This is the first study to examine a broad range of Axis I and Axis II DSM-IV disorders in a nationally representative sample of college students and their non-college-attending peers. We found that psychiatric disorders are common in this age group, that the distribution of disorder differs by educational status, and that treatment rates are low for both college students and their non-college-attending peers.
Almost one-half of the college students and their non-college-attending peers met DSM-IV criteria for at least one psychiatric disorder in the previous year. The most common disorders in college students were alcohol use disorders and personality disorders. In non-college respondents, the most common disorders were personality disorders and nicotine dependence. However the prevalence of mood and anxiety disorders was also high in both groups. The prevalence of psychiatric disorders in college-aged individuals was similar to the prevalence of psychiatric disorders in the US, with the exception of alcohol and substance use disorders, which were more than twofold the prevalence found in the general adult population.50-53
Previous research has shown that the hazard rate for onset of alcohol use disorders peaks at age 19 years and becomes much lower in the following years.51
Furthermore, about one-half of individuals with alcohol use disorders at age 19 continue to have these disorders at age 25.54, 55
The high prevalence and low rate of treatment for alcohol disorders found in this study mirrors findings in the U.S. general population across all ages of adulthood51
but were even more accentuated in college students. Given the lifelong mental and general medical health consequences of alcohol use disorders, the implementation of effective interventions to reduce or prevent the onset of alcohol use disorders in college-aged individuals are important public health goals. Heavy drinking and alcohol use disorders in college have been associated with a broad range of high-risk behaviors and adverse health outcomes, including driving while intoxicated, unsafe sex, physical and sexual assault, physical injuries, and death from unintentional injuries.14, 56
Interventions that decrease the rates of alcohol use and alcohol use disorders in this population are an important public health priority. Despite doubts about the effectiveness of treatment for drinking problems,57-59
recent reviews and meta-analyses have shown that brief interventions with college students, including skills-based interventions, motivational interviewing, and personalized normative feedback are effective methods for reducing college student drinking.60, 61
In view of the high prevalence and low rates of treatment of alcohol use disorders in college students, greater efforts to implement screening/intervention programs on college and university campuses are warranted. The centralized delivery of campus student health services might offer an advantageous structure for carrying out such screening and interventions. Additional prevention and intervention efforts could be implemented at many levels, including the organizational (fraternity/sorority, and campus- and community-wide).
Our study also documents that the correlates of psychiatric disorders among college students and their non-college-attending peers parallel those of the general population. Indicators of loss of social support (e.g., being widowed/separated/divorced or breaking up with a college romantic partner) were associated with increased the risk for psychiatric disorders. Alternatively, important social supports might have been lost by those with psychiatric disorders. These findings underscore the powerful influence of relationships in the lives of young people. The results also highlight the need to encourage youth to develop social support networks that may help to buffer the effects of romantic disappointments and other interpersonal losses. Life stressors were relatively uncommon in this population but, when present, they increased the risk for psychiatric disorders. College-age individuals may have less well-developed coping mechanisms or less experience than older adults with romantic disappointment and interpersonal losses, making them particularly vulnerable to the effect of these and related stressors. By contrast, foreign-born individuals and those from ethnic/racial minorities were at lower risk for psychiatric disorders, confirming reports in the general population.51
Identification of the mechanisms underlying the protective effect of racial/ethnic minorities may offer some clues to increase the resilience ethno-racial majority populations.
Most college-age individuals with psychiatric disorders did not seek treatment in the previous year, regardless of their educational status. Treatment rates were lowest for substance use and highest for mood disorders, consistent with patterns previously documented in the general population.51-53
Lower treatment rates for substance use disorders may be related to the stigma often associated with these conditions62-67
and failure by the individuals or their friends and family members to recognize early signs and symptoms or their need for care.68, 69
It is also possible that the time lag between onset of substance use disorders and the manifestation of their more severe consequences70, 71
interferes with mental health seeking for behaviors that can be so powerfully reinforced during young adulthood, especially among college students. Higher treatment rates for mood disorders may be the result of educational campaigns by the government, advocacy groups and the pharmaceutical industry, which have led to the growing recognition of these disorders as medical conditions,72
although the fact that more than one-half the individuals with mood and over 80% of individuals with anxiety disorders did not seek treatment suggests substantial unmet need. Delays or failures to seek early treatment for substance use or other psychiatric disorders are important to avoid because they often lead to future relapses and a more chronic course of the disorder.15, 73, 74
Our study has the limitations common to most large-scale surveys. First, information on educational status was based on self-report and not confirmed by collateral informants. However, the weighted numbers of college students in the NESARC match very closely to the yearly estimates of college enrollment,75
suggesting the degree of possible misclassification to be small in our study. Second, the cross-sectional design does not allow attribution of causality to the associations between psychiatric disorders and college attendance. Third, although the NESARC provides the most extensive assessment of psychiatric disorders among college students and their non-college-attending peers, some disorders including oppositional defiant disorder (ODD), attention-deficit hyperactivity disorder (ADHD), and learning disabilities were not assessed in this study. Fourth the NESARC did not systematically assess respondent’s perceived need for treatment and its influence on rates of treatment-seeking. Fifth, the mental health treatment results, because they rely on respondent linkage to specific disorders, may underestimate the proportion of affected young people who received any mental health care during the past year.
Despite these limitations, the NESARC constitutes the largest nationally representative survey to date to include information on psychiatric disorders in college students and their non-college-attending peers. The prevalence of psychiatric disorders is high in this population at a particularly vulnerable time of their development. Groups with particularly high prevalence were identified and should be the focus of prevention, assessment, and intervention efforts. The vast majority of the disorders suffered by this population can be effectively treated with evidence-based psychosocial and pharmacological approaches. Early treatment could reduce the persistence of these disorders, and their associated functional impairment, loss of productivity and increased health care costs. As these young people represent our nation’s future, urgent action is needed to increase detection and treatment of psychiatric disorders among college students and their non-college-attending peers.