I am Sarah Ketchen Lipson, assistant professor in the Department of Health Law Policy and Management at the Boston University School of Public Health.

My research focuses on understanding and addressing mental health in adolescent and young adult populations, especially college students. The traditional college years (ages 18-24) are a vulnerable period for mental health as this time directly coincides with age of onset for lifetime mental illnesses. College is also one of the only times when many of the main aspects of a person’s life are contained within a single institution. This presents an opportunity to identify and support students through prevention, early intervention, and treatment. For almost 10 years now, I’ve been conducting public health research to understand and address rising prevalence rates of depression, anxiety, eating disorders, suicidality, and other mental health concerns on campus. There is a lot to think about with regard to student mental health in the context of COVID-19 pandemic and campus closures.

How can faculty support student mental health during COVID-19 and campus closures?

Do certain populations face more mental health challenges than others? Why or why not?

Why is college such an important time to address mental health challenges and conditions?

What can family members, friends, caretakers, peers, etc. do to help an individual struggling with mental health

What are healthy ways to cope with stress, anxiety, depression, and other mental health challenges during COVID-19?

What are helpful resources we can access from home to improve mental health?

What kind of behaviors should we be avoiding to preserve and protect our mental health?

I am co-Principal Investigator of the Healthy Minds Study and Associate Director of the Healthy Minds Network – a research effort examining adolescent and young adult mental health. My scholarship has appeared in publications including American Journal of Preventive Medicine, Journal of Adolescent Health, Psych Services and Journal of American College Health, among others.

Proof: https://twitter.com/BUexperts/status/1253346083557736456

Thank you everyone for writing in – this has been a wonderful conversation! I will try to come back and address some of the questions that I did not get to today, but I have to log off for now. In the meantime, for more on my perspectives related to mental health please follow me on Twitter at @DrSarahLipson. Be well!

Comments: 259 • Responses: 21  • Date: 

peachjjam336 karma

This is a Q about the guilt associated with not being productive during this time. Especially for people who are typically juggling school, work, org activities, etc. how do you not feel like a complete failure when you're not meeting deadlines and getting work done the way that you normally would? It also feels like it builds and builds as time goes on and while I think most professors/managers are understanding, it isn't easy to admit to them that you're not doing well--especially in courses you really care about and when you want to "impress" the professor or at the very least, not taint their image of you as a smart/high performing student. Also worry about their willingness to provide recommendations in the future.

sarahlipson330 karma

Let me start by saying that as a professor myself, I have struggled with the same guilt in recent weeks. So here are some things I remind myself of: a huge body of research from neuroscience, psychology, and education has shown that memory, cognition, concentration, motivation (all hugely important to learning outcomes and academic performance) are negatively affected by fear, anxiety, loneliness, isolation, etc. etc. With that in mind, it makes complete sense that you're "not meeting deadlines and getting work done that you normally would." It's more challenging to do "deep work" under current circumstances.

I also want to acknowledge that I know how hard it is for students to tell professors when they are struggling with their mental and emotional health. Ideally faculty are making space for students to share updates like this--having an open door, even if not physically. I think faculty can do this in many ways, including checking in with students proactively and making space in class (I do so at the beginning of class) for students to share high's/low's of the week. I have more thoughts on what faculty can be doing to support students, but let me just end by saying that the smartest/most high performing students (and faculty) are struggling. I am impressed when students speak up and share what they're going through. If speaking up to tell a professor that your mental health is affecting your academic performance results in that professor not writing you a letter of recommendation in the future, reach out to me and I will write you a letter! :)

Luv_Big_Krizzle83 karma

As a person who just recently graduated college in the target age range, I stopped working and have been quarantined due to fear of the virus. I feel unhappy, and rarely see my girlfriend besides facetime. My parents want me to look for a job with my new degree, but the whole world is shut down.....any thoughts?

sarahlipson112 karma

Congratulations on recently graduating! It's an understatement to say that it's "challenging" to go from seeing your friends regularly in person, to seeing them only on FaceTime. So I just want to acknowledge how hard that is.

