Clinical Psychiatry Open Access

Keywords

Mental health; Social support; University students; Coping; Depression

Introduction

Mental health problems are common across university students and are considered a leading cause of impediment to academic success. Mental illness in students affects their motivation, concentration, social interaction, all of which that are important to succeed in higher education [1]. As per the 2019 Annual Report of the Centre for Collegiate Mental Health [2], anxiety continues to be the major problem (62.5%) followed by depression More than 50% of the students seek universitybased counseling services for managing their mental health problems. Different factors predispose the risk of depression in university students that could range from academic issues to personal issues. It is necessary to understand the domain and course of depression in university students for designing support interventions to ensure coping across the concerned stakeholders and reduce the severity of depression even if it is not possible to eliminate the cause of depression. Ajinkya et al. [3] showed that major depressive disorder incidence was higher among undergraduates who were enrolled in Arts or Humanities as majors. The odds of MDD were 3.84 times more than those who did not decide their majors. On the contrary, the risk of MDD was lower in college students who took STEM (Science, Technology, Engineering and Mathematics) as one of their majors (OR:0.80 95% CI:0.27 to 2.39) or non-STEM subjects apart from arts and humanities (OR:0.77, 95% CI:0.26 to 2.29).

It could be inferred that students who were enrolled in Arts and Humanities as majors might not be confident with their professional careers compared to their peers in STEM and non- STEM majors. In another study, Ceyhan et al. [4] showed that dissatisfaction with academic performance caused depression in university students. The findings of Ajinkya et al. [3] and Ceyhan et al. [4] showed that choice and performance with majors is a significant contributor to depression in university students. The authors further showed that the family history of depression and parental violence predisposed the risk of MDD in the participants more than dissatisfaction with the majors (OR:4.20 versus OR:3.84). Dang, et al. [5], found that in the Chinese culture, the social relationship and social attitude is a factor that is highly considered and is linked to depression. Reasonably, the central function of self-efficacy and self-esteem based on the association of psychological disorders and social support remains unnoticeable. However, their association remains latent and significant, considering negative societal attitudes as one of the major reasons for precipitating depression in Chinese children. The Chinese culture strongly underlines filial piety and hierarchy in social association. The values result in unique cultural nurturing characteristics, such as strict parenting styles, better parental involvement, better parental control, and community involvement [6].

Contrary, the lack of these attributes can lead the child to develop low self-esteem. Low self-esteem can bring an intermediating effect on the individual's self-esteem and can be cut-rate on the relationship between depression and the availability of social help among Chinese learners [7]. Childhood family instability, which is commonly the partial outcome after the family structure, has endured negative ramifications on mental health. Children from single-parent households are known to be affected disproportionately by psychological problems compared to the other students from families with both parents [8]. Furthermore, the change from residing with both biological parents to cohabitation with stepfamily setups or living with only one biological parent is thought to be related to the high number of depressed learners in Chinese universities. The family stress model proposes that inauspicious family environments affect the child's functioning in a variety of ways, including depression due to a lack of resources or chronic poverty, chronic hardships, and strained parent-parent and parent-child relationships negatively.

Conditions of chronic poverty often mean that parents find it challenging to meet the basic needs of the household, including medical care, food, decent shelter, as well as education. Such a chronic lack of resources inevitably created pressure that activates emotional distress in parents. This distress often manifests in the form of irritability, anxiety, aggression, argumentativeness, and depression [9]. Such negative emotions inevitably cause disruptions in parental caring, support, warmth, and nurturing that, in turn, affect the development of children negatively. The coping with silence concept could explain some of the behavioral, social, and physical problems that are faced by children of depressed patients [10]. The concept could be explained by the General Adaptation Syndrome (GAS) of Hans Selye. Selye introduced the GAS model, which explains the changes in somatic and psychological behavior of an individual upon exposure to stress and stressors. Depression could be considered a stressful event and a persistent stressor in the life of an individual. As a result, the child tends to exhibit withdrawal or externalizing behaviors when they first confront the respective stressor [11]. These assumptions were supported by Kirsten et al. [12], who showed that the balance between risk and protective factors plays a significant role in mediating behavioral outcomes and social functioning in the concerned stakeholders during their adulthood because studies suggest that children of depressed parents exhibit a two to four-fold increase in the prevalence of depression during late adolescence compared to their peers whose parents do not suffer from depression. For example, social support is considered a positive factor that promotes resilience, which means that social support promotes a normal life trajectory in spite of adversities. These findings suggest that Chinese university students might require social, moral, and psychological support for overcoming their episodes of depression.

