Mental health of students in higher education

College Report CR166Students must anticipate going into a highly competitive workenvironment. The expansion in higher education that has taken placeover the past 20 years means that possession of a degree on its own isno guarantee of a job. There is pressure on students to gain good honoursdegrees and in addition to show evidence of attainment in other areassuch as university societies and sports clubs, or participation in voluntaryactivities. Students who have experienced mental health difficulties may beat an added disadvantage when applying for jobs if they have taken longerto complete their courses because of deferrals of coursework or breaks fromstudy to recover their health.A further factor is that students often live in close proximity to otheryoung people, for example in halls of residence or shared flats. Disturbedbehaviour (such as repeated self-harm) on the part of one young personcan cause considerable distress and disruption to fellow students and tostaff in halls of residence. Students who are mentally unwell can also placeexcessive or inappropriate demands on academic staff, for example byacademic underperformance, becoming overdependent or making vexatiouscomplaints.The epidemiology of mental disorders in studentsin higher educationStudents in higher education represent a unique group in which todescribe the epidemiology of mental illness. They broadly fall into the agegroup of 17–25 years. This age span encompasses the transition fromadolescence to adulthood. The high-risk period for onset of schizophreniaand bipolar disorder in late adolescence and early adulthood coincideswith entering higher education. Some in this age group are affected bylong-term conditions with onset in adolescence, such as anorexia nervosa.Others are among the youngest to develop illnesses related to substancemisuse. As such, university students span an age range in which a widespectrum of mental illness is seen and pose specific problems with regardto epidemiology. In the USA, it has been estimated that mental disordersaccount for nearly a half of the disease burden for young adults (WorldHealth Organization, 2008), and most lifetime mental disorders have firstonset by age 24 years (Kessler et al, 2005).Whereas the priority for clinical services is to ascertain the incidenceand prevalence of major mental illness, broader concepts of mental disorder,such as conditions that are loosely described as ‘stress’ or ‘distress’, mayhave more relevance for those involved in university counselling services.Such concepts represent the milder end of the symptom spectrum and theyare universally more prevalent across college campuses. One key questionin this area relates to how the epidemiology of mental disorders in studentsmay be different to that of non-students matched for age, gender and socialclass. Epidemiologists have historically ignored university students as adistinct group. Clinicians and those in health service research are primarilyinterested in prevalence by age rather than by occupation. Nevertheless,research into student mental disorder is made easier by the fact thatresearchers have easy access to the populations on the campuses on whichthey work. A second question arises from the enormous changes that havetaken place in the student population in the UK in the past 20 years or so.22 http://www.rcpsych.ac.uk