Editor’s note: This is the second in a two-part series evaluating depression among students on campus and how they seek help. Part 1 analyzed how Duke students fit into the trend of increasing rates of depression at universities nationwide and why some students choose medication over other treatment options. In this part, The Chronicle will assess what about the college environment makes students more susceptible to depression and will explore alternative treatment options to medication.
Rates of depression are increasing across college campuses nationwide, and students at Duke face unique risks for mental health.
Struggling with some sort of loss—whether it be the death of a loved one, a break-up or dropping the pre-med track—is a common reason students may seek assistance at Counseling and Psychological Services, said Gary Glass, assistant director for outreach and developmental programming at Counseling and Psychological Services. Although anyone can have those experiences, the stresses of being a student at a competitive and prestigious school such as Duke may contribute to the intensity of disorders like anxiety and depression, he said.
“Think about the student who comes to Duke,” said Donna Lisker, associate vice provost for undergraduate education. “She or he has had to be by definition very driven, ambitious, hard working and Type A. I think those kinds of folks have much more of a tendency toward anxiety and perfectionism, [and] depression can go hand in hand with those things.”
In response to the stresses experienced by Duke students, CAPS has expanded offerings in recent years to give students treatment options other than medication. Mental health leaders subsequently have noticed a shift in campus attitudes toward greater understanding of the complexity of depression.
Depression risks at Duke
Students who come to Duke may have excelled in high school but face the prospect of being average once they get to campus in a field of overachievers, said Tom Szigethy, associate dean and director of the Duke Student Wellness Center. This phenomenon, like discomfort at entering a new social environment, contributes to stress that may lead to depression.
“There is a kind of general culture [at Duke] of having to present yourself as not struggling,” said senior Ahmad Jitan, who was diagnosed with depression as a sophomore. “That contributes to a superficial [image] that you want to save.”
Once he came back to Duke after taking two leaves of absence, however, Jitan said that he did begin to realize how common it is for students on Duke’s campus to feel stressed, sad or depressed, which helped him feel less isolated.
“A lot of people deal with these things,” said Jitan, who is also a columnist for The Chronicle. “Even if it doesn’t manifest itself to a full-blown disorder, people in general don’t have healthy ways to deal with stress.”
CAPS does not release information on the number of students who seek help for depression, nor does it keep statistics on the number of students who identify as depressed, Glass said. However, according to the 2012 Center for Collegiate Mental Health report, in which Duke annually participates, 16.1 percent of students nationwide attended counseling for mental health concerns only after beginning college.
Slightly more than half of college students—52.4 percent—had never attended counseling for mental health reasons. Of the remaining respondents, 18.6 percent sought counseling before college began, and 12.9 percent sought counseling both before and during college.
An array of offerings
To help deal with the stress, CAPS offers several treatments other than medication, including individual counseling, couples counseling and several other types of workshops. CAPS is expanding its group therapy sessions to help students realize that, despite the fact that many Duke students may exude an aura of “effortless perfection,” it is common to be struggling, Glass said.
“[Students are] always nervous about getting into groups, but then it’s so liberating to find out they’re not alone,” Glass said. “It helps get rid of the notion that there are those who struggle and those who don’t.”
In the past several years, CAPS has observed a spike in the number of graduate and professional students who seek help—graduate and professional students now outnumber undergraduates who seek treatment at CAPS, Glass said. Additionally, it has become increasingly common for couples to come in for assessments, Glass added, noting that he is unable to explain those trends.
Although Glass said he believes counseling has a positive effect on Duke students, some may find it more useful than others.
“There were times when therapy felt like a waste of time, but it just depended on who I was seeing,” Jitan said about counseling in general. “[It was a process of] reminding myself to not get discouraged to ask for help.”
These counseling offerings have been supplemented by newly created student groups independent of CAPS that focus on student empowerment, such as Peer for You, a web-based support system, and #DukeEncourage, an Honor Council initiative that spreads positive messages around campus.
For Jitan, part of the process of feeling like he had a home at Duke also came from finding outlets for himself that made him happy.
“It sucks enough to be depressed, but on top of that to feel ashamed for it doesn’t make it any better,” he said. “Doing a column, or writing and sharing poetry at different events was a way to get over that shame for myself.... If I see the social atmosphere has a stigma, a good way to break it was to put it out there.”
Senior Advait Ghuge, who has also struggled with depression, says he is sometimes more selective about the people he tells, but does recognize the power of sharing his experiences with depression with others who may be struggling.
“It’s helped me in the past to talk with people who have been through difficult times,” he said. “The fact that you’ve been through it means you can help someone else get through it.”
Although Glass still spends some of his time conducting appointments and counseling sessions with students, he also speaks to groups such as Common Ground, fraternities and sororities about how to combat stress and to be supportive of peers in times of stress. He also engages with audiences new to Duke, such as the pre-orientation program Project BUILD.
“I [try to] send out messages that will get students to create a more supportive campus environment,” he said. “The most promising trend is that students are more comfortable opening up to their vulnerabilities.”
Since starting work at Duke in 2006, Glass has seen a shift in the culture surrounding how mental health disorders are perceived, he said. Instead of being viewed as something that happens to a small minority of the population, Glass said increasingly more students appreciate the complexity of mental illness and depression. Students are more aware of the notion that certain factors, such as stress or grieving, may predispose someone who has no history with mental illness to feel depressed.
“Students are much more literate about mental health issues than they were 10 or 20 years ago,” he said.
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