State of Mind

Abby Ridgeway should be a senior. Her first attempt at college lasted only two weeks. She cried, called her mom countless times and obsessed about the new possibilities college could bring her. She was alone for the first time and couldn’t figure out how to manage her new world by herself. Now, she is a year behind her peers.

It was the same nervousness that still makes her shaky and short of breath, the same anxiety that kept her from studying abroad and keeps her from going out on weekends. New environments — like the off-campus apartment she’s renting for the first time this year — make her anxious. She can’t help it; the anxiety she was born with dictates how she will react.

Ridgeway knows the ins and outs of wrestling with mental health issues in college just as well as the increasing number of students in the United States and on IU’s campus who struggle with anxiety and depression.

College students’ mental health is a growing concern for collegiate mental health care providers. Data provided to the Indiana Daily Student by IU’s Counseling and Psychological Services indicates anxiety is catching up to depression as the top concern at IU for counseling and psychiatric clients.

The Center for Collegiate Mental Health, a research center at Penn State University, gathered information on clients from 140 university health centers across the United States, including IU.

Penn State found in their latest annual report, which was released in January and comprised of information from the 2013-2014 school year, 55 percent of college students seeking help at campus psychological service centers are affected by anxiety. Forty-five percent of students nationwide are diagnosed with depression.

IU is no exception to this trend. So far in 2015, 50 percent of all clients at Counseling and Psychological Services in the IU Health Center have been diagnosed with anxiety, an increase of seven percent in the last four years.

It isn’t a secret as to why more students are flooding mental health centers and anxiety and depression diagnoses are increasing. Academic pressures, social media, world events and identity struggles are increasingly affecting young people and students.

Social woes

BJ Toole is outgoing. Always present to be social and to learn, he speaks his mind in class. In the fall semester of 2014, however, he began skipping class and stayed up for days straight.

Toole said he had never felt that way before and knew it was something he couldn’t control. He also said he didn’t believe depression was a real illness until he decided to see a doctor about his sleeping problems. After a week of taking sleeping medications with no success, he was given a depression diagnosis.

That was probably one of the last things he ever wanted to hear. ‘I’m a functioning human,’ he thought. How could he be considered mentally ill, in the same category as the Sandy Hook shooter and others who committed acts of violence?

It took some convincing for Toole to believe the diagnosis. The physician explained depression is a chemical imbalance in the brain. Then he realized he had an illness, not an emotional excuse for his nights awake and his days in bed.

Toole was frustrated even after starting to take Sertraline, an antidepressant. It can take up to six weeks for a person to feel the effects of antidepressants. For almost two months, he wouldn’t speak up in class, meet people or believe he was worth anyone’s time.

After multiple follow-up appointments, his physician asked how he felt. And for the first time in months, he could say something positive.

“You know,” he told his doctor, “I actually feel pretty good.”

He was elated to gain back the weight he had lost in the depths of his depression. He could pay attention in class for more than ten minutes. He could actually have conversations, and most importantly, he could enjoy things again.

Toole, a junior studying environmental science, spent last summer working for Camp Krem, a program in Boulder Creek, California, that provides outdoor activities for individuals with special needs. That experience helped him pull out of the depression he was diagnosed with the preceding school year, he said. He knows what type of environment he needs now, and what he has to do to make himself happy.

Toole also realized that he cannot live on a college campus. When he returned for this semester, he realized he is not meant to be in Bloomington.

“Some people aren’t meant to be in this academic structure,” he said. “Some people really thrive in it. But I know I’m one of those people who doesn’t.”

Nevertheless, Toole said he plans to finish school. He knows he isn’t alone: to him, many students are not meant to be in college but feel that they have to meet their goals.

Wishing they were just as successful as their peers seem, looking their best on social media and having a stable financial situation are among the strongest issues for students.

Dr. Nancy Stockton, director of CAPS, said increased pressure on students’ economic futures is a stressor that has contributed to anxiety.

“There is more pressure on students to get jobs after college, and now there is increased competition,” she said, adding admission standards to attend college have become more stringent.

IU’s party culture and its wide display on social media feeds into Ridgeway’s anxiety.

“I think the Snap Chat story has been the death of me,” Ridgeway said, “because I’m always like, ‘Are they mad at me?’ or did I just not get invited? It makes you feel like you’re missing out.”

Prescribing Medication

Anxiety and depression are strongly correlated illnesses. Symptoms often cross over, and treatments can be similar.

“It can be awfully hard to tease (anxiety and depression) apart because people diagnosed with depression also have some anxiety,” Stockton said, but added that anxiety is not always enough of an issue to warrant a separate diagnoses.

Though many people are diagnosed with anxiety and depression through CAPS, not all are put on medication.

Only seven percent of CAPS clients diagnosed with depression are prescribed medicine.

Though more students are being diagnosed with anxiety, prescription rates for those clients are at 58 percent, down 24 percent from 2012.

