Running head: DEPRESSION IN COLLEGE STUDENTS

Depression in College Students

Rebecca A. McCallister
James Madison University

DEPRESSION IN COLLEGE STUDENTS

Depression in College Students

Feeling sad, difficulty concentrating and an inability to sleep are all regular occurrences
in ones lifetime, but for some, these symptoms are present every day for at least two weeks and
impair these individuals functioning at work and home. Major depressive disorder (MDD) is a
debilitating mental illness that causes difficulty in all aspects of ones life which can continue to
lead to a downward spiral. For instance, if a person with MDD struggles to get out of bed in the
morning which results in missing days at work, this individual may then be fired which could
lead to economic strain and increased feelings of worthlessness. This cycle occurs all too often
when symptoms of MDD go untreated. Unfortunately, a common symptom of MDD is isolating
oneself due to not enjoying activities or feeling energetic enough for social interactions. If this
isolation continues, it is often difficult for the individual with MDD to reach out for help and
support after feeling so alone and abandoned, even if they played a part in pulling away from
others. When MDD goes unnoticed or untreated, suicidal ideation and suicidal action plans
become a large concern that needs to be addressed as immediately as possible by mental health
professionals.
Although some of the possible symptoms of MDD have been touched on, the
requirements an individual must meet to be diagnosed with MDD is better outlined by the
American Psychiatric Association's Diagnostic and Statistical Manual (DSM) 5th edition. The
DSM describes major depressive disorder as consisting of the following criteria: Five or more
of the following symptoms have been present during the same 2-week period and represent a
change from previous functioning; at least one of the symptoms is either (1) depressed mood or
(2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to

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another medical condition. The symptoms include depressed mood most of the day, diminished
interest or pleasure in most activities, significant weight loss or gain, insomnia or hypersomnia
nearly every day, psychomotor agitation or retardation nearly every day, fatigue or loss of
energy, feelings of worthlessness or inappropriate guilt, diminished ability to think or
concentrate, and recurrent suicidal thoughts (American Psychiatric Association, 2013). These
symptoms must cause difficulty in the daily functioning of an individual and impact their ability
to maintain a stable career and hinder fostering relationships with friends and family.
Major depressive disorder affects millions of people in America every day, but often the
effects the disorder can have on individuals lives are forgotten. According to the Center for
Disease Control and Prevention (2010), between the years of 2006 to 2008, 9% of the US
population met criteria for current depression. Research done by the DSM 5, indicates that
depression in 18-24 year olds is threefold higher than the prevalence rate in individuals 60 years
or older (American Psychiatric Association, 2013). Females also experience higher rates of
depression (CDC, 2010).
This age group prevalence rate for 18 to 24 year olds, is also the same age span for
individuals attending college. College can already be a tough transition due to leaving home,
time management, balancing independence and forming a new support network, however, many
college students also experience depression while attending college which can make all of the
other aspects of adjusting to college much more daunting. About one-third of college students
have had difficulties within the last 12 months in school due to depression, while almost half
have reported feeling severely anxious within the past year (Novotney, 2014).

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College students are at a high risk for developing depression which can impact various
aspects of their daily lives such as their academic success, overall mood and relationships with
others. In a study done by Heiligenstein and Guenther (1996), 92% of college student
participants reported levels of academic impairment due to their mood disorders. Academic
impairment was defined by absenteeism (missing half or more of their classes), diminished
productivity, interpersonal functioning and poor overall functioning. The reason for attending
college is to earn a higher education, but with depression rates on the rise it seems as if this
dream may be at risk. Students are no longer able to keep up with the rigorous demands of
school when the symptoms of depression are weighing down on them and making the
responsibilities of being a student seem incredibly daunting. Sometimes, simply getting out of
bed can be a challenge for those affected with MDD which can impact their attendance in class,
ability to keep up with the homework and their test scores in classes. Once a student has fallen
behind, the challenge of keeping up can seem impossible and feeling inadequate may become a
new common emotion.
The academic impairment statistic mentioned earlier varied in terms of severity of
depression, but all students who were affected with a mood disorder (specifically depression)
reported symptoms of affective impairment as well (Heiligenstein & Guenther, 1996). Affective
impairment was described as feelings of inadequacy, disinterest and distress. Students who have
fallen behind in school due to their depression may internalize feelings of worthlessness, guilt
and possibly even defeat. Even if a student may be keeping up with their coursework, these
feelings can impact their overall mood leading to a negative cycle of thoughts, emotions and

