Guide to Mental Health in College

Guide to Mental Health in College

2020 has been a tough year for college students. Here's how you can stay

Every student feels pressure on occasion, especially during midterms and finals. However, a bad mood becomes a concern if it interferes with your day-to-day activities. When it's tough to get to class, hard to concentrate, or too much of a hassle to hang out with friends, you may be struggling with mental distress.

Many factors cause unpleasant feelings and emotions. A 2018 study found that the sharpest increase in anxiety for college students occurs during the initial transition to college. Sleep disruption — fueled by drinking excess caffeine or pulling all-nighters — is also associated with heightened anxiety.

Excessive social media use may also be responsible for impaired social interactions and an increased sense of isolation. A bad grade, a fight with a roommate, or a relationship ending can lead to feelings of sadness, loneliness, or low self-worth.

As if that weren't enough, the coronavirus pandemic has been a major source of additional distress for many students. According to a survey by TimelyMD, 85% of college students reported higher than normal levels of stress and anxiety due to COVID-19. However, only 21% of students surveyed reached out to a therapist for help — a disparity that TimelyMD referred to as an "awareness gap" about the availability of virtual counseling resources.

Recognizing early signs and symptoms is crucial to managing anxiety, stress, and depression. Knowing when to ask for help is equally as important. The good news is that college students can curb the effects of these symptoms by accessing resources like counseling centers, hotlines, and support groups.

Here, we explain what causes certain types of psychological distress and how to cope with them. Keep in mind that this is only an introduction to mental health and well-being. If your struggles are persistent, we encourage you to seek counseling, therapy, mental health clinics, and other professional support services.

DISCLAIMER: The following is intended as an information resource only; we are not a medical organization and we cannot give medical advice. If you are experiencing a life-threatening situation, seek medical help or dial 911.


Stress is a feeling of emotional, mental, or physical tension. It usually flares up in response to a challenge or demand, such as an upcoming assignment, rent payment, or significant life change.

Stress levels can vary, depending on the degree to which it impacts you. It can be a positive driver, helping you meet a deadline, or a negative influence that makes you feel overwhelmed and unable to cope.

According to the American College Health Association's 2018 National College Health Assessment, 87% of college students reported feeling tremendous stress at least once in the previous year.

Signs of Stress

Because stress affects both the mind and body, there can be physical, mental, and emotional symptoms. According to the Mayo Clinic, being able to recognize these signs can help you manage them.

Some common physical symptoms of stress include headaches, backaches, rapid breathing, upset stomach, and nausea. Overly stressed people often also encounter sleep problems, changes in sex drive, or fatigue.

Stress can also manifest in your thinking, behavior, or mood. You may feel irritable, restless, and unmotivated. Stress can also lead to angry outbursts, misuse of drugs or alcohol, or social withdrawal.


  • Headaches
  • Backaches
  • Rapid breathing


  • Irritability
  • Restlessness
  • Lack of motivation


  • Angry outbursts
  • Social withdrawal
  • Misuse of drugs or alcohol

How to Manage Stress

Unchecked stress can cause long-term health problems, including high blood pressure, heart disease, and diabetes. It can also interfere with your ability to function at school or at work. If you feel very stressed, it's crucial to address those symptoms sooner rather than later.

There are many strategies for managing stress. Deep breathing, meditation, and walks are all useful in the short run. Other techniques, such as writing down stressors in a diary or practicing kindness and self-compassion, can help you deal with prolonged periods of stress.

Stress SOS

  • Count to 10 before speaking or reacting.
  • Take a few slow, deep breaths to recalibrate your mind and body.
  • Listen to a guided meditation to break a cycle of tension.
  • Practice mindfulness techniques that help you acknowledge and accept your thoughts and feelings in the present moment.
  • Try saying positive affirmations, such as "I will try my best, regardless of the challenge," to turn negative thinking around.
  • Exercise for at least 30 minutes to produce endorphins that can help relieve pain and reduce stress.

If you're feeling overwhelmed, it may help to give yourself a mental break. Go for a walk, put aside school work for the night, or listen to soothing music. You can also turn to activities that put you in a happy mood, such as reading a book, taking a relaxing bath, or making art.

The hectic unpredictability of college can make it challenging to stay on top of all the twists and turns. For this reason, Lisa Smith, director of the Center for Anxiety and Related Disorders (CARD) at Boston University, encourages students to be mindful of how they respond to stress.

