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Carol J. Scott, M.D. Headshot

Back to School Stressors -- Invisible Indicators in the Lives of College Students

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Last week two boys; an 8-year-old and 10-year-old were brought into the emergency room by parents and coaches for visibly deformed forearm fractures. They had just begun school-based football and soccer practice respectively. I treated them and provided referrals to orthopedic surgeons for definitive casting after reduction in swelling. They were obvious 'back to school' injuries.

For college students, "back to school" injuries experienced are often invisible; however, these are the kind of silent injuries that can be life altering. Traditional college students, particularly freshman, are often unaware of the impact of day-to-day choices on their physical and emotional well-being. Managing time, commitments, new relationships, academic standards, decisions about sexual activity, what to eat and when as well as conscious and unconscious choices about alcohol and substance use.

I want to share information; facts and ideas about three interrelated college student 'injuries' seen in emergency departments across the nation with alarming frequency in recent years. Not only are students themselves patients, but also the collateral damage of parents, grandparents, and friends whose lives are often destroyed by the impact of these problems.

First, college students are stressed! Across the nation the emotional health of college students has been trending downward and feeling overwhelmed has been trending upward. While the academic ability and drive to achieve are traits parents, high school counselors and college admissions offices measure as indicators of success, we need to pause and consider the overall impact on our kids beyond the immediate goals of matriculation in the 'right' college.

Did your student feel pressured to achieve a 'perfect' SAT score or perfect 4.0 average? Healthy perfectionism refers to the thoughts and behaviors of individuals who are high achievers, have realistic self-expectations and derive satisfaction from hard work.

Neurotic perfectionism, on the other hand, refers to the disposition of someone who irrationally strives for extreme, unrealistic levels of excellence and rarely if ever, feels satisfied with their accomplishments. Many students enter college with this neurotic disposition; which can be associated with diminished performance, anxiety, depression and stress.

According to the Higher Education Research Institute at UCLA, self-rated emotional health for incoming first-year students in 2010 was at the lowest point since their survey first asked the question 26 years ago in 1985. In "The American Freshman: National Norms Fall 2010," involving more than 200,000 incoming full-time students at four-year colleges, the percentage of students rating themselves as "below average" in emotional health rose.

Then there is "real life trauma." That is the thousands of college kids adjusting or re-adjusting to college life after leaving a home situation where stress due to economic constraints, family illnesses, floods, hurricanes, or the ongoing wars in middle East add another dimension of stress; traumatic stress.

A recent study in the Journal of Counseling Psychology reported that 85 percent of college students surveyed had experienced a traumatic event in their lifetime (lifetime prevalence) and 21 percent reported experiencing a traumatic event over a two-month period in college.

Traumatic or stressful life experiences are a risk factor for suicide. (Trauma defined by the American Psychiatric Association diagnostic criteria for PTSD is when a person "has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others...")

Students who withdraw during first semester often cite emotional reasons for dropping out. Clearly some students are better able to adjust to the undergraduate experience than are others. If your college student's unhappiness is more than just home-sickness -- be cautious and listen. Before you react, it may be helpful to know that overall, about 1 in 3 students who enroll in either a four-year or two-year college will probably transfer at some point. For a particular student, that may be just the right answer.

Second, there is a related suicidal crises on college campuses across the nation. According to the American College Health Association (ACHA) the suicide rate among young adults, ages 15-24, has tripled since the 1950s and suicide is currently the second most common cause of death among college students.

Experts estimate 1,088 suicides occur at colleges every year -- that's roughly 7.5 per 100,000 students. According to an ACHA study in 2002, one in 12 college students has actually made a suicide plan at some point and 1.5 out of every 100 have actually attempted it.

In a related 2008 ACHA study, 25.6 percent of male college students and 31.7 percent of female students reported that on at least one occasion in the last year, they had felt so depressed it was difficult to function. Between 8 and 10 percent reported feeling that way in the last two weeks.

The Cornell University community experienced a wave of suicides. Six students committed suicide at Cornell University between September 2009 and March 2010, including two in the same week, in the same department and by the same method, jumping from one of the bridges that criss-cross the Ithaca campus.

This well documented tragic occurrence along with data from a study by David Drum from University of Texas at Austin highlight the need for re-conceptualizing and expanding the approach to addressing the problem of college student suicide as a community problem and to question 'forced leave" policies for students who admit to suicidal thoughts or behaviors.

Drum found that half of students who had had suicidal thoughts never sought counseling or treatment. Moreover 85 percent of students who died by suicide never participate in counseling services. They concluded that suicide prevention on campuses cannot rely on individual-focused counseling services. Comprehensive approaches much be developed to implement plans to intervene early at all point along the continuum of suicide.

Third, consequences of excessive and underage drinking and other substance abuse affects virtually all college campuses, college communities, and college students and can change lives forever. Alcohol use is a continuing problem on most college campuses, where nearly 73 percent of the students drink at least occasionally, according to Southern Illinois University's Core Institute, the United States' largest national statistics database on alcohol and drug use by college students.

First, this blog is not meant to engender parental guilt. Nor am I an expert in trained specifically in stress in the lives of college students, suicide and alcohol and substance abuse. My comments are based on my experience in emergency rooms over the years; awakening parents hundreds of miles away informing them of near tragedies, caring for near fatal alcohol toxicity students, traumatized rape victims (male and female), and listening to student conversations during prevention/awareness sessions I have conducted with students college campuses over the last few reasons.