Both counselors and psychiatrists can give depression and anxiety diagnoses at CAPS. Counselors can prescribe solutions such as exercise, cognitive behavioral therapy or any other outlet for clients to use to relieve their illnesses. Only psychiatrists can prescribe medicine.

Who diagnoses anxiety and depression at CAPS

Psychiatrist aren't the only people able to diagnoses a patient with a mental illness, in fact the majority of diagnosis are given by counselors who cannot prescribe medication. They can prescribe other treatments like exercise and therapy that are also shown to help with depression and anxiety.

In addition to her medications, Ridgeway uses other outlets aside from medicine to help, such as practicing music or exercise.

“I’m working on finding things that make me happy and reduce my anxiety, like exercising more or finding a hobby that makes me happy,” Ridgeway said.

Trouble at Jacobs

Academic distress, according to the Penn State report, is strongly correlated with depression. However, adverse effects of academic struggles like attention difficulties, health problems and physical abuse, are strongly correlated with anxiety.

Emily, who asked to be identified only by her first name to avoid future job discrimination due to her mental health history, is a sophomore studying music education. She has been diagnosed with depression and post-traumatic stress disorder since high school.

Emily had a series of suicide attempts in the eighth grade after a sexual assault. She was diagnosed with post-traumatic stress disorder after her assault. She was also hospitalized for being a danger to herself when she was a freshman in high school. Since coming to college, she has been off medication and has not self-harmed.

But it doesn’t mean depression and PTSD are only a part of her past. Emily can’t have her friends grab her wrists without going into a panic attack. She uses a snap band on her arm to bring herself back to reality if she has thoughts about self-harm.

Academics are her biggest trigger. As a music education major, Emily deals with the regiment and intense practices of the Jacobs School of Music, where a large portion of students seek mental health support.

For Emily, stress builds, anxiety ensues, mental health plummets, then it repeats.

This year, CAPS hired a counselor strictly for students in Jacobs.

Stockton said the choice to give Jacobs students a counselor was not CAPS’ idea. Rather, the Jacobs administration approached CAPS with the idea.

"When you're a music major, you're under a lot of pressure, especially in this university," Emily said. "The professors aren't going to be nice to you just to save your feelings, so if you go into a lesson and you didn’t sound great, they’re going to say, ‘That was really bad, come back next week, don’t waste my time’ and make you leave your lesson. It’s a very cut-throat field.”

But the environment of IU’s music school is the nature of the beast, Emily said.

“The general atmosphere of the degree is very negative and intense,” she said. “I don’t know if it would be possible to have a nice music program.”

Gender and racial divide

Mental health, especially in regards to anxiety and depression, has significant racial and gender divides.

An overwhelming majority of clients nationally are white. The most common client at a university counseling center, according to the Penn State report, is a straight, white female with roommates.

White students make up 69 percent of national clientele. Straight students account for 86 percent.

CAPS is actively seeking a Mandarin-speaking counselor for students, Stockton said. There are also counselors available who speak multiple languages for the after-hours crisis service. Translators can be requested for in-house sessions as well.

Stockton said the University recently approved a new telecounseling service. The pilot program will allow students to call and speak with a counselor via the telephone instead of in person.

According to the Penn State report, approximately 60 percent of clients at college mental health centers are women, which stays true at IU — men make up 39 percent of visits.

It follows that college women are more likely to be diagnosed with depression and anxiety than college men, according to the report.

Clientele who chose not to identify their gender made up less than one percent. Stockton said CAPS is seeing an increasing number of transgender students and students who choose not to identify with either gender.

One kind of approach to encourage more men to seek CAPS services is letting men know that while their gender’s turnout is low, men still come, Stockton said. This outreach includes making it known that sexual assault services are available to men as well as women.

Toole is all too familiar with this stigma. While he considers himself gender neutral, he still felt that seeking help for his depression was a jab at his masculinity and pride.

“You have a brain, and there are chemicals in your brain, and they get off balance and that’s not something you can fix by building a treehouse or being manly,” he said. “It’s not seen as stigmatized for girls to go get help, but society expects guys to work it out on your own and tough it out.”

Alcoholism, hostility and suicide are significantly greater concerns for men visiting mental health centers than women, who are more likely to be diagnosed with depression, general and social anxiety and eating disorders, according to the Penn State report.

Men, Toole said, can often feel as if receiving help makes them weaker, or means that they’re crazy.

He said he believes the hardest step recognizing that help is necessary, but depression holds many people back from seeking help in the first place, both he and Stockton said.

Toole, who says he did not believe depression was a real illness before he was diagnosed, and Emily said part of the de-stigmatization process should be treating mental illnesses like physical ones.

“All you can do is de-stigmatize the thing and say, ‘Hey, go to the doctor if you’re feeling sick,’” Toole said.