Education Resources

Mental Health and the Transition to College

How friends can look out for each other's mental well-being.

High school and college students are at risk for untreated mental illness.

It is common for symptoms of mental illness to manifest during high school and college, then go unrecognized for years. Among people who will experience mental illness during their life, 50% suffer from their first episode by age 14. This figure rises to 75% experience their first episode by age 24.  On average, there is an 8-10 year delay between the onset of symptoms and treatment.

A person having a depressive episode typically has a very low mood and an inability to experience pleasure from activities he or she used to enjoy. Other symptoms of depression include thoughts and feelings of worthlessness, hopelessness, helplessness, inappropriate guilt, and self-hatred.

Depression is one of the most common mental illness experienced by college students. College students are more likely than the general population to experience a depressive episode, and they are less likely to seek treatment for it. Untreated depression is the leading cause of suicide.

Anxiety disorders are the most common mental illness in the U.S, affecting 40 million adults in the United States age 18 and older, or 18% of the population.

Anxiety disorders are characterized by excessive worry about the future and fear during the present. Sometimes, people with anxiety disorders experience physical symptoms like a racing heartbeat and shakiness. Anxiety disorders come in many forms, including generalized anxiety disorder, social anxiety disorder, panic disorder, post-traumatic stress disorder, and others.

Increased stress during college can sometimes worsen the symptoms of students with certain anxiety disorders. The 2013 National College Health Assessment found that about half of all college students report experiencing “overwhelming anxiety” during the past year.

Bipolar disorder is characterized by periods of mania or hypomania and periods of depression. During manic or hypomanic episodes, a person may engage in impulsive behaviors, experience elevated mood and have a decreased need for sleep. Symptoms of both mania and depression may sometimes be present. In these cases, impulsivity and low mood create a high risk for suicide.

While less common than major depressive disorder, untreated bipolar disorder is associated with extremely high drop-out rates in college.

Bipolar disorder tends to be more heavily stigmatized and less well-understood by the public than other mood disorders. A NAMI study found that 35% of parents and 48% of students believe bipolar disorder is at least somewhat attributable to character flaws or weak willpower. More than 70% of parents and students would be uncomfortable if a close friend or family member was dating or marrying a person with bipolar disorder.

Eating disorders involve abnormal eating habits that threaten a person’s physical or mental health. The best-known examples include anorexia nervosa (where people eat very little) and bulimia nervosa (where people eat a lot and then try to rid themselves of the food). Eating disorders often occur alongside anxiety disorders, depression, and substance abuse disorders.

25% of college-aged women engage in bingeing and purging as a weight-management technique. In a survey of 185 female students on a college campus, 58% felt pressure to be a certain weight, and of the 83% that dieted for weight loss, 44% were of normal weight.

Personality disorders are a very diverse category of mental illnesses involving rigid patterns of thoughts, feelings, and behavior that differ greatly from what society expects. From time to time, most people have thoughts, emotions, or behaviors that meet those criteria. In a person with a personality disorder, these those thoughts, feelings, and behaviors are inflexible parts of an enduring pattern that causes distress and impairment.

About 20% of people age 19 to 25 have a personality disorder. These disorders often occur alongside another mental disorder. Between 40-60% of patients diagnosed with another mental illness also have a personality disorder. Management usually consists of a form of talk therapy, as well as treatment of coexisting mental disorder.

Schizophrenia is a mental disorder involving abnormal behavior and an inability to recognize reality. Symptoms vary, but often include disorganized thinking or speech, delusions, hallucinations, social withdrawal, reduced emotional expression, and loss of motivation. These symptoms can cause significant impairment and subject schizophrenics to significant stigma. However, schizophrenia is often treatable. Ten years after a diagnosis of schizophrenia, 25% of people completely recover, 25% improve and are mostly independent, 25% improve but still require extensive support, 15% are hospitalized and unimproved, and 10% are dead (mostly from suicide).

Schizophrenia affects 1.1% of the population. As with most mental disorders, both environmental and genetic factors contribute to the development of symptoms. Among those environmental factors are life changes such as going to college, stress from the demands of coursework, and new or continuing drug use. There is evidence that marijuana use can increase the risk of developing schizophrenia in predisposed populations.

The abuse of drugs – both legal and illegal – is common on college campuses. Substance abuse can exacerbate underlying mental illness.

According to the National Institute for Alcohol Abuse and Alcoholism, about 40% of college students report binge drinking in the last 30 days. The 2013 Monitoring the Future study found that 39% of college students report using an illicit substance in the last year. 36% report using marijuana, 11% report using prescriptions stimulants like Adderall, and 2% report using synthetic cannabinoids (e.g. “K-2” or “Spice”). 5.1% report daily or near-daily use of marijuana.



The transition to college is a time of increased stress and decreased support.

For many young adults, the transition to college involves a weakening of the support network offered by friends and family. College students are often living away from home for the first time. They have less contact with high school friends who attend other institutions. College itself presents an unfamiliar learning environment, with more demanding coursework contributing to stress. The combination of increased stress and weakened support can have a negative impact on students’ mental health.


Parents’ perceptions of a student’s mental health are often inaccurate.

A 2004 study by the National Institute for Mental Illness (NAMI) and Abbott Laboratories found that 50% of students rated their mental health as below average or poor, while only 25% of parents rated their students’ mental health in that range. A further 30% of students reported that they had problems functioning in school due to mental illness, while only 7% of parents reported the same issue. The disparity could be explained by reduced contact between parents and students, an unwillingness of students to communicate mental health issues to parents, a failure by parents to recognize signs of mental illness in students, or a combination of any of the three.


Students are most likely to seek out other friends for support. Be prepared to act.

The 2004 NAMI study found that college students were most likely to reach out to friends when suffering from an episode of mental illness. Rachael’s First Week encourages college students to “always look for each other,” whether it is an issue of physical or emotional health.

1What kind of mental health resources are available to college students?
Most colleges and universities offer some form of counseling and psychiatric care through their student health centers. Some institutions include a certain number of counseling sessions in the cost of the student health plan. The best time to learn about the resources available is before classes begin.
2What are signs that a friend might be depressed?
1. Loss of interest in things that were previously pleasurable. Also known as anhedonia, this inability to experience pleasure is often one of the first symptoms to manifest and the last to resolve. It may not be complete, and it may take the form of pursuing only the interests that provide instant enjoyment with little effort. It is often accompanied by social withdrawal. Engaging with another person to participate in social activities requires more effort than solitary like surfing the Web and watching TV.

2. Sleep disturbances. Sleeping too little and sleeping too much can both be a sign of depression. The important thing to look for is a departure from your friend’s prior sleep schedule.

3. Changes in weight or diet. Eating too little or too much can both indicate a potential problem. Signs of an eating disorder might include avoidance of food, absences after meals for purging, and extreme weight loss. Overeating and undereating can both be signs of depression as well. This can be a difficult topic to raise with a friend, especially if an eating disorder is suspected.

4. Irritability. Depression saps energy in an insidious way. Each day becomes a greater and greater challenge. Frustration builds, and tempers may flare over even matters. When a friend shows a pattern of increased irritability, it is easy (and natural) to justify avoiding that person. If that irritibility is due to depression, this can only make the situation worse.

5. Low mood and negative outlook. Sometimes the signs of depression are not subtle. A change toward a consistently sad or pessimistic outlook can be a sign of depression (e.g. reacting to a good grade with a comment like “What does it matter? It makes no difference.”) Depression creates a self-fulfilling prophecy where negative thoughts influence behavior, and behavior is interpreted in a way that validates those negative thoughts.

