National Survey on Drug Use and Health TheRNSDUH eport May 3, 2012 Major Depressive Episode among Full-Time College Students and Other Young Adults, Aged 18 to 22

ragic events on college campuses In Brief in recent years and a growing awareness of the significance ●● Combined data for the years 2008 to T 2010 show that 8.4 percent of full-time of prevention and early intervention college students aged 18 to 22 and 8.2 for mental disorders have focused new percent of other young adults (part- attention on the needs of time college students and those not young adults. Research indicates that currently enrolled in college) aged 18 to 22 experienced a major depressive about half of Americans will meet the episode (MDE) in the past year criteria for a disorder from the Diagnostic and Statistical Manual of Mental ●● Although both groups had similar rates 1 of past year MDE, other young adults Disorders, fourth edition (DSM-IV), with MDE were more likely than full- sometime in their lifetime, with first onset time college students with past year usually in childhood or adolescence.2 New MDE to report that the mood related to information from the National Survey their MDE very severely impaired their on Drug Use and Health (NSDUH) important activities and relationships and to report that they experienced regarding the prevalence and severity of more than 60 days in the past year mental health disorders among young when they were totally unable to carry adults who are in college and among those out their normal activities who are not in college (and about whom ●● Despite greater severity of symptoms less is generally known) can therefore among other young adults with be very useful to policy makers and MDE, both groups were equally likely behavioral health providers. to receive specialty mental health treatment (43.9 vs. 40.4 percent) Using combined data from the NSDUH for 2008 to 2010, this issue of The NSDUH

The NSDUH Report is published periodically by the Center for Behavioral Health Statistics and Quality (formerly the Office of Applied Studies), Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Center for Behavioral Health Statistics and Quality are available online: http://www.samhsa.gov/data/. Citation of the source is appreciated. For questions about this report, please e-mail: [email protected]. NSDUH_060 NSDUH REPORT: Major Depressive Episode among Full-time College Students and Other Young Adults, Aged 18 to 22 May 3, 2012

Report focuses on the prevalence of past year Table 1. Major Depressive Episode (MDE) in major depressive episode (MDE) among college the Past Year among Persons Aged 18 to 22, students and other young adults (part-time by Full-Time College Status and Demographic college students and those not currently enrolled Characteristics: Percentages, 2008 to 2010 in college) aged 18 to 22.3 The report compares the prevalence of MDE for these two groups Full-Time by gender and race/ethnicity. The extent to College Other Young Demographic Students Adults which full-time college students and other young Characteristic (%) (%) adults aged 18 to 22 with MDE report that their symptoms interfere with their important Total 8.4 8.2 activities and their personal relationships (based Aged 18 to 20 8.2 8.1 on the Sheehan Scale, or SDS) is Aged 21 to 22 8.6 8.3 4 also described. The report also indicates the Male 4.5 5.5* proportion of each group that reported that they Female 12.0 11.3 received specialty mental health treatment.5 For this analysis, respondents were classified Non-Hispanic White 8.4 9.4 as college students if they reported that they Non-Hispanic Black 7.4 6.2 Non-Hispanic American -- 4.6 were in their first through fourth year (or Indian/Alaska Native higher) at a college or university and that they Non-Hispanic Native -- -- were a full-time student. Respondents who were Hawaiian or Other Pacific on break from college were considered enrolled Islander if they intended to return to college or university Non-Hispanic Asian 6.3 4.2 Non-Hispanic Persons of 17.6 17.8 when the break ended. Two or More Races Hispanic 9.1 6.4* MDE by Demographic Characteristics * The difference between full-time college students and other young Combined data from the 2008 to 2010 adults was statistically significant at the .05 level. -- Estimate not reported due to low precision. NSDUH surveys show that 8.4 percent of full- Source: 2008 to 2010 SAMHSA National Surveys on Drug Use and time college students aged 18 to 22 experienced Health (NSDUHs). MDE in the past year; similarly, 8.2 percent of other young adults aged 18 to 22 experienced MDE in the past year. For both full-time college students, the percentage with past year MDE students and other young adults aged 18 to 22, ranged from 6.3 percent among Asians to females were more likely than males to have had 17.6 percent among persons of two or more a past year MDE (Table 1). Among full-time races. Among other young adults aged 18 to college students, 12.0 percent of females had 22, the rates of past year MDE ranged from a past year MDE compared with 4.5 percent 4.2 percent among Asians to 17.8 percent of males; among other young adults aged 18 among persons of two or more races. Hispanic to 22, 11.3 percent of females had a past year full-time college students were more likely than MDE, compared with 5.5 percent of males. other Hispanic young adults to have had past No differences were observed with regard to year MDE (9.1 vs. 6.4 percent). age (18 to 20 year olds vs. 21 to 22 year olds) for either full-time college students or other Reported Severity of Symptoms young adults. The prevalence of MDE differed by racial/ Although the overall proportion of individuals ethnic categories. Among full-time college aged 18 to 22 with past year MDE was

