Times have changed — one in two college kids has a psychiatric disorder?

Wild and crazy toga parties, food fights, drinking, smoking, and foolish pranks made National Lampoon’s Animal House a cult classic thirty years ago. Today, college kids like Bluto, played by John Belushi, and his friends would be diagnosed as needing psychiatric treatment.

Nearly half of all college-age young people had a psychiatric disorder in the past year, according to psychiatrists from New York in the latest issue of Archives of General Psychiatry. More precisely, their behaviors, as reported to interviewers during a 2001-2002 epidemiological survey, matched symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Because the survey — National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) — was not conducted by clinicians, to make the mental illness diagnoses, they used criteria in a version of DSM designed for lay people (the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule–DSM-IV). The authors used data on about 5,100 young people 18-24 years of age from the NESARC survey of a representative sampling of the U.S. adult population. The survey had asked about:

“substance use disorders,” including alcohol use, tobacco use, medicine use, drug use; “mood disorders,” including major depression, dysthymia (bad mood or “ill humor”), mania and hypomania (irritability, hypersensitivity, racing thoughts, impulsiveness, decreased sleep, risky sexual activity, wasteful spending, getting in trouble with the law; “anxiety disorders,” including panic disorder and agoraphobia, social phobia and feelings of self-consciousness and embarrassment in social situations, specific phobia or general anxiety; conduct and personality disorders, self-denigrating thinking, antisocial personality disorder, problem gambling, dependence, obsessive-compulsive, victimization; and family history and treatments

Recent stressful life events were also measured using a 12-item Social Readjustment Rating Scale that included things like being recently fired or laid off, moving, property damage, losing a partner, etc.

A total of 45.8% of college students and 47.7% of young adults not in college met the criteria for at least one ‘psychiatric disorder.’ The most common disorders identified in college students, according to the authors, were alcohol use disorders (in 20.4%) and personality disorders (17.7%). Among those not in college, 21.6% met the criteria for a personality disorder and 20.7% smoked.

The authors said most did not seek treatment for their ‘psychiatric disorders.’ Treatment rates were higher for mood disorders, which they attributed to “educational campaigns by the government, advocacy groups, and the pharmaceutical industry, which have led to the growing recognition of these disorders as medical conditions.” They said that there was a substantial unmet need for treatment. The high prevalence of alcohol use and alcohol use disorders in this population is an important public health priority, they added, and that “greater efforts to implement screening and intervention programs on college and university campuses are warranted.”

“Early treatment could reduce the persistence of these disorders and their associated functional impairment, loss of productivity and increased health care costs,” they wrote. “As these young people represent our nation's future, urgent action is needed to increase detection and treatment of psychiatric disorders among college students and their non–college-attending peers.”

Is there really a near epidemic of psychiatric disorders among today’s young people that necessitates screening, prevention and treatment interventions, as the authors said… or has the definition just changed?

Bloomberg took a more critical view of this study, quoting Dr. Joseph Glenmullen,M.D., a psychiatrist at Harvard Medical School in Boston and author of The Antidepressant Solution, who said the figures seem “extraordinarily high.” Instead, he said, they may reflect “a watering down of the diagnostic criteria such that they capture more people with milder symptoms.”

The only factors the authors could find a tenable correlation to the young people meeting at least one criteria for a ‘psychiatric disorder’ was having recently been widowed, separated, divorced or ended a long relationship — with more than a two-fold risk. Has the grief process been medicalized and now a psychiatric disorder, too?