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beliefs. These affective impairments may carry over into interpersonal relationships as well,
which may cause additional stress in a students life.
Although these symptoms described above may seem obvious and easily recognizable,
there has recently been an unnoticed form of depression appearing in the college student
population. High functioning depression is best described in a quote by Alexa Erickson (2016),
someone with high-functioning depression and anxiety may seem to have it all together on the
outside, but things are erupting on the inside. Often, people affected by high functioning
depression are those who may be known as overachievers and perfectionists. These individuals
maintain the faade of having the perfect life and achieving all of their successes with ease, but
they are internally struggling daily with symptoms of depression. College students may not
realize that they are dealing with this more recently coined type of depression if they, like most
of society, are familiar only with the stereotypical image of depression seen in the media of
someone sobbing who cannot get out of bed (Laurence, 2016). This can make reaching out for
help difficult because students may feel as if they do not fit the definition of depression.
The danger of overlooking individuals who may have high functioning depression can be
devastating to those affected because they often could feel as if their symptoms are not severe
enough to seek help or that they will not be believed because they seem to be functioning fine to
their peers (Smith, 2016). College students affected with high functioning depression need all the
support they can get to better understand their disorder. A recent spike in students who have
completed suicides are reported to have been living a perfect life, but internally these students
were struggling with deeper emotional issues that may not have been noticed by their friends or
family (Leventhal, 2016). High functioning depression does not have scholarly research done on

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it yet since it is a more recent term, but those identifying with this disorder are on the rise and
research will likely be conducted within the next few years to gain and spread more knowledge
on this disorder.
Since colleges contain such a high population of individuals at a higher risk of
developing depression, there is an urgent need to reach out to these students through campus
resources to provide as much support as possible. The literature emphasises two main
intervention approaches to treating the depressed college student population: brief therapy and
internet based therapy.
Since college is a stressful time for many students and finding time to schedule a weekly
therapy session can be difficult, a brief approach is often taken to treat individuals who may only
be available to come to therapy for one or two sessions. A brief approach to therapy focuses on
crisis intervention and working on possible next steps towards a resolution to the presenting
issue. At the University of Texas at Austins Counseling and Mental Health Center, a new team,
Brief Assessment and Referral Team (BART) has been created to participate in the initial intake
sessions (Novotney, 2014). This has appeared to be effective, although no official studies have
been done, because students who may be in a crisis state due to their depression are able to see a
mental health professional and immediately be referred to the appropriate level of care rather
than enduring a lengthy intake process (Novotney, 2014). By addressing the students concerns
at the beginning of counseling with a trained mental health care professional, students may feel
as if they are receiving the treatment they needed within just one session. If this is not the case,
then a student is quickly referred to the other levels of treatment that are available without
needing to wait weeks for this process to be done which can shorten the length of treatment by

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tackling the issues immediately. However, considerations do need to be taken into account when
it comes to certain personality traits such as intense perfectionism because research has shown
that these individuals need longer treatment times when dealing with depression than a brief few
sessions (Blatt, 1995).
Continuing with the theme of students not having enough available time to see a
counselor weekly, other options have become available for clients in general, but specifically
ones targeted towards the college student population. Internet based therapy has gained
popularity within the past few years. Individuals already use the internet frequently for leisure
and work. Often times they may turn to this source for more information on their mental illness
symptoms and for support from others.
Recently, those dealing with mental illness seek out others who may share their
experience via the internet and in turn counselors have begun using technology as a way to reach
a wider population. In a study done by Andersson et al. (2005), internet based therapy, even with
minimal therapist interaction, paired with an online discussion forum resulted in less depressive
symptoms compared to the other group that only participated in an online discussion forum.
These results were maintained after a six month follow up as well (Andersson et al., 2005). A
special consideration with internet based therapy is that these results were only for individuals
self-reporting a mild to moderate form of depression. More severe cases should likely seek
face-to-face frequent counseling sessions.
College students in particular are already a very technology based population which
indicates great potential in reaching out to depressed students to provide therapy in a brief and
efficient manner. At the University of Floridas Counseling and Wellness Center, a new form of

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treatment, Technology Assisted Online (TAO) program, has taken off with great success
(Novotney, 2014). This is a seven-week program with several modules that assist with the
presenting concerns, paired with short video conferences with a counselor. After comparing the
TAO program to clients with similar concerns that received face-to-face counseling, those in the
TAO program had more significant improvements in their well-being (Novotney, 2014). This
method of treatment has been beneficial for students, but also for counselors who are able to
reach out to a larger client base due to the lessening of time constraints.
A possible treatment plan for a hypothetical client is described below:
Samantha, a 20 year old college student, has come to counseling to seek out help
with her depression.
Problem/Symptoms #1: Depression manifested through lethargy, lack of interest in
hanging out with friends or playing soccer (a hobby she used to love), feelings of
hopelessness, guilt and sadness, difficulty concentrating in class and disturbances in her
sleep patterns.
Long term goal: Samanthas symptoms of depression will be significantly reduced. This
will be measured on the progress reports she will fill out every two weeks before
attending the counseling session that day.
Short term goal & objectives:
Samantha will actively begin including herself in social situations. She will do
this by participating in at least one soccer practice per week.

