|Year : 2021 | Volume
| Issue : 2 | Page : 225-229
Mental health in the university campus: Emphasizing the need for preventive health actions
Namita Rath1, Shreyan Kar2, Nilamadhab Kar3
1 Faculty of Management Studies, Sri Sri University, Cuttack, Odisha, India
2 Birmingham Medical School, University of Birmingham, Birmingham, UK
3 Department of Psychiatry, Black Country Healthcare NHS Foundation Trust, Wolverhampton, UK
|Date of Submission||24-Oct-2020|
|Date of Decision||28-May-2021|
|Date of Acceptance||29-May-2021|
|Date of Web Publication||30-Jun-2021|
Dr. Nilamadhab Kar
Department of Psychiatry, Black Country Healthcare NHS Foundation Trust, UK Steps to Health, Showell Circus, Low Hill, Wolverhampton, WV10 9TH
Source of Support: None, Conflict of Interest: None
Background: Life in college and university can be stressful. It was intended to evaluate mental health, specifically depression, anxiety, substance use, and stress among management students to explore the need for support in a campus. Methods: It was a cross-sectional study in the setting of a university campus. Using a questionnaire method, students of the Master of Business Administration course were evaluated for stress, depression, anxiety, and substance use. Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 were used for assessing anxiety and depression. Stress explored through open-ended questions was later categorized. Results: Majority of students (60.7%) reported stress which was broadly course-related and personal issues. Stress was significantly associated with anxiety and depression. Around 36.1% of students had anxiety and 44.2% had depression at a clinically relevant level. The proportion of students reporting wish to die or self-harm ideas nearly every day was 11.5%. Substance use was reported by 18.3%. In contrast to these proportions, only 10% of students acknowledged having mental health problems. Conclusion: Considerable mental health concerns exist in students. The results highlight the need for specific mental health promotion and preventive health actions in a university campus.
Keywords: Anxiety, depression, mental disorder, stress, substance use, university
|How to cite this article:|
Rath N, Kar S, Kar N. Mental health in the university campus: Emphasizing the need for preventive health actions. Indian J Soc Psychiatry 2021;37:225-9
|How to cite this URL:|
Rath N, Kar S, Kar N. Mental health in the university campus: Emphasizing the need for preventive health actions. Indian J Soc Psychiatry [serial online] 2021 [cited 2021 Nov 28];37:225-9. Available from: https://www.indjsp.org/text.asp?2021/37/2/225/320223
| Introduction|| |
It is known that most (around 75%) psychiatric patients have the onset of their mental illness by the age of 25 years. Unsurprisingly, many younger adults experience the onset of mental illness and substance use during college or university period. This age group also has a higher risk of suicidal and nonsuicidal self-injury.,, With intense competition and heightened emphasis on examination results, there appears to be increased stress for the students these days.
Many studies highlight the psychiatric morbidity in college and university students. A study involving 21 countries reported a 1-year prevalence of psychiatric disorders as 20.3% among college students; and it was approximately 33% in another study. A wide range of mental illnesses has been observed in these studies. Anxiety disorders being more common (11.9%), followed by depression (7%–9%), bipolar disorder (3.2%), and eating disorder (9.5%), while many students have continuing disorders with onset in childhood, for example, attention deficit hyperactivity disorder (2%–8%) and high-functioning autistic spectrum disorder (0.7%–1.9%). In a more focused study, the prevalence of depression, anxiety, and panic attacks was 12.6%, 7.6%, and 1.0%, respectively. Besides these, generalized anxiety disorder, phobia, obsessive–compulsive disorder, and posttraumatic stress disorder have also been reported.
A study in Pondicherry University, using a standardized University Student Depression Inventory, reported that 37.7%, 13.1%, and 2.4% of the students were suffering from moderate, severe, and extremely severe depression. A survey of undergraduate students in the University of Toronto found that 58.6% of students were stressed, 9.9% had diagnosed anxiety, and 8.6% were diagnosed or treated for depression. In Ulster University Student Wellbeing study, the reported 1-year prevalence of depression (21.4%), anxiety (21.9%), alcohol dependence (9.3%), and substance abuse (1.8%) highlighted the magnitude of the problem.
A major concern of college and university students is substance use which for many begins during this period. Prevalence varies widely in different studies; some indicative prevalence in the literature are as follows: alcohol dependence 12.5%, abuse/harmful use 7.8%, binge drinking around 44%, marijuana 30%, other substance abuse 4.2%, and dependence 1.4%. Another study reported that the 1-month prevalence of smoking marijuana was 10.0%, frequent-to-heavy tobacco smoking 6.3%, and regular alcohol drinking 0.6%. It is well known that alcohol consumption is associated with road traffic accidents, a leading cause of death in this age group.
Another area of mental health concern in students is suicidal behavior. Young age is a known risk group in India., Suicidal ideas and plans have been reported in college/university students, and the major risk factors include depression, hopelessness, and substance use. In Northern Ireland, 18.5% of university students had suicidality in the previous year. In India, an alarming number of suicides are reported among students.,, Although information is available in the media, there are much fewer focused studies on student suicide in India in comparison to the magnitude of the problem.
