Dr David Hill (Host): This is Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill. Today we're talking with Dr. Brandyn Mason, a Family Medicine Physician at Carle Health about mental health challenges in college students. Brandyn welcome.

Dr Brandyn Mason: Well, thank you for having me.

Dr David Hill (Host): So, Brandyn, I have in my own family, three college students. I know that they have had their own struggles. We hear about increasing prevalence of mental health disorders in college students. What's going on here? Do you think we're really seeing this increased prevalence or we're just more aware of it. What are the trends?

Dr Brandyn Mason: I think it is a combination of both. I mean, there is an increased prevalence, but mostly probably because of the increased identification of these and understanding from a lot of different areas and groups. When we talk about prevalence of mental health in that age group, there's a number of different reasons that exist and plausible explanations for why there is that increase for any individual once they reach that college age.

Most of which, kind of revolves around them going through this major life transition into college with its associated issues of having that unstable life structure that they may be used to, leading to those feelings of uncertainty and the need to explore other options and focusing on one self causing a significant amount of distress.

But furthermore, they're really for the most part, confronted with adult responsibilities that they probably haven't had before, including financial stability and the development and maintenance of significant relationships, within that age group. So, there's a number of reasons for that, that they have that significant increase in prevalence during that group.

Dr David Hill (Host): So that there's a lot going on at this time. Do we have a sense that colleges are getting better at supporting students and giving them places to go to get help?

Dr Brandyn Mason: We get the sense that they're trying. I mean, a lot of these places, colleges and other institutions have moved towards virtual health, which has become a bigger part of how medicine is produced, since the Covid pandemic.

So online therapy has really been used then to increase their options for therapeutic relationship and be able to identify resources within the community. But what we have found out is that after the initial couple of visits with online therapy and online online resources, the relationship really loses a lot of its effectiveness because then questions about security and confidentiality about that information really comes into effect.

And so in person care becomes more needed, which has not really increased tremendously within the college community. Although some colleges have moved towards different options including, Mental Health First Aid, which is a program that was first actually developed in Australia where really it's training during the orientation for other students knowing how to identify and see mental health to those individuals seek help. It's really about improving the confidence in students to be able to offer the aid during mental health crisises and direct fellow students to the available resources. That's been growing more and more in certain college groups.

Dr David Hill (Host): You know, I know that one of my kids lost three different classmates in rapid succession to suicide. What do we understand about suicidal ideation, suicide attempts and suicide itself among college students?

Dr Brandyn Mason: It's really interesting and there's a drastic difference in the prevalence in suicidal ideations and attempts when you compare college students to the adult population. It's 24% in college students, 9% for the suicidal ideation and 9% versus 2.7% for an actual attempt. So a huge increase there.

And there's a number of factors that actually predispose those students to those ideations and attempts. They include depression, impulsivity, poverty that they may not have experienced before. And, the lack of parental warmth they had prior to kind of moving out and being on their own.

But there's another number of different important contributing and factors including racial minorities and other minority groups who, for whatever reason, view mental health services and mental health diagnosis as a weakness. So they don't seek out what is actually already in place for them to seek the assistance they need.

Dr David Hill (Host): And are there signs that people's roommates or parents should be looking for to sort of raise a red flag and let them know, man, I need to help this person get help, or reach out to them or check in on them?

Dr Brandyn Mason: There's a lot of different things. You know, self-damaging behaviors is what you see, and it includes a number of different concepts, including causing physical harm to themselves, but also substance use increases, physical altercations with others and lack of common safety concerns and precautions; such as those who no longer wear seat belts anymore while they're driving, or don't take the normal precautions that they would've taken to ensure their safety previously.

Those would be signs that maybe something is going on that requires a little further discussion with that individual.

Dr David Hill (Host): And what do you do if you see those signs? Are there effective ways to approach people and say, Hey, you want to talk? Do you need to see somebody?

Dr Brandyn Mason: Yeah, and most of the research out there does demonstrate that having a close connection to that individual is really what's going to open you up to have a meaningful conversation that's going to lead to the ability to help. It's noticing the difference and just asking, saying, Hey, I noticed this change or this difference in your view. Is there something you want to talk about, something you want to discuss, to kind of help open and start that conversation. Just letting somebody you know that you're close to, identify and say, Hey, there's something going on. Maybe I should discuss what's going on, how I feel. And understand that a lot of times, people enter these communities, these college communities, and don't understand that there's a number of different individuals that are going through similar stressful issues that they're going through.

And not have the feeling of isolation where they feel like they're aren't good enough basically to be where they are in life.

Dr David Hill (Host): You know when you talk about not feeling good enough or not feeling like you belong, it brings up some real identity issues; racial, sexual identity, gender, socioeconomic differences that we're paying attention to in college. How do those identity issues play out when it comes to depression in college students?

Dr Brandyn Mason: There's a number of things that play out. I mean, sexual identification, obviously does add to some of that. Being an older student when starting college. Those that don't start until they're 19 or 20 years old rather than right out of high school, have a larger incidence of depression. Female gender is another group that has a larger prevalence. And, there are also some positive correlations from students, from unmarried parents, with at least one deceased parent or even lower high school rankings. Those also lead to that and a number of different things, including socioeconomics, and other difficulties growing up, do lead to a higher incidence of depression. And, when we talk about a little bit the identity of not feeling good enough or having a little bit of that imposter type syndrome that exists; it kind of becomes self-fulfilling prophecy as those that are diagnosed or have mental health disorders, actually have a significant negative impact on their academic performance with drops in their GPA of about 0.5 when compared to others that aren't having those same issues. So you start having that little bit of imposter syndrome where you don't feel like you're good enough, you have the depression that goes with it, and then your GPA and academic performance kind of corresponds to those same issues leading to those problems as well.

Dr David Hill (Host): So kind of a vicious cycle. Is there one thing that you wish everybody knew about mental health issues in college students before we go?

Dr Brandyn Mason: I think there's a number of things that are extremely important to know about mental health, actually, especially in college students. But I think one of the most important things to know from this whole thing is the risk for suicidality in the college student, it's a growing concern. And there's been studies that have demonstrated prior to a student's death by suicide, about 50% of those had visited a primary care provider within the last month preceding it, and 25% had been under the care of some mental health professional the month preceding the event as well. So a lot of these individuals who end up, you know, we think impulsivity is one of the driving causes. A lot of these individuals still do commit suicide and have been seen by a provider. And I think it importantly for physicians, providers, anybody seeing people in this age group is to be able to ask and identify issues that may be resulting from poor mental health and trying to help associate those individuals with the proper resources to help improve their current mental condition.

Dr David Hill (Host): You know, that is some really useful data, and I think, those of us who see these kids need to keep it in mind. Dr. Brandyn Mason, thank you so much for talking with us today.

Dr Brandyn Mason: Yes. Thank you.

Dr David Hill (Host): For more information and to get connected with one of our providers, please visit carle.org. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill.