Student Stress, Anxiety, and Mental Trouble

Anxiety has now surpassed depression as the most common mental health diagnosis among college students, though depression, too, is on the rise. ...

Nearly one in six college students has been diagnosed with or treated for anxiety within the last 12 months, according to the annual national survey by the American College Health Association. [actually 14.3%, according to http://www.acha-ncha.org/docs/ACHA-NCHA-II_ReferenceGroup_ExecutiveSummary_Spring2014.pdf ] ...
Anxiety has become emblematic of the current generation of college students, said Dan Jones, the director of counseling and psychological services at Appalachian State University in Boone, N.C. ...
“A lot are coming to school who don’t have the resilience of previous generations,” Dr. Jones said. “They can’t tolerate discomfort or having to struggle. A primary symptom is worrying....”
Indeed, Dr. Locke and his colleagues at Penn State, who have tracked campus counseling centers nationwide for six years, have documented a trend that other studies have noted: Students are arriving with ever more severe mental-health issues. ...
According to federal statistics, just 59 percent of students who matriculated at four year colleges in 2006 graduated within six years.
- Anxious Students Strain College Mental Health Centers, by JAN HOFFMAN, MAY 27, 2015, http://well.blogs.nytimes.com/2015/05/27/anxious-students-strain-college-mental-health-centers/

Anxiety and depression appear to be common among American students:

A survey of more than 123,000 students at 153 colleges by the American College Health Association in 2013 found that more than half experienced overwhelming anxiety and about a third felt deep depression during the academic year.
- Marc Brackett, Today’s Students May Be Emotionally Unprepared, NYT, June 22, 2016

According to a 2013 survey by the American College Health Association, 57 percent of female and 40 percent of male college students reported feeling overwhelmingly anxious, while 33 percent of females and 27 percent of males reported feeling seriously depressed. The association also found that suicide rates in young adults had tripled since the 1950s, with the National Alliance on Mental Illness estimating that a quarter of college students have had suicidal thoughts.
- Ashton Katherine Carrick, Drinking to Blackout, NYT, Sept. 19, 2016

An update on college student anxiety:

More than half of all college students report feeling “overwhelming anxiety” and over a third feel “so depressed that it was difficult to function.”
- Lisa Heffernan and Jennifer Wallace, For Freshmen, Campus Life Poses New Risks, NYT, Aug. 17, 2016, citing Undergraduate Students (National College Health Assessment, Fall 2015)

“I don’t know if it’s related to the way we parent, I don’t know if it’s related to the media or the pervasive role of technology—I’m sure there are a lot of different factors—but what I can tell you is that every campus I know is investing more resources in mental health,” he says. (Data confirm this.) Maybe it’s the pressure of school, he says, but maybe it also has to do with a welcoming gate. “Students are coming to campuses today with mental-health challenges that in some instances have been diagnosed and in some instances have not. Maybe, in previous eras, those students would not have been coming to college.” He pauses thoughtfully. “That’s all to the good, in terms of society, because it means that we are bringing in people to be productive and capable and supporting them.”
- Nathan Heller, THE BIG UNEASY: What’s roiling the liberal-arts campus?, The New Yorker, May 30, 2016

Thirty-nine percent of college students have gone binge drinking at least once in the previous month. Half of them use illicit drugs. The sexual culture on campuses is morally clouded, at best. One in four students has an S.T.D., according to one survey, while another shows a discrepancy between how male and female students understand sexual relationships: 66 percent of women say they are in a “committed” partnership, while only 38 percent of men say so. These statistics all feed into what the education reporter Craig Bandon calls “The Five-Year Party.”

And when it comes to offensive behavior, one rarely hears students critique or police pop music that is riddled with abusive-sounding insults, mostly about women. Profanity, in general, doesn’t seem to be something students worry about. Walk through a crowded cafeteria and curse words pop up gratuitously among students as if vocabulary has failed them. When I say, “Hey, ease up on the language, O.K.?” they look at me with incomprehension, not realizing they’ve said anything offensive.