In terms of looking for a job with your new degree, I think the key word here is "looking." This could actually be an ideal time to be "looking" for a job and to be taking the time to really think about your goals, career trajectory, the type of work environment you want, etc. etc. Sometimes the transition from graduating to starting a job can be so fast that recent graduates end up in a job and wonder "how did I end up here?" I encourage you to take this as an opportunity to be intentional about thinking about the career that you want. From there, informational interviews (by phone, Zoom, FaceTime) could be a great way to further refine what you are looking for and make connections that could be valuable moving forward. If your alma mater has a career services center, I would also encourage you to reach out to them. If they have not yet developed materials to support recent graduates job searching amidst the pandemic, you can advocate for them to develop resources, since I guarantee you are not alone in being in this position. Good luck to you!

bogberry_pi74 karma

How do you recommend coping with the feeling that you're not doing enough and should always be productive? College, and especially grad school, left me feeling like I couldn't relax or enjoy anything because I should be doing something else. So I was always stuck in the middle of "I need to take a break because I've been working too hard and can't focus" and "I shouldn't be relaxing because I still have too much to do."

Things are pretty good now that I've been out of school for a while, but I really hated college because I could never truly relax or stay focused on work for long periods (lack of sleep, motivation, difficulty with course material, etc). I always felt like I should be doing the opposite of what I was doing and it was miserable!

sarahlipson57 karma

This is a great question, and something that I think a lot of people, including students and faculty, are experiencing right now. Another user asked a similar question earlier actually, so please see my response below to peachjjam, which gets at some of the points you raised. I'll also say that it's really interesting to hear your perspective as someone who has been out of school for a while, able to look back and reflect on how the college atmosphere affected you. When I was in graduate school, I saw an advertisement for an energy drink that read: "Nobody ever wishes they'd slept more in college" accompanied by a cartoon of a student quadruple-tasking. It really struck me as a terrible message to send to students, but also one that is consistent with the pressures many students feel to do everything. I wrote a brief response to that advertisement in Huffington Post, which might resonate with you: https://www.huffpost.com/entry/red-bull-why-college-stud_b_8118916.

I'm glad to know that things are pretty good now, and I hope that the great work of organizations like Active Minds can continue to spread the message that self-care is an essential aspect of college success. Thanks for sharing!

Aeromile68 karma

Is there a larger portion of the college community/university community with mental health issues than the world at large and if so what do you think contributes to that?

sarahlipson99 karma

Excellent question! The prevalence of mental health conditions (depression, anxiety, eating disorders, etc.) varies across different age groups. Overall, mental health conditions are the largest burden of disease among adolescents and young adults. The former director of the National Institute of Mental Health referred to mental illnesses as "the chronic diseases of the young." So it's important to compare college student populations to their same-aged peers, namely adolescents and young adults who are not in college. When comparing college students to their peers who are not in college, the prevalence is very similar. In other words, college students aren't doing significantly better or worse than non-college-students. There has been limited research on this, but one of the largest comparative studies on mental and behavioral health found similar rates in the two groups with the exception of binge drinking being higher in college students and rates of schizophrenia being higher in non-college-attending adolescents and young adults.

As for what contributes to the generally high rates in adolescents and young adults, there are many factors, as you might imagine. The main explanations are likely factors that are common to young people throughout the U.S. and probably many other countries. Social media use has been one factor that has been talked about a lot as a potentially important contributor to rising rates, as have sociopolitical factors that contribute to concerns such as ecoanxiety (fear about environmental damage and climate change). Sociologists have also talked about intrinsic vs. extrinsic motivation, societally.

For more information, check out this article by my colleague Daniel Eisenberg in the Journal of Adolescent Health called "Countering the Troubling Increase in Mental Health Symptoms Among U.S. College Students."

rcc7374 karma

Extending on some of your points.....I've read a fair amount of information regarding mental issues. How much validity is there regarding the relationship between mental health, diet, exercise, instant gratification, participation trophies and sleep?