DEPRESSION IN COLLEGE STUDENTS

Samantha will reduce feelings of hopelessness, guilt and sadness. This will be
done through keeping a journal of her emotions and thoughts that preceded these
strong feelings.
Samantha will develop a healthy sleep schedule. She will do this by only using
her bed for sleep and sex. Also, she will develop a consistent bedtime and will not
use any technology with a blue screen at least an hour before her bedtime.
Samantha will develop healthy coping skills. This will be shown by completing
assigned homework (such as the journal) and bringing it to counseling sessions.
She will also demonstrate healthy coping skills by participating in an online
module for self-care.
Interventions:
Samantha will attend individual therapy with Renee Staton, LPC weekly for a 50
minute session. The sessions will focus on helping Samantha to learn appropriate
coping skills while also allowing space for her to process her emotions.
Samantha will see a psychiatrist (with the referral of Renee Staton) to explore the
idea of medication for her depression.
Problem/symptom #2: Due to her depressive symptoms of inability to concentrate and
lethargy, Samantha has not been attending classes and therefore is facing a large amount
of academic stress.
Long term goal: Samantha will feel confident in her academic ability and reduce the
amount of academic stress.
Short term goal & objectives:

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Samantha will begin attending all of her classes (unless extreme illness or
emergency). This will be measured by attendance records from her professors.
She will also begin seeing an academic advisor to assist with more specific
concerns. Renee Staton is not competent in particular details relating to classes or
the curriculum and therefore can not help with these concerns. After gaining
Samanthas permission, Renee will be in touch with the academic advisor to
receive feedback on Samanthas academic standing.
Interventions:
Samantha will begin seeing an academic advisor bi-weekly for an hour long
session to help with study skills, time management and reading comprehension.
Samantha will continue seeing Renee Staton for individual sessions. This will be
a space to discuss her concerns emotionally with academics and her improvement
towards academic achievement.
Cultural considerations with MDD need to be taken into account. Across various cultures,
depression is reported significantly, but the symptoms differ. There is no single common
symptom across any culture, but it is important for counselors to be aware that somatic
complaints are often the most reported symptoms across all cultures (American Psychiatric
Association, 2013). Females have a higher prevalence for depression, but there have not been
significant differences with symptomatology, development of disorder or treatment options for
genders (American Psychiatric Association, 2013).
Although college students affected with depression has been extensively researched,
more studies need to be done as to the specific interventions for this population. This current age

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group is very technologically focused and hopes to receive treatment efficiently with quick
resolution to the issues presented. Therefore, research should continue to be done on brief
internet based therapy which could achieve all of these needs of college students in one effective
treatment model. Also, more studies needs to be done looking into high functioning depression.
Even though this is a very new term, many individuals may identify with this disorder, but not be
aware of the potential label for their current state and therefore not feel comfortable expressing
these concerns to loved ones or seeking out mental health services.
Major depressive disorder affects millions of individuals throughout their lifetime.
College students in particular are facing a larger amount of stress than in previous years which
can result in MDD. However, through treatments such as brief therapy or internet based therapy,
students can seek out resources without adding in weekly therapy sessions which could be an
additional stressor. More research needs to be done into specific subsets of depression such as
high functioning depression, but the future looks promising due to this recent upswing in
popularity of this term. Due to the higher prevalence of depression in people aged 18-24 years
old, college students are a great population to reach out to in order to learn more about MDD
within this age group and to provide multiple resources for those who may be dealing with this
disorder. With a shift in focus on college students overall health and well-being, the outlook of
students mental health is working towards improvement thanks to the increase in self-care
strategies taught and various support systems scattered throughout college campuses.

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References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). doi/full/10.1176/appi.books.9780890425596.dsm04
Andersson, G., Bergstrom, J., Hollandare, F., Carlbring, P., Kaldo, V. & Ekselius, L. (2005).
Internet based self help for depression. British Journal of Psychiatry, 187(5), 456-461.
Blatt, S. J. (1995). The destructiveness of perfectionism: Implications for the treatment of
depression. American Psychologist, 50(12), 1003-1020.
Center for Disease Control and Prevention (2010). Current depression among adults--United
States, 2006-2008. Morbidity and Mortality Weekly Report, 59(38).
Erickson, A. (2016). Why we need to talk about anxiety and high functioning depression.
Collective Evolution. Retrieved from
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h-functioning-depression/
Heiligenstein, E. & Guenther, G. (1996). Depression and academic impairment in college
students. Journal of American College Health, 45(2).
Laurence, E. (2016). Why we need to talk about high functioning depression. The Huffington
Post. Retrieved from
http://www.huffingtonpost.com/wellgood/why-we-need-to-talk-about_b_12126160.html
Leventhal, A. (2016). We cannot continue to overlook high-functioning depression. The
Mighty. Retrieved from
https://themighty.com/2016/05/high-functioning-depression-we-cant-overlook-the-overac
hievers/

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Novotney, A. (2014). Students under pressure. American Psychological Association--Monitor on

Psychology, 45(8).
Smith, L. (2016) World mental health day: What are the dangers of high functioning depression
and anxiety? International Business Times. Retrieved from
http://www.ibtimes.co.uk/world-mental-health-day-what-are-dangers-high-functioning-d
epression-anxiety-1585154