College officials won’t tell students to avoid this kind of horrible stuff, though. Establishing behavioral codes that curtail hookup culture and profanity — those old-fashioned proprieties — are [sic] sexist and puritanical, we are told.

- Mark Bauerlein, Why Halloween at College Is So Frightening, NYT, Oct. 28, 2016 (Bauerlein is an English professor at Emory University, yet somehow fails to make his predicate agree with his subject when writing "Establishing... are...." It is not clear there is any basis for his claim that half of college students use illicit drugs. The source he cites reports that as of 2013, "annual prevalence of use of any illicit drug was nearly equivalent for college students (39%) and the noncollege respondents (40%).")

Seeing the growing insecurity of the working class, not to mention the poor, parents are determined to keep their kids on the right side of the income gap. They see the way to do that is providing ever more education and ever larger inheritances. Thus, if they can possibly afford it, they select the best private schools, trainers to give their children swimming, tennis, music, art, and every other sort of lesson, and make sure they participate in the requisite number of team sports and other extracurricular activities.

The children have no time left in their jam-packed days to explore their own interests or to read books that aren’t assigned in school—or just to lie in the grass, look at the clouds, and daydream. Instead, they fall into bed exhausted at the end of the day and wake to get on the treadmill again. A shy or introverted child is not acceptable, so some children might need the modern equivalent of charm school, which is often some sort of treatment for a putative psychological disorder. By the time some children are in high school, they’ve acquired a flotilla of private tutors to coach them in college entrance exams, and they’ve been trained in how to write exactly the right sort of essay, beginning with a proper topic sentence.

All of this takes an enormous amount of work and attention by the parents, not to mention serious money. And, I believe, it creates an enormous amount of anxiety in the children, who learn well enough that everything seems to depend on their performance, and that they’re in competition with similar children in the same class.

- Marcia Angell, Why Be a Parent?, NY Review of Books, Nov. 10, 2016

It is widely believed that the demand for mental health services in college is growing at an unprecedented pace. is belief is based on widespread anecdotal reports from clinicians, student surveys, surveys of counseling center directors, and a handful of data-driven reports from individual counseling centers.
To examine this question systematically from a national perspective, CCMH conducted a supplemental membership survey in November 2015 that asked counseling centers to provide the following specific data points over the last five academic years between 2009-2010 and 2014-2015: (1) total institutional enrollment during the Fall semester, (2) total number of students seeking services at the counseling center, and (3) the total number of attended appointments in the counseling center. Ninety-three CCMH members (out of a total of 120 responses) were able to provide complete data for both 2009-2010 and 2014- 2015 academic years. These 93 cases were used for the following five-year trend analysis.

The number of enrolled students, students seeking counseling services, and attended appointments were averaged across institutions, and the percentage of change was calculated for each data point. Results indicated that, on average over the last 5 years, institutional enrollment grew by 5.6%, the number of students seeking services increased by 29.6%, and the number of attended appointments increased by 38.4%. In other words, the number of students treated by counseling centers grew at more than 5x the rate of institutional enrollment and the number of attended appointments grew at more than 7x the pace of institutional enrollment.
- Center for Collegiate Mental Health, 2015 ANNUAL REPORT, p. 7

You might say Ms. Fader struck a nerve. “If you’re a human being living in 2017 and you’re not anxious,” she said on the telephone, “there’s something wrong with you.” ...
According to data from the National Institute of Mental Health, some 38 percent of girls ages 13 through 17, and 26 percent of boys, have an anxiety disorder. On college campuses, anxiety is running well ahead of depression as the most common mental health concern, according to a 2016 national study of more than 150,000 students by the Center for Collegiate Mental Health at Pennsylvania State University. ...
To Kai Wright, the host of the politically themed podcast “The United States of Anxiety” from WNYC, which debuted this past fall, such numbers are all too explicable. “We’ve been at war since 2003, we’ve seen two recessions,” Mr. Wright said. “Just digital life alone has been a massive change. Work life has changed. Everything we consider to be normal has changed. And nobody seems to trust the people in charge to tell them where they fit into the future.” ...
Scott Stossel, editor of The Atlantic, whose “My Age of Anxiety” helped kick off the anxiety memoir boom three years ago, urged people to pause, not for deep cleansing breaths, but for historical perspective.