Also, I live in an area where teens and young adults are under massive pressure to "win" at life from peers, teachers, parents and other societal figures. Unofficial estimates put 60%-80% of teens in the "requires professional help" category. Is this the direction society is going to go or is there something we can do to change it?

sarahlipson1 karma

These are great questions! I'll focus my response on the second piece--is this the direction society is going to go or is there something we can do to change it? Certainly we are seeing an increase in the prevalence of clinically-significant need (young people with mental health symptoms that are at the level of needing professional support). This trend was worrisome pre-COVID. Now more than ever, we need to take a "public health approach" to addressing mental health, by which I mean, investing in prevention. My colleague Daniel Eisenberg wrote a short and very captivating article about this recently, which you might be interested in. It's called "The Need for Investments in Children’s Mental Health" and is available here: https://oxfordre.com/economics/view/10.1093/acrefore/9780190625979.001.0001/acrefore-9780190625979-e-411?print=pdf

To your first set of questions, there has been some research looking at these relationships, but if you are interested in conducting some research yourself, we make all of our Healthy Minds Study data publicly available (https://healthymindsnetwork.org/research/data-for-researchers/) and we have survey data on mental health, diet, exercise, and sleep. Just wanted to mention that in case you're interested in an opportunity to analyze data!

sephstorm57 karma

How good is our mental health education system?

sarahlipson94 karma

This is a great question and something I think about a lot as someone in public health, where the focus is on PREVENTION. There are opportunities to educate students about mental health at all levels, beginning in elementary school and extending to college and university environments. In particular, incorporating mental health education into college curriculums is especially important (now more than ever). It is not yet the norm that colleges and universities are offering courses in mental health (or related topics like Social Emotional Learning). Because college is often a time of new freedom and autonomy for students and because nearly two-thirds of all adolescents and young adults in the U.S. enroll in postsecondary education, teaching about mental health, coping skills, how to seek help and serve as a "gatekeeper" for peers, etc. has the potential to improve lifelong trajectories.

So how good is our mental health education system? I'd say that we have a long way to go because the opportunity is so enormous. We are seeing promising examples in K-12, particularly for teaching Social Emotional Learning, and in higher education, particularly through first-year seminars. However, from my perspective this is far from the norm presently!

mr-choww44 karma

You guest lectured in my BUSPH PM 760 course last semester! Your research is amazing and it's really heartening to know faculty at BU care so much about progress in mental healthy and wellbeing. How has COVID-19 impacted your research and are you taking on new research projects related to mental health and pandemics?

sarahlipson20 karma

Hi fellow BUSPHER! :) Thanks for your message and kind words. There are so many faculty at BU who care about student mental health and wellbeing. I feel really lucky to have like-minded colleagues who care about our amazing students!

As I mentioned when I guest lectured last semester, I co-lead a national mental health survey called the Healthy Minds Study, which is conducted every semester at college and university campuses across the country. Last month, we revised Healthy Minds to include new questions designed to understand students’ personal experiences, behaviors, and beliefs during the pandemic. We will have data from those new items in the coming weeks, which we will disseminate publicly. So that's one key way that my research has shifted to focus on the impact of COVID-19. Another way is collaborating with colleagues tracking state policies and building a detailed database that can be used by researchers to answer a variety of key public health questions. The COVID-19 US state policy database is led by my colleague Julia Raifman at BUSPH, and more info is here: https://www.bu.edu/sph/2020/04/01/tracking-covid-19-policies/. There are many other really exciting and important research projects going on at BUSPH related to the pandemic, highlighted on our school website, as you've likely seen!

Thanks for being part of our community, and good luck with finals!

opendomain28 karma

I know someone with severe depression. They have tried several medications - some work OK, but have to switch after long use to be more effective.

They are thinking about trying Psilocybin (magic mushrooms).

What do you think about using them? What should they look out for?

How does someone obtain them?

sarahlipson58 karma

This person is lucky to have you in their life, to have someone who is actively trying to support them as they consider new options to treat their depression. You are amazing to be asking these questions, all of which are super important. I am not a mental health clinician, and unfortunately I don't know much about the use of mushrooms to treat depression. I believe the organization MAPS (Multidisciplinary Association for Psychedelic Studies) is one of the leading organizations in this area, so you might check out the evidence posted on their website: https://maps.org/. Best of luck to you and your loved one!

