Isabel, a 20-year-old undergraduate student, is no stranger to hard work. She graduated high school a year early and spent most of 2021 keeping up with three jobs. But when she started college that fall, she felt like she was “sinking.”
She knew that she wasn’t feeling like herself that first semester: Her bubbly personality had dimmed, and she was crying lots more than she was used to.
It all came to a head during a Spanish exam. Isabel, who identifies as both Latina and Black, overheard a video that other students were watching about racism in her communities. Negative emotions swelled, and she had to walk out without finishing the test. She rushed back to her room, angry and upset, and broke her student card when hitting it on the door to get in.
“And I just started having a full-blown panic attack,” she said. “My mind was racing everywhere.”
Isabel says she begged her parents to let her stay on campus, but they insisted that she make the three-hour drive home, and she soon took a medical withdrawal.
A new survey shows that a significant number of college students struggle with their mental health, and a growing share have considered dropping out themselves.
Two out of 5 undergraduate students – including nearly half of female students – say they frequently experience emotional stress while attending college, according to a survey published Thursday by Gallup and the Lumina Foundation, a private independent organization focused on creating accessible opportunities for post-secondary learning. The survey was conducted in fall 2022, with responses from 12,000 adults who had a high school degree but had not yet completed an associate’s or bachelor’s degree.
More than 40% of students currently enrolled in an undergraduate degree program had considered dropping out in the past six months, up from 34% in the first year of the Covid-19 pandemic, the survey found. Most cited emotional stress and personal mental health as the reason, far more often than others like financial considerations and difficulty of coursework.
Young adult years are a vulnerable time for mental health in general, and the significant changes that often come with attending college can be added stressors, experts say.
“About 75% of lifetime mental health problems will onset by the mid-20s, so that means that the college years are a very epidemiologically vulnerable time,” said Sarah K. Lipson, an assistant professor at Boston University and principal investigator with the Healthy Minds Network, a research organization focused on the mental health of adolescents and young adults.
“And then for many adolescents and young adults, the transition to college comes with newfound autonomy. They may be experiencing the first signs and symptoms of mental health problems while now in this new level of independence that also includes new independence over their decision-making as it relates to mental health.”
An estimated 1 in 5 adults in the United States lives with a mental illness, and young adults between the ages of 18 and 25 are disproportionately affected. The share of college students reporting anxiety and depression has been growing for years, and it has only gotten worse during the Covid-19 pandemic.
An analysis of federal data by the Kaiser Family Foundation shows that half of young adults ages 18 to 24 have reported anxiety and depression symptoms in 2023, compared with about a third of adults overall.
Stopping the ‘shame spiral’
Mental health in college is critically important, experts say.
It’s “predictive of pretty much every long-term outcome that we care about, including their future economic earnings, workplace productivity, their future mental health and their future physical health, as well,” Lipson said.
And the need for support is urgent. About 1 in 7 college students said that they had suicidal ideation – even more than the year prior, according to a fall 2021 survey by the Healthy Minds Network.
Isabel knew that she was struggling, but it took a while to realize the extent of her mental health challenges.
“The number one thing I struggled with was feeling overwhelmed and like I had space to even remember to eat,” she said. “People were like, ‘You don’t know how to take care of yourself.’ But no – I had five papers due, and assignments, and I also had to work and go to [class] on top of that. And then I also had to find time to sleep. Most of the time, I was chugging an energy drink. And God forbid if you have a social life.”
For Isabel, as with many college students, thinking about or deciding to leave a degree program because of mental health challenges can often bring its own set of negative emotions, such as anxiety, fear and grief.
“For a lot of students, this isn’t what they saw their life looking like. This isn’t the timeline that they had for themselves,” said Julie Wolfson, director of outreach and research for the College ReEntry program at Fountain House, a nonprofit organization that works to support people with mental illness.
“They see their friends continuing on and becoming juniors and seniors, graduating and getting their first job. But they feel stuck and like they’re watching their life plan slipping away.”
It can create a sort of “shame spiral,” Lipson said.
But mental health professionals stress the importance of prioritizing personal needs over the status quo.
“There’s no shame in taking some time off,” said Marcus Hotaling, a psychologist at Union College and president of the Association of University and College Counseling Center Directors.
“Take a semester. Take a year. Get yourself better – whether it be through therapy or medication – and come back stronger, a better student, more focused and, more importantly, healthier.”
They also encourage higher education institutions to help ease this pressure by creating policies that simplify the process to return.
“When a student is trying to do the best thing for themselves, that should be celebrated and promoted. For a school to then put up a ton of barriers for them to come back, it makes students not want to seek help,” Wolfson said.
“I would hope that in the future, there could be policies and systems that are more welcoming to students who are trying to take care of themselves.”
Building support
Appropriately managing mental health is different for each person, and experts say a break from school isn’t the best solution for everyone.
Tracking progress through self-assessments of symptoms and gauges of functioning, like class attendance and keeping up with assignments, can help make that call, said Ryan Patel, chair of the American College Health Association’s mental health section and senior staff psychiatrist at The Ohio State University.
“If we’re making progress and you’re getting better, then it could make sense to think about continuing school,” he said. “But if you’re doing everything you can in your day-to-day life to improve your mental health and we’re not making progress, or things are getting worse despite best efforts, that’s where the differentiating point occurs, in my mind.”
Understanding the support system a student would have if they return home, including access to resources and treatment providers, is also a factor, he said.
For a while, experts say, it was a challenge to articulate the problem and build the case for broader attention to the mental health of college students. Now, the mental health of students is consistently cited as the most pressing issue among college presidents, according to a survey by the American Council on Education.
As the need for services increases, however, college counseling centers are struggling to meet demand – and the shortage of mental health professionals doesn’t stop at the edge of campus.
But colleges are uniquely positioned to surround students with a close network of support, experts say. Taking advantage of that structure needs buy-in to create a broader “community of care.”
“Colleges have an educational mission, and I would make the argument that spreads to education about health and safety,” Hotaling said.
College faculty should be trained in recognizing immediate concerns or threats to a student’s safety, he said. But they should also understand that students can face a range of mental health challenges and know the appropriate resource to direct them to.
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Isabel recently graduated from Fountain House’s College ReEntry program and is back at school – this time at university that’s a little closer to home, one that a close friend from high school also attends. It helps her to know that she has a strong friend group to support her and an academic program that supports her professional goals – to become an art curator.
Things are still challenging this time around, but she says she feels like she now has the right tools to cope.
“This foundation I am building is constantly in need of maintenance. There’s like a crack every day,” she said. “Back when I was trying to figure everything out, I feel like I was looking for a screwdriver when I needed a hammer. Now, it’s not that I know I can handle it – but I know that I have the healthy coping mechanisms and strategies and people to help. That gave me confidence and stamina to do it again.”