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Local schools see increase in anxiety, depression and trauma among college students

Chattanooga Times Free Press - 12/2/2019

As more college students across the country seek help for mental illnesses such as anxiety and depression, local school officials say the same is true for students at universities in Chattanooga and the surrounding areas.

An Associated Press review of more than three dozen public universities recently found that the number of students seeking treatment has nearly doubled over the last five years, while overall enrollment has remained relatively flat.

At Lee University, the private Christian school located in Cleveland, Tennessee, the number of students seeking treatment at the university's counseling center has more than doubled in the past decade, according to Dr. David Quagliana, a licensed psychologist and director and clinical coordinator for the Lee University Counseling Center.

"What we see at the Lee University Counseling Center follows a lot of the same trends in the national data," Quagliana said. "The percentage of students seeking treatment is far outstripping the percentage of enrollment increase."

But he said students are also seeking help for more complicated or serious issues than he's seen in the past.


The most common mental illnesses that college students deal with are depression, anxiety or specific relational or interpersonal problems, Quagliana said. But many students are arriving at school with a history of trauma or suicidal thoughts/suicide.

This can put further stress on already burdened programs meant to support students.

In its review, the Associated Press requested five years of data from the largest public university in each state. The data shows that most universities are working to scale up their services, but many are far outpaced by demand.

Since 2014, the number of students receiving mental health treatment at those schools has grown by 35%, while total enrollment grew just 5%. By last year, nearly 1 in 10 students were coming for help, but the number of licensed counselors changed little, from an average of 16 to 19 over five years.

At the University of Tennessee at Chattanooga, one of the smaller regional campuses in the University of Tennessee System, the school's counseling center has seven full-time counselors and, typically, four interns for more than 11,000 students.

"We've seen an approximately 20-25% increase in demand every fall for the past four years. That's really great in terms of students seeking services, but that also means meeting that increased demand," said Elizabeth O'Brien, executive director of the UTC Counseling Center.

O'Brien echoes Quagliana about the challenge of an influx of students with more severe issues who might need more therapy than a student struggling with a less acute illness.

"We've had a pretty big increase in individuals coming in with severe mental illness that is considered so severe it could impair their success in school," she said. "It's very concerning in terms of wanting to serve students and keep them safe while struggling with how we meet those demands."

Though UTC did not provide data, at Lee, 14.8% of students who were treated at the university's counseling center went to 21 or more appointments during the 2018-19 school year and more than half of students evaluated by the center had reported seriously considering suicide in the prior academic year.

With a smaller student population and more flexibility as a private, independent school, Lee has more flexibility in policy regarding how many sessions a student can attend for free or what services the school can provide, Quagliana said. But there are barriers to treatment.


In Cleveland and Bradley County as a whole, there are few mental health providers and even fewer psychiatrists who can prescribe medications for individuals who might need them. Sometimes Lee might refer a student to an agency or provider off campus for more specific concerns such as substance abuse or extreme eating disorders, but students might not have the time or means to get to Chattanooga for an appointment.

O'Brien echoed the difficulties students often face when seeking treatment. Students often lack transportation, health insurance, money and even time to seek treatment. It can also be challenging to even find a provider locally.

"We have a bottleneck in terms of seeking services in Chattanooga and not enough providers and accessibility in terms of getting in to see those providers," she said. "The psychiatrists in town are booking 4 or 5 months out."

Some states and universities are working on ways to tackle these barriers and the shortages of resources, according to the Associated Press.

Students at the University of Maryland called for change last year after some on campus said they had to wait 30 days or more for an initial appointment. Organizers called the campaign "30 Days Too Late." Since the campaign began, the school has now hired more counselors.

Other schools that have received student petitions to improve counseling include Michigan State, Louisiana State, Columbia and Cornell universities.


Chattanooga State Community College, like many colleges and universities, is partnering with outside organizations to help meet student needs.

"We work with community partners for referral for more in-depth counseling as needed. As more college students face mental health, substance abuse and other social issues, Chattanooga State partners with support organizations to better meet the needs of our students," said Debbie Adams, vice president of Student Services, in a statement.

At UTC, the Center for Student Wellbeing holds workshops for students and faculty that teach individuals how to identify or respond to a person who is presenting signs of a mental illness. Resident hall staff are also trained on "Mental Health First Aid" and how to help someone before they reach a crisis point.

Quagliana said many universities are exploring supplemental therapy resources such as online apps or campus programs that teach resiliency or coping skills, as well as offering group therapy in addition to individual sessions with a counselor.

"We do our best to make sure that they don't see that as a consolidation prize for those who don't get into therapy," Quagliana said. "The research on these types of interventions is that on the one hand they are effective on reducing symptoms, but on the other they are not as effective as traditional one-to-one therapy."

Lee hasn't explored apps or similar programs yet, but the school's counseling center does offer small group therapy sessions like UTC does.


O'Brien and Quagliana both agree that students are seeking treatment more often not only because of the decrease in stigma, but also because of an increase in the number of students facing mental health challenges.

"One main theory of why we are seeing an increased need for mental health services and need for psychological services, in general, is that the current generation of students coming into college are having more difficulty with resiliency one way or another," Quagliana said. "I believe there are multiple factors that basically are causing students to have more difficulty dealing with the same kind of issues that previous generations might have dealt with. This generation has different expectations and a lower skill set for dealing with things that might happen, but this generation is also facing more stressors and access to negative psychological experiences."

O'Brien thinks the willingness of current college students to seek help is a testament to this new generation of college students.

"We are seeing Gen Z as opposed to millennials. I think among Gen Z there is less of a stigma around mental health and mental illness," she said. "This is a generation that has experienced more trauma, and is more aware of adverse childhood experiences and the traumas they've faced. Gen Zers are also more educated customers and are more willing to seek services."

The Associated Press contributed to this story.

Contact Meghan Mangrum at or 423-757-6592. Follow her on Twitter @memangrum.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK), or the line is available in Spanish at 1-888-628-9454. You can find a list of additional resources at SpeakingOf


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