Results of an analysis of health survey data from more than 560,000 U.S. college students concludes that depression symptoms have steadily increased over the past 15 years, particularly among women, minorities and students experiencing financial stress.
The study, led by researchers at Johns Hopkins Children's Center along with McDaniel College and University of Maryland, specifically found that the rate of self-reported depression symptoms continued to grow over the 15 years of the analysis period (2007–2022), extending a trend reported by many researchers for the past two decades.
According to Carol Vidal, M.D., Ph.D., M.P.H. , child and adolescent psychiatrist at the Children's Center, thoughts of suicide, or "suicidal ideation," increased across all demographic groups regardless of race, age, gender or financial stress, but reports of other symptoms, such as restlessness and lack of concentration rose most steeply among female, financially distressed and minority students.
A report about the new study, published in the Journal of Affective Disorders , concluded that the findings highlight growing mental health disparities among college students. The report adds that the consistently steeper increases among women, students of racial minority groups, and those experiencing financial stress reveal that the rise in symptoms of depression is not uniform, and that the growth of suicide ideation across all groups signals an urgent need for prevention and targeted support strategies on college campuses.
For the study, researchers analyzed data from the Healthy Minds Study , a long-running research project led by several universities across the country that surveys college students about their mental health.
Depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), a tool used by psychiatrists and other mental health providers to diagnose and monitor the severity of depression. The questionnaire asks about nine symptoms, including suicidal ideation, poor appetite and trouble sleeping. The students are asked to give each symptom a score from 0 to 3 — 0 meaning never and 3 meaning they experience that symptom every day.
Points are then added together for a total score. An overall score of 0 to 4 means the person likely is not experiencing depression. A score of 20 to 27 indicates severe depression.
In the new analysis, average overall PHQ-9 scores increased every year. The highest symptom increase was seen in suicidal ideation, which increased by nearly 154%. The next highest was restlessness, which increased by nearly 80%. Trouble concentrating increased by over 77%.
Vidal says that some minority students and those experiencing financial stress are considered vulnerable populations, and are more likely to encounter both acute life events and chronic stressors that can lead to psychological and physiological changes, including elevated stress hormones.
The study also showed that sleep disturbance and appetite problems grew significantly faster among women compared with men. But Vidal says that men are generally less likely to report mental health symptoms. She noted that suicide rates are higher among men than women.
Students who reported financial stress specifically saw higher PHQ-9 scores in symptoms of poor appetite, feelings of worthlessness and suicidal ideation. Minority racial and ethnic groups overall, but especially Hispanic students, saw higher PHQ-9 scores in symptoms of sleep problems. Women showed an average overall increase of 0.041 points each year in losing interest in activities that were once enjoyable, compared with a 0.028-point increase per year among men.
Vidal says colleges, universities, parents and health care providers can all play a role in addressing differences in mental health indicators by being alert to those differences, addressing underlying stressors among the most vulnerable populations and seeking services when needed.
Other authors in this study are Jenny Owens with University of Maryland, and Phillip Sullivan and Flavius Lilly with McDaniel College.
Vidal received research funding from the National Institute on Drug and Abuse- American Academy of Child and Adolescent Psychiatry (NIDA/AACAP) Physician Scientist Training Physician Scientist Program in Substance Use Career Development Award and program implementation funding from the Maryland State Community Health Resources Commission while conducting this study.
No authors declared conflicts of interest under Johns Hopkins University School of Medicine policies.
