The Distressed College Student

How to Recognize Signs of Distress, Interact with Students, and Make Effective Referrals

The college experience is a time of self-discovery and transitions. Even changes that are exciting, that students have been looking forward to, can be a source of stress as they demand that they adapt to new situations and face new challenges. Often, along with exciting opportunities are significant losses (e.g., familiar places, friends, family, mentors, pets, religious community). Also, family life goes on and when there is stress at home, students often find themselves divided; a part of their heart at home and another at school.

Frequently, the supportive structures available at the University and the students’ own resources are enough to facilitate a successful adaptation. Sometimes, these stressors become increasingly burdensome and begin to interfere with the students’ sense of wellbeing and their ability to interact with their environment. In addition, some students arrive with a history of psychosocial challenges that further tax their resources and their ability to cope successfully. When this happens, students may become more withdrawn, their academic work suffers, their relationships deteriorate, their spiritual lives faint, and their health declines.

Faculty members are in a unique position to intervene when they identify these failures to adapt and thrive. They interact with their students often, observe how they relate to others, and through their academic work, they can identify changes in their state of mind (e.g., confused thought processes, melancholic themes, aggression, changes in quality of work). In order to accomplish this, it is important to understand the common sources and signs of distress for students and know how to interact and make effective referrals.

• Sources of Distress for Students
• Signs of Distress
• Events that Increase Risk for Depression and Suicide
• How to Interact with a Distressed Student
• Consult with a Counselor
• Make a Referral
  • Resources for Consultaton & Referral Chart (pdf document)

General Sources of Distress for Students

Frustration when expectations of self and/or others are not realized:

• A sense of failure: Performing less than self-expectations
  • Sometimes, students that were used to have A’s in high school, and didn’t develop appropriate study habits, find themselves struggling in school.
  • Some students have unrealistic expectations of themselves and they interpret an A- or a B as a sign of failure.
  • Losses: Family member, friend(s), familiar places, emotional support, financial support

Loneliness:

• Willingness to seek contact is inhibited
• Lack of social self-confidence
• Lack of ability to get their needs met in a relationship
• Existential/spiritual estrangement:
  • Feeling estranged from the Divine
  • Feeling disconnected from their religious community
  • Unable to find meaning and purpose in life

Pressure:

• Confidence or willingness to meet self or other’s expectations is low
• Competition with other students or with the self
• Academic expectations
  • Student’s may have unrealistic expectations about their academic performance or might have irrational beliefs about what their family expect from them
  • Sometimes family members do have unrealistic expectations of students’ academic performance
• Social expectations
• Family expectations: Social life, personal attire, religious activities, career of choice
• The sense that there are not enough hours in a day…

Conflicts: Intentions or motivations are divided between…

• Roommate vs. no roommate
• Own desires, beliefs, plans vs. those of boyfriend/girlfriend, marital, family
• Dependence vs. self-direction
• Safety vs. risk
• Sexual desires vs. restraint
• Study vs. play

General Signs of Distress

Changes in eating and sleeping habits

• Missing classes or meetings
• Falling asleep in class
• Taking more naps than usual
• Noticeable/Significant weight gain or loss
• Anxiety about eating in public
• Frequent and excessive preoccupation about food
• Purging:
  • Compulsive, excessive, rigid, extreme exercising
  • Use of laxatives
  • Vomiting (Look for damage to teeth, bad breath)
• Restricting, calorie counting

Drug and Alcohol Abuse

• Student is under the influence in class
• You learn that the student got in trouble because of alcohol or drug abuse (e.g., arrests, disciplinary actions)
• Chronic or excessive use is a significant sign of distress given its relationship with mood disorders and anxiety.

Social Withdrawal

• A sudden change in social interaction or withdrawal from social contact
  • Spending less time with teammates before and after practice
  • Not visiting friends and family as often
  • Spending less time talking with faculty, participating in class, talking with other students
  • Withdrawing from student organizations
• These sudden changes in social interaction can be related to:
  • Feelings of shame, guilt or inadequacy
  • Feeling that others don’t care about them
  • Feeling that it’s too taxing to interact with others

Decreased interest in activities they used to enjoy

• A sudden loss in interest or pleasure in doing things they once enjoyed could be a sign of depression.
  • Listening to music, playing an instrument, working out, dating, gaming, etc.
  • Losing interest in their area of studies
• Giving away prized possessions is a sign of loss of interest and of potential suicidal ideation.
• Neglect of appearance and hygiene

Talking about death, dying, or “going away”

• Comments about their desire to die or go away or talking more about death in general are signs of depressed mood. These include expressions of hopelessness or meaninglessness.
  • “Maybe it would be better if I wasn’t here”
  • “I’d like to sleep and never wake up”
  • “I’d like to go away… disappear”
  • “If something like that happened to me, I think I’d kill myself”
  • “Nobody cares”
  • “I’m going to end it all”
  • “What’s the point of living?”
  • “Soon, you won’t have to worry about me”
  • “Who cares if I’m dead anyway?”
• Fascination with death: Asking others about death or what happens after death, overly involved in news about other suicides, especially recent ones.
  • This is not to be confused with the curiosity about their own death and funeral or preoccupation with philosophical, metaphysical, or religious questions in young adults that are otherwise happy and well adapted.
• Giving gifts, contacting long lost friends or family to say goodbye, cleaning out their rooms because they don’t need those things anymore