skiimpo22 karma

Hello, I have developed some sort of social phobia and social awkwardness, how can I overcome this ? Thanks

sarahlipson41 karma

Hi, and thanks for sharing what you're going through. Your comment shows a great deal of self-awareness. I think stepping back and recognizing that is one thing to feel good about. Just reading your comment shows that you are in touch with yourself, which is a huge first step. It can be really hard to make observations about our own mental and emotional health, especially right now when we are more isolated and less connected to other people. In terms of what you can do to overcome this, I can't provide clinical guidance because I am not a mental health professional. Right now, more so than ever, people are relying on mobile mental health resources. You question reminded me of an app I heard about a while back called Youper. I don't know much about it, but the website has a video called "Overcome Social Anxiety": https://youtu.be/4cCezXy64OM. Here's a link to their website (and I'm sure there are other great resources for social anxiety as well!): https://www.youper.ai/app-for-social-anxiety. Lastly, I would never want to pathologize awkwardness. It sounds like it's bothering you, which is why I am suggesting resources. But remember that being uniquely you is what the world needs!

Grushcrush22219 karma

I go to a small (1500 people) private art school and we’ve had 3 deaths this year all in the span of 1 month. One suicide, one OD, and one unknown. Our school is very competitive and it’s common to say hi to a classmate and get no acknowledgement or response. Sometimes people are hateful without even knowing the person they’re targeting. The kid who committed suicide had artwork up in the gallery with the statement next to his art explaining his reasons. He died a few days after his work was put up. I’m wondering if we failed as a community? His suicide note was up for everyone to see and no one spoke to him! It became his memorial after. One of my good friends attempted suicide 3 times during the same time frame.

I had the idea of creating a mental wellness club for the students to train people to see the signs, even though they didn’t see it when it was clearly written out with the words suicide and everything. Mostly I just want to make a place where people can feel safe sharing their hardships and getting support. The counselors in my school genuinely don’t care they even refused to help me with planning and administration of a club related to their work even though they’re free most of the time. I almost got the club going before the virus hit. I know this isn’t the best idea and in a lot of ways we really can’t help those who decide to die, but it feels like if we at least see them and their suffering with empathy we can validate them in a way. There’s nothing worse when you’re dying inside and no one sees you, it feels like no one cares. But if you’re struggling and someone approaches you with kindness and openness to listen I truly believe there can be a positive outcome in some cases.

sarahlipson18 karma

Thanks for sharing this here. On the one hand, this is extremely hard to read. On the other hand, that your response to what you've seen on your campus and with your good friends is to work towards change, now that's inspirational. Really amazing and we need students like you on campuses across the country. The work that you've been planning to establish a club to support student mental health on your campus is more important now than ever in light of the pandemic and campus closures. It sounds like you haven't always received the support needed from your own campus, so I would encourage you to check out Active Minds, which supports more than 500 student-led mental health chapters on campus: https://www.activeminds.org/programs/chapter-network/. They have lots of resources about starting a student mental health organization on campus as well as best practices for responding to peers in distress. Approaching someone with kindness and openness is exactly the right approach. Simple acts can be life-saving. Continue to spread your activism and optimism! This is what it really means to be a student leader. Thanks for being you!

salmanshams18 karma

I've 2 questions, one for specific to this pandemic and one in general.

For someone who now has to finish their PhD from home, and being just as productive as normal but not being able to leave the house at all and feeling trapped, what's the best advice you can give to not feel overwhelmed and/or depressed.

Why is it that research work has adversely affected the mental health of every PhD candidate I've ever seen?

sarahlipson2 karma

You've got some nice responses below, thank you to those users for weighing in! As someone who relatively recently completed a PhD myself (in 2016), I very much remember feeling this way at times. It felt cyclical to me, especially during the dissertation phase, when i would have weeks of feeling productive and energized and other weeks when I felt just the opposite. I'm sure it's infinitely harder to be finishing your PhD at a time like this. My best advice, which you can also take with a McDonald's serving of salt!, is: (1) to schedule worry time (like 30 minutes each day when you let your brain spin with the overwhelming thoughts)--possibly combined with journaling (which I've never been good at keeping up with myself!); (2) to break every task (especially the dissertation) into bite-size pieces (e.g., this week the goal is to write paper #1 methods section and create table templates--something specific and not too ambitious--and then break the week's goal down into day-by-day goals to get a sense of accomplishment); and (3) seek the support that feels right to you, whether that's a therapist, a group of PhD students who can support one another, or something else. I also echo the comments about exercise, sunlight, diet, and keeping a regular sleep schedule. Good luck to you! You will be PhDone soon!

derTechs17 karma

General mental health question:

Is population got crazier/weaker, or is it just more open now?

