Data snapshot: Mental health and substance use in higher education

September 21, 2023

As college students settle into a new semester, they might revel in their newfound freedom and independence. But they also might face a host of new pressures: to find the right friends, perform well academically, and set themselves up for a bright future. Plus, students are still searching for a “new normal” in the wake of the COVID-19 pandemic, which likely disrupted their high school and, in some cases, their undergraduate years.

Because of these factors, plus any existing traumas or challenges from childhood or adolescence, college students face risks for developing anxiety, depression, substance use, self-harm, and suicidal ideation.  

Finding the right behavioral health care at college can also be a challenge for students. Students may not be familiar with campus resources available to them. Even when they do know where to go for help, campus counseling centers are often understaffed and under-equipped to help with more complex issues, such as eating disorders.

In this data snapshot, we highlight national prevalence rates of mental health conditions among U.S. college students as well as state rates of alcohol and substance use among college-age Oklahomans.

Anxiety and depression

The changes, academic challenges, and new responsibilities that come with attending college can be anxiety-inducing for many young people: the Healthy Minds Study Student Survey, an annual national survey of college students, found that 36% of college students had an anxiety disorder in the 2022-2023 academic year (study is not affiliated with Healthy Minds Policy Initiative).

Rising rates of anxiety and depression among U.S. college students

Common anxiety symptoms can include feeling nervous, panicked, or a sense of impending doom. Physical symptoms include an increased heart rate, rapid breathing, trouble concentrating, sleep problems, and gastrointestinal problems, according to the Mayo Clinic.

Stressful changes that cause anxiety in one person could lead to depression for someone else. In college students, depression is especially prevalent: the Healthy Minds Study found that 41% of college students had depression.

Symptoms of depression include sadness or a persistent sense of hopelessness over time. Signs of depression include changes in academic performance, eating habits, and sleeping patterns. Someone might also be more irritable, more lethargic, or less engaged with activities they used to enjoy, according to the Mayo Clinic.

Self-harm and suicidal ideation

Some people inflict pain on themselves or self-injure without the intention of ending their lives, as a way to externalize or release their internal psychological pain, and it’s common among college students: 29% of college students self-injured in the past year, according to the 2022-2023 Healthy Minds Study.

Suicidal ideation and self-harm among U.S. college students

People who self-harm might cut, burn, or hit themselves, and they may feel guilt or shame for hurting themselves. In addition to signs friends and family might notice — such as scars, cuts, bruises, puncture wounds, or repeated “accidental” injuries — people who self-harm might wear long sleeves and pants even in hot weather to hide signs of self-injury.

A significant number of college students may also struggle with suicidal ideation — 14% of college students had thoughts of suicide in the past year, the Healthy Minds Study found.

If you suspect someone may be thinking about suicide, it’s important ask directly if the person is thinking of killing themselves.  

While a peer may be able to offer support and encouragement, it’s also important to connect the person with resources. 988 can be a resource to help someone in crisis connect with support in the community.  

Alcohol and substance use

College students can face pressures to drink excessively. Binge drinking is when someone drinks too much alcohol in a short time — for women, this is defined as four drinks, and for men, five drinks on one occasion, according to the Centers for Disease Control and Prevention.  

Binge drinking in 18 to 25 year olds, 2021

About 26% of Oklahomans ages 18 to 25 had engaged in binge alcohol use in the last month, according to the 2021 National Survey on Drug Use and Health.  

Binge drinking can lead to vomiting, blacking out, difficulty breathing, losing consciousness, and even death, according to Healthline. If a person passes out from drinking too much, call 911 and don’t leave them alone. While waiting for first responders to arrive, put them in the recovery position (laying on their side) to keep their airways open.

Many universities have amnesty policies that will not penalize students for reaching out for medical help for someone, even if they were doing something illegal or against school policy at the time.  

Prevalence of alcohol and substance use disorder among Oklahomans ages 18 to 25

Separate from binge drinking, alcohol use disorder involves a pattern of drinking over time that is hard for someone to control or stop, despite the negative impacts drinking has on their life. About 14% of Oklahomans ages 18 to 25 had alcohol use disorder in the past year, according to the 2021 National Survey on Drug Use and Health.

Signs that could indicate a problem are drinking at inappropriate times or when it is unsafe, failure to follow through on obligations, hiding the amount or frequency in which they drink, more alcohol needs to be consumed to feel the effects, or experiencing withdrawal symptoms when not drinking alcohol. Alcohol use disorder can contribute to certain kinds of cancer, heart problems, liver disease, and pancreatitis.

The 2021 National Survey on Drug Use and Health found that about 28% of Oklahomans aged 18-25 had a substance use disorder in the past year.

Substance use can take several forms, including abuse, misuse, and addiction. Abuse is a pattern of substance use that has a notable negative impact on someone's life. Misuse is when someone uses alcohol or prescription drugs inappropriately, including taking a higher dosage or taking it more frequently than directed by the prescriber. Addiction is when someone has a mental or physical dependence on a substance and feels a compulsive drive to consume it, even if they don’t want to.

In addition to alcohol, people can develop substance use disorders with marijuana, hallucinogens, inhalants, opioids, sedatives, stimulants, or tobacco/nicotine, according to the American Psychiatric Association.  

Recreational use or experimentation with a drug can turn into a substance use disorder, as can building a reliance on addictive prescription medications, like opioids, benzodiazepines, barbiturates, or stimulants, according to the National Institute on Drug Abuse. There are also high rates of co-occurrence of mental illness and substance use disorders, and it is not uncommon for people to self-medicate to try and alleviate symptoms of their mental health condition.

Where to find help

On-campus resources

Most Oklahoma colleges offer counseling services to students. These can include psychological assessments, individual therapy, couples’ therapy, group therapy, alcohol and substance use services, wellness checks, crisis counseling, grief counseling, community referral consultations, student group training, and assistance with coping skills or healthy habits.  

Some campuses may only provide short-term therapy, limiting students to a certain number of free sessions — often 4 to 6. For longer-term care or for more intensive or specialized services, students will likely need to connect with off-campus community resources.  

Accessing services through insurance

Many college students remain on a parent’s insurance as a dependent. Because of the Affordable Care Act, young people can stay on a parent’s insurance plan until they’re 26.

But some families aren’t in a financial position to keep a young adult on their insurance plan. College students have several options for gaining health coverage on their own: school-sponsored plans, Medicaid, or the Health Insurance Marketplace. Working students may be able to participate in an employer-sponsored plan if they meet the requirements.

Some college students on a parent’s insurance plan might avoid seeking mental health services for fear that their parents will find out. Dependents don’t necessarily have a right to privacy when it comes to the explanation of benefits that gets sent to the policyholder, and while there are options to circumvent this issue, it would require the student to contact their insurer.

Parents can proactively help their child avoid this discomfort by openly and honestly talking about mental health, encouraging their child to seek out mental health care when they need it, and affirming that it is just as important to take care of one's mental health as it is to take care of physical health.  

Help in crisis

If a student is in crisis or needs help connecting to mental health resources, they can call or text 988 to speak with a trained behavioral health professional.

Individual campuses may also offer campus-specific crisis services for students who need urgent help.  

If someone is in immediate danger, call 911.