Psychology students reported particularly high rates of mental health problems, business students reported the highest rate of drug abuse, while law students reported the highest alcohol misuse

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.

Higher social status benefits women's well-being and relationship quality, until they surpass their male partner

All is nice and well unless she outshines him: Higher social status benefits women's well-being and relationship quality but not if they surpass their male partner. Melissa Vink, Belle Derks, Naomi Ellemers, Tanja van der Lippe. Journal of Social Issues, December 17 2022. https://doi.org/10.1111/josi.12573

Abstract: In two studies, we find that climbing the societal ladder has positive associations with women's well-being and relationship outcomes but can also have negative consequences when women surpass their male partners in status. In Study 1 (N = 314), we found that women who reported having higher personal status also reported several positive relationship outcomes (e.g., higher relationship quality than women with lower personal status). However, these associations reversed for women who surpassed their partners in social status. In Study 2, a diary study (N = 112), we show how women's implicit endorsement of gender stereotypes qualifies the negative associations of surpassing one's partner in status. Among women with higher status than their partner, traditional women intend to adjust their behavior to fit the gender norm (e.g., thinking about reducing work hours in favor of their time at home), whereas egalitarian women did not, but felt guilty toward their partner. We show how the relationship dynamics of women who have surpassed their partners in social status should be considered when attempting to tackle structural discrimination and advance women's careers.

GENERAL DISCUSSION

In two studies, we reveal the contradictory associations women contend with when they reverse traditional status divisions in their relationships. Our data shows that climbing the social ladder has several positive outcomes for women, but this only is the case insofar as their social status does not surpass that of their male partner. Furthermore, the way women respond to their higher status depends on whether they implicitly endorse stereotypical gender beliefs. This research suggests that gender stereotypes prescribing that men should be the breadwinner and women should be the caregiver of their families have their impact on the relationship of women who break with these gendered expectations (Eagly et al., 2000; Heilman, 2001; Prentice & Carranza, 2002).

Replicating earlier findings that higher social status is related to more happy marriages (Bartley et al., 2005; Belle, 1990; Wilcox & Marquardt, 2010), we show in both studies that women who reported high social status also experience more positive outcomes in romantic relationships than women who reported low social status. The main point of the cross-sectional study, however, is that relationship outcomes are not only predicted by women's personal status. Crucially, women's relationship outcomes were also predicted by how their social status compared to their partners’ status, and here the results are generally more negative as their relative status is higher. This pattern was replicated and extended in the diary study in which we showed that women who reported higher status relative to their partner also reported more negative relationship and work-life outcomes during the 8 days of the study.

By providing insight into the underlying dynamics that partly explain negative relationship outcomes for women in a role-reversed relationship, we complement previous work showing that relationships in which the woman earns more than the man are less satisfying than more traditional relationships (Bertrand et al., 2015; Meisenbach, 2009; Pierce et al., 2013; Wilcox & Nock, 2006; Zhang, 2015). Specifically, we show that—in addition to objective income differences—women's perception of the social status division of their own relationship also predicts relationship outcomes. We reveal how these perceptions influence daily experiences and decisions about time allocations and activities in relationships where the woman has higher status relative to her partner.

Both women with traditional and egalitarian gender associations face difficulties

Additionally, we show how women's implicit gender associations (i.e., the degree to which they associated career-related words with men and family-related words with women) related to how women feel and cope when they surpass their partner in social status. Other than anticipated, we did not find that women's implicit gender associations qualify their relationship outcomes. However, we did find that among women who had higher status relative to their partner, those with more traditional implicit gender associations were more likely to consider on a daily basis how they might adjust their behavior to accommodate this (e.g., by sacrificing leisure time and reducing working hours in favor of their family). It is possible that especially women with traditional gender associations feel that they deviate from the traditional norm when they have surpassed their partner in status. These women may be more sensitive to the negative associations of surpassing one's partner in status. This would be in line with the notion of gender deviance neutralization, which maintains that men and women who violate gender norms try to reduce their deviance by showing more traditional behaviors (Bittman et al., 2003; Brines, 1994; Greenstein, 2000). In this case, this might be achieved by these women sacrificing leisure time and time at work to spend more time with their families.

