Variations in psychological disorders, suicidality, and help-seeking behaviour among college students from different academic disciplines. Margaret McLafferty,Natasha Brown,John Brady,Jonathon McLaughlin,Rachel McHugh,Caoimhe Ward,Louise McBride,Anthony J. Bjourson,Siobhan M. O’Neill,Colum P. Walsh,Elaine K. Murray. PLoS One, December 30, 2022, https://doi.org/10.1371/journal.pone.0279618
Abstract
Background: Elevated levels of suicidality, ADHD, mental ill-health and substance disorders are reported among college students globally, yet few receive treatment. Some faculties and courses appear to have more at-risk students than others. The current study aimed to determine if students commencing college in different academic disciplines were at a heightened risk for psychopathology, substance use disorders and suicidal behaviour, and examined variations in help-seeking behaviour.
Materials and methods: The study utilised data collected from 1,829 first-year undergraduate students as part of the Student Psychological Intervention Trial (SPIT) which commenced in September 2019 across four Ulster University campuses in Northern Ireland and an Institute of Technology, in the North-West of Ireland. The SPIT study is part of the World Mental Health International College Student Initiative (WMH-ICS) which uses the WMH-CIDI to identify 12-month and lifetime disorders.
Results: Students from Life and Health Sciences reported the lowest rates of a range of psychological problems in the year prior to commencing college, while participants studying Arts and Humanities displayed the highest levels (e.g. depression 20.6%; social anxiety 38.8%). However, within faculty variations were found. For example, psychology students reported high rates, while nursing students reported low rates. Variations in help seeking behaviour were also revealed, with male students less likely to seek help.
Conclusions: Detecting specific cohorts at risk of psychological disorders and suicidality is challenging. This study revealed that some academic disciplines have more vulnerable students than others, with many reluctant to seek help for their problems. It is important for educators to be aware of such issues and for colleges to provide information and support to students at risk. Tailored interventions and prevention strategies may be beneficial to address the needs of students from different disciplines.
Discussion
Early analysis of the SPIT data revealed variations in the prevalence of mental health and substance disorders, suicidal behaviour and ADHD among undergraduate students commencing college in NI and the ROI [10, 12]. The current study added to this research, revealing that prevalence rates varied between faculties and also within faculties, providing important information for educators, with some courses having more students with psychological difficulties than others. Variations in help seeking behaviour were also revealed.
Overall, the study found high prevalence rates of suicidal behaviour and a range of mental health and substance abuse problems, which is of great concern. Suicidal behaviour was particularly high among students in the IT in the ROI. A recent study conducted among third level students in Ireland, found that students attending Institutes of Technology had poorer mental health [38]. Furthermore, the IT has the highest proportion of students from a disadvantaged area, when compared to other higher education institutes in the ROI [39], which may partially explain the elevated prevalence rates revealed in the current study.
When examining students attending college in NI, variations were revealed across the four UU campuses, with very high rates of psychopathology revealed among those attending Campus B. Conversely, students on Campus D reported the lowest rates of mental health problems but had the highest rate for drug abuse, and when comparing students across the NI campuses they also had the highest rate for alcohol abuse. Some geographical locations may have higher levels of mental health problems in the population than others for a number of reasons, for example, they may have elevated levels of deprivation. However, as students are not necessarily from the area the campuses are located in, further analyses were conducted to determine why these variations might occur.
The finding that students on Campus D were the least likely to engage in suicidal behaviour and have the lowest levels of depression or panic disorder, but high rates of substance abuse may be related to the demographic characteristics of students attending the campus, with males making up a large percentage of the student population. This is in line with previous research which reported higher levels of substance problems among male students, while females are more likely to have internalizing problems such as depression [7], as was found in the current study. It should also be noted however, that males may be less likely to admit to having a psychological problem, due to stigma, internalized traditional masculine norms and fears of looking weak [40]. Indeed, studies have found that young males are more prone to underreporting symptoms of mood disorders, and demonstrate higher levels of denial about psychological disorders on self-report surveys [41, 42].
When considering variations in prevalence rates between faculties, the lowest rates of mental health and substance problems were revealed among students in L&HS. A higher proportion of students in L&HS were 21 or over when compared to students from other faculties. Many students may have completed exams in the year prior to starting college, which may partially account for the elevated 12-month prevalence rates reported among younger students. The highest prevalence rates were found within the faculty of AH&SS, with the exception of alcohol misuse which was highest amongst students from the Business School. This is consistent with findings from another Irish study [32]. It should be noted that the Business School had the highest percentage of younger students in the current study, therefore this finding is particularly concerning, as prolonged, heavy alcohol usage throughout the academic course of study is associated with poorer academic performance, attrition, and increased likelihood of mood disorders [43]. Substance awareness campaigns during secondary education may be beneficial and further information sessions in the college setting would be advantageous.
In relation to treatment seeking, students in L&HS were least likely to have received treatment while those in AH&SS were most likely to have received treatment or felt that they may have needed treatment in the year prior to starting college, which is in line with the reported prevalence rates. Nevertheless, the proportion of students receiving or acknowledging that they may need help is much lower than the prevalence rates of disorders reported. In accordance with prior studies [34], students from CE&BE were least likely to believe that they may have needed help, which may be related to the fact that many males are enrolled on these courses. Indeed, it has been reported that male college students tend to have poorer mental health literacy and are poorer at recognising symptoms of depression, therefore male dominated courses may have lower levels of help-seeking and they may score lower on self-report questionnaires due to poor recognition of symptoms [44]. The most important reason participants in the current study reported for not seeking help was that they wanted to handle it themselves or they talked to friends or family. It is important therefore to encourage help seeking behaviour and provide information on a wide range of services available within the college and community setting.
