Chapter 1: Introduction
The goal of this publication is to provide education abroad professionals (located both in and outside the United States) with a better understanding of how to identify and help education abroad participants facing mental health challenges. As a first step, it may be helpful to examine the broader context of the incidence and severity of mental health problems among U.S. college students.
Entering college has traditionally signaled a major life transition for students, one that comes with a variety of developmental challenges: changing relationships with parents, negotiating intimate relationships, examining values, clarifying identities, and sorting out long-term career decisions. Data from a number of sources document that increasing numbers of students on college campuses are dealing with serious mental health concerns such as clinical depression, bipolar disorder, and anxiety disorders. Major depression and bipolar disorder, for example, now typically make their first appearance during the late adolescent years, severely impacting the development, school performance, and interpersonal relationships of large numbers of students. On a positive note, however, effective treatments are available. Early detection and intervention can reduce the seriousness of these conditions and their disruption to healthy development.
What the Data Show:
- Fifty years ago, the mean age of onset for most mood disorders was age 30; today, the mean age is closer to age 15 (Evans et al., 2005).
- A recent poll revealed that 85 percent of colleges and universities have seen an increase in mental health problems on their campuses (Gallagher, 2001).
- Disabled students who choose to study abroad disclose having a psychiatric disability twice as frequently (45 percent vs. 22 percent) as do disabled students generally (Institute of International Education/Mobility International USA, 2004; U.S. Department of Education, 2004).
- Approximately 35 percent of all students who seek counseling already have been prescribed psychotropic medications (Gallagher, 2003).
- Psychiatric hospitalization rates—a treatment of last resort, typically—have increased significantly over the past 10 years. It is not uncommon today for larger university counseling services to arrange psychiatric hospitalizations for students on a routine basis—weekly and sometimes daily (Gallagher, 2004).
- A recent study of campus counseling center clients (Benton et al., 2003) revealed that the rates of students presenting with problems of depression, anxiety, suicidal ideation, and sexual assault have doubled, tripled, and in some instances, quadrupled over the past 12 years.
- Eating disorders—anorexia and bulimia—are pervasive among college women. Surveys have indicated that up to 40 percent of female students and increasing numbers of male students at some time during their college years struggle with these concerns in some way (Grayson & Meilman, 1999).
- Self-mutilation—deliberate self-injury such as cutting one’s arm with a knife or burning cigarettes into the skin—used to be considered a rarity among college students. However, recent surveys of campus counseling center directors reveal that approximately 70 percent report increases in this behavior (Gallagher, 2004).
- Nationwide studies of college students reveal that approximately 45 percent of both undergraduate and graduate students reported an emotional problem that significantly interfered with their ability to function within the past 12 months. Ten percent had seriously considered suicide (American College Health Association, 2004).
- Suicide is the second leading cause of death among traditional-age college students (ages 18–24). Even more alarming is the rate of students attempting suicide—10 times the rate of completed suicides (Marano, 2004)
Increasing levels of emotional distress among U.S. college students also have taken a toll on U.S. campus infrastructures. In the United States, faculty members, advisers, parents, and college administrators are increasingly facing complex, volatile, and high-risk situations that require greater degrees of skill in assessing, managing, and referring students to appropriate care.
Yet the data do not reflect the larger problem: many students dealing with psychological concerns do not seek out help from mental health professionals or from campus advisers. In a 1999 report, the U.S. Surgeon General estimated that 20 percent of college-age adults are depressed, yet far fewer seek help. With increasingly competitive pressures within academic environments, many students view asking for psychological assistance as a sign of weakness that runs counter to their self image or to the image they want others to see.
For some students, the stigma associated with psychotherapy and mental health services continues to be strong. This is particularly true among students from particular ethnic and religious backgrounds where personal problems are expected to be handled within the family or the community. Some students are wary of seeking assistance given the common perception that mental health diagnoses have been used historically to discriminate against individuals from particular groups.
It is critical that education abroad professionals both in the United States and abroad, faculty members, parents, and friends learn how to spot problems early on. The goal is to sensitively offer support that connects the student to professional help before a problem reaches a crisis state or seriously derails the student’s academic and career plans.