News. “This might involve efforts to extend access to self-help groups, college counseling centers, and mental health professionals within student health centers or deans' offices. Such efforts might take the form of voluntary and confidential mental health screening, collegewide efforts to destigmatize mental health care, and greater availability of the services themselves. The time between illness onset and first treatment tends to be especially prolonged in addictive disorders, and concerted efforts will likely be required to accelerate the flow of young people in need of treatment into care.”

Jerald Kay, M.D., chair of APA's Corresponding Committee on College Mental Health, said the study shows that advances in combating stigma and extending access to care and in addressing the topic of suicide on campus have not been extended to the area of alcohol and drug use disorders.

“I think a reason why [college students] may not get treatment for alcohol abuse has a lot to do with the nature of being on a college campus, where alcohol use and binge drinking are so pervasive,” Kay told Psychiatric News. “Students may be much less likely to see alcohol abuse as pathological, but if they do, there is greater stigma attached to it. A take-home message is that despite the advances made in treating depression, we have not made a dent in treating substance abuse.”

Study Methodology Outlined

The 2001-2002 National Epidemiologic Survey of Alcohol and Related Conditions is a nationally representative sample of the adult population of the United States conducted by the U.S. Census Bureau under the direction of the National Institute on Alcohol Abuse and Alcoholism.

The final sample included 43,093 respondents drawn from individual households and group quarters and had a response rate of 81 percent; African-American individuals, Latino individuals, and young adults (aged 18 to 24) were oversampled. Data were adjusted to account for oversampling and respondent and household nonresponse. The weighted data were then adjusted using the 2000 Decennial Census to be representative of the U.S. civilian population for a variety of sociodemographic variables.

For the purposes of this study, Olfson and colleagues focused on the population aged 18 to 24. Of these, 2,188 attended college, and 2,904 did not.

All of the diagnoses were made according to DSM-IV criteria using the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule–DSM-IV version. History of conduct disorder and personality disorders was assessed on a lifetime basis.

The number of stressful life events was measured with 12 items from the Social Readjustment Rating Scale. Such events include having been fired from a job, breaking up with a boyfriend or girlfriend, moving residence, or having had one's property intentionally damaged by someone in the last 12 months. To estimate rates of mental health service utilization, respondents were classified as using mental health services if in the past year they had sought treatment for a mood or anxiety disorder from a physician, psychologist, or other health or medical professional; were a patient in a hospital for at least one night or visited an emergency department for a mood or anxiety disorder; or were prescribed medications for a mood or anxiety disorder.

Respondents were classified as receiving treatment for substance use disorders if they visited a physician, psychologist, or other professional; were a patient in an inpatient ward of a hospital, an outpatient clinic, a drug detoxification or rehabilitation unit, or a methadone program; visited an emergency department or crisis center; or received treatment by a paraprofessional, through an employee assistance program or family or social services, or attended self-help groups.

Two Groups Have Different Problems

Researchers found that the most prevalent disorders in the college students were alcohol use disorders (20.37 percent), followed by personality disorders (17.68 percent). In the non-college-attending individuals, personality disorders were most prevalent (21.55 percent), followed by nicotine dependence (20.66 percent).

College students were significantly more likely than their non-college-attending peers to have an alcohol use disorder in the preceding 12 months (20.37 percent compared with 16.98 percent) but were significantly less likely to have a diagnosis of drug use disorder or nicotine dependence or to have used tobacco than their non-college-attending peers.

Moreover, college students were less likely to receive treatment for an alcohol abuse disorder than non-college attending peers.

“It is likely that college students have many more opportunities than their non-college-attending peers to socialize with people of their own age,” Olfson said. “A student culture may develop that supports or normalizes heavy drinking. If, for example, a student misses a class because he or she is hung over following a night of heavy drinking, other students may view this as normal. To the extent that such student attitudes exist on college campuses, they will reduce appropriate substance use treatment seeking behavior.”

Olfson also drew attention to the finding that a significant risk factor for psychiatric illness was the occurrence of a romantic breakup or loss.“ After controlling for a wide range of factors, the odds of meeting criteria for a psychiatric disorder were more than 2.5 times higher for young people from both groups who recently broke off a steady relationship than those who had not,” he said. “The importance of this association is underscored by the commonness of such losses in this age group: approximately 1 in 8 individuals reported a breakup in the past year.”

Kay said that APA, through the Corresponding Committee on College Mental Health, participates in the Higher Education Mental Health Alliance, composed of the American College Counseling Association, American College Health Association, Association for University and College Counseling Directors, and American Psychological Association, among others. He said the purpose of the group is to advocate for recognition and treatment of mental illness among college students and for the development of policies and dissemination and promotion of research relevant to college mental health.

“Mental Health of College Students and Their Non-College-Attending Peers: Results From the National Epidemiologic Study on Alcohol and Related Conditions” is posted at<http://archpsyc.ama-assn.org/cgi/content/full/65/12/1429>.▪