6. Expressing thoughts of hopelessness, despair, and/or suicide.. Suicidality can be expressed in passively (e.g. “The world would be better off without me in it.”) or actively (“Some days, I feel like could just end it all.”) Always take any mention of suicide seriously. There is a common myth that if a person is really suicidal, they don’t tell others about it; they do it.

7. Evidence of self-harm.

8. Drinks more or abuses drugs, including prescription sleeping pills and painkillers. Abuse of drugs and alcohol may be signs that a friend is self-medicating.

3What are signs that a friend might be suicidal?
Suicide has many warning signs, all of which should be taken seriously. Read this handout or visit our suicide prevention section below for more information.
4How do I approach a friend who might be depressed or suicidal?
Starting the Conversation

Find a time where you can speak to your friend in private. Mention that you have been feeling concerned about that person. Gently introduce the changes in behavior that you’ve observed and explain why they trouble you. You can ask questions like:

“How long have you been feeling this way?”
“Did something happen that made you feel like this?”
“What can I do to help you through this?”
“Have you thought about getting help from (campus counseling, etc…)?”

Do’s and Don’ts

It is important to remember that depression fundamentally changes a person’s outlook on life and response to your words. Your message needs to come through clearly to a person in that mindset. Do say things like:

“You are not alone in this. I’m here for you.”
“You may not believe it now, but the way you’re feeling will change.”
“I may not be able to understand exactly how you feel, but I care about you and want to help.”
“When you want to give up, tell yourself you will hold on for just one more day, hour, minute—whatever you can manage.”
“You are important to me. Your life is important to me.”
“Tell me what I can do now to help you.”

Don’t say things like:

“It’s all in your head.”
“We all go through times like this.”
“Look on the bright side.”
“You have so much to live for why do you want to die?”
“I can’t do anything about your situation.”
“Just snap out of it.”
“What’s wrong with you?”
“Shouldn’t you be better by now?”

Adapted from: The Depression and Bipolar Support Alliance and helpguide.org

5What are signs of an eating disorder?

1.) Preoccupation with body or weight

2.) Obsession with calories, food, or nutrition.

3.) Constant dieting, even when thin.

4.) Rapid, unexplained weight loss or weight gain.

5.) Abusing laxatives or diet pills.

6.) Compulsive exercising.

7.) Making excuses to get out of eating.

8.) Avoiding social situations that involve food.

9.) Going to the bathroom right after meals.

10.) Eating alone, at night, or in secret.

11.) Hoarding high-calorie food

6How do I approach a friend who I think has an eating disorder?

Do: focus on feelings and relationships, not food. Share memories of specific times when you felt concerned about your friend’s eating behavior. Explain that you think these things may indicate a problem that needs professional help.

Don’t: comment on your friend’s appearance or weight. Your friend person is already too focused on his or her body image and weight. Even a compliment can reinforce an unhealthy obsession with body image and weight.

Do: tell your friend that you are concerned about their health while being respectful of their privacy. Eating disorders are often a cry for help, and the individual will appreciate knowing that you are concerned.

Don’t: reinforce a desire to be thin. If a friend says that he or she feels fat or want to lose weight, don’t say “You’re not fat.” Instead, direct the conversation toward their fears about being fat, and what they think they can achieve by being thin.

Do: use “I” statements. For example: “I’m concerned about you because you refuse to eat breakfast or lunch.” Or, “It makes me afraid to hear you vomiting.”

Don’t: use accusatory “you” statements like, “You just need to eat.” Or, “You are acting irresponsibly.” Instead, use “I” statements.

Do: try to remain positive, calm, focused, and respectful during conversations.

Don’t: demand change or criticize eating habits. People with eating disorders often feel like they aren’t in control of their life, and food is their means of reasserting that control. Trying to trick or force a friend to eat can make things worse.


Suicide Prevention Resources

Suicide is the second-leading cause of death for college students. The number one cause of suicide is untreated depression.

College Counseling Services

Talk to someone who cares. Don't be afraid to get help when you need it. Learn how to contact your college’s counseling services .