University life can be stressful. Some of the stresses are specific to this age group and situation; for example, for the first time in their life, many of these students stay away from home and family, in hostels or rented houses, away from parental supervision, and in this situation, it has been observed that living alone, more so in women than men, is associated with anxiety. Attending college has been reported to be stressful for some students because of the academic pressure that comes with it, besides many other stressors such as financial difficulties.
Mental health problems are known to be associated with lower educational attainment of students. This is a major concern as academic achievement is perceived as a key element determining success in future. In spite of the huge concerns regarding the mental health of the college and university students, available literature in the area is rather sparse. All these above factors make it relevant to study the mental health issues in college and university students. In the above background, this study intended to evaluate mental health, specifically depression, anxiety, substance use, and stress, among a group of university students.
| Methods|| |
This was a cross-sectional questionnaire-based study involving 2nd-year students of the Masters of Business Administration course, studying at a university in Odisha. All the students were approached to participate in the study, except those who were absent in the week of data collection.
For anxiety symptoms, the Generalized Anxiety Disorder (GAD)-7 questionnaire was used which is a commonly used, self-rated, validated instrument for screening for GAD and assessing its severity. GAD-7 has been used as a screening instrument in university students. The cutoff score for GAD-7 was considered at 10 which indicates severity to be moderate or above. Depressive symptoms and their severity were assessed using Patient Health Questionnaire (PHQ)-9 scale. PHQ-9 is a validated, self-rated scale, which has been used and validated as a screening instrument for depression, in India, and in the university students., The cutoff score for PHQ-9 was 10 which included moderate or higher severity.
We intended to understand the nature of stress experienced by the students, which was assessed through an open-ended question, rather than a specific scale. The question asked was, “Do you have any stress in the last 1 month” with a “Yes” or “No” response. Those who reported having stress were asked to mention the three most common stresses they experienced. These stresses were analyzed based on their theme and categorized. We enquired about the use of any substances, specifically cigarette, tobacco, cannabis, alcohol, and any other illicit substances in the previous month, and checked if these were used daily. Demographic details such as age, gender, religion, relationship, and self-reported socioeconomic status of family were asked for as well as the presence of any physical or mental illnesses.
The project was considered as a noninterventional survey by the Ethics Committee of the Quality of Life Research and Development Foundation (Ref: QoLReF/2018/mhu/, date: August 25, 2018). It was also approved by the university. Ethical considerations such as informed consent, anonymity, voluntariness, and option to withdraw at any point were followed. There was a facility to discuss any aspect of the survey or any concern following the participation with the faculty or research team. Clinical support through a psychiatrist and a clinical psychologist was available if needed for any participant, along with support from local mental health services. This was facilitated through a designated faculty member.
All the data were entered in a spreadsheet and were rechecked for accuracy for quality assurance. Missing data were excluded from the analysis. Data were analyzed on SPSS version 25. Appropriate statistical tests including Chi-square, t-test, and Pearson's correlations were used, and the level of significance was P < 0.05 as standard.
| Results|| |
The response rate for the survey was 70.1%. The sample consisted of 61 students with 42 (68.9%) men and 19 (31.1%) women. Most of them were from upper-middle (78.3%) socioeconomic status (20% from lower middle) and were of a Hindu (96.7%) religious background. Majority were single (61.7%), 36.7% were in a relationship, and 1.7% were married. Mental and physical health problems were reported in a minority of students [Table 1]. The type of reported mental health problems included stress, anxiety attack, and depression. Physical health problems were mostly pain related (low back ache, arthritis, spondylitis, and headache), and others were varied such as asthma, allergies, and anemia.
|Table 1: Reported physical and mental health issues, anxiety, and depression|
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A considerable proportion of students reported clinically relevant level of anxiety (36.1%) and depression (44.2%) based on GAD-7 and PHQ-9, respectively [Table 1]. The mean ± standard deviation (SD) anxiety scores for female (9.4 ± 6.4) and male (8.0 ± 5.4) students were comparable. Similarly, the mean ± SD depression scores of female (9.7 ± 7.3) and male students (9.8 ± 6.1) were not significantly different. There was a significant (Pearson's correlation coefficient: 0.7, P < 0.01) correlation between anxiety and depression scores. Comorbidity of anxiety and depression was present in 42.6% in varying degrees, with 9.8% having both morbidities at severe level.
Based on PHQ-9, wish to die or self-harm ideas were reported by 19.7% for several days, 13.1% for more than half the days, and by 11.5% of students nearly every day in the previous 2-week period. There was no significant difference between genders.
