Higher Education Strategy Associates

Tag Archives: mental health

June 02

Student Health (part 2)

Now you may have seen a headline recently talking about skyrocketing mental health problems among students.  Specifically, this one from the Toronto Star, which says, among other things:

A major survey of 25,164 Ontario university students by the American College Health Association showed that between 2013 and 2016, there was a 50-per-cent increase in anxiety, a 47-per-cent increase in depression and an 86-per-cent increase in substance abuse. Suicide attempts also rose 47 per cent during that period.

That’s a pretty stunning set of numbers.  What to make of them?

Part of what’s going on here is looking at the size of the increase instead of the size of the base.  If the incidence of something goes from 1% to 2% in the population, that can be accurately expressed either as “a one percentage point increase” or “IT DOUBLED!”.   The increase for the numbers on “attempted suicide in the last 12 months”, for instance, rose from 1.3% to 2.1%.  With such a tiny base, double-digit increases aren’t difficult to manufacture.

(in case you’re wondering whether these figures are a function of possible measurement error, the answer is no.  With a 40,000 student sample, the margin of error for an event that happens 1% of the time is 0.1, so a jump from 0.8% is well beyond the margin of error).

Now, the Star is correct, there is a very troubling pattern here – across all mental health issues, the results for 2016 are significantly worse than for 2013 and troublingly so.  But it’s still a mistake to rely on these figures as hard evidence for something major having changed.  As I dug into the change in figures between 2013 and 2016, I was amazed to see that in fact figures were not just worse for mental health issues, but for health and safety issues across the board.  Some examples:

  • In 2013, 53.4% of students said their health was very good or excellent, compared to just 45.3% three years later
  • The percentage of students whose Body Mass Index put them in the category of Class II Obese or higher rose from 3.15 to 4.3%, a roughly 35% increase.
  • The percentage of students with diabetes rose by nearly 40%, migraine headaches by 20%, ADHD by nearly 25%
  • Even things like incidence of using helmets when on a bicycle or motorcycle are down by a couple of percentage points each, while the percent saying they had faced trauma from the death or illness of a family member rose from 21% to 24%.

Now, when I see numbers like this, I start wondering if maybe part of the issue is an inconsistent sample base.   And, as it turns out, this is true.  Between 2013 and 2016, the institutional sample grew from 30 to 41, and the influx of new institutions changed the sample considerably.  The students surveyed in 2016 were far more likely to be urban, and less likely to have been white or straight.  They were also less likely to have been on varsity teams or fraternity/sorority members (and I suspect that last one tells you something about socio-economic background as well, but that’s perhaps an argument for another day).

We can’t tell for certain how much of the change in reported health outcomes have to do with the change in sample.  It would be interesting and helpful if someone could recalculate the 2016 data using only data from institutions which were present in the 2013 sample.  That would provide a much better baseline for looking at change over time.  But what we can say is that this isn’t a fully apples-to-apples comparison and we need to treat with caution claims that certain conditions are spreading in the student population.

To conclude, I don’t want to make this seem like a slam against the AHCA survey.  It’s great.  But it’s a snapshot of a consortium at a particular moment in time, and you have to be careful about using that data to create a time series.  It can be done – here’s an example of how I’ve done it with Canadian Undergraduate Survey Consortium data, which suffers from the same drawback.  Nor do I want to suggest that mental health isn’t an issue to worry about.  It’s clearly something which creates a lot of demand for services and the need to be met somehow (though whether this reflects a change in underlying conditions or a change in willingness to self-identify and seek help is unresolved and to some degree unresolvable).

Just, you know, be careful with the data.  It’s not always as straightforward as it looks.


June 01

Student Health (part 1)

I have been perusing a quite astonishingly detailed survey that was recently released regarding student health.  Run by the American College Health Association-National College Health Assessment, this multi-campus exercise has been run twice now in Canada – once in 2013 and once in 2016.  Today, I’m going to look at what the 2016 results say, which are interesting in and of themselves.  Tomorrow, I’m going to look at how the data has changed since 2013 and why I think some claims about worsening student health outcomes (particularly mental health) need to be viewed with some caution.  If I get really nerdy over the weekend, I might do some Canada-US comparisons, too.


The 2016 study was conducted at 41 public institutions across Canada.  Because it’s an American based survey, it keeps referring to all institutions as “colleges”, which is annoying.  27 of the institutions are described as “4-year” institutions (which I think we can safely say are universities), 4 are described as “2-year” institutions (community colleges) and 10 described as “other” (not sure what to make of this, but my guess would be community colleges/polytechnics that offer mostly three-year programs).  In total, 43,780 surveys were filled out (19% response rate), with a roughly 70-30 female/male split.  That’s pretty common for campus surveys, but there’s no indication that responses have been re-weighted to match actual gender splits, which is a little odd but whatever.


