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May 3, 2012

Major Depressive Episode among Full-Time College Students and Other Young Adults, Aged 18 to 22

In Brief
Combined data for the years 2008 to 2010 show that 8.4 percent of full-time college students aged 18 to 22 and 8.2 percent of other young adults (part-time college students and those not currently enrolled in college) aged 18 to 22 experienced a major depressive episode (MDE) in the past year Although both groups had similar rates of past year MDE, other young adults with MDE were more likely than full-time college students with past year MDE to report that the mood related to their MDE very severely impaired their important activities and relationships and to report that they experienced more than 60 days in the past year when they were totally unable to carry out their normal activities Despite greater severity of symptoms among other young adults with MDE, both groups were equally likely to receive specialty mental health treatment (43.9 vs. 40.4 percent)

Tragic events on college campuses in recent years and a growing awareness of the significance of prevention and early intervention for mental disorders have focused new attention on the mental health needs of young adults. Research indicates that about half of Americans will meet the criteria for a disorder from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV),¹ sometime in their lifetime, with first onset usually in childhood or adolescence.² New information from the National Survey on Drug Use and Health (NSDUH) regarding the prevalence and severity of mental health disorders among young adults who are in college and among those who are not in college (and about whom less is generally known) can therefore be very useful to policy makers and behavioral health providers.

Using combined data from the NSDUH for 2008 to 2010, this issue of The NSDUH Report focuses on the prevalence of past year major depressive episode (MDE) among college students and other young adults (part-time college students and those not currently enrolled in college) aged 18 to 22.³ The report compares the prevalence of MDE for these two groups by gender and race/ethnicity. The extent to which full-time college students and other young adults aged 18 to 22 with MDE report that their symptoms interfere with their important activities and their personal relationships (based on the Sheehan Disability Scale, or SDS) is also described.⁴ The report also indicates the proportion of each group that reported that they received specialty mental health treatment.⁵

For this analysis, respondents were classified as college students if they reported that they were in their first through fourth year (or higher) at a college or university and that they were a full-time student. Respondents who were on break from college were considered enrolled if they intended to return to college or university when the break ended.

MDE by Demographic Characteristics

Combined data from the 2008 to 2010 NSDUH surveys show that 8.4 percent of full-time college students aged 18 to 22 experienced MDE in the past year; similarly, 8.2 percent of other young adults aged 18 to 22 experienced MDE in the past year. For both full-time college students and other young adults aged 18 to 22, females were more likely than males to have had a past year MDE (Table 1). Among full-time college students, 12.0 percent of females had a past year MDE compared with 4.5 percent of males; among other young adults aged 18 to 22, 11.3 percent of females had a past year MDE, compared with 5.5 percent of males. No differences were observed with regard to age (18 to 20 year olds vs. 21 to 22 year olds) for either full-time college students or other young adults.

Table 1. Major Depressive Episode (MDE) in the Past Year among Persons Aged 18 to 22, by Full-Time College Status and Demographic Characteristics: Percentages, 2008 to 2010
Demographic Characteristic	Full-Time College Students (%)	Other Young Adults (%)
Total	8.4%	8.2%
Aged 18 to 20	8.2%	8.1%
Aged 21 to 22	8.6%	8.3%
Male	4.5%	5.5%*
Female	12.0%	11.3%
Non-Hispanic White	8.4%	9.4%
Non-Hispanic Black	7.4%	6.2%
Non-Hispanic American Indian/Alaska Native	--	4.6%
Non-Hispanic Native Hawaiian or Other Pacific Islander	--	--
Non-Hispanic Asian	6.3%	4.2%
Non-Hispanic Persons of Two or More Races	17.6%	17.8%
Hispanic	9.1%	6.4%*

* The difference between full-time college students and other young adults was statistically significant at the .05 level.
-- Estimate not reported due to low precision.
Source: 2008 to 2010 SAMHSA National Surveys on Drug Use and Health (NSDUHs).

The prevalence of MDE differed by racial/ethnic categories. Among full-time college students, the percentage with past year MDE ranged from 6.3 percent among Asians to 17.6 percent among persons of two or more races. Among other young adults aged 18 to 22, the rates of past year MDE ranged from 4.2 percent among Asians to 17.8 percent among persons of two or more races. Hispanic full-time college students were more likely than other Hispanic young adults to have had past year MDE (9.1 vs. 6.4 percent).

Reported Severity of Symptoms

Although the overall proportion of individuals aged 18 to 22 with past year MDE was similar among full-time college students and other young adults, differences between the two groups were apparent in the severity of depressive symptoms and in the degree to which symptoms impaired important activities and relationships (Table 2). For example, 8.2 percent of full-time college students reported that they experienced very severe impairment in their ability to maintain close relationships, whereas 13.0 percent of other young adults reported this level of impairment.

