As high school students across the country try on caps and gowns and settle their plans for college, some will be matriculating this fall with some heavy baggage.
Rising concerns about mental-health challenges among today's teenagers are prompting some colleges to try to do more to help troubled kids - even before the students arrive at college. Such efforts to give more attention to mental-health awareness follow highly publicized student suicides at universities such as the Massachusetts Institute of Technology.
Healthcare professionals say adolescence is a key point at which to intervene. Suicide is the third leading cause of death for those ages 15 to 24, and was the second leading cause of death among college students in 1998, according to the National Mental Health Association.
Some see a connection between the rhythms of college-student life and the peaks in the suicide rate, which occur in late spring and throughout the summer. In May, for example, the overall suicide rate is 18 percent higher than in December, according to published reports.
"The number of students we see [at the clinic] doubles from October to November and mid-March to May. That's when the stress of exams falls," says Richard Kadison, University Health Services mental-health service director at Harvard University in Cambridge, Mass.
In a recent survey of college freshmen at the University of California at Los Angeles, more than 30 percent said they often felt "overwhelmed."
Nationwide, 1 in 10 college students has been diagnosed with depression. Heath experts warn that existing mental-health issues, when combined with academic pressure, can undermine a student's feelings of competence and peace of mind.
"[Increased depression] does warrant increased awareness and education in high school," says Dr. Kadison. "The number of depressed, suicidal adolescents is even more [troubling]."
Few high schools, though, are well-equipped to address psychological issues. High school guidance counselors are often responsible for several hundred students, and their role is limited. A student often doesn't see a health professional unless parents seek a private evaluation, and many families don't have healthcare coverage to pay for it.
"Students start out more stressed," says Sherry Benton, assistant director of counseling services at Kansas State University. "They really try to do a lot of résumé building to a far larger degree than they did a decade ago. They feel pressured to achieve, achieve, achieve." She and other counselors see in this pressure the seeds of anxiety and depression.
Psychotropic medications - such as Prozac, Paxil, Zoloft - are increasingly being prescribed for students who say they might not otherwise handle college.
"We see more students coming in from high school on medication already," Kadison says.
Though concerns are rising, too, about the number of kids taking psychotropic drugs, others say psychiatric treatment is enabling more kids to attend who otherwise never could have coped with the stresses of college.
Eighty-four percent of student-counseling center directors are seeing more students arriving on campus with severe psychological illnesses, according to the National Survey of Counseling Centers. It's unclear what's behind the rise in mental-health diagnoses: academic pressure or a rise in depression and mental illness in the overall population.
Dr. Benton, who surveyed Kansas State University students, found that they "frequently have more complex problems that include both the normal problems of difficulties in relationships and developmental issues, as well as more severe problems."
The flip side is that students with less pressing concerns may feel the clinic isn't for them. These students are also more likely to ratchet up their academic output at the expense of basic necessities.
"What they [struggle to achieve] is at the expense of self-care," Benton says. "Students don't attend to their diet or get enough sleep. They tell themselves they don't have time, when the reality is they don't have time not to. We're far more likely to see people with high anxiety and depression with 3.5 to 4.0 GPAs."
The college counseling center has evolved in step with psychological concerns, with many colleges dividing resources into two facilities - one for mental health and one for career counseling.
"College counseling started off as guidance centers, and about 70 percent of the time was spent with career issues," says Robert Gallagher, former director of the University of Pittsburgh's counseling center and author of an annual survey of counseling-center directors on 300 campuses.
"Now it's something like 8 percent [spent on] career. Career concerns are probably the No. 1 concern of students. We can't afford to back off [from] that, [but] we just need more resources for the personal side of things."
Few resources are available, however, to deal with psychological issues on the high school level. High school counseling services focus on three areas: academic, career, and personal/social, according to Brenda Melton, president of the American School Counselor Association.
While university services focus on mental health, high schools concentrate on wellness. "If a student is depressed, they're not able to achieve academically," Ms. Melton says. "The goal is to help them be successful in school." With an average of 600 students to 1 high school counselor - well over the recommended 250 to 1 - more resources "wouldn't hurt," she adds.
The result is guidance departments whose primary focus is on academics and college planning, with a few high schools looking at more preventative options.
A program called Screening for Mental Health has brought a suicide-prevention screening to nearly 1,400 high schools since 2000. Ninety percent of educators reported that the program brought students who needed services to the school's attention.
"Schools are all struggling with budget issues," Dr. Gallagher says. "Counseling might be an area where some national funding might be important, as was done for learning disabilities."