There’s a lot of data here, so I’m mostly going to let the graphs do the talking.  First, the frequency of students with various disabilities.  I was a little bit surprised that psychiatric conditions and chronic illnesses were as high as they were.

Figure 1: Prevalence of Disabilities

Figure 1 Prevalence of Disabilities

Next, issues of physical safety.  Just over 87% of respondents reported feeling safe on campus during the daytime; however, only 37% (61% of women, 27% of men, and right away you can see how the gender re-weighting issue matters) say that they feel safe on campus at night.  To be fair, this is not a specific worry about campuses: when asked about their feelings of personal safety in the surrounding community, the corresponding figures were 62% and 22%.  Students were also asked about their experiences with specific forms of violence over the past 12 months.  As one might imagine, most of the results were fairly highly gendered.


Figure 2: Experience of Specific Forms of Violence Over Past 12 Months, by Gender

Figure 2 Experience of Specific Forms of Violence

Next, alcohol, tobacco, and marijuana.  This was an interesting question as the survey not only asked students about their own use of these substances, but also about their perception of other students’ use of them.  It turns out students vastly over-estimate the number of other students who engage with these substances.  For instance, only 11% of students smoked cigarettes in the past 30 days (plus another 4% using e-cigarettes and 3% using hookahs), but students believed that nearly 80% of students had smoked in the past month.


Figure 3: Real and Perceived Incidence of Smoking, Drinking and Marijuana Use over Past 30 Days

Figure 3 Real and Perceived Incidence of Smoking

Figure 4 shows the most common conditions for which students had been diagnosed with and/or received treatment for in the last twelve months.  Three of the top ten and two of the top three were mental health conditions.

Figure 4: Most Common Conditions Diagnosed/Treated in last 12 Months

Figure 4 Most Common Conditions Diagnosed

Students were also asked separately about the kinds of things that had negatively affected their academics over the previous year (defined as something which had resulted in a lower mark than they would have otherwise received).  Mental health complaints are very high on this list; much higher in fact than actual diagnoses of such conditions.  Also of note here: internet gaming was sixth among factors causing poorer marks; finances only barely snuck into the top 10 reasons, with 10.3% citing it (though elsewhere in the study over 40% said they had experienced stress or anxiety as a result of finances).

Figure 5: Most Common Conditions Cited as Having a Negative Impact on Academics

Figure 5 Most Common Conditions Cited as Having

A final, disturbing point here: 8.7% of respondents said they had intentionally self-harmed over the past twelve months, 13% had seriously contemplated suicide and 2.1% said they had actually attempted suicide.  Sobering stuff.

December 04

Mental Health on Campus

There’s a lot of talk about mental health on campus these days – Sunday’s Globe feature, a Toronto Star piece from last week, and the September cover story in Maclean’s, are but three recent examples.  Part of what seems to be driving the increased concern is that the kids affected by this crisis aren’t necessarily the ones on the margin, but are often amongst those considered to be “high-achievers.”

Without casting doubt on the seriousness of the issue – and it is a serious issue – there’s a part of this story which I find quite puzzling: Why is this suddenly an issue, now?  What’s changed?

I don’t find any of the commonly-advanced explanations particularly convincing.  The main one is that, “youth are just under so much pressure these days”, usually followed by references to high tuition fees, student debt, and/or weak graduate job prospects.  But the facts don’t bear-out the claim: Net tuition is stable (or declining) in much of Canada, student debt in real dollars has barely changed in a decade, and student job prospects were appreciably worse in the early-to-mid-90s, without triggering any similar rise in mental health issues.

Instead, I see two factors more at work here.

First is the tendency to over-medicalize daily life.  Melonie Fullick, for example, wrote a few months back about mental health issues in graduate school.  She does an excellent job of outlining the difficulties and frustrations accompanying graduate studies, and the ways in which institutional academic policies accentuate those frustrations.  But, in fact, much of what she describes can more properly be characterized as “angst,” rather than mental health issues, and we should be careful about conflating the two.

Second, Fullick is undoubtedly on to something in pinpointing the roots of anxiety in failure (either real or anticipated).  But it’s not as though failure has spiked lately (student job prospects, on the whole, remain better than they were for most of the 90s).  So if this “epidemic” is real, then it must mean that it’s fear of failure which is rising, independent of any actual change in students’ fortunes.

I can’t prove this, obviously, but I get the sense that as a society we’ve spent too much effort raising kids’ self-esteem and, in the process, removed any sense of adversity (or the importance of overcoming adversity) from their lives.  As Paul Tough has written about, both for The New York Times Magazine, and in his latest book, How Children Succeed: Grit, Curiosity and the Hidden Power of Character, what high-achieving, high-income kids often lack most is any experience in dealing with failure.  University may in fact be the very first time they’re forced to confront it.

So, although parents might be loath to hear it, we need to consider a very different possibility: that the spike in rates of reported mental stress might have more to do with incoming students simply being a lot more fragile, and less prepared, than were their predecessors.