Now that the Thanksgiving festivities have ended, students are feeling final exam stress becoming more acute every day. The impending deadlines for papers and looming tests have many feeling the pressures associated with this hectic time of year.

“I think that it’s just a lot of time crunches all at once, like a lot of time management problems,” said LSA junior Sarah Zaccardo. “It’s kind of like the last of it all, so anything that happens you can’t really change afterwards. It’s like the determining factors.”

In addition to all of the expected stress from finals, LSA junior Patrick Schoeps said there are still the usual, non-seasonal stresses to worry about, such as exercising.

Such stress factors have a variety of effects on college students. Nationally, 17.3 percent of undergraduate and graduate students reported having depression, 7 percent reported anxiety and 6.3 percent reported serious thoughts about attempting suicide in a 2013 study by Daniel Eisenberg, an associate professor of health management and policy in the School of Public Health and the director of the Healthy Minds Network.

Furthermore, stress and anxiety are the top two reported impediments to academic performance for college students at both the undergraduate and graduate levels, according to recently released results from the National College Health Assessment survey, administered by University Health Services last February. Between 2010 and 2014, the proportion of students reporting stress as an academic impediment rose from 25 to 31 percent and anxiety rose from 17 to 22 percent.

The number of undergraduate students listing depression as an academic impediment also increased from 10 percent in 2010 to 15 percent in 2014.

Eisenberg said depressive symptoms have been rising steadily not only for college populations, but also more generally for all younger demographics. He attributed this trend in part to a shift in the social pressures felt by many college students.

“(There is) the idea that young people increasingly are motivated by extrinsic factors like social approval, status, money, and that’s probably exacerbated by social media and the interconnectedness that we all have now as opposed to more intrinsic factors like people’s values, their morals, their self-esteem, and doing things that make us feel good based on our own values,” Eisenberg said. “That’s the sociological explanation, which seems to make sense from people’s observations, but is difficult to prove.”

Eisenberg conducts an annual survey across more than 100 colleges and universities that seeks to assess mental health-related issues such as depression, anxiety and substance abuse, as well as how well students utilize campus resources.

“The majority of students who are experiencing mental health problems are not receiving treatment,” he said. “Around 40 percent of students with apparent mental disorders like depression have not received any mental health services within the past year.”

Robert Winfield, the University’s chief health officer and director of UHS, said the competitive nature of the University means students can suffer from stress even when everyday lives are going well. He noted that students face stress from their roles on campus as well as from the pressures of the world they must inhabit once they leave Ann Arbor.

“It’s a competitive campus and it’s also a competitive world,” Winfield said. “The pressures are not just immediate, but enormous as we look out.”

He said some of the University’s responses to stress on campus — while intended to ease student stress — send mixed signals.

For instance, after receiving feedback from students, the University authorized 24-hour operations at the Shapiro Undergraduate Library in October 2012. Winfield said this message escalated the competiveness among students by suggesting that their peers are studying throughout the night.

“There are all of these subtle messages that come out,” he said.

LSA junior Emma Shapiro and Zaccardo said they know students who have stayed at the UGLi until 5 a.m. Zaccardo said she knows pre-med students, in particular, who stay well into the early hours of the morning.

LSA junior Natalie Imirzian said she has occasionally taken advantage of the UGLi’s late operating hours, both by herself and with friends.

“I’ve utilized it somewhat, more so now, near the end of the semester, as I panic and try to get everything done,” she said. “I’ve been (at the UGLi) until three or four before.”

Addressing stress and stigma

Despite the rise in stress, anxiety and depression among college students, there are a host of reasons that students may not seek treatment.

Gregory Dalack, associate professor of psychiatry and chair for education and academic affairs in the Department of Psychiatry, said stigma can play a role in discouraging students from seeking help, despite the fact that many conditions are treatable.

“Stigma is a major issue and it exacerbates all the other reluctance to acknowledge that we’re less than perfect,” he said.

“This is where cancer was 50 or 60 years ago,” he added. “You didn’t talk about it, you didn’t mention that your relative had it, and you sort of hushed it up.”

Eisenberg said such stigma surrounding treatment can be broken down into two categories: perceived public stigma and personal stigma. In his research, he has observed much higher levels of perceived public stigma.

“We see that the personal level of stigma is quite low; they have positive attitudes (toward treatment),” he said. “There is a discrepancy between what people think everyone else is thinking versus what people are actually thinking based on their own reports.”

Todd Sevig, director of Counseling and Psychological Services, believes one of the greatest barriers to treatment for students is the belief that stress is always a normal part of the college experience.

“There’s some truth to that,” he said. “I think that the biggest myth is that I have to experience that stress and anxiety almost every day, or all 15 weeks of the semester, and that is simply not true.”

