Dr. Sarah Lipson waited all year to get the report she hoped would confirm that last year’s data was not an outlier. 

“Each year over the past decade had been the worst we’ve seen in terms of prevalence rates until the 2022-2023 survey indicated things got a little better in terms of anxiety, depression and flourishing,” she said. “With the 2023-2024 data now in, it looks like we may be turning the corner.” 

Dr. Lipson is a principal investigator of the national Healthy Minds Study, one of the largest data sets used to determine the mental health and wellbeing of the college student population.  The data she awaited indeed showed that the prevalence of depression, anxiety, and suicidality among college students has decreased for two consecutive years for the first time in a decade. Meanwhile, flourishing (positive mental health) among students has increased during this same time frame, having been in decline for ten straight years. 

The latest data were collected between September 2023 and May 2024 from over 104,000 undergraduate and graduate students at 196 institutions, including community colleges, technical colleges, HBCUs and other minority-serving institutions. The variances were small – a 5% drop in anxiety, a 6% drop in depression and a 6% increase in flourishing -- but the change itself is significant. 

“Because it’s a population-based survey, Healthy Minds is often a starting point where we can say ‘here’s what we see at a population level in terms of trends,’” said Lipson, who is also an associate professor at the Boston University School of Public Health.  “The levels are still very high, but we are hopeful we have the start of a positive trend.” 

Asked what might be driving the shift, Lipson said, “There’s a broader context for sure, but I’d like to think that a lot of it has to do with what’s happening on campus in terms of increased awareness and support and more schools taking a public health approach to addressing student mental health.  I hope so.”

The latest healthy Minds survey report is a glimmer of hope for colleges and universities yearning for some form of good news related to the mounting mental health problems their students have reported over the years. Yet despite the progress, this year’s data still produced last year’s headline: too many students are emotionally unwell.  According to the survey, a third of students screened positive for some form of anxiety and almost four in 10 met the criteria for moderate or severe depression. 

Furthermore, the 2023-2024 changes in anxiety, depression and flourishing were a return to what students were reporting before the spikes caused by the pandemic.  And while cautiously optimistic, Lipson points to data in the report that reveals one of the most tenacious problems in college student mental health – the unmet need for services among students who need them. According to the 2023-2024 report, almost 40% of students who screened positive for anxiety or depression are not receiving any kind of mental health services.

“The levels are still very high, but we are hopeful we have the start of a positive trend.” 

“Even though the rates of treatment seeking have gone up, there’s still a significant unmet need that exists, with a lot of inequities in it,” she said.  “From a public health perspective, this is a missed opportunity during a really epidemiologically vulnerable, psychosocially significant time between 18 and 25.”

The Long and Winding Road

According to the Healthy Minds study, rates of depression and anxiety among college students doubled from 2010 to 2021 (from 20% to 44% for depression; and 20% to 37% for anxiety).  An early sign of the looming crisis was the increase in demand for campus counseling services which often went unmet.

According to the Center for Collegiate Mental Health at Penn State University, between fall 2009 and spring 2015, counseling center utilization increased by an average of 30-40%, while enrollment increased by only 5%. More serious consequences ranged from significant stop-out rates due to mental health problems to tragic deaths by suicide on campuses throughout the country. The pandemic fueled what was already a burning fire, adding isolation and lack of connection to the myriad of potential drivers.  In a 2021 survey by the American Council on Education, college presidents rated student mental health their number one concern.

Since then, most colleges and universities have put in place a range of responses, from service improvements to preventative strategies aimed at improving overall wellbeing. By the time the US Surgeon General came out with his young adult mental health advisory in 2021, it was hard to find an institution in the country that wasn’t working hard on mental health, or at least talking about doing so. Most schools have increased capacity for services through a number of strategies including utilizing a triage approach that prioritizes services by acuity, digital mental health interventions like apps and teletherapy and increasing staff when feasible. 

Cultural changes on campus have included prioritizing mental health through chief wellness officer positions and ongoing student-driven initiatives like awareness campaigns that reduce stigma and peer counseling which many students, particularly those of marginalized identities, find accessible and effective. The focus on student mental health and wellbeing on campus has encouraged other student-centered initiatives involving equity and basic needs and has raised questions about faculty’s role in student mental health and what academic policies or pedagogical changes may be needed to improve wellbeing. 

The question, which the recent Healthy Minds data raises, but does not fully answer, is, has all this activity had an impact?

