University doctors should start routinely screening for depression in their young patients, urges a new Canada-U.S. study that found one in four students who showed up at campus health clinics had symptoms of clinical depression — and one in 10 students had recently thought about suicide.
College health professionals not involved in the study say the findings confirm what they see on campus, with a growing number of students needing care for sometimes-serious mental-health problems.
The reasons behind the problems may include the pressures of a society that no longer guarantees success to young university graduates, and young people being simply less equipped to cope with life's challenges, experts suggest.
At the University of Calgary, the number of students presenting at the campus Wellness Centre with psychiatric issues doubled between the 2005-2006 academic year and 2008-2009, said Debbie Bruckner, the university's director of health services.
"By far the most common presenting concern is around depression or depression-related issues," said Ms. Bruckner, though their initial complaint is often something else, such as difficulty sleeping, upset stomach or headaches. "The world is more complex. The kind of pressures that are on students now are more severe, from a number of different angles."
The trend may be partly a function of the unique qualities of the so-called Millenial children — those who started attending post-secondary institutions around 2000, said Peggy Patterson, a University of Calgary education professor. Raised largely by Baby Boom parents, they are more open than predecessors about discussing psychological problems, but also bear the marks of a protective upbringing.
"They are more confident but they have led more sheltered lives. The world feels like a more dangerous place," Prof. Patterson said. "Because of the more sheltered lives they've led, they have fewer coping skills."
Another factor behind the increase is that institutions are taking in students with disabilities and mental-health problems who in the past — without the help of modern medication and more accessible campuses —would not have made it.
The researchers at the Universities of Washington and Wisconsin in the U.S. and at the University of British Columbia administered a detailed survey to 1,622 students who visited campus health centres for a variety of mostly physical issues.
About 25% disclosed signs of clinical depression—answering affirmatively to such questions as "I feel sad all of the time" — while one in 10 admitted to suicidal "ideation" in the previous two weeks, said the study just published in the American Journal of Orthopsychiatry. Depressive symptoms were strongly linked to reports of dating violence, emotional abuse and smoking.
Dr. Elizabeth Saewyc, a UBC nursing professor and one of the authors, said she was somewhat taken aback by the findings. She and her colleagues recommend that college health clinics ask all their patients a few questions to determine whether they might be seriously depressed, "so we can help them before it gets really out of hand."
"The fact that we have one in four of our university students who go to these clinics who actually scores in the ranges for clinical depression suggests there are a lot of distressed young people out there that we're not providing help for," said Dr. Saewyc, an expert in adolescent health.
Dr. Stan Kutcher, an adolescent psychiatrist at Dalhousie University in Halifax, cautioned that some of the study's findings were over-stated. The survey that students completed could tell only if they had depressive symptoms, not necessarily if they were actually suffering from clinical depression, he said. And a majority of the 10% with suicidal thoughts said "I have thoughts of killing myself but wouldn't carry them out," which is not nearly as worrisome as the smaller portion who said "I would like to kill myself," Dr. Kutcher said. Still, he said depression and other mental illness is, indeed, a major health issue in that age group and clearly needs more attention.
At McGill University in Montreal, students often arrive at the campus clinic complaining of something physical—from fatigue to premature ejaculation — when the real underlying problem is psychological, said Dr. Pierre-Paul Tellier, director of student health services.
"Frequently they don't recognize these symptoms as symptoms of stress, anxiety and depression."
Dr. Tellier said demand on the university's separate mental-health service has been climbing, which he attributes partly to a broader range of teenagers being admitted to university, and a greater awareness and diagnosis of mental-health problems. The clinics see some 19-year-old students who have been on antidepressants for two or three years, he said.
In Edmonton, the University of Alberta added five new psychological counsellors last year to meet demand but could probably use more, says Nick Dehod, the student union president, who is also lobbying for the addition of a one-week fall break in part to help students deal with stress.
"We see a lot of students who face all kinds of pressures, and in turn they struggle with depression, anxiety, all sorts of mental health issues."
Dr. Kutcher and others, though, wonder if universities could handle the demand for service — whether provided by non-medical counsellors, family doctors or psychiatrists — if patients were routinely vetted for depression.
"The problem we have with any screening is, 'What are we going to do with the positives?' " he said. "You should make sure the services are there."
Institutions have to be careful, as well, not to overreact if they find widespread signs of mental distress, Prof. Patterson said.
"It's not necessarily a problem," she said. "We don't want to pathologize the fact that, 'Oh no, they all have stress issues.' It's a stressful world we live in."
