Students Don’t Know How Depressed They Are

College students in the United States experience depression at alarming rates: more than 40 percent reported experiencing clinically significant symptoms of depression, according to a recent nationwide study. At the same time, college students (and young Americans generally) are increasingly aware of mental health problems and open to talking about them, challenging a long-held stigma toward mental illness. Increasing the identification of mental health problems like depression is a major goal of today’s mental health awareness efforts, often promoted by colleges and universities.

However, the usefulness of these awareness efforts has recently been called into question. Some psychologists, such as Lucy Foulkes, have begun to wonder whether mental health awareness campaigns may be unintentionally leading to worse mental health.

Critics have suggested that identifying with mental illness labels can become a self-fulfilling prophecy: when people see normal experiences of sadness and anxiety as signs of a clinical disorder, they might start to act in ways that exacerbate those problems. For example, a student who sees their fear of public speaking as a symptom of an anxiety disorder might feel justified in avoiding in-class presentations, perhaps preventing them from learning that public speaking is something they can handle.

Likewise, a student who sees their low mood as a symptom of clinical depression might think there is nothing they can do to change their mood other than seek medical help—depression being a mental illness, after all—and use fewer action-oriented strategies on their own to boost their mood. Importantly, periods of anxiety and low mood are common and—for many people—transitory. Thus, Foulkes and others suggest that counterproductive coping strategies could in some cases create long-term disorders out of what would otherwise be short-term periods of distress.

Given this context, it may be surprising to learn that many college students who meet clinical criteria for depression don’t identify as being depressed. Yet this is exactly what my co-authors and I found in a new survey of college students: while about 40 percent of college students in the survey meet the criteria for clinical depression, only half of that number—22 percent—identify as having depression.

Perhaps more surprising—and important in light of concerns about possible risks of self-labeling—is what separated students who identified as having depression from their peers who did not. When comparing students with similar levels of depression symptoms, those who identified as having depression coped with emotional distress in less healthy ways.

Not only did these students spend more time catastrophizing about their problems, they also spent less time engaging in the kinds of action-oriented coping strategies known to help with emotional distress, including taking a new perspective on their problems, refocusing on enjoyable activities and problem-solving. They also expressed more pessimism about their ability to handle depression compared to students who did not identify as being depressed.

These findings add concrete data to an ongoing argument about the role of mental health awareness efforts in schools and college campuses, providing support for the notion that identifying as “having depression” may be linked to coping strategies that exacerbate depression in the long term.

Of course, these new data don’t prove that identifying as having depression causes people to cope with distress less effectively. The study is particularly limited by the fact that it used data from a one-time survey. Without longer-term data, we can’t tell whether identifying as having depression leads to worse coping or whether the opposite is true—that students who cope with their emotions in worse ways become more likely to see themselves as having depression. We are still far away from knowing the true consequences of identifying as having depression—or any other mental illness, for that matter.

Still, these new results provide critical food for thought for anybody interested in ways to improve the mental health of college students. Given the preliminary nature of these results, it’s too early to suggest that colleges’ mental health awareness efforts are causing harm to students. Nor do these results change the fact that mental health awareness and antistigma campaigns have improved the lives of those with mental illness in a number of ways. And certainly, we should not be trying to convince depressed students that they don’t actually have depression. However, it may be worth considering ways to improve college students’ mental health without encouraging them to see their problems as mental illnesses, per se.

College can be an immensely stressful period for young adults; it is no surprise that so many are depressed. However, helping these students see themselves as having depression—even if, by clinical measures, they do—may not be the way out of this problem. Rather than seeking to provide diagnoses to the 40 percent of college students who are depressed (and many others who suffer from anxiety or other problems), we should continue to invest in mental health resources that appeal to all students in distress, even if they do not see themselves as mentally ill. Or, better yet, perhaps we should invest in ways to make college less depressing.