Further analyses were conducted to uncover at risk subgroups, within the student population. While many students in the faculty of L&HS had low levels of mental health problems, when individual courses were examined, distinct variations were uncovered. For example, psychology students reported elevated rates of panic disorder and social anxiety, which is in line with previous research [20]. Furthermore, these students were most likely to say that they felt that they may have needed treatment which would suggest that while the psychology students had an awareness about their mental health issues, it did not encourage them to seek help. This is in accordance with prior research which reported that taking psychology classes does not appear to predict positive attitudes to seeking mental health care for mental health problems [45, 46]. One of the reasons provided for not seeking help, by psychology students in the current study, was a fear of it impacting on their academic and future career. These findings would imply that when promoting help-seeking behavior among those in the health profession, especially psychology students, it is important to be mindful of their fears and encourage them to disclose any problems.
Nursing students were least likely to report a range of psychological problems. It should be noted however that mental health nursing students reported higher rates of disorders than those studying general nursing, with the exception of depression, which may have drawn them towards the course, in the first instance. Mental health nursing students were most likely to have received treatment despite lower levels of disorders. This may be related to their knowledge and understanding of the importance of treatment [20]. Engineering students were least likely to have received treatment or felt that they needed treatment, but they also reported low levels of psychological and substance related issues. As this is a male dominated course, the question remains if these findings may be related to a reluctance of males to disclose mental health issues and to seek help for their problems or poor symptom awareness.
Indeed, many students appear to be unwilling to seek help from traditional sources within the college. This maybe be because they are concerned that the information may be shared with academic staff, although if adjustments are made, such as extensions to deadlines, this can be very advantageous. Moreover, stigma, preference for self-management and time commitments can be deterrents. Students on the health professional courses, for example, mental health nurses or psychology students, may be particularly reluctant to divulge that they have a mental health problem for fear that it may impact on their career [46]. It may be useful therefore for colleges to employ the use of more anonymised, self-directed, digital or online interventions [47]. The second phase of the SPIT study involves the trial of an online CBT based guided intervention and the findings may provide a useful alternative to face-to-face sessions, particularly for those who don’t want to seek help from traditional sources.
The study also found that art students, in particular, reported very high rates of a range of mental health problems and suicidal behaviour, which is in accordance with prior research [30]. An interesting finding was that the prevalence rate of bipolar disorder among those studying art was almost twice the average rate reported in the study overall. Indeed, studies have revealed high levels of creativity among those with bi-polar disorder [48, 49]. Almost a fifth of art students also had clinical levels of depression in the previous 12 months and were most likely to engage in self-harm or have attempted suicide. It is very important therefore that support is offered to this vulnerable cohort within the college setting.
Business students reported the highest rate of drug abuse, while law students reported the highest alcohol misuse rates and suicide ideation and plans but not attempts. Prior studies have suggested that such findings are connected to stressors related to the course [31, 50]. It must be remembered, however, that this cohort was surveyed shortly after registering at college, before they had engaged on their course. It may be beneficial to conduct further research to help determine factors that may draw students with such problems towards these courses.
Previous authors have theorised that specific traits and environmental influences shape intellectual interests and attract certain individuals to specific courses [51]. Socioeconomic status and problematic early life experiences may have an impact. Widening access to higher education, while being extremely beneficial, can bring additional challenges, with students enrolling from diverse backgrounds. They may be attracted towards certain courses, such as psychology or law, due to negative early life experiences. For example, it has been found that students who study humanities, social work and counselling were more likely to report childhood adversities [52, 53], which are strongly associated with poor mental health [11]. Additionally, personality is thought to influence degree selection. For example, high levels of neuroticism have been found in law and psychology students [29, 54]. These factors may not only attract individuals towards specific degrees but also predispose them to poorer mental wellbeing. Further research is therefore warranted to explore these risk factors in greater detail and plans are in place to conduct additional analyses utilising the SPIT data.
As this study identified courses with many at-risk students it may be beneficial to provide targeted support and information to students through their lectures and encourage social interaction with their peers, creating a sense of belonging as they embark on their college life. Discipline specific support may be warranted. For example, students on some courses, such as those involving the arts, may feel isolated and they may benefit from initiatives to increase social interaction. Peer Assisted Study Sessions (PASS) and wellbeing sessions may be beneficial to help support the transition to university life [55]. As these are embedded within courses, such sessions can be tailored to the needs of the students, addressing the individual challenges of that specific course, with first year students being supported by their higher year peers.
Limitations
While this study identified several important findings, a number of limitations should be considered when interpreting the results. Firstly, the study relies on self-report measures, therefore some students may not have responded accurately or honestly. Secondly, only the 191 students who said that they felt that they may have needed help in the previous year, but were not in treatment, were asked the subsequent question related to reasons why they would not seek help, therefore these findings may not be generalised to the wider population. Furthermore, the current study is cross-sectional in nature, and is based on findings from year one only, when students started college for the first time. It will be very beneficial to monitor these students throughout their time at college, to determine if suicidality, psychopathology and substance abuse prevalence rates vary as they progress through their courses, some of which may be more stressful and academically challenging than others. Finally, it should be noted that a number of courses were not well represented in the study.
To conclude, the study revealed that many students commence college with pre-existing psychological and substance related problems and suicidal behaviour. However, the prevalence rates varied considerably across academic disciplines, with some courses having many at-risk students enrolled. However, many of these students did not seek help for these problems. It is important therefore for educators to be aware of such issues and for colleges to provide information and support to students at risk. Tailored interventions and prevention strategies may be beneficial to address the needs of students from different disciplines. This may be even more important, since the pandemic, when students were working remotely, with some cohorts missing out on practical classes, lab work and placements, with many struggling since the return to face-to face leaning. The findings from this study should appeal to educators and those with an interest in student mental health and wellbeing.
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