“Every generation, going back to Periclean Greece, to second century Rome, to the Enlightenment, to the Georgians and to the Victorians, believes itself to be the most anxious age ever,” Mr. Stossel said.
- ALEX WILLIAMS, Prozac Nation Is Now the United States of Xanax, NYT, JUNE 10, 2017

Almost a decade ago, faculty at Stanford and Harvard coined the term “failure deprived” to describe what they were observing: the idea that, even as they were ever more outstanding on paper, students seemed unable to cope with simple struggles. “Many of our students just seemed stuck,” said Julie Lythcott-Haims, the former dean of freshmen at Stanford and the author of “How to Raise an Adult.”

They soon began connecting the dots: between what they were seeing anecdotally — the lack of coping skills — and what mental health data had shown for some time, including, according to the American College Health Association, an increase in depression and anxiety, overwhelming rates of stress and more demand for counseling services than campuses can keep up with.

It was Cornell that, in 2010 after a wave of student suicides, declared that it would be an “obligation of the university” to help students learn life skills.
- JESSICA BENNETT, On Campus, Failure Is on the Syllabus, NYT, JUNE 24, 2017

Rates of teen depression and suicide have skyrocketed since 2011. It’s not an exaggeration to describe iGen [born between 1995 and 2012] as being on the brink of the worst mental-health crisis in decades. Much of this deterioration can be traced to their phones.
- JEAN M. TWENGE, Have Smartphones Destroyed a Generation?, The Atlantic, SEPTEMBER 2017

In its annual survey of students, the American College Health Association found a significant increase — to 62 percent in 2016 from 50 percent in 2011 — of undergraduates reporting “overwhelming anxiety” in the previous year. Surveys that look at symptoms related to anxiety are also telling. In 1985, the Higher Education Research Institute at U.C.L.A. began asking incoming college freshmen if they “felt overwhelmed by all I had to do” during the previous year. In 1985, 18 percent said they did. By 2010, that number had increased to 29 percent. Last year, it surged to 41 percent.

Those numbers — combined with a doubling of hospital admissions for suicidal teenagers over the last 10 years, with the highest rates occurring soon after they return to school each fall — come as little surprise to high school administrators across the country, who increasingly report a glut of anxious, overwhelmed students. ...
The more she looked for explanations, the more she kept returning to two seemingly unrelated trend lines — depression in teenagers and smartphone adoption. ... Since 2011, the trend lines increased at essentially the same rate. In her recent book “iGen,” and in an article in The Atlantic, Twenge highlights a number of studies exploring the connection between social media and unhappiness. “The use of social media and smartphones look culpable for the increase in teen mental-health issues,” she told me.
- BENOIT DENIZET-LEWIS, Why Are More American Teenagers Than Ever Suffering From Severe Anxiety?, NYT, OCT. 11, 2017

The course, taught by Laurie Santos, 42, a psychology professor and the head of one of Yale’s residential colleges, tries to teach students how to lead a happier, more satisfying life.... ...

Dr. Santos speculated that Yale students are interested in the class because, in high school, they had to deprioritize their happiness to gain admission to the school, adopting harmful life habits that have led to what she called “the mental health crises we’re seeing at places like Yale.” A 2013 report by the Yale College Council found that more than half of undergraduates sought mental health care from the university during their time there.