“I agree with the Healthy Minds team that increased attention to mental health since the pandemic and additional resources for mental health are likely contributing factors to the slightly declining trend in anxiety and depression and slight increase in flourishing,” said Nance Roy, Chief Clinical Officer at the Jed Foundation, the country’s leading non-profit dedicated to protecting emotional health and preventing suicide in young people.

Roy also theorized that students have gotten better at distinguishing between "normal" feelings of anxiety and depression and clinical anxiety and depression. She believes the change in the way we talk about mental health – away from “crisis” and toward positive mental health – has been helpful.

The Jed Foundation itself may have had a role to play in the potential turnaround by providing schools a response to mental health issues, including suicides on campus, with mental health strategic planning support.  Launched in 2013 and now in 500+ campuses, the JED Campus Program engages colleges and universities in collaborative work over the course of four years. After conducting an initial needs assessment, a JED advisor draws on the data to create a strategic plan that, when implemented seriously by leadership on down, has led to impressive outcomes. Its recent impact report suggests that the students on campuses who engaged with JED reported lower rates of anxiety, depression and suicidality and increased flourishing, GPA and retention rates.

Another major player that emerged during the consecutive years of escalating prevalence rates is telehealth or teletherapy, most often provided by a third party.  First introduced as a potential way to expand capacity within counseling centers, telehealth became a permanent fixture during the pandemic and is now widely used.  These services range significantly in scope but the most popular provide components such as a clinically-staffed, 24/7 crisis line; online therapy appointments with a remote clinician one can choose, and apps or access to wellbeing supports such as mindfulness.  There are a number of advantages to these services, staring with convenience in time and place, a prerequisite for flexibility-focused Gen Z.

Uwill is a leading mental health and wellness company serving 3 million students at 400+ institutions in all 50 states and 40 countries.  Students begin their Uwill experience by indicating  how quickly they want to see a licensed therapist, with the option to choose a same-day appointment as well as preferences such as race, ethnicity, gender and clinical need.  Amaura Kemmerer, LICSW ,is Uwill’s Director of Clinical Affairs and the former Associate Dean for Wellness at Northeastern University. She says that teletherapy options solve a number of problems that had always existed for mental health providers on campus. 

“Traditionally, students embraced in-person therapy over teletherapy.  However, in-person creates a barrier in trying to serve students after hours, off campus, or out of the state or country” she said. “During the pandemic, there was no choice but to move online and what has happened since is that students and counselors have realized the advantages – students can access therapy wherever they are and whenever they need it, or if they are uncomfortable going to a center, and they can choose the type of therapist they want to see, which is really important for students of certain identities.”

Kemmerer says over 60% of students engaged with Uwill report never having gone to therapy before, underscoring its benefit as a new onramp to care for students who might not otherwise seek help.  Ironically, while introduced as a salve for the capacity problem, digital therapy may be providing access to care for a new population of students who have not been seeking help on campus. But most college health professionals would agree that’s a good thing and are comfortable with its place among their care continuum.

According to the Healthy Minds study, rates of depression and anxiety among college students doubled from 2010 to 2021 (from 20% to 44% for depression; and 20% to 37% for anxiety).

“Even though the restrictions around the pandemic have eased, our students are still preferring digital therapy due to convenience,” said Dr. Zoe Ragouzeos, the Executive Director of Counseling and Wellness Services at New York University.  “And the data still reflect that the efficacy of remote treatment compares to that of in-person care.” 

It is clear that technology-based mental health support is here to stay but the lack of data on the full range of digital mental health tools – including apps that are self-directed or only include partial coaching -- is a concern of Dr. Lipson’s.  She and her colleague, Dr. Daniel Eisenberg recently published a paper sponsored by the Ruderman Family Foundation concluding “although research has demonstrated that DMHI (Digital Mental Health Interventions) can be effective at improving mental health, the majority of widely used DMHIs in college settings have limited direct evidence of effectiveness in student populations.”

While they are supportive of the adoption of DMHI’s, Lipson and Eisenberg recommend colleges consider how these tools fit into campus mental health and wellbeing plans that take a preventative, population-based approach.  They call for rigorous evaluation of commonly used programs and more information about user engagement, particularly regarding whether or not these services are being accessed by students of color or groups that may be needing help but not seeking it.  In a separate effort, the researchers are working to create a comprehensive student mental health repository where easy access to evidence-based best practices will help campus professionals understand which interventions are best for which students. 

As campuses continue to work at improving student mental health in a variety of ways, Lipson believes we will need several more years of prioritizing mental health at a population level to truly understand how far the needle has moved.  In the meantime, the Healthy Minds team will continue to produce the indicators.