Methodology

The study was conducted as a cross-sectional survey of 168 Chinese university students through an online survey. The semistructured questions inquired regarding their perceptions on the support they receive in overcoming episodes of depression from societal, parental, and mental health services. The questionnaire also inquired regarding the perceptions and stigma of the stakeholders for accessing structured psychosocial support within and outside the University premises.

Results

The results are expressed in terms of descriptive statistics in Figures 1-3.

Figure 1: Perceptions of Chinese University students on societal attitude and COVID-19 for parental depression.

Figure 2: Coping and resilience attributes.

Figure 3: Stigma related to seeking mental health services.

Discussion and Conclusion

The study showed that 45% of the students wanted psycho counseling services, which suggested the importance of such services irrespective of the history of parental depression among university students. Interestingly, the percentage of respondents who advocated for mental health services was higher than the percentage of respondents affected with depression, the finding implicated that there could be other psychotic disorders in the students on account of parental depression apart from depression, and it could also be possible that there could be episodes of depression that are unrelated to parental depression. Around 69% of the individuals felt that the societal attitudes toward them could have been different if the concerned stakeholders did not know that their parents are depressed. This finding again substantiated the assumption that society holds certain prejudices toward children of depressed parents. Nevertheless, 55% of the respondents agreed that they are empathetic to their peers whose parents suffer from depression and help them often to overcome their negative emotions. Such findings indicate the positive intention of the students in helping out depressed individuals while they grow into adults. However, being empathetic toward the concerned stakeholders does not ensure that they would actively cooperate in helping out individuals with depression. The study further showed that only 15% of the students felt that the negative societal attitudes enhance their resilience and selfdetermination amidst the parental crisis.The study showed that 45% of the students wanted psycho counseling services, which suggested the importance of such services irrespective of the history of parental depression among university students. Interestingly, the percentage of respondents who advocated for mental health services was higher than the percentage of respondents affected with depression, the finding implicated that there could be other psychotic disorders in the students on account of parental depression apart from depression, and it could also be possible that there could be episodes of depression that are unrelated to parental depression. Around 69% of the individuals felt that the societal attitudes toward them could have been different if the concerned stakeholders did not know that their parents are depressed. This finding again substantiated the assumption that society holds certain prejudices toward children of depressed parents. Nevertheless, 55% of the respondents agreed that they are empathetic to their peers whose parents suffer from depression and help them often to overcome their negative emotions. Such findings indicate the positive intention of the students in helping out depressed individuals while they grow into adults. However, being empathetic toward the concerned stakeholders does not ensure that they would actively cooperate in helping out individuals with depression. The study further showed that only 15% of the students felt that the negative societal attitudes enhance their resilience and selfdetermination amidst the parental crisis.

The finding further supports the need for societal support, parental support, and mental health services in helping them to overcome their episodes of depression as well as their mental health problems that could stem from their history of parental depression. The assumption is supported by the fact that 47% of the students agreed that a positive societal attitude is highly solicited for helping them to overcome the parental crisis. The present study showed that 62% of the students felt that the current COVID-19 crisis had invoked depression or aggravated depression in their parents that have influenced their behavior too. However, the students agreed that parental depression did not significantly impact their personal traits and gender identity, but 44% of them felt that the negative societal attitudes significantly impacts their personal traits and gender identity.These findings are aligned with the observation that negative societal attitudes impact the professional and personal aspirations of the concerned stakeholders.

As 26.2% of the students felt that society around them tries to avoid them and 17.2% of the students responded to be depressive, it implicates that the presence of depression in them might have invoked societal avoidance. Moreover, 80% of the students felt that society wants that they should always be taken care of by mental health services. The study showed that almost 55% to 65% of the participants felt that the coping and resilience exhibited by them would be inadequate to overcome the physical health problems, mental health problems, and academic problems that are faced by them amidst parental depression and negative societal attitudes. This finding further implicated the need for social support and parental support for children of depressed parents. The respective assumption was supported by the fact that almost 55% to 63% of the students agreed that the university should make provisions for psycho counseling and mental health services outside or within university premises, respectively. The need for societal support and parental support for children of depressed parents become evident as 32% to 45.5% of the students agreed that they often suffer from stigma in accessing psycho counseling and mental health services outside and within university premises.

