Student access to mental health care a growing issue

Access to mental health care will likely be a critical need for large numbers of United States college students in the upcoming academic year, according to a pair of reports released this summer examining the impact of COVID-19 on higher education.

One, released on 18 August by the Student Experience in the Research University Consortium or SERU, finds that about one-third of all students had screened positive for major depressive disorder and two out of five screened positive for major depressive and generalised anxiety disorders.

Another, published in July by the Healthy Minds Network and American College Health Association or ACHA, found not only that the rate of depression among college students had increased since the coronavirus emerged, but also that 60% of students surveyed said the pandemic had made it harder for them to access mental health care last spring.

Calling the impact of the pandemic on student mental health “alarming”, Igor Chirikov, a senior researcher and director of the SERU consortium – which is housed at the University of California, Berkeley – urged universities to “allocate more resources for a potential increase in students’ requests for mental health services”.

Sarah Ketchen Lipson, a Boston University School of Public Health assistant professor and co-researcher for the study by the Healthy Minds Network-ACHA, said that given prior research showing that mental health problems such as depression are associated with an increase in students dropping out of college, “there is a strong economic case” to be made for investing in such services.

University mental health concerns

Most college presidents acknowledged mental health concerns early on in the pandemic. It was the top concern in a poll conducted in March by Inside Higher Ed. More than 90% of presidents reported being very or somewhat concerned about COVID-19’s impact on student mental health.

Yet as they prepare to reopen their campuses under the most extraordinary of circumstances, mental health is just one of many challenges universities face. In April, 41% of presidents, responding to a survey by the American Council on Education, selected student mental health as a pressing issue during the pandemic. It came in fifth among 14 issues.

Higher priorities were “fall or summer enrolment numbers” (selected by 86%), “long-term financial viability” (64%), “sustaining an online learning environment” (45%), and “laying off of faculty and-or staff” (44%).

The intersection of those concerns have only intensified over the summer. While most universities last spring urged students in campus housing to return home, many intend to welcome at least some students back to campus in August and September for at least part of the semester, though not necessarily for classroom-based instruction.

One-fourth of US universities have yet to announce how they intend to deliver classroom instruction this autumn.

And the fast-moving virus continues to force plans to change. After seeing a spike in coronavirus cases after its first week of classes, the University of North Carolina at Chapel Hill this week shut down its in-person teaching for undergraduates and moved instruction entirely online.

These challenges are in addition to already existing concerns about the status of mental health care on US campuses.

Living and learning environments far from ideal

“The campus mental health crisis that existed [before COVID-19] bubbles quietly underneath our attention to a more visible virus,” says Rebecca Harrison, a Cornell University graduate student writing this month in Inside Higher Ed. “It waits, ready to capitalise on the far-from-ideal living and learning environments that college campuses have actively designed for themselves this fall.”

Moreover, while the SERU survey finds that a relatively small share of students struggled with remote instruction in the spring, those who did were more likely to screen positive for mental health issues than those who said they adapted very well.

Of those universities that had announced by 14 August how they would provide instruction in the autumn semester, 32% of institutions were planning instruction that is primarily or fully online, and 15% were planning hybrid instruction, data compiled by Davidson College and published by the Chronicle of Higher Education show. Just over 10% were planning to offer classes primarily or fully in person.

The SERU findings are based on a survey of 30,725 undergraduate students and 15,346 graduate and professional students conducted between May and July at nine public research universities. Drawing from two standard mental health screening questionnaires, the survey asked students two questions each about the frequency of symptoms associated with depression and anxiety over the past two weeks.

Nearly four in 10 and 39% of students in the SERU study screened positive for generalised anxiety disorder, while 35% of undergraduates and 32% of graduate and professional students screened positive for major depressive disorder.

Graduate students in doctoral research programmes reported the highest levels of symptoms, with 36% showing major depressive disorder and 43% reporting generalised anxiety disorder.

Moreover, the prevalence of major depressive disorders among graduate and professional students was two times higher in 2020 than it had been in a 2019 SERU survey, and the prevalence of generalised anxiety disorder is 1.5 times higher than in 2019. No comparative SERU data for undergraduates was available.

International undergraduates students were slightly less likely than domestic undergraduates (31% versus 35%) to report symptoms associated with depressive and anxiety disorders, while international graduate and professional students were more likely than domestic students to report symptoms of major depressive disorder (34% versus 31%) but less likely to report generalised anxiety disorder (45% versus 41%).

Undergraduates majoring in the arts, humanities, communication and design were most likely to screen positive for depression or anxiety. Within those disciplines, English language and literature majors were most likely to screen positive. Within social and behavioural sciences, psychology majors were mostly likely to screen positive. Among the STEM fields – science, technology, engineering and maths – undergraduates in the physical sciences were most likely to screen positive.

Most vulnerable populations

Also among the most vulnerable populations – those in which 50% or more screened positive for depression, anxiety or both – are low-income and working-class students, students who identify themselves as something other than a heterosexual male or heterosexual female, and students who are caregivers to adults or other children.

“We encourage institutional leaders to attend specifically to the needs of vulnerable students,” says Krista Soria, SERU assistant research director and director for student affairs assessment at the University of Minnesota.

“We recommend that institutions take proactive approaches to help students manage the additional burdens of stress, anxiety, depression, social isolation, and loneliness associated with attending college during the pandemic.”

The SERU report emphasised the need to expand virtual or online options for those seeking mental health care and recommended that faculty and academic advisers be made aware of the potential and consider making access to resources available as part of their coursework material.

About 18,000 students on 14 campuses participated in the Healthy Minds Network-ACHA study, which was conducted between March and May and focused on student attitudes, concerns and preventive behaviours, and the perceived supportiveness of colleges and universities related to COVID-19.

Mary Hoban, chief research officer for the American College Health Association, told Inside Higher Ed she expects universities in the upcoming semester will have overcome some of the problems they faced in the spring in providing mental health care and counselling centres will be improve in the autumn. Most of the challenges had to do with regulations that prohibited providing mental health services across state lines.

“Not to say that all the challenges will have been addressed, but we’ll have better systems in place” now that some of those obstacles have been resolved or relaxed temporarily, Hoban said. “Those were things that were bigger challenges in the beginning.”