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For college-bound students and their families, the start of the school year can be a time of excitement and optimism, but a new study brings to light that the college years are also a time of increased risk of stressful events and a wide range of accompanying mental health challenges. Published online today in Depression & Anxiety, a study of more than 67,000 college students from across more than 100 institutions has found that while racial/ethnic, sexual or gender minorities are especially vulnerable, high rates for stress events, mental health diagnoses and the risk of suicide or suicidal thoughts were reported among all students surveyed.

“Colleges and family members who are sending students off to college need to remember that this is a phase of life where young people are confronted with expectations from new relationships and living situations and other encounters that are stressful,” said lead author Cindy Liu, PhD, of the Departments of Pediatric Newborn Medicine and Psychiatry at BWH. “Some stressful events cannot be prevented and, in some cases, are completely normal. But for others, a plan should be in place for family, friends, and colleges to provide support. Our study highlights an urgent need to help students reduce their experience of overwhelming levels of stress during college.”

Liu and her colleagues analyzed results from a survey conducted in the spring of 2015 by the American College Health Association-National College Health Assessment (ACHA-NCHA). The survey asked students a variety of questions related to depression and anxiety, including whether they had been diagnosed or treated for a mental health issue in the past year; if they had engaged in self harm, considered suicide or attempted suicide in their lifetime; and how many stressful events they had experienced in the last year.

Stressful life events, defined as exposures that the student felt were traumatic or difficult to handle, included academics, career-related issues, death of a family member or friend, family problems, intimate relationships, other social relationships, finances, health problem of family member or partner, personal appearance, personal health issue and sleep difficulties.

The team reports the following:

• Rates of stressful life events were high and associated with mental health issues. Three out of four students reported having experienced at least one stressful life event in the last year. More than 20 percent of students reported experiencing six or more stressful life events in the last year. Stress exposure was strongly associated with mental health diagnoses, self-harm, and suicidality. 
• Mental health diagnoses and suicidality were common. One in four students reported being diagnosed with or treated for a mental health disorder in the prior year. One-fifth of all students surveyed had thought about suicide, with 9 percent reporting having attempted suicide and nearly 20 percent reporting self-injury in their lifetime.
• Sexual minorities showed elevated rates of mental health disorders and suicidality/self-injury. Transgender students showed particularly elevated rates of all outcomes, with approximately two-thirds reporting self-injury and more than one-third attempting suicide. Over half of bisexual students reported suicidal ideation and self-harm, with over a quarter reporting attempted suicide.
• Rates of concerning self-harm and suicidality are higher now than they were the last time the survey was given. Among gay/lesbian and bisexual students, rates were higher than the 2009 administration of the survey for suicidal ideation (57.8 vs. 47.7 percent), suicide attempts (27.6 vs. 25.3 percent) and self-injury (51.4 vs. 44.8 percent).
• Mental health issues may be underreported for racial/ethnic minorities. Despite a higher likelihood of suicidal thoughts and suicide attempts, Asian students reported a lower rate of mental health diagnosis compared to white students. Black students showed a lower likelihood of reporting all outcomes compared to white students.

The authors note that all these rates are based on self-report, and that there may be a response bias among those who received the online surveys. While the 108 colleges in the survey were diverse in setting and included minority-serving institutions, each elected to participate, and their results may not be generalizable to all schools across the U.S. Additional research is needed to determine if there is increased vulnerability among students who belong to an intersection of identities (for instance, students who identify as both a sexual and racial/ethnic minority).

Support for this work was provided through the Commonwealth Research Center (SCDMH82101008006), Tynan Faculty Research Fellowship and a NIMH K23 MH 107714-01 A1 award.