BY LAURA KALITSIS — PUBLICATIONS OFFICER
The mental health status of university students is a growing public health concern. Students in the higher education system are susceptible to mental health struggles. Rates of mental illness, such as anxiety and depression, as well as states of emotional exhaustion and burnout are greater in the student population compared to the general population. Despite the recognition of the stressors that university students face, prevention and treatment of the consequential mental health struggles remain unclear and inadequate.
An introduction to student mental health
According to the World Mental Health Survey conducted by the World Health Organisation (WHO), university students have a significantly higher proportion of mental health illnesses compared to the general population. Students participating in this survey were screened for six different mental health conditions (major depression, generalised anxiety disorder, panic disorder, mania/hypomania, alcohol use disorder and substance use disorder). Results from this survey indicate that 35% of students suffer from a mental health condition. Similarly, the National Youth Mental Health Foundation conducted a National Student Wellbeing Survey in collaboration with Headspace. This questionnaire investigated the impact of academic, financial, transitional and health stressors on the university experience of Australian students. It was observed that 65% of students reported high or very high psychological distress during the academic year and 67% of students rated their mental health as fair or poor at times.
The results of both studies clearly show that whilst the student experience is an exciting and growth inducing phase of life, instability and stress accompany it. Navigating the transition to independence introduces financial and housing instabilities. Exploring one’s identity may lead to changes in social groups and relationships. Selecting courses and careers is a daunting process that many students find distressing. There are also several academic stressors such as meeting high-stake assessment deadlines, understanding large content loads and inadequate academic support. Although such experiences are important learning opportunities, the associated stress is a causative factor of mental health struggles in the student population.
The impact of COVID-19 has only heightened stress and mental health challenges faced by students. The necessary lockdown policies induced feelings of isolation and loneliness as social activities came to a halt. Academic teaching moved to online modes and many internships and work experience opportunities were cancelled. Additionally, loss of jobs enhanced financial distress and created difficulties for students to meet accommodation and tuition fees.
What is burnout?
Psychologists describe burnout as a state of mental and physical exhaustion. Currently, burnout is not recognised as a diagnosis as it is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Therefore, it is difficult to develop treatment plans and management guidelines. Furthermore, this lack of a formal diagnosis creates challenges in understanding the prevalence and distribution of burnout amongst students. To assist in it’s recognition, burnout can be broken down into three components: emotional exhaustion, depersonalisation and reduced sense of personal accomplishment. Emotional exhaustion is characterised by physical and psychological symptoms of fatigue and feeling depleted from academics or work. Depersonalisation is the feeling of detachment from oneself, as if one is watching their life from the outside. Lastly, reduced sense of accomplishment describes a lack of internal motivation and reduced satisfaction from study or work.
Stress is both a predictive factor and indicator of burnout. Due to increased levels of instability and psychological distress associated with the university experience, students are at risk of developing burnout during their academic years. Academic burnout has a plethora of consequences. Students working with burnout are less effective in academic and professional settings. Additionally, failure, absenteeism and dropout rates are higher in chronically stressed or burnout students. Burnout increases the risk of future mental health problems such as depression, substance abuse, suicide and suicidal thoughts.
Preventing and treating burnout
Both the management and treatment of burnout currently remains unclear. However, there are several strategies students can implement to prevent burnout. Motivation is a force that drives learning and sustains behaviours towards a particular goal. For students, it can be difficult to recognise and find motivation, which can make academic tasks and deadlines more daunting and stressful than they should be. Therefore, it is important for students to reflect and identify what is motivating their academic study. Intrinsic motivation is an internal drive to study or work because of one’s inherent interest in the course content and their future career. Whilst it can be challenging to find intrinsic motivation, studying with intention is associated with higher levels of accomplishment.
Developing stress management techniques is vital in preventing burnout during the academic year. Self-care strategies vary from student to student, but it is important that students implement such techniques within their routines. Meditation is an effective way of monitoring and supporting mental health. Practising mindfulness is demonstrated to decrease stress and improve student wellbeing. Organisations such as Headspace and Calm provide guided meditations to reduce stress and anxiety and improve sleep quality. Alternatively, regular physical activity has multiple mental and physical health benefits. Studies show that physical inactivity is associated with poorer mental health, self-harm and suicidal thoughts. Thus, it is important that students are encouraged to find an enjoyable form of exercise, especially if this exercise takes place in natural environments, as additional research has demonstrated that exercise in nature or green spaces can improve mental wellbeing.
Building emotional support systems also plays a significant role in preventing and treating mental health struggles. Discussing problems with friends and family or participating in social activities are great mechanisms of psychosocial support. Additionally, asking student mentors and alumni questions can aid in relieving academic and career stress. However, in circumstances where one’s support systems are insufficient, seeking help from professionals can provide struggling students with the necessary care and treatment plans. Unfortunately, several barriers prevent students from seeking professional help. According to the WHO World Mental Health International College Student Initiative, only 24.6% of students reported that they would definitely seek treatment for future mental health issues, and many students would prefer to handle mental health problems on their own or discuss with friends and family. There are an abundance of reasons that prevent students seeking necessary care, including stigma surrounding mental health issues, the high cost and extensive wait times for psychologist appointments, failure to recognise problems, or perception that treatment is not necessary. Universities endeavour to support the mental wellbeing of students by encouraging discussion about mental health and providing counselling services. However, the number of students in need of treatment well exceeds the psychological and counselling services available.