Page 2 NSDUH REPORT: Major Depressive Episode among Full-time College Students May 3, 2012 and Other Young Adults, Aged 18 to 22 similar among full-time college students and Table 2. Severity of Impairment due to Symptoms other young adults, differences between the of among Persons Aged 18 to 22 two groups were apparent in the severity of with Past Year Major Depressive Episode (MDE), depressive symptoms and in the degree to which by Full-Time College Status: Percentages, 2008 symptoms impaired important activities and to 2010 relationships (Table 2). For example, 8.2 percent of full-time college students reported that they Full-Time Other College Young experienced very severe impairment in their Students Adults ability to maintain close relationships, whereas Severity of Impairment (%) (%) 13.0 percent of other young adults reported this Home Management: 6.5 3.0* level of impairment. No Interference Among full-time college students aged 18 to Home Management: Mild 23.3 21.7 22 with past year MDE, 14.0 percent reported Home Management: 43.0 40.3 that the maximum severity level of their MDE Moderate was very severe (Figure 1).6 Among other young Home Management: Severe 23.0 28.1* Home Management: Very 4.1 6.9* adults aged 18 to 22, however, the percentage Severe reporting that the maximum severity level of their MDE was very severe was 19.8 percent. Ability to Work: 6.0 6.5 No Interference Although only 10.0 percent of full-time college Ability to Work: Mild 31.4 28.5 students aged 18 to 22 with past year MDE Ability to Work: Moderate 39.9 38.1 reported that there were more than 60 days Ability to Work: Severe 19.2 20.5 in the past year when they were totally unable Ability to Work: Very Severe 3.5 6.4 to carry out normal activities, for other young Close Relationships: 2.7 2.4 adults aged 18 to 22, this percentage was No Interference 19.7 percent (Figure 2). Similarly, 30.7 percent Close Relationships: Mild 19.4 18.3 of full-time college students with past year MDE Close Relationships: 31.6 33.4 reported there were no days in the past year Moderate when they were totally unable to carry out their Close Relationships: Severe 38.0 32.9* normal activities, but only 24.9 percent of other Close Relationships: Very 8.2 13.0* Severe young adults reported that this was the case. Social Life: No Interference 3.1 3.7 Receipt of Specialty Mental Health Social Life: Mild 16.9 15.0 Treatment Social Life: Moderate 32.2 35.8 Social Life: Severe 39.2 32.2* Full-time college students aged 18 to 22 with Social Life: Very Severe 8.6 13.3* past year MDE and other young adults with * The difference between full-time college students and other young past year MDE were equally likely to receive adults was statistically significant at the .05 level. specialty mental health treatment in the past Source: 2008 to 2010 SAMHSA National Surveys on Drug Use and year (43.9 and 40.4 percent, respectively) Health (NSDUHs). (Figure 3). The percentage of full-time college students aged 18 to 22 with past year MDE However, full-time college students and other who received specialty mental health counseling young adults with past year MDE were almost was slightly higher than the percentage of other equally likely to receive prescription medication young adults with past year MDE who received for their MDE (28.1 and 29.4 percent, mental health counseling (41.1 vs. 35.7 percent). respectively).

Page 3 NSDUH REPORT: Major Depressive Episode among Full-time College Students and Other Young Adults, Aged 18 to 22 May 3, 2012

Figure 1. Maximum Level of Severity of Figure 2. Number of Days in the Past Year Unable Impairment due to Symptoms of Depression to Carry Out Normal Activities due to Symptoms among Persons Aged 18 to 22 with Past Year of Depression among Persons Aged 18 to 22 Major Depressive Episode (MDE), by Full-Time with Past Year Major Depressive Episode (MDE), College Status: 2008 to 2010 by Full-Time College Status: 2008 to 2010

100 100 10.0 14.0 19.8 19.7 9.0 80 80 12.0 11.6

10.6 48.6 60 60 More than 44.7 Very Severe 60 Days Severe 29 to 60 Days

rcent rcent 38.3 Moderate 14 to 28 Days Pe No or Mild Pe 1 to 13 Days Interference 33.2 40 40 0 Days