Despite the importance of mental health services, only small proportion of the students who commit suicide contact their institutional counseling services due to stigma from peers and teachers. It is further contended that negative stigma from peers and society could lead to non-adherence with university-based mental health services [1]. Recent studies have suggested that the COVID-19 crisis has prompted university students to seek mental health counseling [1]. Therefore, it is not surprising why mental health services, including screening for depression and other psychotic disorders, should be carried out outside university premises that would encourage more volunteering among the concerned students. The finding also highlighted the internalizing stigma that the students hold regarding the surfacing of mental health problems to their peers or teachers because conducting mental health screening within university premises might result in framing a student to be suffering from mental health problems even if the concerned stakeholders utilize the referred provisions for screening purposes. However, such internalizing stigma might not be present in the concerned stakeholders in stakeholders for accessing such services beyond the university premises because the chances of getting framed or labeled with a mental health problem would be less. The need for mental health services becomes more evident because more than 50% of the participants felt that parents, counselors, and teachers do not often interact and make a joint plan to help overcome the societal stigma toward them. Further, 54% of the students agreed that they are often bullied by their peers, which might be due to impairments in social functioning. The finding also suggests why the concerned stakeholders feel that they would be more inclined to access mental health services outside the university premises. This is because such arrangements would make them less susceptible to bullying or getting framed as an individual with mental health problem.

Recommendations

The findings of the study helped to draw certain recommendations for managing and rehabilitating university students exhibiting signs and symptoms of mental health problems and behavioral dysfunctions such as social malfunctioning. The recommendations are as follows:

Screen mental health problems routinely across university students through evidence-based screening tools in a confidential manner.

Make it mandatory to screen for mental health problems in all students to avoid the stigma.

Arrange for mental health services outside university premises through public-private partnerships.

Launch awareness programs and arrange parent-teacher meetings through personalized communication platforms.

Tailor mental health programs based on the coping needs of the students

References

1. Son C, Hegde S, Smith A, Wang X, Sasangohar F (2020) Effects of COVID-19 on College Students' Mental Health in the United States: Interview Survey Study. J Medic Inter Res 22: e21279.
2. Centre for collegiate mental health (2020) University Park, PA: Penn State University.
3. Ajinkya S, Schaus JF, Deichen M (2016) The relationship of undergraduate major and housing with depression in undergraduate students. Cureus 8: 786.
4. Ceyhan A, Ceyhan, Esra, Kurty Y (2009) Investigation of university students depression. Eurasian J Educ Res 36: 75-90.
5. Dang Q, Li Y, Zhang B (2016) Interpersonal relationships and adolescent depression roles of self-esteem and gender. Chinese J Clin Psych 1: 69 –73.
6. Huang C, Cheah CSL, Lamb ME, Zhou N (2017) Associations between parenting styles and perceived child effortful control within Chinese families in the United States, the United Kingdom, and Taiwan. J Cross-Cultural Psychol 48: 795–812.
7. Leung K (2010) Beliefs in Chinese culture. The Oxford. 350 p.
8. Laukkanen M, Hakko H, Riipinen P, Riala K (2016) Does family structure play a role in depression in adolescents admitted to psychiatric inpatient care. Child Psych Human Develop 47: 918-924.
9. Lerner RM, Carmichael L (2015) Handbook of child psychology and developmental science. Hoboken NJ. 3969 p.
10. Evans LD, Kouros C, Frankel SA, Diamond SG, McCauley E, et al. (2015) Longitudinal relations between stress and depressive symptoms in youth: coping as a mediator. J Abnormal Child Psych 43: 355-368
11. Franke HA (2014) Toxic stress: Effects, prevention and treatment. Children 1: 390-402.
12. Hansen K, Kristensen O, Sogaard H, Christensen K (2018) Danish general practitioners professional attention to children of parents with depression. Danish Medi J 65: 492