Although previous research has suggested several factors that may contribute to the successful adjustment of college students, it has not been adequately established whether any specific factors (e.g., self-esteem, coping tactics, perfectionism, optimism, and extraversion) works in a positive or negative manner for your student. And it is likely you know your student better than anyone else. Here are some thoughts for your consideration. I invite your comments and questions as a national community caring about the well-being of our young people beginning college life this fall.

1. Stress is inevitable! Now may be a good time to allow your student to have greater insight into the 'grown-up world.' The key is learning how to navigate and transform potentially harmful reactions in to healthy responses. Optimal Stress is the term I used to describe this process in my book, Optimal Stress: Living in Your BestStress Zone (John Wiley & Sons 2010). Life is a series of transitions. The only constant is the need for awareness of shifting personal purpose and passions.

Let your student know that we all struggle to 'make sense' in an ongoing way of what life presents to us on a day-to-day basis. Although ultimately this is a personal experience, it is well documented that social comparisons and perceptions of peer emotional lives can affect the quality of well-being.

So, a word about Facebook. Most of what your student gets from friends updates on Facebook are expressions of friends unbridled joy and happiness. According to an illuminating new study from Stanford University suggests that feelings of loneliness, isolation and dissatisfaction in an already alienating environment for some students may result from these seemingly frivolous exchanges.

In the article, "Misery Has more Company Than People Think: Underestimating the Prevalence of Others' Negative Emotions," researchers asked 63 college freshmen to report the positive and negative experiences they had had in the previous two weeks; and whether or not they were alone when they had these experiences. Also they were asked if they tried to conceal the negative stuff.

Researchers found that 29 percent of students' bad experiences occurred in private, compared with 15 percent of the good ones. And 40 percent of the time, people deliberately concealed negative feelings. They concluded that students often misperceived the emotional lives of specific peers-people they know well. Students mis-perceive that others are experiencing a more positive life than they really are! Further, there is a connection between thinking others are not experiencing negative emotions and "feeling isolated from others" -- feelings that can be linked to loneliness and depression. Have you 'friended' your student lately?

2. College policies and statistics. Become aware of policies, practices and resources regarding stress prevention, suicidal behavior management and alcohol/substance abuse on the your student's campus. Talk to your student about the resources available. You know your student; if you think they need extra emotional support -- rev up your helicopter -- and make the necessary arrangements to have a safety net available.

If you are concerned have your student seek professional help. It can work only if accessed. Among students who disclosed their suicidal ideation to others, only 58 percent of students were advised by the first person they told to seek professional help according to the Drum study. Professionals make sense of what is going on, help students make meaningful changes, find ways to better handle stress, identify sources of support, discover solutions, if necessary, see the psychiatrist and (if needed) obtain a prescription for medications.

3. Communication. Keep in touch with your college student on a regular, ideally scheduled basis. YOU still are important and needed. Now perhaps as a consultant. Scheduled weekly or bi-weekly contact does not have to be a protracted phone call. Sustaining a healthy dialogue can be critical. Express your love. Texting is quick and easy -- for both of you! Send care packages. Facebook friends is even better.

The According to Drum's study cited above:

Student reasons for not telling others about their suicidal ideation provide some valuable insight into the way students perceive both the seriousness of their suicidal thoughts and the potential consequences of sharing these thoughts with others. Prominent themes that emerged from this inquiry there fear of being stigmatized or judged, not wanting to burden others, not having anyone to tell and fear of consequences such as expulsion from school or forced hospitalization.

Finally, here is the good news about what you can do just by maintaining a positive healthy relationship with your student.

Again from Drum's study, when students who seriously considered attempting suicide but did not ultimately make an attempt within the past 12 months to rate the importance of various factors in prevention a suicide attempt the number one factor related to family. Disappointing or hurting their family had a large on very large impact on 77 percent of student decision to not attempt suicide. Your communication and relationship is indeed vital! Look and listen for warning signs including; extreme academic problems, mood swings, becoming angry over 'nothing,' crying very easily, constant negative thoughts, withdrawal from you, expression of feelings of hopelessness, or obsession with death.

4. Substances. Many college students think alcohol helps their social lives, but alcohol use can take a toll on relationships with friends and roommates. Be brave. Express & keep your concerns about alcohol and substance abuse on your student's radar. If your student thinks they have a problem or ever says a friend implied it, urge him to take a self-assessment quiz, such as the simple one offered online by UC Berkeley's Tang Health Center.

5. Expectations. Parents weekend is a good time to listen to your student establish THEIR realistic goals for the first semester. Your role may be to just listen-really listen to what is and is not being stated. Ask explicitly if your student is happy with an emphasis on self-generated happiness, gratitude and service. It's okay to 'downsize.' Help them begin to think about establishing achievable goals with an understanding of the need for healthy 'college life.'

Better understand the culture of the clubs and social organizations that your student may be interested in joining. Most colleges have an online paper. If you attend parents weekend, be sure to invite your students closest friends for coffee, snack or dinner. A worthwhile investment to better understanding peers and influencers. Check out some online resources for how your student may be thinking about issues of drinking and academic performance.

6. Resources. If you are thinking about a gift for your student for Christmas, consider HeartMaths scientifically based devices called desktop EMWave.

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