Frequent bodily, health-related complaints

• Frequent complaints of fatigue, feeling exhausted
• Frequent headaches
• Upset stomach
• Lethargy and irritability

Problems concentrating, focusing, or remembering

• Depressed and/or anxious students often describe feeling that their minds are in a fog, jammed up, or racing.
• Difficulty expressing thoughts; needing more time to process and express their thoughts or describe their experience
• More forgetful or distracted than usual; lost in their thoughts
• More disorganized; forgetting meetings, datelines for papers, procrastination
• Difficulty with reading comprehension (e.g., having to re-read the same page many times, taking more time completing exams)
• Difficulty making decisions

Poor Contact with Reality

• Difficulty distinguishing fantasy from reality, confused/illogical thinking, speech patterns that jump from one topic to another and seem disconnected
• Overly suspicious of others (becomes more withdrawn, mistrustful)
• Overreactions to minor oversights due to misinterpretation of intentions
• Distorted perceptions (hallucinations)

Loss or Change of Emotions

• Becoming less emotionally expressive, e.g., a student that used to joke and laugh a lot might stop doing so.
• Showing inappropriate or incongruent emotions
  • More animated, more talkative, laughing at inappropriate times
  • Becoming more tearful or upset than usual
• Becoming more irritable
  • Easily frustrated with self or others; lashing out
  • More impulsive, blurting out responses, hurrying others
  • A student that used to be easy-going begins to get into arguments or fights
  • Pushing others away; making others angry with them
  • Threatening others

Events that Increase Risk for Depression and Suicide

• First semester in college
  • Needing to provide structure to their own life, making decisions on their own, making medical appointments on their own, buying and preparing food, doing laundry, etc.
  • Andrews University welcomes students from all over the world. Students may experience a change in what its familiar to them: Colors, places, weather, food, music…
  • Coming to college often means to leave behind the familiar and secure support network of extended family, friends, church, and community.
  • Students might need to adapt to a different lifestyle than they had at home due to financial stress
• When graduation approaches
  • Feelings of ambivalence about leaving the familiar setting of college
  • Doubts about their ability to do find a job or do their jobs well
  • Multiple losses of close friends, mentoring relationships, familiar places, place in academic community, etc.
• Traumatic or unexpected events at home may increase feelings of guilt or helplessness
  • Severe illness (mental or physical)
  • Deaths
  • Legal problems, arrests
  • Financial stress
  • International conflict, war
• Traumatic events experienced by the student or someone close to him/her
  • Sexual assault / rape
  • Car accidents
  • Victim of crime
  • Victim of prejudice or racism
  • Domestic violence
• Acculturation stress
• Failing to make adequate progress in their studies
• Finding out that he/she doesn’t have the abilities for their chosen field of study or career
• Breaking up of a significant romantic relationship
• Conflicts with close friends
• Suicide of a person they know or in their community
• Being disciplined at school (feelings of shame and guilt, excessive preoccupation about what others –friends, family, faculty- are thinking of them)
• Struggle with sexual orientation or gender identity
• Major changes to the student’s religious meaning-making system

1. Engage / Connect with the student
   • Friendly Opening: 
     • “Hi! How are you? You’re usually attentive in my class. I’ve appreciated your unique writing skills. Today, I noticed that things didn't go too well for you.” 
   • Reflect with empathy: Restating in your words what you heard in a calm, non-threatening, non-judgmental voice. This suggests to the student that you are actively listening to him or her. For example:
     • Student: "The assignment you gave is very confusing"
     • Faculty: "So, I gather you’re having a hard time with the assignment"
   • Validate: Listen carefully to the student’s story. Allow him/her time to share their concerns and try to imagine things from his/her point of view without necessarily agreeing or disagreeing; e.g., “I can see why you may be confused.”
   • Affirm: "I think that with some help you would be able to make sense of what the assignment is all about."
2. Explore the problem
   • Ask for specifics in a calm empathetic tone. This allows you to obtain more information about the issue in question, leading to greater possibility of problem solving; e.g., "What exactly about the assignment is making it confusing to you?"
   • Collaborate: Communicate with the student an intent to remain in a partnership role with the student; e.g., "Here are some ways in which I can help or you can get help."
   • Empower: Help the student identify ways to resolve the problem responsibly.
   • Encourage: Instill hope in the student; e.g., "I believe that using this strategy you have a good chance of doing well…."
3. Refer for further assistance
   • Recommend a resource on campus for further assistance.
   • Reassure: This helps reduce student’s level of anxiety, allowing him or her to envision some relief.
4. Follow Up:
   • Reconnect with the student within a short time frame to ask about progress. This step helps the student understand that you truly care
   • Reaffirm the student: This communicates to the student care, concern, and a genuine desire to see him or her succeed, and gives the student an extra empowerment boost

Additional Campus and Community Resources to Consider:

Resources for Consultation & Referral (pdf document)

Campus Safety: 269-471-3321

University Student Intervention Team (USIT): 269-471-3321; usit@andrews.edu

Dean for Student Life: 269-471-3215

Student Success Center: 269-471-6096

Campus Ministries: 269-471-3211; engagefaith@andrews.edu

University Medical Specialties: 269-473-2222

Berrien County Victim Assistance: 269-982-8640

Neighbor to Neighbor (Adventist Community Services): 269-471-7411

Riverwood Center’s 24 Hour Crisis Hotline: 800-336-0341