“In reality, a lot of us are anxious, stressed, unhappy, numb,” said Alannah Maynez, 19, a freshman taking the course.
- DAVID SHIMER, Yale’s Most Popular Class Ever: Happiness, NYT, JAN. 26, 2018

Lucy, NJ, Sept. 7, 2018
As a teacher, I wholeheartedly disagree with much of what I read in this opinion piece. I have been teaching high school for ten years. The students today are very different from the students that I had only ten years ago. They lack depth of concentration, self-efficacy, often (but not always) have a limited sense of humor, do not understand sarcasm, and have buckets of test anxiety and social anxiety. While technology can be a tool, the impact of the increase in the use of cell phones and consequently social media among young people can visibly be seen in many classrooms across the country. Yes, all teens have normal human emotions that should not be over-analyzed. But it is also not normal have permanent traces of bullying left on your internet profile for perpetuity. It is not normal to stay up until 3 AM because you were on the internet all night as a sixteen-year old. It is not normal to have so much anxiety about every assignment you hand in that you hand them ALL in late. But the modifications that teachers are having to make to repeat and simplify instructions, reduce assignments, and reassure anxieties are just one sign of the tendencies of the generation.
- Comment on Richard A. Friedman, The Big Myth About Teenage Anxiety, NYT, Sept. 7, 2018

Mike Brooks, Austin, Sept. 7, 2018
There is solid data indicating that levels of stress, anxiety, depression, and suicide are going up among teens and young adults. Screens offer many benefits, but they are is a strong tendency to overuse them. ... Also, this time spent on screens can displace other activities that are more that are more need satisfying, such as sleep, physical activity, time outdoors, and in-person social interactions. Just as the types and quantities of foods that we now eat in America have lead to an obesity epidemic, in a similar fashion, our consumption of the digital can have health consequences. That's not a myth. We evolved to live in a world very different from the world in which we now live. This "evolutionary mismatch" has a price, and we are paying it.
- Comment on Richard A. Friedman, The Big Myth About Teenage Anxiety, NYT, Sept. 7, 2018

Diogenes, Belmont MA, Sept. 7, 2018
The digital age may not cause anxiety but it seems to be producing a generation that doesn't read and doesn't think.
- Comment on Richard A. Friedman, The Big Myth About Teenage Anxiety, NYT, Sept. 7, 2018

Hans Richter, San Diego, Sept. 7, 2018
As a teacher with 29 years of experience, I am wondering why your article did not bring up two important elements: multitasking and the prefrontal cortex (PFC). From my perspective, I agree that technology is not changing our brains, but it is the way that tweens and teens use technology that is the source of stress and anxiety.

More often than not, tweens and teens multitask and entertain themselves with something else while doing homework. This “something else” can be gaming, social media, video watching, or listening to music, and it often interferes with the immediate task at hand, be it studying for a Spanish quiz, writing an essay, or solving a set of math problems. It is a well-established fact that multitasking increases time on task and increases error rates, but young people with undeveloped PFCs cannot and will not accept that fact.

In human brains the PFC houses our executive centers and helps us navigate and make sense of our worlds. Teenagers do not have fully developed PFCs and are therefore more at risk for confusion and duping. As such, they believe in the myth of multitasking, and they are largely unaware of the addictive pitfalls of social media, gaming, and 24/7 entertainment — pitfalls that tech companies are starting to admit.
- Comment on Richard A. Friedman, The Big Myth About Teenage Anxiety, NYT, Sept. 7, 2018

They began arriving on college campuses in 2013. Rates of anxiety and depression soon skyrocketed, along with demands for trigger warnings, safe spaces and disinvitations to controversial speakers, as well as sometimes violent confrontations with such speakers when they did appear on campus. ...
Where Egginton sees a threat to democracy in a polity insufficiently and unequally educated in the liberal tradition, Lukianoff and Haidt notice something unprecedented and a lot more frightening: a generation, including its most privileged and educated members — especially these members — that has been politically and socially “stunted” by a false and deepening belief in its own fragility.
- Thomas Chatterton Williams, Does Our Cultural Obsession With Safety Spell the Downfall of Democracy?, NYT, Aug. 27, 2018

