Optometric Education

The Journal of the Association of Schools and Colleges of Optometry

Optometric Education: Volume 45, Number 2 (Winter-Spring 2020)


Students Increasingly Affected by Anxiety, Depression

Aurora Denial, OD, FAAO

Aurora Denial, OD, FAAO

Anxiety and depression are apparently on the rise among students at various education levels. The Pew Research Center reported in 2019 that 70% of teens say anxiety and depression are major concerns among their peers.1 According to the American College Health Association’s National College Health Assessment II, in 2016 nearly two-thirds of college students reported anxiety, which was an increase of 50% over the previous five years.2

Depression and anxiety seem to be on the rise among graduate healthcare students as well, including optometry students. I’ve had informal discussions with colleagues in a variety of healthcare professions, and all report seeing an increase in student anxiety and depression at their institutions. Published data support these impressions. A meta-analysis by Quek et al. showed a high prevalence of anxiety among medical students globally, ranging from 29.2% to 38.7% compared with 3% to 25% in the general population.3 According to data collected for a study done by The Ohio State University, 17% of incoming students in seven disciplines (dentistry, medicine, nursing, optometry, pharmacy, social work and veterinary medicine) reported moderate to severe depressive symptoms, 14% reported moderate to severe anxiety, and 6% reported suicidal ideation.”4 Risk factors or predictors for anxiety and depression identified by the researchers included lack of sleep, lifestyles behaviors, general health, perceived lack of control and stress.4

Defining Anxiety and Depression

Anxiety as defined by the American Psychological Association (APA)5 is “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure. People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat.” The APA6 characterizes depression as “more than just sadness” and states “People with depression may experience a lack of interest and pleasure in daily activities, significant weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt and recurrent thoughts of death or suicide.”

Why are Students Struggling to Cope?

Why do we have a generation of students who seem to have very little ability to cope with stress? Certainly healthcare education is academically and emotionally challenging. In graduate health programs, students must master a large quantity of information, develop clinical skills, pass formalized tests and deal with difficult emotional topics and patient scenarios. Additionally, students at the graduate level are often living on their own, dealing with financial issues and having to adjust to a prescribed academic schedule. It is not surprising that the stress inherent in graduate education may worsen pre-existing mental health issues.

Researchers have hypothesized that academic pressure, the use of electronic devices and social media may be contributing to the rise in anxiety and depression.2 However, previous generations all had academic pressure to succeed. Although the use of social media and electronic devices has definitely influenced this generation, I find it difficult to believe that it is significantly responsible for these trends. Have parenting styles changed so that children are no longer required to deal with small stresses that would enable them to develop coping skills? As parents are we nurturing coping skills in our children or are we solving problems for them and protecting them from any stressful situation? College environments used to prepare students both academically and emotionally for the adult world. However, students now report that in many instances there is great flexibility in college and very few consequences for underperformance.

Stress is a normal component of everyday life and definitely a component of graduate education. Should institutions screen for anxiety and depression following admission? This would allow for early identification and possible treatment. As faculty, we are all concerned about this trend.

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ASCO posted a podcast on this topic, an interview with Jonathan Peretz, PsyD, a student wellness expert. Dr. Peretz talks about stress among students and strategies for handling it, including mindfulness and self-care and how to know when professional help is needed. Listen here.

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  1. Most U.S. teens see anxiety and depression as a major problem among their peers [Internet]. Washington, DC: Pew Research Center; c2020 [cited 2020 Feb 15]. Available from: https://www.pewsocialtrends.org/2019/02/20/most-u-s-teens-see-anxiety-and-depression-as-a-major-problem-among-their-peers/.
  2. National College Health Assessment II, Undergraduate Student Reference Group, Executive Summary Fall 2016. Hanover, MD: American College Health Association; c2017 [cited 2020 Feb 15]. Available from: https://www.acha.org/documents/ncha/NCHA-II_FALL_2016_UNDERGRADUATE_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf
  3. Quek TT, Tam WW, Tran BX, et al. The global prevalence of anxiety among medical students: a meta-analysis. Int J Environ Res Public Health. 2019 Jul 31;16(15). pii: E2735.
  4. Hoying J, Melnyk BM, Hutson E, Tan A. Prevalence and correlates of depression, anxiety, stress, healthy beliefs, and lifestyle behaviors in first‐year graduate health sciences students. Worldviews Evid Based Nurs. 2020 Feb;17(1):49-59.
  5. Anxiety [Internet]. Washington, DC: American Psychological Association; c2020 [cited 2020 Feb 15]. Available from: https://www.apa.org/topics/anxiety/.
  6. Depression [Internet]. Washington, DC: American Psychological Association; c2020 [cited 2020 Feb 15]. Available from: https://www.apa.org/topics/depression/.

Dr. Denial [deniala@neco.edu], Editor of Optometric Education, is a Professor and Chair of the Department of Primary Care at the New England College of Optometry and a Clinical Instructor at a community health center in Boston.