Table 2. Severity of Impairment due to Symptoms of Depression among Persons Aged 18 to 22 with Past Year Major Depressive Episode (MDE), by Full-Time College Status: Percentages, 2008 to 2010
Severity of Impairment	Full-Time College Students (%)	Other Young Adults (%)
Home Management: No Interference	6.5%	3.0%*
Home Management: Mild	23.3%	21.7%
Home Management: Moderate	43.0%	40.3%
Home Management: Severe	23.0%	28.1%*
Home Management: Very Severe	4.1%	6.9%*
Ability to Work: No Interference	6.0%	6.5%
Ability to Work: Mild	31.4%	28.5%
Ability to Work: Moderate	39.9%	38.1%
Ability to Work: Severe	19.2%	20.5%
Ability to Work: Very Severe	3.5%	6.4%
Close Relationships: No Interference	2.7%	2.4%
Close Relationships: Mild	19.4%	18.3%
Close Relationships: Moderate	31.6%	33.4%
Close Relationships: Severe	38.0%	32.9%*
Close Relationships: Very Severe	8.2%	13.0%*
Social Life: No Interference	3.1%	3.7%
Social Life: Mild	16.9%	15.0%
Social Life: Moderate	32.2%	35.8%
Social Life: Severe	39.2%	32.2%*
Social Life: Very Severe	8.6%	13.3%*

* The difference between full-time college students and other young adults was statistically significant at the .05 level.
Source: 2008 to 2010 SAMHSA National Surveys on Drug Use and Health (NSDUHs).

Among full-time college students aged 18 to 22 with past year MDE, 14.0 percent reported that the maximum severity level of their MDE was very severe (Figure 1).⁶ Among other young adults aged 18 to 22, however, the percentage reporting that the maximum severity level of their MDE was very severe was 19.8 percent. Although only 10.0 percent of full-time college students aged 18 to 22 with past year MDE reported that there were more than 60 days in the past year when they were totally unable to carry out normal activities, for other young adults aged 18 to 22, this percentage was 19.7 percent (Figure 2). Similarly, 30.7 percent of full-time college students with past year MDE reported there were no days in the past year when they were totally unable to carry out their normal activities, but only 24.9 percent of other young adults reported that this was the case.

Figure 1. Maximum level of Severity of Impairment due to Symptoms of Depression among Persons Aged 18 to 22 with Past Year Major Depressive Episode (MDE), by Full-Time College Status: 2008 to 2010

Figure 1 Table. Maximum level of Severity of Impairment due to Symptoms of Depression among Persons Aged 18 to 22 with Past Year Major Depressive Episode (MDE), by Full-Time College Status: 2008 to 2010
Maximum level of Severity of Impairment	Full-Time College Students (%)	Other Young Adults (%)
Very Severe	14.0%	19.8%
Severe	48.6%	44.7%
Moderate	31.2%	28.1%
No or Mild Interference	6.2%	7.4%

Source: 2008 to 2010 SAMHSA National Surveys on Drug Use and Health (NSDUHs).

Figure 2. Number of Days in the Past Year Unable to Carry Out Normal Activities due to Symptoms of Depression among Persons Aged 18 to 22 with Past Year Major Depressive Episode (MDE), by Full-Time College Status: 2008 to 2010

Figure 2 Table. Number of Days in the Past Year Unable to Carry Out Normal Activities due to Symptoms of Depression among Persons Aged 18 to 22 with Past Year Major Depressive Episode (MDE), by Full-Time College Status: 2008 to 2010
Number of Days	Full-Time College Students (%)	Other Young Adults (%)
More than 60 Days	10.0%	19.7%
29 to 60 Days	9.0%	11.6%
14 to 28 Days	12.0%	10.6%
1 to 13 Days	38.3%	33.2%
0 Days	30.7%	24.9%

Source: 2008 to 2010 SAMHSA National Surveys on Drug Use and Health (NSDUHs).

Receipt of Specialty Mental Health Treatment

Full-time college students aged 18 to 22 with past year MDE and other young adults with past year MDE were equally likely to receive specialty mental health treatment in the past year (43.9 and 40.4 percent, respectively) (Figure 3). The percentage of full-time college students aged 18 to 22 with past year MDE who received specialty mental health counseling was slightly higher than the percentage of other young adults with past year MDE who received mental health counseling (41.1 vs. 35.7 percent). However, full-time college students and other young adults with past year MDE were almost equally likely to receive prescription medication for their MDE (28.1 and 29.4 percent, respectively).

