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Mental Health & Prevention (2015) 3, 1–4

http://dx.doi.org/1 2212-6570/& 2015 E

nCorresponding au E-mail address: r

(R.M. Holm-Hadulla)

Mental health of students in a globalized world: Prevalence of complaints and disorders, methods and effectivity of counseling, structure of mental health services for students

Rainer Matthias Holm-Hadullaa,b,c,n, Asimina Koutsoukou-Argyrakia,b

aUniversity of Heidelberg, Germany bCounseling Service for Students, Studierendenwerk Heidelberg, Germany cUniversidad Diego Portales, Santiago de Chile, Chile

Received 30 March 2015; accepted 21 April 2015 Available online 30 April 2015

KEYWORDS Mental health; Students; Depression; Anxiety; Counseling

0.1016/j.mhp.201 lsevier GmbH. All

thor ainer.holm-hadull .

Abstract In our globalized world the necessity for student flexibility is increasing. Psychological problems and mental disorders are frequent, and students seek help at the places where they study. This special issue presents data on the prevalence of complaints and disorders reported by students around the world. Examples of counseling services and the methods they employ are given. Proposals for the structure and the methods of mental health services for students are derived from international perspectives. & 2015 Elsevier GmbH. All rights reserved.

1. Introduction

Since the classical period in European culture, there has been no shortage of descriptions of psychological crises, adjustment disorders, anxiety and depressive episodes recorded by young people studying at colleges and universities. The most detailed reports of psychological problems besetting university students

5.04.003 rights reserved.

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can be found in the letters and autobiographical notes of the politician, scientist and poet J. W. v. Goethe (Holm-Hadulla, Roussel, Hofmann & 2010). Academic disillusion and rejection by a young lady caused states of anxiety and melancholic moods that led to a depressive episode. During this episode, which lasted more than a year, he was forced to return to parental custody, as his mother and father feared that his suicidal ideations could become reality. Fortunately, he developed coping and self-therapeutic strategies that helped him to overcome his crisis. Like modern counselors, he made use of helping alliances, cognitive-behavioral techniques, psychody- namic reflection, and existential understanding (Holm-Hadulla,

R.M. Holm-Hadulla, A. Koutsoukou-Argyraki2

2013) In masterpieces like “The Sufferings of Young Werther” and “Faust: A Tragedy”, he described his melancholic moods and suicidal ideas and transformed them into art. But not every student can draw upon the talent and the favorable circum- stances that helped Goethe to cope with crisis creatively. A famous example is pop icon Jim Morrison, who consulted a counselor or psychotherapist. He had only one session and could not be prevented from killing his creativity and himself with alcohol and drugs (Holm-Hadulla & Bertolino, 2014). Many students need professional assistance to cope with psychosocial conflicts and mental disorders.

2. Results

Our survey demonstrates that student mental health and specialized services helping students to come to terms with psychological problems and disorders are an important professional issue worldwide. In the United States of America several studies show increasing mental health issues among students (Prince, 2015). Tragic incidents at educational institutions are frequent. Accordingly, the mental health of students has become a major national concern in the United States. Specific examples from the University of California at Berkeley illustrate themes that are common nationwide, e.g. the increase of students seeking counseling and the increase in the severity of their mental health issues. One nationwide study indicates that 37% of college students in the United States had reported feelings of overwhelming anxiety in the previous 12 months; approximately one-third reported feeling so depressed that it was difficult for them to function; and 9% reported having attempted suicide at some point in their lifetime (American College Health Association, 2014). The demand for counsel- ing services has increased significantly over the last year.

The first counseling services for students were established in the United States in the late 1940s (Prince, 2015). They focused on career counseling and assessment. In the 1960s, personal counseling and psychotherapy gradually became a focus in the work of counseling centers, a development followed by more rigorous training and licensing require- ments for staff members. Today, the typical staff member of a university counseling service in the United States holds a license to practice, typically as a psychologist, and the primary student disorders at present are anxiety and depres- sion (Gallagher, 2013). Current practice at the counseling services focuses on four essential functions: individual and group counseling; prevention and outreach; consultation for faculty and staff; contributions to campus safety.

Risk management has become a key concern at many colleges, and most universities have increased their efforts toward preventing mental health problems by means of a public health model designed to address environmental factors at campus that influence students' mental health. A major challenge is adapting to increasing globalization. Mostly, counseling staff are not sufficiently well trained to provide internationally informed, culturally congruent, and accessible counseling and mental health services (Davidson & Locke, 2010). Hyun, Quinn, Madon and Lustig (2007) report that 44% of the international graduate students questioned in their study reported emotional or stress-related problems that significantly interfered with their academic performance

or their personal well-being. They also found that interna- tional students were less likely to seek advice from services provided by campus counseling centers. From the United States perspective, Prince (2015) concludes that “counseling centers have become a key resource, not only for helping students with problems that interfere with learning, but also for keeping the campus safe … Similar trends and challenges are occurring in colleges and universities globally”.