The launch of Gradiant coincides with unprecedented levels of depression and anxiety on college campuses, including at Stanford. In a 2017 American College Health Association survey, nearly 40 percent of college students said they had felt so depressed in the last year that it was difficult for them to function and 61 percent of students reported feeling "overwhelming anxiety" in the same period.
- Elena Kadvany, A new kind of college prep program, Palo Alto Weekly, Nov 2, 2018

Such testimonials make CBD seem like a perfect cure for our times. Every cultural era, after all, has its defining psychological malady. This also means that every era has its signature drug.

The jittery postwar era, with its backyard bomb shelters and suburban fears about keeping up with the Joneses, gave rise to a boom in sedatives, as seen in the era’s pop songs (“Mother’s Little Helper,” by the Rolling Stones) and best sellers (“Valley of the Dolls,” by Jacqueline Susann).

The recessionary 1990s gave rise to Generation X angst, Kurt Cobain dirges and a cultural obsession with newfangled antidepressants (see Elizabeth Wurtzel’s “Prozac Nation: Young and Depressed in America”).

The defining sociological condition today, especially among millennials, is arguably anxiety: anxiety about our political dysfunction, anxiety about terrorism, anxiety about climate change, anxiety about student loan debt, even anxiety about artificial intelligence taking away all the good jobs.

The anxiety feels even more acute since the wired generation feels continuously bombarded by new reasons to freak out, thanks to their smart devices.
- Alex Williams, Why Is CBD Everywhere?, NYT, Oct. 27, 2018

First, while talking about the “myth” of the teenage anxiety epidemic, he fails to mention that — whatever the cause — by age 18, almost one-third of youths will experience debilitating, clinical levels of anxiety. ...
Second, I agree with Dr. Friedman that kids and teenagers are facing an anxiety-provoking world, so distress is largely normal. But to dismiss parents’ instincts that our kids are in trouble and that technology may be part of the problem risks being both misguided and condescending.

Finally, Dr. Friedman argues, like many before him, that smartphones and video games are just another technological innovation that has triggered existential panic. ...
Tracy A. Dennis-Tiwary ...

The everyday lives of young people confront them with much more uncertainty about their futures than everyday life did for those of us who came of age in the 1960s and 1970s.

Young people today experience increased financial uncertainty relative to previous generations, with housing, education and health care costs having escalated astronomically relative to income. In addition, young people today have to contemplate the consequences of climate change over the next five or six decades, which will in all likelihood transform the quality of everyday life in many ways, almost none of which are desirable.
Ben Susswein ...

In the last 10 years in particular I have noted, among other things, a dramatic drop in attention spans, a decline in reading levels and an inability to stick with a difficult, even tedious, task.
Ann Goethals ...

Yet on college campuses like mine, we have seen a notable increase in the use of mental health services. ...
Without better epidemiological data, it would be premature and unwise to conclude that increased anxiety among teenagers is a “myth.”
Kathleen McCartney ...

Bravo to Dr. Friedman for raising questions about parental panic over their teenagers’ addiction to technology, but this is not a new concern. The first edition of Dr. Benjamin Spock’s “Baby and Child Care” (1946) contains an ominous section warning parents about letting their children listen to too much radio.

Peter Hirsch

- LETTERS, Is Technology Harming Teenagers?, NYT, Sept. 15, 2018

Despite news reports to the contrary, there is little evidence of an epidemic of anxiety disorders in teenagers. This is for the simple reason that the last comprehensive and representative survey of psychiatric disorders among American youth was conducted more than a decade ago, according to Kathleen Ries Merikangas, chief of the Genetic Epidemiology Research Branch at the National Institute of Mental Health. ...
But it’s more likely that the epidemic is simply a myth. The more interesting question is why it has been so widely accepted as fact.

