The mental health of college students is a source of ongoing concern, with reports of rising rates of mental illness and suicide among young people around the world. Much concern has also been expressed about the mental well-being of students in South Africa and the need for a coordinated, strategic and evidence-based national response.
An example of such a response is the South African National Student Mental Health Survey., funded by the Medical Research Council of South Africa and initiated by Universities South Africa, with the support of the Chancellors of all universities in the country. It uses the best available scientific methods to assess the mental health needs of the nation’s college students and collects the data needed to plan effective interventions.
The survey was conducted in early 2020 by scientists from the Medical Research Council of South Africa, the University of Stellenbosch and the University of Cape Town, in consultation with researchers from Harvard Medical School as part of the International University Students Initiative. World Mental Health of the World Health Organization. .
They collected data from undergraduate students at 17 institutions. Over 70,000 students responded to the survey, making it one of the largest national student mental health surveys in the world and the first study of its kind in South Africa collecting data from many universities and assessing a wide range of mental health problems.
A total of 11 common mental disorders were evaluated, which goes far beyond the typically narrow focus on depression and anxiety. The survey is also novel in that, rather than simply detecting symptoms of mental disorders (as is often done in studies of this type), it used the best available survey methods and statistical analysis models in psychiatric epidemiology to identify the proportion of students who would likely meet the diagnostic criteria for the more common mental disorders.
The first results of the survey were recently published in the Journal of Affective Disorders and provide good evidence of both the scale of the problem and where more interventions are needed. These results focus on the prevalence of mental disorders among students in the previous 30 days and are an analysis of data from the 28,268 students out of 70,000 who responded and provided information about the university they attend.
Findings suggest that up to 16.3% of students met diagnostic criteria for a mood disorder (either major depressive disorder or bipolar mood disorder) in the 30 days prior to assessment. , while 10.9% experienced a generalized anxiety disorder.
Additionally, 21% of students reported clinically significant symptoms of post-traumatic stress disorder, highlighting the alarmingly high rates of trauma among the nation’s youth. Also of concern was that 6.6% likely met diagnostic criteria for a substance use disorder and 21% reported marked symptoms of attention deficit hyperactivity disorder.
The finding that up to 6.6% of students are likely to meet the diagnostic criteria for a substance use disorder reminds us of the urgent need to address alcohol and other drug use among South African youth. In particular, these prevalence estimates are unlikely to reflect the full extent of hazardous alcohol use, as they do not include students who binge drink (binge drinking) but do not meet other diagnostic criteria for a disorder.
Alcohol use among students should be the focus of ongoing research and should be high on the list of priorities for universities and government. Similarly, the liberalization of cannabis laws in South Africa is likely to have some negative impacts on students, given scientific evidence suggesting that adolescent brains are likely to be negatively affected by cannabis exposure.
The students were also screened for other disorders, including social anxiety disorder and eating disorders. While screening instruments are not very accurate in identifying people who are likely to meet all of the diagnostic criteria for a disorder, they do provide a fair indication of the number of people experiencing symptoms of a disorder.
Screening instruments showed that 22.7% of students reported symptoms of an eating disorder and 24.5% reported symptoms of social anxiety in the past 30 days. The proportion of students who would be diagnosed with these conditions is certainly being overestimated, but the findings nonetheless show that these are areas where students also need help.
Interestingly, the distribution of disorders varied significantly across institutions, with disorders consistently more frequent at historically white colleges. For example, while 22.5% of students at these institutions reported a mood disorder in the past 30 days, at historically disadvantaged colleges the prevalence was significantly lower, at 16.5%.
The risk of a mental disorder was marginally elevated among gender-nonconforming students and females relative to males. Sexual minority students (including gay, lesbian, and bisexual students, as well as those who question their sexual orientation or prefer not to label their orientation) are also more likely to have mental health problems compared to heterosexual students.
The risk was weakly related to parental education, with students being more likely to report mental health problems if their parents had lower levels of education. These patterns of increased risk were consistently observed across institutions.
Black students attending historically white institutions had a slightly elevated risk of a mental disorder relative to white students; however, no significant differences in the distribution of disorders were observed between population groups at historically disadvantaged technological colleges or universities.
The mental health of our nation’s students is a key priority, not least because mental disorders can lead to lower academic achievement and because higher education is integral to economic growth and human development. Reliable epidemiological data on mental disorders is required to help plan effective interventions on campus, formulate context-sensitive policies, set priorities, especially in resource-limited settings, and ensure that limited resources can be allocated where they are most needed.
The initial survey results are an important step in identifying where interventions are needed, what kinds of issues students are struggling with, and the number of students who need help. As more data is analyzed and published, it will become even clearer how services should be delivered and what interventions are required to support the psychological well-being of our nation’s students.
The survey results do not explain the increased vulnerability to mental disorders observed among sexual minority students, sexual minority students, and gender nonconforming women at all institutions, as well as among black students at historically white.
It is possible that the marginally higher risk among these groups reflects experiences of marginalization, discrimination, and/or alienation that can only be addressed through systemic interventions aimed at transforming the culture of institutions. Increasing student access to counseling will not help change institutional cultures, personal attitudes, and institutionalized practices that compromise student well-being.
While the survey findings draw attention to the proportion of students requiring mental health services, they obscure the reality that the vast majority of students do not have mental disorders. In fact, the majority of students in South Africa reported that their mental health is good or excellent.
It is important not to forget that while interventions are needed for the approximately 20-30% of students with diagnosable mental disorders, there are also approximately 70-80% of students who are coping well and demonstrating resilience.
It is easy for discussions of student mental health to create the impression that all students are struggling, but this is simply not true and it would be a serious mistake to think of all students as patients in need of treatment. Most students manage just fine and even thrive, though they face a wide range of problems including housing insecurity, food insecurity, and financial and academic stress.
This is not to say that students don’t face adversity and experience high levels of stress, but rather that they face the normal struggles of being a student (such as dealing with a broken heart or struggling to find a balance between academic and social commitments) they are the same as having a mental disorder.
Nonetheless, we need more resources for student mental health services on our campuses, and we need to identify scalable and sustainable alternatives to traditional individual therapies, including the appropriate use of digital technologies and peer support.
Professor Jason Bantjes is Chief Specialist Scientist in the Alcohol, Tobacco and Other Drugs Research Unit of the South African Medical Research Council. He also has an extraordinary appointment as Associate Professor at the Institute for Life Course Health Research at Stellenbosch University.
Professor Dan J Stein is head of the department of psychiatry at the University of Cape Town and director of the Risk and Resilience in Mental Disorders Unit at the Medical Research Council of South Africa.