Because I don't remember people talking about mental health as much as they do now 20 years ago

sarahlipson39 karma

Thanks for this first question! In general, mental health has become a more familiar, openly discussed topic. Over the past decade or so, we've seen decreasing stigma in college student populations. But improved attitudes are not the full picture. In other words, it's not just that people are more likely to talk about their mental health or seek help. There has been a significant increase in psychopathology. Rates of depression and anxiety have nearly doubled in the past decade in college student populations. I'm happy to talk about the factors have been pointed to as explaining this increase. But yes to both of your questions: prevalence rates are increasing, and at the same time, people are talking about and seeking help for their mental health at higher rates.

Unfamiliar_Familar13 karma

Can you elaborate on the factors that have led to the increase in depression and anxiety?

sarahlipson10 karma

Thanks for the follow-up. I shared some thoughts on this in a response to another user (Aeromile) here, so I encourage you check that out. I also mentioned a journal article that might be of interest to you: https://www.jahonline.org/article/S1054-139X(19)30408-2/pdf.

Sotorp2514 karma

Hello, my OCD arose 2 weeks ago, I have memory doubting and what if scenario ocd. I have had it my whole life,but only very mild, now 3 years ago event happened that made it 1000 times worse, I dealt with it through sertraline and neurol, it reduced after 9 months to absolute minimum again. Now since 2 weeks ago it is very very bad.

How would you recommend me to deal with it, my "memory doubting" and "what if scenario" ocd? Thanks

sarahlipson24 karma

Hi, and thanks for sharing this. I am not a mental health professional (my training is in public health and education), but I often collaborate and speak with mental health clinicians. I was recently on a webinar where several clinical experts talked about how current circumstances are affecting college students with pre-existing mental health conditions, including OCD. For more information, the recording of that webinar is available here: https://www.youtube.com/watch?v=cCMtggCLX2Q&feature=youtu.be. I don't want to overstep my knowledge by giving recommendations for how to deal with it, but I do want to acknowledge that this a trend that mental health professionals are seeing, whereby people who have managed their OCD are finding this to be a really challenging time in that regard. The webinar goes into some guidance for how to deal with this and resources available. I hope it's helpful to watch that (the first part in particular focuses on this topic) and to know that you are not alone.

NicNic88 karma

Why do you believe higher ed has a role in mental health?

Why shouldn’t a university focus on teaching and let the medical system treat?

If it is higher Ed’s responsibility to address mental health, why isn’t it the post office’s, the grocery store’s, or all other institutions?

sarahlipson3 karma

This is a fantastic question and one I think about a lot. My brief response is consistent with what the user Sashimiak wrote below, which is that the role of higher education in mental health can really be looked at as both a responsibility and an opportunity. The opportunity is that college (particularly four-year residential college) is one of the only times in a person's life when a single setting encompasses the main aspects of daily existence—academic, residential, social, and health. Four-year campuses are typically integrated communities with substantial human and organizational resources that can be leveraged to enact change for entire student populations. Furthermore, mental health is a strong predictor of academic performance and college persistence, so there's an economic case for campuses to invest in mental health prevention and treatment to retain students and avoid lost tuition. The "return on investment" for institutions here doesn't include the enormous benefits to students and society writ large. If interested, you can see some of the research my colleagues and I have conducted looking at the return on investment in campus mental health here: https://www.acenet.edu/Documents/Investing-in-Student-Mental-Health.pdf

xWoWZerZx5 karma


sarahlipson11 karma

For anyone who is experiencing suicidal thoughts, the National Suicide Prevention Lifeline is available 24/7 at 1-800-273-TALK. Another 24/7 resource is Crisis Text Line, which anyone can reach out to by texting 741-741. Reach out. People are here to listen and support. I would remind everyone that you are loved and that the world is a better place for having you here!