From a South American perspective, Villacura et al. (2015) describe the problems and disorders of students consulting the counseling service at the University of Chile. They show that the most frequent reasons for consultation are academic problems (21%), anxieties (19%), affective problems (18%), and adverse life events (19%). In 2014, the following diagnoses were the most frequent on Axis I of the DSM-IV: “Other problems that might be subject to clinical care” (58%), anxiety disorders (10%), mood disorders (12%), and adjustment dis- orders (7%). This squares with German studies indicating that more than 50% consult the counseling service because of subclinical problems (Kress, Sperth, Hofmann, & Holm- Hadulla, 2015). Between 2010 and 2014, the demand for consultation at the University of Chile increased by almost 80%.

Also in China there is a growing demand for student counseling. Yang, Lin, Zhu & Liang (2015) give an overview of mental health services in China and report on a special counseling strategy that is deeply rooted in traditional Chinese philosophy. Kulygina and Loginov (2015) describe mental health problems of students in Russia and suggest a multistage and multidisciplinary prevention program aiming both at the psychosocial adjustment of students and the promotion of their personal growth.

In Europe, a recent health survey shows that 33.3% of the population suffer from some kind of mental disorder in the course of a given year (Rückert, 2015). But there is strong criticism with respect to diagnostic criteria. The most reliable studies performed in the UK, Sweden, Norway, and Germany show prevalence rates among students of between 20% and 25% (Kress et al., 2015). Depression and anxiety are the most frequent diagnoses. 90% of the students diagnosed with depressive or anxiety disorders feel unable to pursue their studies. Villacura et al. (2015) shows that mental disorders and stress interact negatively with identity development. Although most European countries provide counseling service for students, quality and quan- tity differ greatly. Some offer information only, others offer qualified counseling and even short-term psychotherapy. Methods applied individually or in groups are mostly cogni- tive-behavioral, psychodynamic, and integrative (Holm- Hadulla, Sperth & Hofmann, 2011; Hofmann, Kress, Sperth & Holm-Hadulla, 2015). The special problems of interna- tional students are being increasingly addressed. There is a need to develop international standards of student counsel- ing (Villacura et al., 2015).

In Germany, systematic data on the mental health of students have been made available since 1987. At the time, a nationwide survey (n=20,000) showed that about 20% of students feel impaired in their studies by psychological problems. Nearly half of this group believe they are able to solve their problems by themselves. 10% of the representa- tive sample feel in need of professional assistance. This finding was confirmed in subsequent years (Kress et al., 2009). Despite the dominant popular view that mental health

3Mental health of students in a globalized world: Prevalence of complaints and disorders,

problems have increased in the last few decades, Berger, Franke, Hofmann, Sperth and Holm-Hadulla (2015) show that this widespread opinion cannot be confirmed. Their study shows a decrease in the frequency and severity of mental health problems among students of psychology and medicine. Nonetheless, problems caused by mental health issues are common, frequently ending in academic failure and leading often to personal and societal tragedies.

The main complaints of university students are anxiety, depressive moods, lack of self-esteem, psychosomatic pro- blems, alcohol and substance abuse, and suicidality. Besides adverse life events and academic problems, these are also the main reasons for consulting a counseling service (Kress et al., 2015). The objective of counseling centers is to promote academic success and positive personal develop- ment of their clients. Well-trained counselors and psy- chotherapists assist in coping with psychosocial crises and do their best to prevent mental disorders, suicide, and violence. Many counseling services can also offer crisis intervention and short-term psychotherapy. If 10% of students consulted a counseling service and an average of 5 sessions per client could be offered, five qualified psychosocial counselors would be needed for every 10,000 students. An average of five sessions per client or patient would only be sufficient in the case of effective cooperation with psy- chotherapists and psychiatrists in private practices and/or clinical institutions. The job of counseling centers is to offer diagnostic assessment, individual counseling, crisis interven- tion, and group counseling with a view to enhancing social competence, enabling the students to cope with academic problems, and overcoming psychic disability. Telephone and online counseling help to reduce the inhibitions preventing young people from seeking help.

At the University of Heidelberg, a model for integrative counseling and short-term psychotherapy has been developed (Holm-Hadulla et al., 2011; Holm-Hadulla & Hofmann, 2012). It works on the following principles: (a) establishment of a trustful, empathic, and respectful alliance; (b) behavior change; (c) correction of dysfunctional meanings and beliefs; (d) psychodynamic reflection; and (e) reinforcement of existential creativity (Holm-Hadulla, 2013). An empirical outcome study shows that 85% of the participants achieve a significant improvement in their satisfaction with their lives and their studies and display a significant and clinically relevant reduction of symptoms. The effect sizes are high (Hofmann et al., 2015).

3. Conclusion

Psychological and mental disorders in students are frequent. Effective methods of counseling exist that are designed to to prevent tragic outcomes, help to cope with crises, and treat certain disorders. Counseling services should be avail- able at every college and every university. Counselors are to be psychologically qualified academics. They should be able to offer qualified assessments, diagnoses, crisis interven- tion, individual counseling, and counseling in groups, and in many centers also short-term psychotherapy. Discretion and confidentiality are central issues. Flexible opening hours and services free of charge lower the inhibition threshold preventing students from consulting the service. Online

counseling and telephone counseling are helpful in certain cases. Consultations with tutors and the initiation and supervision of student-to-student coaching are also of value. Cooperation with psychotherapists and psychiatrists in private practice is essential. In severe and acute cases, close collaboration with the psychiatric departments of the universities is necessary. Cooperations with psychological departments and with psychotherapeutic training institutes provide opportunities for research.

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