The student mental health crisis is a multifaceted issue that involves solutions from various sectors. Improving mental health literacy and accessibility to treatment is necessary for students to prevent, recognise and manage any mental health issues. Discussing mental health aims to break down associated stigma and hopefully allow students to feel comfortable seeking treatment. For students battling mental health struggles, you are not alone. There is always someone to talk to whether that be a friend, family member or professional. ●
1. Auerbach R, Mortier P, Bruffaerts R et al. WHO World Mental Health Surveys International College Student Project: Prevalence and distribution of mental disorders. J Abnorm Psychol. 2018;127(7):623–638. https://doi.org/10.1037/abn0000362.
2. Rickwood D, Telford N, O’Sullivan S, Crisp D, Magyar R. National Tertiary Student Wellbeing Survey 2016. Headspace.org.au. https://headspace.org.au/assets/Uploads/headspace-NUS-Publication-Digital.pdf.
3. Agius M, Goh C. The stress-vulnerability model; how does stress impact on mental illness at the level of the brain….and what are the consequences? European Psychiatry. 2010;22(2):198–202. https://doi.org/10.1016/s0924-9338(10)71572-8.
4. Lyons Z, Wilcox H, Leung L, Dearsley O. COVID-19 and the mental well-being of Australian medical students: impact, concerns and coping strategies used. Australasian Psychiatry. 2020;28(6):649–652. https://doi.org/10.1177/1039856220947945.
5. Parker G, Tavella G. Burnout: modeling, measuring, and managing. Australasian Psychiatry. 2021;29(6):625–627. https://doi.org/10.1177/10398562211037332.
6. Ishak W, Nikravesh R, Lederer S, Perry R, Ogunyemi D, Bernstein C. Burnout in medical students: a systematic review. Clin Teach. 2013;10(4):242–245. https://doi.org/10.1111/tct.12014.
7. Kilic R, Nasello J, Melchior V, Triffaux J. Academic burnout among medical students: respective importance of risk and protective factors. Public Health. 2021;198:187–195. https://doi.org/10.1016/j.puhe.2021.07.025.
8. Rehman A, Bhuttah T, You X. Linking Burnout to Psychological Well-being: The Mediating Role of Social Support and Learning Motivation. Psychol Res Behav Manag. 2020;Volume 13:545–554. https://doi.org/10.2147/prbm.s250961.
9. Ryan R, Deci E. Intrinsic and extrinsic motivation from a self-determination theory perspective: Definitions, theory, practices, and future directions. Contemp Educ Psychol. 2020;61:101860. https://doi.org/10.1016/j.cedpsych.2020.101860.
10. Wu H, Li S, Zheng J, Guo J. Medical students’ motivation and academic performance: the mediating roles of self-efficacy and learning engagement. Med Educ Online. 2020;25(1). https://doi.org/10.1080/10872981.2020.1742964.
11. de Vibe M, Solhaug I, Tyssen R et al. Mindfulness training for stress management: a randomised controlled study of medical and psychology students. BMC Med Educ. 2013;13(1). https://doi.org/10.1186/1472-6920-13-107.
12. Meditation and Sleep Made Simple – Headspace. Headspace.com. https://www.headspace.com.
13. Calm – The #1 App for Meditation and Sleep. Calm.com. https://www.calm.com.
14. Grasdalsmoen M, Eriksen H, Lønning K, Sivertsen B. Physical exercise, mental health problems, and suicide attempts in university students. BMC Psychiatry. 2020;20(1). https://doi.org/10.1186/s12888-020-02583-3.
15. Ewert A, Chang Y. Levels of Nature and Stress Response. Behavioral Sciences. 2018;8(5):49. https://doi.org/10.3390/bs8050049.
16. Dunn L, Iglewicz A, Moutier C. A Conceptual Model of Medical Student Well-Being: Promoting Resilience and Preventing Burnout. Academic Psychiatry. 2008;32(1):44-53. https://doi.org/10.1176/appi.ap.32.1.44.
17. Ebert D, Mortier P, Kaehlke F et al. Barriers of mental health treatment utilization among first‐year college students: First cross‐national results from the WHO World Mental Health International College Student Initiative. Int J Methods Psychiatr Res. 2019;28(2):e1782. https://doi.org/10.1002/mpr.1782.
18. Vidourek R, King K, Nabors L, Merianos A. Students’ benefits and barriers to mental health help-seeking. Health Psychol Behav Med. 2014;2(1):1009–1022. https://doi.org/10.1080/21642850.2014.963586.
19. Sussman S, Arnett J. Emerging Adulthood. Eval Health Prof. 2014;37(2):147–155. https://doi.org/10.1177/0163278714521812.