We observed a different pattern for women with more egalitarian associations. When they had higher status relative to their partner, these women did not think about adjusting their behavior. However, they did report feeling guilty toward their partner on a daily basis. Women with egalitarian gender associations might realize that surpassing their partner in status is not in line with current gender norms in society. People feel guilt when they evaluate their moral transgression as a violation of an important norm and having hurt another person (Haidt, 2003; Ortony et al., 1988; Tangney & Dearing, 2002). Feeling guilt toward their partner might motivate women to change their behavior and recognize that their partner's relationship expectations and standards differ from their own (Baumeister et al., 1995). Repeated and uncontrollable feelings of guilt are associated with lower well-being (Ferguson et al., 2000) and psychological distress (e.g., anxiety; Jones & Kugler, 1993). Consequently, women's feelings of guilt toward their partner might eventually cause them to adjust their behavior somehow to bring it more in line with current gender norms. However, this might also imply that if gender norms are more egalitarian (e.g., because friends have similar role-reversed status divisions within their relationships), these women feel less or no guilt (Haidt, 2003). Future research might investigate how norms relate to long-term consequences of guilt experienced by women with egalitarian gender associations and who have surpassed their male partner in status.

Limitations

A first limitation of our studies is that we only investigated women's perceptions of the status division in their relationship as well as how it impacts their relationship outcomes and well-being. Future research can expand these associations by applying a dyadic approach and see how women's outcomes are affected by their partner's perceptions of the relative status division within their relationship. Furthermore, this line of research could also investigate whether these associations are similar for men in role-reversed relationships. In our own work, we find first evidence that heterosexual couples highly agree upon the status division within their relationship and that both the man's and the woman's relationship quality suffers when they report being in a role-reversed relationship (Vink et al., in press).

A second limitation is that we chose to use the Implicit Association Task to measure a person's endorsement of gender stereotypes because explicit measures of gender stereotypes are susceptible to social desirability, and the IAT has been found to outperform these explicit gender stereotype measures in predicting actual behavior (Greenwald et al., 2009). It is important to be mindful of the recent critiques on using the IAT to measure a person's implicit gender stereotypes (Hahn & Gawronski, 2019; Gawronski & Bodenhausen, 2006; Gawronski et al., 2017). These critiques are related to women's potential awareness of their scores, susceptibility to situational factors, and stability over time. Irrespective of these critiques, our results indicate that the extent to which women associate work with men and family with women predicts how women themselves feel and cope when they surpass their partner in social status 8 days after filling out the IAT.

A third limitation is that both of our samples included women with mostly higher educational degrees. As such, it remains to be seen whether our results are generalizable to women with lower educational degrees. Lower educated individuals are more likely to endorse social conservative ideologies that favor maintaining the current status quo (e.g., the existing gender hierarchy; Jost et al., 2003). For this reason, it could be that lower educated women who have surpassed their partner in status report even more negative relationship outcomes compared to higher educated women. On the other hand, lower educated women are more often the breadwinner of the family because of temporary economic reasons (e.g., the man being unemployed) than higher educated women (Drago et al., 2005). When women work out of financial necessity, both men and women may find it easier to justify women's breadwinning role (Heckert et al., 1998; Orbuch & Custer, 1995). Future research could examine whether lower educated individuals indeed report more negative relationship outcomes when they are in a role-reversed relationship. Furthermore, it could assess whether their relationship outcomes are qualified by the fact that the woman works out of economic necessity or not.

Implications

This research adds another layer to our understanding of why gender inequality persists (see e.g., Ellemers, 2018). Women are stigmatized when they are successful in the workplace (Heilman & Okimoto, 2007; Rudman et al., 2012), but growing evidence shows how women who become more successful than their partner are also stigmatized (Hettinger et al., 2014; MacInnis & Buliga, 2019; Vink et al., in press). Moreover, we show that successful women experience negative relationship outcomes when they surpass their partner in status. These relational dynamics offer an additional perspective on the other considerations that may prevent women from pursuing professional and societal success.