A proportion of students (24.4% of men and 5.3% of women; mean: 18.3%) reported using substances in the previous month, which were mostly tobacco, cannabis, and alcohol, and these were used daily by 4.9%, 4.9%, and 3.2% of students, respectively. Among those who used substances, 63.6% reported anxiety, which was not significantly different to 73.5% who did not use substances. Similarly, 90.9% of students with substance use had depression in contrast to 71.4% without any substance use (not significant).
Among the stresses reported by the students, most were associated with the course and related activities [Table 2]. These included course-related tasks, presentations, attendance, rules and regulations, knowledge gap, teacher, and behavior. There were a few who reported personal stresses, which were related to relationship with friends, health issues, financial, and lack of skills in some areas such as communication and time management. Among these, stress related to the relationship issues with friends predominated. Among the students who reported having stress, 86.5% had anxiety (versus 50% with no stress, P < 0.01) and 89.2% had depression (versus 54.2% with no stress, P < 0.01).
| Discussion|| |
This cross-sectional study results suggested that mental health issues including anxiety, depression, substance use, and stress are prevalent in management students in the university campus. Considerable proportions of students had anxiety (36.1%) and depression (44.2%) at a clinical level. Around 19.7% had a severe level of anxiety, which appears higher than the reported figures elsewhere., Higher anxiety in the studied population may reflect the stressful situations that are experienced in university. A severe level of depression was noted in 9.8%, with 13.1% at a moderately severe level, which was comparable to reports from other universities. The figures for anxiety and depression in this study were more than that of the general population, with a current mental morbidity of 10.5% reported from India (depression disorder figures were 3.0% for women and 2.4% for men). This suggested that the university students had a higher morbidity compared to the general population. It is interesting to note that a lower proportion of students reported having mental health problems, compared with the proportions having anxiety and depression. This may be due to lack of realization of having mental health issues, and the other possibility could be stigma attached to acknowledging mental health problems, in spite of the anonymity of the survey. In this regard, it is better to use a screening instrument to assess the mental morbidity.
Comorbidity of anxiety and depression was common in this study, even at the severe level. In the Ulster University study, 15.3% of students had three or more psychiatric disorders. Mental health problems along with dysfunctional personality traits reported in university students affect their educational attainment., Suicidality in the form of wish to die and self-harm ideations was present in 11.5% of students nearly every day and less frequently in a considerable proportion. A recent Indian study reported a 2-week prevalence rate of suicidal ideation as 9% in medical students. A study in the USA, 1st-year university students reported 6% having current suicidal ideations. There is a specific concern regarding student suicides in India, and it deserves focused attention. Reported figures of substance use are comparatively low in prevalence, however, there is a possibility of underreporting, especially for casual intake of substances. Substance use is often associated with other risk-taking behaviors, financial problems, and deviations from the primary objectives being in university, besides the substance-induced mental illnesses. These observations indicate that students reporting any warning signs of mental illnesses should be evaluated adequately to provide effective timely interventions for all the associated illnesses and stresses.
The majority of students in this study reported stress; this was associated significantly to anxiety and depression. It may be highlighted that it is self-reported stress, and there was not an in-depth exploration; in spite of that limitation, it appears that the reported stress has contributed partly to the high level of anxiety and depression in the sample. There were various types of stresses, although in most cases those were course related, many had personal issues and other sources of stress. The educational system in India is highly competitive, and there are issues about finances and future employability along with personal stresses. These kinds of stresses could possibly be dealt with a structure of support for students who are struggling with their academics.
Stresses, substance use, and mental health morbidities affect functional abilities and academic achievement. Although highly prevalent, often these mental health issues in the university campus go unnoticed; and appropriate help is not available. Besides, in places, where the help is available; these are not taken up for various reasons, including lack of information and stigma. The results suggested that there is an urgent need for setting up supportive systems for preventive health actions with mental health promotion, through various means which students can access easily and in confidence. It is important for the authorities and students to discuss the methods how mental health support can be arranged in the university campus.
The study covered only one department in one university as a pilot assessing feasibility; for a more representative sample, number of universities in different locales may be considered in future studies. A wide range of mental health problems was not explored, considering feasibility issues, so the figures could be an underestimate of the actual prevalence of mental illness in the sample. There were no specific scales used for substance use and stress, which could have made the assessments more uniform rather than self-reports. In addition, assessments based on self-report and self-rated questionnaires have their inherent limitations, in contrast to assessment by clinicians using standardized instruments. While the anonymity of their answers was assured, some students may have still hesitated to provide sensitive personal information.
| Conclusion|| |
More than half of the university students reported experiencing stress, and considerable proportions had anxiety, depression, and substance use. These were easily identifiable by screening. There is a need for setting up and improving the use of supportive infrastructures within the campus to deal with these mental health issues. Mental health promotion and prevention of common stress-related mental illnesses should be a key feature in the campuses. Future studies should explore the effects of such interventions to improve the mental health of students on their academic and extracurricular performances.
We thank faculty and students of Management Studies in Sri Sri University, Cuttack; Quality of Life Research and Development Foundation, Bhubaneswar; and the Institute of Insight, UK, for their support.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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