Sevig said stress and anxiety are the most frequently documented reasons that students come in to CAPS, a trend that started about five or six years ago.

Beyond the perceived stigma, Eisenberg added that a lack of urgency might also be contributing to the small number of students who seek help.

“It’s got us thinking about the parallels between seeking help for mental health and things like diet and exercise, or other health behaviors where people seem to have fairly good knowledge and fairly positive attitudes about the behavior, and yet a large percentage of cases don’t actually adopt the healthy behavior … I think that there are some really subtle interventions that can really change behaviors in terms of mental health.”

Dalack, the professor of psychiatry, said mental illness should be looked at like any other physical ailment, such as the flu or a high fever.

“There’s a part in the middle of the flu where you can’t remember what it felt like to feel good,” he said. “And you feel like, ‘I’m never going to feel well again.’ When you think about that and depression, that can be pretty terrifying, especially if it’s affecting your psychological state.”

Looking for help

Dalack recognizes that “the support network is key, whether that’s friends, family, professors, teachers, or counselors, because we all tend to not recognize issues when it’s us versus in somebody else. Our own insight can be undermined by our own wish to not identify with being sick. Partly it’s education, and partly it’s overcoming the stigma … I view it both as an individual thing as well as importance of the friend network.”

He said efforts have been made to educate RAs in dorms as well as faculty and GSIs, who may be able to intervene if they see someone who is at risk.

Eisenberg and the Healthy Minds Network have started a student-leader coalition that meets every two weeks and joins leaders of a variety of student organizations. Some of these groups — such as PULSE, Active Minds and Own It — have a specific focus on health and well-being, while others such as Central Student Government have established branches focusing on such issues. There is hope that the coalition will play a large role in disseminating information about mental health to large portions of the University.

In addition, Eisenberg said he and his team hope to create new courses in which students will help with the production of the brief videos that the Healthy Minds Network produces. Such courses would focus on a variety of disciplines, from film production to psychology to social marketing and dissemination. If the program receives funding, these courses could be offered at the University as early as Winter 2016.

Wolverine Wellness, a division of UHS with the goal of promoting overall wellness on campus, piloted wellness coaching last January. Students can see a wellness coach who is able to provide tools and strategies to those concerned about high stress levels. Similar programs are also in place at Ohio State University and West Virginia University.

Within UHS, there is a proactive focus that allows students to set individualized goals for themselves. Coaching begins with a 90-minute session, and participants can set up regular appointments in order to follow up with goals and track progress.

Wolverine Wellness Director Mary Jo Desprez explained the importance of the wellness model and all of its different dimensions in relation to wellness coaching. The wellness model encompasses many different aspects of life, including intellectual, physical, financial, emotional, mental, environmental, occupational, social and spiritual health.

“We help the student take a long, deep breath and look at how they are doing in each of the different dimensions, and understand how they sort of are interdependent on each other,” she said. “Really what they can do, in wellness coaching, is self-assess and focus in on one or multiple areas and they can make goals for them.”

“The University … is to really start to understand that students are whole people, they’re not just the brain in the classroom,” Desprez said. “When you ask students what their definition of success is, they say ‘my GPA’ and ‘if I get a job.’ Our collective job is to say it’s much more holistic than that.”

To expand the University’s role in promoting mental health, Eisenberg said he hopes to integrate the mental health checkup process with academic advising. Such an effort would demonstrate the link between health and academic success, he said.

“We want to normalize it and make it part of a routine,” he said.

CAPS provides traditional one-on-one counseling, but also engages students in a variety of other ways. For example, in 2011, CAPS opened the Wellness Zone, which allows students to simply walk in and use the available facilities, which include massage chairs, meditation cushions, yoga mats, a couch for napping, a lamp for seasonal depression and even a gaming system.

Additionally, CAPS offers different workshops, among other types of support, in order to reach out to more students.

Regarding CAPS services, Imirzian said, “I know people that have (used CAPS). I’ve heard mixed things. I’ve heard it’s hard to get access or get appointments … it’s like you have an issue right now, so you want something immediately, but I’ve also heard great things about it.”

While Shapiro said she does not know much about CAPS, she said she would definitely be interested in learning more about it if it could help her with her stress levels.

Sevig noted that not every student wants or needs individual counseling, so CAPS provides alternate means for students to better manage stress and anxiety.

“The notion of leaders and best — if we keep increasing that every year, at some point, it’s going to be unrealistic, and that pressure that that then creates is going to be detrimental to our health,” he said. “Somehow, we’ve got to reclaim that and turn it around where we have the message that you can be healthy physically, psychologically, and perform well academically, but have room to fail or to not have everything go perfectly, to reclaim the spirit of ‘I’m here to learn.’ And learning is going to involve failing sometimes.”

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