More specifically, women with higher status than their partners walk a tightrope for breaking with traditional gender norms. Women with traditional gender beliefs and who thus feel that their relative status in the relationship is conflicting with their gender role try to adjust their behavior but still report lower relationship quality and well-being. On the other hand, women with egalitarian gender beliefs and who thus feel that their role is in line with their own attitudes feel guilty toward their partner. Though the process of women with traditional and egalitarian gender associations is different, either way, these women are worse off compared to women who have not surpassed their partner in status.

Consequently, and in order to increase women's labor market participation and their chances of career success, systematic and structural change is needed rather than (well-intended) interventions aimed at individual women or couples (Barker et al., 2010). Our results suggest that social policies aiming to promote women's employment and career success must not only focus on individual women but also on what support they need from the organization in their careers, and what support is required in order to ensure that no problems arise on the home front. Policies that target individual women and the support they need at work may unintentionally assume that the male employees have the “most important” or “most successful” career in the family. In contrast, men also need support in combining their own careers with that of their partners. In fact, men who violate traditional gender norms are still stigmatized, and there have been few changes in that regard in the past decades (Croft et al., 2015). To illustrate, fathers who decide to work fewer hours to take care of their families are seen as “weak” and experience worse work outcomes than mothers who also choose to work fewer hours (Rudman & Mescher, 2013). For policies to be successful, they should also tackle the stereotype that men should be breadwinners and prioritize their careers. By placing the focus primarily on female employees and not on male employees, organizations are actually also perpetuating the stigma that a relationship with a more successful woman is “abnormal” and therefore stigmatizing.

In order to break this stigma, policymakers who address gender equality should be mindful of the broader relational contexts in which the targets of their policies operate. This focus is in line with the argument presented by Doyle and Barreto (2023), who emphasize the role of the social and relational context in which individuals operate as a crucial factor in understanding and tackling stigma. Policymakers can do this by applying a more relational focus when designing and implementing new social policies within the government and organizations. For example, policies that aim to facilitate career advancement for women might be complemented with policies that support homemaking roles for fathers (e.g., extending paid parental leave) to help them move away from the male breadwinner model (Cooke, 2006). Furthermore, HR professionals and managers in organizations can facilitate role-reversed couples by, for instance, by considering the careers of employees’ partners during performance reviews and by stepping away from the expectation that a good employee is someone who prioritizes their work 24/7 (Petriglieri, 2018). Indeed, team leaders that facilitate the combination of work-life issues succeed in preventing stress and conflict among male and female employees, resulting in increased well-being, health, and work performance (Van Steenbergen, 2007). Through this relational approach toward careers, employers can become more aware of how the careers of their employees’ partners also affect the choices and behaviors of individual employees.

Suggestions for future research

This research shows how women's social status can have negative consequences for their relationship outcomes once they surpass their male partner in status, and how women intent to behave in line with traditional gender roles. Future research can unravel the specific mechanisms that cause these associations. Some studies show how others outside the relationship stigmatize men and women in role-reversed relationships (Hettinger et al., 2014; MacInnis & Buliga, 2019; Vink et al., in press). However, more research is needed to examine how the negative social evaluations of others relate to the experiences of women and men in role-reversed relationships. To illustrate, future research can investigate whether it is mainly men's loss in status that causes stigmatization in heterosexual relationships or whether women's relative increase in status also predicts stigmatization (see Link & Phelan, 2001 for how stigmatization is associated with status loss). Also, a more elaborate investigation of how stigma is related to couples’ experiences may show that role-reversed couples experience less support and social acceptance than traditional couples, which is also related to negative outcomes in the interpersonal context (less flourishing and increased distress; Debrosse et al., 2022). Also, Park et al. (2022) show how lower socioeconomic status is often devaluated in higher education contexts. Consequently, the lower status of men with successful female partners may be even more salient in the couples’ contexts, making stigmatization even more likely to occur for these men. As experiences with stigma are associated with decreased relational closeness and impaired relationship satisfaction (Frost & LeBlanc, 2023), future research can investigate whether couples in role-reversed relationships experience decreased relational closeness toward each other compared to traditional couples.