"Often it is more important to manage your emotional reaction to stress than to try to change the stressful situation, which may not be fully under your control," Smith said in her school's "Mental Health Matters" series.

- Lisa Smith, director of the Center for Anxiety and Related Disorders (CARD) at Boston University


Anxiety is a physiologic and emotional reaction to a perceived threat, which can be real or imagined. This threat could be a tough test, a class presentation, or a memory of a traumatic experience. The brain floods the body with adrenaline as a "flight or fight" response, causing a sensation similar to fear.

It's completely normal to feel anxiety sometimes, but if your fight or flight instincts kick in too rapidly or too frequently, you may have an anxiety disorder.

There are many kinds of anxiety disorders, including generalized anxiety disorder (GAD), social anxiety disorder, post-traumatic stress disorder (PTSD), separation anxiety, phobias, and panic disorder. The severity, longevity, and effects of each condition vary.

Anxiety is one of the most common mental health issues among college students. According to the American College Health Association's 2019 National College Health Assessment, 66% of college students reported feeling overwhelming anxiety within the previous year. Following the outbreak of COVID-19, a UC Berkeley study found that 39% of undergraduate and graduate and professional students screened positive for generalized anxiety disorder.

Signs of Anxiety

Anxiety produces intense, overwhelming, and uncomfortable feelings through a surge of hormones in the body, including adrenaline and cortisol. Adrenaline can cause your breathing, heart rate, and blood pressure to increase. You may sweat, grind your teeth, or tremble. Long-term exposure to cortisol can lead to weight gain.

Stomach problems, such as cramps in your gut, constipation, or diarrhea, are also typical during an anxious episode. Issues like these are caused by a hormone and chemical imbalance in your digestive system, resulting in gastrointestinal stress.

Beyond physical sensations, you may feel lightheadedness, extreme fatigue, or an impending sense of doom. Anxiety can also cause insomnia, social isolation, or an inability to relax. Other symptoms include sadness, irritability, and difficulty concentrating.

How to Manage Anxiety

There are several strategies that can help manage anxiety. The most critical step is identifying and acknowledging how it affects you; acceptance can start you on the path to curbing the most harmful effects.

Deep breathing exercises, walks, and meditation can dampen the effects of mild anxiety. When you are experiencing overwhelming physical sensations, the 5-4-3-2-1 technique can take your mind off what is making you uncomfortable. This method focuses the mind on your five senses: what you can see, feel, hear, smell, and taste.

Coping with Anxiety Using the 5-4-3-2-1 Technique

  • 5: Look for five things you can see around you. It could be a wallpaper, a dent in a wall, or an object near you.
  • 4: Find four things you can touch around you. It could be your leg, an armrest, or the carpet.
  • 3: Identify three things you can hear. Listen to the noises in your surroundings, like a conversation, the spinning of a fan, or passing cars.
  • 2: Notice two things you can smell, such as the aroma of a recently cooked dinner or a candle.
  • 1: Recognize one thing you can taste.

More severe symptoms can be more difficult to curb, especially if the effects last for months. Students with chronic anxiety or anxiety disorders may resolve some issues through psychotherapy, cognitive behavioral therapy, support groups, and medication.

Over the years, colleges have expanded mental health services to address students struggling with anxiety, depression, and stress. College counseling centers can help determine whether you need to be seen by a campus therapist or an outside referral.

Angela Retano, a psychiatric nurse practitioner, wrote on that psychotherapy helps you understand why your body and mind behaves the way it does in stressful situations. It also gives you the tools necessary to work through the things that trigger your anxiety.

"Psychodynamic psychotherapy can help you begin to understand how early life experiences have shaped your view of the world — especially when it comes to perceived threats," Retano wrote. "By getting a fuller grasp on this, you can better comprehend not only your fear and anxiety but also the way you approach relationships, stress, and challenges."

- Angela Retano, a psychiatric nurse practitioner


Depression is a common but serious mood disorder that causes distressing feelings of sadness or loss of interest. These symptoms can negatively affect how you think, feel, and behave, causing significant daily impairment and even thoughts of suicide in some cases.

Research suggests that many possible causes can trigger depression. According to Harvard Health Publishing, depression can stem from faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications, and medical problems.

