by Claire Wheeler, MD, PhD & Katherine Grill, PhD
Introduction
It’s long been known that mental health can affect a student’s academic performance and ability to reach graduation, whether in high school or college (Pascoe et al., 2020). Due to the COVID pandemic, student mental health has suffered as young people had to make a radical shift away from the classroom and into remote learning. The consequences of this “lost year” could persist for years, if not decades.
Since the outbreak of COVID, several studies have been published documenting the rise in mental health symptoms and stress levels among students. Others have examined the impact of these challenges on academic performance and retention in school. To highlight the relationship between mental health and academics, the authors present a brief summary in this paper.
The Lasting Impact of COVID on Student Mental Health
Student health and wellness centers at schools across the United States are chronically underfunded and understaffed. While demand for services has risen 40% over the past five years, overall enrollment has only increased 5% (Center for Collegiate Mental Health, 2018). Challenges over the past year have brought this inadequacy to light, resulting in calls for more funding and resources to address both preexisting needs as well as the urgent needs posed by the pandemic. A recent survey of college and university presidents found that student mental health is their “top concern”, as 40% of undergraduate students have a mental health condition (Fullmer et al., 2021).
While COVID has brought student mental health to the center stage, it’s important to state that mental health challenges among students were rising well before the pandemic. A survey of 275 college counseling center administrators published in 2014 found that in the five years previous, all of the following conditions increased by over 50%: anxiety disorders, crises requiring immediate response, psychiatric medication issues, and clinical depression. Other disorders on the rise included learning disabilities (up by 47%), sexual assault (up by 43%) and self-injury issues (35% increase) (Gallagher, 2014).
The same survey revealed that of the 125 students who committed suicide in 2013, 86% had never sought assistance from their college counseling center. Most of those students killed themselves with a firearm (Gallagher, 2014).
A major barrier that prevents students from seeking help for mental health is stigma (Fullmer et al., 2021). Stigma can be life-threatening given that in 2016, the Association for University and College Counseling Center Directors (AUCCCD) reported 21% of college students seeking services were doing so because of suicidal ideation (Reetz et al., 2016). While Gen Z reports less stigma than previous generations, it’s a fallacy to think that they aren’t affected by stigma. In focus groups conducted by Neolth with over 200 high school and college students throughout 2020 and 2021, nearly all students stated stigma exists at their schools.
The Impact of Mental Health on Academic Performance
The impact of mental health problems on academic performance is significant. The National Academy of Mental Health surveyed 765 college students across the U.S. to examine the links between mental health and academic achievement. They found that 64% of students who dropped out, dropped out because of a mental health problem (NAMI, 2014). Of those who dropped out, only half of them had accessed or tried to access campus mental health services. Reasons given for not seeking help included fear of being stigmatized by faculty and fellow students, not knowing that accommodations were available, and fear of losing financial aid.
In 2010, it was reported that college students with mental health conditions are half as likely to graduate as students without these challenges (Hartley, 2010). A report prepared for the U.S. Department of Health and Human Services stated: “Students with a mental health condition also have the poorest rates of school attendance, lowest grade point averages (GPAs), and highest course failure and expulsion/suspension rates of any students with disabilities” (Ringelsen et al., 2015, p. 1).
According to the American Public Health Association (APHA), approximately 523,000 (about 10% overall) U.S. high school students dropped out of school in the 2016/2017 academic year (National Center for Education Statistics, 2019). The 25 school districts in the U.S. with the highest amount of dropouts report graduation rates between 50% and 60% (APHA, 2018).
At Risk Students & Warning Signs
Some students are at higher risk for dropout than others. The dropout rate among students with disabilities is dismal: 36% of high school students with disabilities dropped out of school in 2017. In a study of 1524 students, male college students with mental health challenges were found to have a five-fold greater risk of dropout than those reporting “good mental health” (Hjorth et al., 2016). Similar results were found in a global study of termination of education (Lee et al., 2009).