Figure 3. Receipt of Specialty Mental Health Treatment in the Past Year among Persons Aged 18 to 22 with Past Year Major Depressive Episode (MDE), by Full-Time College Status: 2008 to 2010

Figure 3 Table. Receipt of Specialty Mental Health Treatment in the Past Year among Persons Aged 18 to 22 with Past Year Major Depressive Episode (MDE), by Full-Time College Status: 2008 to 2010
Treatment	Full-Time College Students (%)	Other Young Adults (%)
Received Any Specialty Mental Health Services	43.9%	40.4%
Received Mental Health Counseling*	41.1%	35.7%
Received Prescription Medication	28.1%	29.4%

* The difference between full-time college students and other young adults is statistically significant at the .05 level.
Source: 2008 to 2010 SAMHSA National Surveys on Drug Use and Health (NSDUHs).

Discussion

Overall, the prevalence of past year MDE was similar among full-time college students and other young adults aged 18 to 22 (8.4 and 8.2 percent, respectively). However, other young adults aged 18 to 22 with MDE were generally more likely to report that the mood related to their MDE very severely impaired their important activities and relationships and were also more likely than full-time college students to report a higher number of days in the past year during which they were unable to carry out their normal activities because of MDE. Despite the reported greater severity of their symptoms, full-time college students with MDE and other young adults aged 18 to 22 with MDE were equally likely to receive specialty mental health treatment, although other young adults were more likely than full-time college students to have received mental health counseling.

Considerable controversy surrounds the question of whether rates of psychiatric disorders and mental health treatment differ between college students and their peers who do not attend college.⁷ Although much attention has been focused on the mental health problems and service needs of full-time college students, the results presented here suggest that other young adults aged 18 to 22 experience similar, and possibly more serious, mental health issues. It is possible that the reason for this is that young adults aged 18 to 22 who are not full-time college students experience different kinds of stresses related to employment (and unemployment) or family responsibilities. These factors may contribute to the increased severity of MDE symptoms and greater functional impairment reported by these other young adults. Further, it is possible that full-time college students are more likely than other young adults aged 18 to 22 to have access to health insurance and/or to specialty mental health and other medical and support services provided by their colleges. The mental health problems and treatment needs of young adults aged 18 to 22 who are not full-time college students may thus warrant increased investigation and attention.

End Notes

¹ American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
² Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602.
³ MDE is defined using diagnostic criteria in the DSM-IV, which specifies a period of 2 weeks or longer during which there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image. In assessing MDE, no exclusions were made for MDE caused by medical illness, bereavement, or substance use disorders.
⁴ The Sheehan Disability Scale (SDS) measures the impact of MDE on a person's life. The SDS asks adults aged 18 or older to give a rating of 0 to 10 (with 10 being the highest) for the level of impairment caused by the disorder in each of four role domains: (1) home management, (2) work, (3) close relationships with others, and (4) social life. Respondents with unknown severity of SDS role impairment data or for whom particular activities were not applicable were excluded.
⁵ Treatment for depression is defined as seeing or talking to a doctor or other professional or using prescription medication in the past year for depression.
⁶ Maximum severity is defined as the highest level of impairment caused by the disorder in any one of the four role domains. For example, if an individual reported no impairment in three of the role domains and a 7 in the fourth role domain, the maximum severity value would be 7.
⁷ Blanco, C., Okuda, M., Wright, C., Hasin, D. S., Grant, B. F., Liu, S. M., & Olfson, M. (2008). Mental health of college students and their non-college attending peers: Results from the National Epidemiologic Study on Alcohol and Related Conditions. Archives of General Psychiatry, 65(12), 1429-1437.

Suggested Citation

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (May 3, 2012). The NSDUH Report: Major Depressive Episode among Full-Time College Students and Other Young Adults, Aged 18 to 22. Rockville, MD.

The National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The 2008 to 2010 data used in this report are based on information obtained from approximately 37,000 persons aged 18 to 22. The survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence.

The NSDUH Report is prepared by the Center for Behavioral Health Statistics and Quality (CBHSQ), SAMHSA, and by RTI International in Research Triangle Park, North Carolina. (RTI International is a trade name of Research Triangle Institute.)

Information on the most recent NSDUH is available in the following publication:

Center for Behavioral Health Statistics and Quality. (2011). Results from the 2010 National Survey on Drug Use and Health: Summary of national findings (NSDUH Series H-41, HHS Publication No. SMA 11-4658). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Also available online: http://www.samhsa.gov/data/.

The NSDUH Report is published periodically by the Center for Behavioral Health Statistics and Quality (formerly the Office of Applied Studies), Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Center for Behavioral Health Statistics and Quality are available online: http://www.samhsa.gov/data/. Citation of the source is appreciated. For questions about this report, please e-mail: shortreports@samhsa.hhs.gov.

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