Editor's Note: This post is part of our “Back to School” series in which our experts discuss the top health-related issues facing children and families as they head back to school. This year, COVID-19 is certainly one of these challenges. Some schools made the decision to reopen this fall, while others are sticking with virtual learning due to the effects of the pandemic. This remains a fluid situation, which is why we developed evidence-based guidance for schools with thresholds for test positivity rates and case counts as they consider reopening strategies into the fall. For more, follow our hashtag #PolicyLabGoesBacktoSchool on Twitter.
As mental health providers who predominantly work with adolescents, we know how common it is for a patient’s transition to college to occur during the course of treatment. During a patient’s senior year, if they have plans to attend college at any level, one of our goals of therapy becomes preparing for this transition. These preparations could include discussing realistic expectations for college experiences and identifying and problem solving potential concerns about the transition.
But for the class of 2020, COVID-19 disrupted the normal planning process and left a lot of questions about what college will look like for new attendees as well as returning students.
College is typically a time for increased independence as students are responsible for managing studying, social times and finances, as well as developing schedules and deciding on coursework. College students are in the developmental period called “emerging adulthood,” reflecting a transition and overlap from adolescence to adulthood. During this phase, they are exploring their identity and garnering more freedom in many areas including medical care. They are also experiencing significant changes in their peer groups, social support, and parental and societal expectations.
Just as the college experience can be an exciting period, it can also be stressful and challenging. An international survey of college students showed that 31% had a 12-month prevalence rate of any mental health disorder with depression and generalized anxiety being the most common across countries. Additionally, suicide risk is a particular concern as a survey of college students in the U.S. showed that 20% endorsed suicidal thoughts and 9% had an attempt within the last year. For youth who have pre-existing mental health disorders, the transition to college can lead to exacerbation or worsening of symptoms.
Disruptions from the Pandemic
This spring, the COVID-19 pandemic abruptly interrupted college life for students across the globe. Instead of exercising their new freedoms and enjoying their independence, students have now been spending more time (not less) at home due to closures of dorms, online classes and stay at home orders. Socializing is limited to virtual encounters or small groups and social distancing. Missing are the experiences of impromptu gatherings in dorms and cafeterias or participating in social events on campus that serve as stress relievers for many students. One recent study showed an increase in rates of depression and anxiety among college students since the COVID-19 pandemic.
At the start of a new semester, students are beginning or returning to a new type of college life that will be filled with uncertainty. This new college experience could be in person, online or some type of hybrid. Social distancing practices will restrict how students socialize and seek informal support. As such, the mental health needs of college students are more important than ever.
Preparing for a New College Experience
For mental health providers and campus health officials guiding adolescents through this process, encourage students to prioritize self-care, which includes adequate sleep, healthy eating, regular exercise, refraining from substances and taking breaks from academics. Be sure they’re able to describe their mental health concerns and diagnosis, as well as their medications and how they impact learning to better equip them to seek help early and independently.
We should also be preparing students and parents to be proactive in identifying social supports and activities to foster college students’ interpersonal relationships, increase activity level and maintain well-being that fits within current social restrictions. Many college campuses have student counseling centers whose services can be identified and accessed prior to attending. We should empower students to learn about these resources as well as their college’s academic requirements and available support services, such as tutoring and special education services.
A recent web-based survey showed a significant increase in college students’ mental health utilization over a 10-year period with the most common location at the college counseling center. Therefore, it’s critical for colleges and communities to have mental health treatments and supports available to meet the growing demands of students, including online interventions.
While we should advise students to learn about community resources for possible long-term therapy and medications, colleges and universities should also consider developing or enhancing collaborative relationships with community-based organizations to help students access appropriate levels of care.
And as students get settled into a new routine, mental health providers should ensure that students and their families can make a plan for regular communication that fits everyone’s needs, giving the student independence and taking into account their location. This will allow parents to check in on students’ mental well-being throughout the semester.
While more research is needed about the impact of COVID-19 on mental health, especially for emerging adults, we know that college students will need additional support from their families, peers and providers, as well as resources from their college or university in support of their mental health as they head back to school amid this pandemic.
The Jed Foundation and the National Alliance on Mental Illness have additional resources focused on college students.
Stacey Julye, PhD, LCSW is a licensed clinical social worker in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at CHOP.