31.2 20 28.1 20 30.7 24.9

6.2 7. 4 0 0 Full-Time Other Young Full-Time Other Young College Students Adults College Students Adults

Source: 2008 to 2010 SAMHSA National Surveys on Drug Use and Source: 2008 to 2010 SAMHSA National Surveys on Drug Use and Health (NSDUHs). Health (NSDUHs).

young adults aged 18 to 22 with MDE were Discussion equally likely to receive specialty mental health Overall, the prevalence of past year MDE was treatment, although other young adults were similar among full-time college students and more likely than full-time college students to have other young adults aged 18 to 22 (8.4 and 8.2 received mental health counseling. percent, respectively). However, other young Considerable controversy surrounds the adults aged 18 to 22 with MDE were generally question of whether rates of psychiatric disorders more likely to report that the mood related and mental health treatment differ between to their MDE very severely impaired their college students and their peers who do not important activities and relationships and were attend college.7 Although much attention has also more likely than full-time college students been focused on the mental health problems and to report a higher number of days in the past service needs of full-time college students, the year during which they were unable to carry out results presented here suggest that other young their normal activities because of MDE. Despite adults aged 18 to 22 experience similar, and the reported greater severity of their symptoms, possibly more serious, mental health issues. It full-time college students with MDE and other is possible that the reason for this is that young adults aged 18 to 22 who are not full-time

Page 4 NSDUH REPORT: Major Depressive Episode among Full-time College Students May 3, 2012 and Other Young Adults, Aged 18 to 22 college students experience Figure 3. Receipt of Specialty Mental Health Treatment in the Past different kinds of stresses Year among Persons Aged 18 to 22 with Past Year Major Depressive related to employment (and Episode (MDE), by Full-Time College Status: 2008 to 2010 unemployment) or family responsibilities. These factors 50 Full-Time College Students may contribute to the increased 43.9 Other Young Adults severity of MDE symptoms and 40.4 41.1 greater functional impairment 40 35.7 reported by these other young adults. Further, it is possible 29.4 30 28.1 that full-time college students are more likely than other rcent Pe young adults aged 18 to 22 to 20 have access to health insurance and/or to specialty mental health and other medical and 10 support services provided by their colleges. The mental 0 health problems and treatment Received Any Specialty Received Mental Received Prescription needs of young adults aged Mental Health Services Health Counseling* Medication 18 to 22 who are not full-time * The difference between full-time college students and other young adults is statistically significant college students may thus at the .05 level. warrant increased investigation Source: 2008 to 2010 SAMHSA National Surveys on Drug Use and Health (NSDUHs). and attention.

5 Treatment for depression is defined as seeing or talking to a doctor or other End Notes professional or using prescription medication in the past year for depression.

6 1 American Psychiatric Association. (1994). Diagnostic and statistical manual Maximum severity is defined as the highest level of impairment caused by of mental disorders (4th ed.). Washington, DC: Author. the disorder in any one of the four role domains. For example, if an individual reported no impairment in three of the role domains and a 7 in the fourth role 2 Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & domain, the maximum severity value would be 7. Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of 7 DSM-IV disorders in the National Survey Replication. Archives Blanco, C., Okuda, M., Wright, C., Hasin, D. S., Grant, B. F., Liu, S. M., & of General , 62(6), 593-602. Olfson, M. (2008). Mental health of college students and their non-college attending peers: Results from the National Epidemiologic Study on Alcohol 3 MDE is defined using diagnostic criteria in the DSM-IV, which specifies a and Related Conditions. Archives of General Psychiatry, 65(12), 1429-1437. period of 2 weeks or longer during which there is either depressed mood or loss of interest or and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, Suggested Citation concentration, and self-image. In assessing MDE, no exclusions were made for MDE caused by medical illness, bereavement, or substance use Substance Abuse and Mental Health Services Administration, Center for disorders. Behavioral Health Statistics and Quality. (May 3, 2012). The NSDUH Report: Major Depressive Episode among Full-Time College Students and Other 4 The Sheehan Disability Scale (SDS) measures the impact of MDE on a Young Adults, Aged 18 to 22. Rockville, MD. person’s life. The SDS asks adults aged 18 or older to give a rating of 0 to 10 (with 10 being the highest) for the level of impairment caused by the disorder in each of four role domains: (1) home management, (2) work, (3) close relationships with others, and (4) social life. Respondents with unknown severity of SDS role impairment data or for whom particular activities were not applicable were excluded.

Page 5

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