People typically experience depression multiple times throughout their lives, but it's especially rampant among college students. The American College Health Association's 2019 National College Health Assessment found that 45% of college students reported feeling so depressed that it was difficult to function at some point within the previous year. The same study found 13% of students had thoughts of suicide during the same period.

Depression can take several forms, including persistent depressive disorder (also known as dysthymia), postpartum depression, psychotic depression, seasonal affective disorder, and bipolar disorder.

Signs of Depression

There are many signs and symptoms that may indicate that you're suffering from depression. Symptoms vary with the stage, severity, type, and frequency of the illness.

According to the National Institute of Mental Health (NIH), the symptoms and signs of depression include:

  • Persistent sad, anxious, or "empty" mood.
  • Feelings of hopelessness or pessimism.
  • Irritability.
  • Feelings of guilt, worthlessness, or helplessness.
  • Loss of interest or pleasure in hobbies and activities.
  • Decreased energy or fatigue.
  • Moving or talking more slowly.
  • Feeling restless or having trouble sitting still.
  • Difficulty concentrating, remembering, or making decisions.
  • Difficulty sleeping, early-morning awakening, or oversleeping.
  • Appetite and/or weight changes.
  • Thoughts of death or suicide, or suicide attempts.
  • Aches or pains, headaches, cramps, or digestive problems without an exact physical cause and/or that do not ease even with treatment.

For a depression diagnosis, you must have a low mood and several symptoms that persist for at least two weeks, according to the NIH. However, people suffering from depression don't necessarily experience every symptom.

How to Manage Depression

Although it can be devastating, depression is a treatable mental illness. Treatment is often more effective the earlier it begins, but depression affects people differently, so there is no universal form of treatment. It may require trial and error to find what works best for you.

According to the NIH, common depression treatments include medications, psychotherapy, or a combination of the two. Antidepressants can help reduce symptoms and regulate the way the brain uses chemicals that control mood or stress. For example, selective serotonin reuptake inhibitors increase the availability of serotonin for nerves and improve transmission between neurons.

There are many types of antidepressants, and each treats depression in different ways. The Mayo Clinic encourages people who take antidepressants to be patient, as they can take a while to start working. It's best to be consistent with scheduling doses and pay attention to side effects as your body adjusts. You should also avoid alcohol and recreational drugs, which can interfere with medications and make depression more difficult to treat.

Psychotherapy or counseling is also helpful for treating depression. The goal of talk therapy or other therapies — such as cognitive-behavioral therapy, interpersonal therapy, or problem-solving therapy — is improving quality of life. The NIH states that seeking help is not an admission of weakness but an act of understanding and reducing distressing symptoms.

The Anxiety and Depression Association of America (ADAA) recommends college students reach out to the counseling center at their school to get started. If a counseling center is not available, or there is a long wait list, you can ask a trusted adult such as a professor, career counselor, or residence assistant to help you get a referral to a therapist in the community.

Hotlines and online resources are also available:

  • The National Suicide Prevention Hotline — 1-(800)-273-TALK (8255) — offers students advice and someone to speak to when they need help. It is available 24 hours a day, seven days a week. All calls are confidential and anyone can use this service. (For more information, see:
  • Text HOME to 741741 in the U.S. to reach the Crisis Text Line — a free, 24/7, confidential text message service for people in crisis.
  • ULifeline, an online resource for college mental health, offers a self-evaluator that helps connect students with campus resources.

Beyond treatment, hotlines, and other support services, the NIH also recommends making changes in your lifestyle that may help offset some of the effects of depression. Here are some tips.

  • Be active and exercise
  • Get plenty of rest and sleep
  • Eat well and avoid caffeine and excessive drinking
  • Set realistic goals for yourself
  • Spend time with other people and share your thoughts and feelings
  • Let others help you, and try not to isolate yourself
  • Be open to gradual rather than immediate improvement
  • Continue to educate yourself about depression

Final Word

Mental health issues like stress, anxiety, and depression can be a major concern for college students, interfering with day-to-day activities. With the right tools, however, you can manage these distressing symptoms and maximize your potential as a student. And remember: There's nothing wrong with asking for help.

Evan Thompson is a Washington-based writer for TBS covering higher education. He has bylines in the Seattle Times, Tacoma News Tribune, Everett Herald, and others from his past life as a newspaper reporter.

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