MapacheMaster3 karma

Due to self-isolation, I went from spending almost no time at home, and juggling friends work and studying to a complete stop. Now I can't bring myself to open a book to study for anything, and I don't really know why. I also feel tired all the time, which is weird because I do literally nothing. Do you have any tips or ideas that might help with all this? Thank you very much for doing this!

sarahlipson1 karma

This is such a hard situation to be in, and one that many students are faced with. I wrote up some thoughts below, which I will reiterate here briefly: A huge body of research from neuroscience, psychology, and education has shown that memory, cognition, concentration, motivation (all hugely important to learning outcomes and academic performance) are negatively affected by fear, anxiety, loneliness, isolation, etc. etc. " It's more challenging to do "deep work" under current circumstances. Tips and ideas for dealing with this--don't be so hard on yourself, set realistic goals (which will be different from what you were able to accomplish previously), and celebrate the little wins!

dunsmuirtrout2 karma

My University struggles with providing mental health expertise for students. As a small (but wealth) private institution, there are only 2 counselors for over 3000 students. The wait for an appointment or meeting can be months, and sometimes the therapist is not right for the individual. The university offers recommendations for off-campus therapists, but does not help pay for the coats. This leaves many students feeling like they cannot get the help they need in one of the most important times in their life for mental health. The university often sites funding as a barrier to hiring more staff, but then spends millions on unnecessary facilities. How do we as students better advocate for on-campus mental health resources so it is not just a privilege of the wealthy?

sarahlipson1 karma

This is an excellent question. I think one of the most powerful ways to make the case to campus leaders that they should invest in student mental health is to articulate the connection between student mental health and academic performance. By investing in student mental health (more counselors, prevention, screening, etc.), campuses will likely retain more students who would have otherwise dropped out. Depression is associated with a nearly two-fold increase in the likelihood of dropping out of college. My colleagues and I have used this to build an "economic case" for investing in student mental health, which has been helpful in motivating campus leaders to make new investments in mental health. You can read more here: https://www.acenet.edu/Documents/Investing-in-Student-Mental-Health.pdf. We also created an interactive Return on Investment Calculator, that you could actually use to calculate the ROI for your institution: https://umich.qualtrics.com/jfe/form/SV_6xN9QUSlFtgtRQh. Lastly, students can have a really powerful role in shaping change at their campuses when it comes to mental health; Active Minds is a great resource: https://www.activeminds.org/.

bofasonsofa2 karma

Should we even expect students to be productive during shelter in place? Personally I’m a 35 yr old that just started a masters program. I can’t concentrate and my emotions are on a roller coaster. I sometimes have good days but I’m NOWHERE as productive as before this all went down.

sarahlipson2 karma

Hi! I made some comments about this below, as I think this is something that many people are concerned about and there are so many reasons why the stress of the pandemic can and is affecting concentration, memory, motivation for learning. Personally I think it's completely unrealistic to expect students to be their most productive during this time. I am pleased to see many (but unfortunately not all) colleges and universities adapting their grading policies for spring 2020, as one small way to minimize the stress students are facing.

supremecommanderp1 karma

Hello! Thanks for doing this important work! Is any of the data you've collected during this pandemic publicly available?

sarahlipson1 karma

Hello, thanks for your message! We will be posting our data in the coming weeks from the Healthy Minds Study, looking at students' responses to a new set of survey questions focused on COVID and mental health. You can check out our website or join our listserv, where we will make an announcement once the data become available: https://healthymindsnetwork.org/.

Ginsinclair1 karma

Dietetic student here - let me know if this has been addressed in an earlier answer - what role do you see food security playing in these issues with college students? Food access is sometimes overlooked when it comes to the hierarchy of needs and there is some research that suggests that food insecurity is much more prevalent on college campuses than previously thought.

Regarding Covid-19, many students may be unemployed and/or living at home with family who are also food insecure. Have you had experience with this?

sarahlipson2 karma

This is such an important question, thanks for asking this. I am not an expert in this area, but the work of Sara Goldrick-Rab and her colleagues have looked at this for many years and are doing incredible work now in response to students' needs during the pandemic. See http://saragoldrickrab.com/.