College can be a stressful time, especially if you’re a Duke student.

In a survey conducted by the American College Health Association in Fall 2016, almost 65 percent of Duke undergraduates ranked their stress level as “more than average” or “tremendous"—about 10 points higher than the national average. 

Danielle Oakley, director of Counseling and Psychological Services, wrote in an email that she is not surprised by the results because college students' stress has been increasing during the past 15 to 20 years. Stress and anxiety have bypassed depression as the number one reason students seek out mental health services.

She attributed Duke's elevated level of stress in part to its reputation as an academically elite institution.

“Stress is often correlated with academic rigor,” Oakley wrote.

But this stress may also stem from the expectations Duke students put on themselves, in addition to Duke's expectations. Many students come to campus believing they have to be number one, she noted, which is difficult to accomplish.

Oakley explained that students think increasing their efforts and participating in more activities will create success down the road, but it often just results in greater stress.

Participants of the survey were asked to identify what factors had been traumatic or very difficult to handle within the prior year. Duke undergrads chose “academics” and “career-related issues” at a higher percentage that their national counterparts.

Several Duke undergraduates agreed that students' desire to excel leave them feeling overwhelmed.

“We are definitely a driven group of individuals who want to do great things in our lives, but I don’t think it comes at such a surprise that we’re more stressed than the national average,” junior Owen Smith noted. “I think we’re just better at tolerating it.”

Senior Nikita Gawande wrote in an email that Duke students' high stress is “100 percent” due to the expectations they have for themselves.

“To be perfectly honest, I don't really think I've ever felt like something was expected from me by Duke," she wrote. "What tends to stress me out is feeling like I'm not doing something as well as I can be doing it."

Junior Emma Palmer had a similar view, explaining that because everyone who got into Duke was successful in high school, they expect to replicate that success in college.

The inclination to outperform is often reflected in the inadequate amount of sleep students get, Oakley noted. Many students label stress as a badge of courage and make a competition out of who is working the hardest.

Other external factors may also play a role in students' increasing stress levels in the past two decades.

Oakley noted that increasing diversity, the high prevalence of sexual assault on campuses, world events and a culture that rewards effort over performance help to explain the rising rate.

Students of color and other marginalized student groups on campus are exposed to aggressions and micro-aggressions on a daily basis that can negatively impact their self-esteem and increase depression and anxiety, she explained.

Oakley noted that the high prevalence of sexual assault on campus negatively impacts mental health because trauma interferes with cognitive processing and concentration.

She said that some criticize today's students as lacking resilience because they were raised in a culture regardless of performance, everyone is given a medal or a prize for their efforts. But this is actually not beneficial to students because they never have to deal with failure or develop coping skills.

Tragic events like 9/11, the Columbine and Virginia Tech shootings and the 2008 recession also weigh heavily on today's students.

“This generation of students has grown up with the reality that planes can fly into buildings, they can be shot in their schools and the recession in 2008 in which many families struggled financially," Oakley wrote. "These unique and traumatic events that have affected this generation may have an impact on their levels of stress."

Due to the increasing number of college students reporting high levels of stress, there have been efforts to decrease the stigma of seeking out mental health services.

Oakley noted that the proliferation of suicide prevention campaigns and increasing education on help-seeking behaviors has led to more students utilizing counseling services on campus.

But higher utilization rates may not necessarily signify a higher incidence of mental health concerns, she explained.

“It represents that students who live on campus near available mental health resources are more likely to seek out services,” Oakley said. “I view this as a protective factor for students.”