A survey answering that question also found that the odds of meeting
criteria for a psychiatric disorder were higher for students who had recently
experienced the end of a romantic relationship than those who did not.
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
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
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
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
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.
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
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
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
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>.▪