Absenteeism, poor grades, and poor exam performance are other signs associated with mental health struggles among college students (Ruz et al., 2018). In a study of 170 nursing students, it was found that those reporting anxiety and anxiety disorders had lower grades and higher rates of absenteeism (7.6 vs 4 days) than those who did not suffer from anxiety. Students with depression had similarly low grades and rates of absenteeism (Ruz et al., 2018).
What We Can do About It
The impact that COVID has had on youth mental health is devastating. One positive trend that has occurred during the pandemic has been an increase in creation and use of digital health platforms. From the uptick telemedicine visits (video chats with one’s physician or therapist) to the increased rate of downloads for mental health apps, digital options offer increased access to mental health services.
Neolth's mobile app seeks to bridge the gap between students' needs and the services their schools are able to provide. Counselors use Neolth's digital platform to receive real-time updates student stress levels, health symptoms, and level of engagement in mental health activities (SEL practices, psycho-education,
and self-care). All of these activities on Neolth are self-guided, so counselors don’t need to do anything except tell their students about the app. On the mobile app students have access to relaxation and SEL practices such as mindfulness, creative art, cognitive behavioral therapy, and breathing exercises. They also can use Neolth’s community section, which includes educational videos about mental health, student videos about their lived experiences, livestream events, and real-time crisis care referral.
If schools want their students to succeed, they need to prioritize mental health. As symptoms and distress subside, it becomes easier for students to focus, to practice good time management, to sleep well, and to engage in a wide variety of behaviors and attitudes that are drivers of academic success.
References
American Public Health Association (2018). The dropout crisis: A public health problem and the role of school-based health care. https://www.apha.org/-/media/Files/PDF/SBHC/Dropout_Crisis.ashx
Center for Collegiate Mental Health. (2019). 2018 annual report. https://ccmh.psu.edu/assets/docs/201 8-Annual-Report-9.27.19-FINAL.pdf
Fullmer, L., Fleming, A. R., & Green, K. M. (2021). Perceptions of help-seeking behaviors among college students with mental health disabilities. Rehabilitation Counselors and Educators Journal, manuscript in press.
Harrer, M., Adam, S.H., Baumeister, H., Cuijpers, P., Karyotaki, E., Auerbach, R.P., Kessler, R.C., Bruffaerts, R., Berking, M., & Ebert, D.D. (2019). Internet interventions for mental health in university students: A systematic review and meta‐analysis. International Journal of Methods in Psychiatric Research, 28(2), e1759–n/a. https://doi.org/10.1002/mpr.1759
Hjorth, C. F., Bilgrav, L., Frandsen, L. S., Overgaard, C., Torp-Pedersen, C., Nielsen, B., & Bøggild, H. (2016). Mental health and school dropout across educational levels and genders: a 4.8-year follow-up study. BMC public health, 16(1), 1-12.
Lee, S., Tsang, A., Breslau, J., Aguilar-Gaxiola, S., Angermeyer, M., Borges, G., ... & Kessler, R. C. (2009). Mental disorders and termination of education in high-income and low-and middle-income countries: Epidemiological study. The British Journal of Psychiatry, 194(5), 411-417.
National Alliance on Mental Illness. (2012). College students speak: A survey report on mental health. https://www.nami.org/Support-Education/Publications-Reports/Survey-Reports/College-Students-Speak_A-Survey-Report-on-Mental-H
Pascoe, M. C., Hetrick, S. E., & Parker, A. G. (2020). The impact of stress on students in secondary school and higher education. International Journal of Adolescence and Youth, 25, 104-112. DOI: 10.1080/02673843.2019.1596823
Reetz, D., Bershad, C., LeViness, P., & Whitlock, M. (2016). The Association for University and College Counseling Center Directors annual survey. https://taucccd.memberclicks.net/assets/documents/aucccd%202 016%20monograph%20- %20public.pdf
Ruz, M. E. A., Al-Akash, H. Y., & Jarrah, S. (2018). Persistent (anxiety and depression) affected academic achievement and absenteeism in nursing students. The Open Nursing Journal, 12, 171. https://nces.ed.gov/pubs2020/2020117.pdf