One reason, I believe, is that parents have bought into the idea that digital technology — smartphones, video games and the like — are neurobiologically and psychologically toxic. If you believe this, it seems intuitive that the generations growing up with these ubiquitous technologies are destined to suffer from psychological problems. But this dubious notion comes from a handful of studies with serious limitations. ...
Considering all this, why do so many parents still insist that their teenager has a problem with anxiety? I fear that it reflects a cultural shift toward pathologizing everyday levels of distress.
There is a difference between an anxiety disorder and everyday anxiety. The first impairs people’s ability to function because they suffer from excessive anxiety even when there is little or nothing to be anxious about. The second is a perfectly normal and rational response to real stress. Teenagers — and people of all ages — will and should feel anxious occasionally.

Some would argue that young people today are more worried because the world is now in a more parlous state, what with intense competition for college and the lingering effects of the Great Recession, among other factors. Sure, but then that anxiety is an appropriate response to life’s challenges — not a disorder. ...
What I have noticed is that more of my young patients worry a lot about things that don’t seem so serious, and then worry about their worry. ...
It’s good to keep in mind that the advent of new technology typically provokes medical and moral panic. Remember all those warnings that TV would cause brain rot? Never happened.
- Richard A. Friedman, The Big Myth About Teenage Anxiety, NYT, Sept. 7, 2018

But it’s not just the crises that have shaken this generation — it’s the grinding, everyday stresses, from social media pressures to relationship problems to increased academic expectations.

More than 60 percent of college students said they had experienced “overwhelming anxiety” in the past year, according to a 2018 report from the American College Health Association. Over 40 percent said they felt so depressed they had difficulty functioning.
Money problems are exacerbating their worries. ... They have great uncertainty about their career prospects and feel pressure to excel academically or risk losing job opportunities.

“There’s a much more radical feeling that you’re either a winner or a loser,” said Victor Schwartz, a psychiatrist and medical director of the Jed Foundation, which helps colleges improve their mental health programming. “That’s put tremendous pressure on college students and is feeding a lot of the anxiety we’re seeing.”
As students have encountered more mental health problems, they have sought help in record numbers. Between the fall of 2009 and spring of 2015, the number of students who visited campus counseling centers increased by more than 30 percent, while college enrollment climbed just 5 percent, according to a 2015 report by the Center for Collegiate Mental Health.
- Brad Wolverton, As Students Struggle With Stress and Depression, Colleges Act as Counselors, NYT, Feb. 21, 2019

According to the psychologist Peter Gray, children today are more depressed than they were during the Great Depression and more anxious than they were at the height of the Cold War. A 2019 study published in the Journal of Abnormal Psychology found that between 2009 and 2017, rates of depression rose by more than 60 percent among those ages 14 to 17, and 47 percent among those ages 12 to 13. This isn’t just a matter of increased diagnoses. The number of children and teenagers who were seen in emergency rooms with suicidal thoughts or having attempted suicide doubled between 2007 and 2015.
- Kim Brooks, We Have Ruined Childhood, NYT, Aug. 17, 2019

Colleges and universities across the country are working to meet rising demand for mental health support. Stanford pointed to a national survey in which 87% of college students reported feeling overwhelmed by their responsibilities in the past year and 85% said they felt exhausted. Seventy-one percent of students nationwide reported feeling very sad, and 66% reported overwhelming anxiety. Twenty-four percent of students surveyed were diagnosed with or treated for anxiety, and 20% for depression. See ACHA-National College Health Assessment II SPRING 2018Reference Group Executive Summary]

"Stanford recognizes the urgent need to respond to these trends, and I have appreciated the campus-wide support and interest in addressing these concerns," Patel said in the announcement. "But we also want to be proactive in promoting positive mental health and well-being.
- Elena Kadvany, Stanford announces new approach to counseling services to better serve students, Palo Alto Weekly, September 6, 2019

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