The battle with mental health problems among university students

Mental health disorders primarily start before the age of 24 but young people lack necessary mental health care. Among (Dutch) university students, these problems are prevalent and have increased with the COVID-19 pandemic. In this study, we also show that at Erasmus School of Economics prevalence is higher among disadvantaged groups and that inequalities have widened during the pandemic. Policy action is needed to tackle these problems.

‘A smoother transition from childhood mental health care to adulthood mental health care services is desirable’

Before the start of the COVID-19 pandemic, around 20% of Dutch young adults had or were at risk of mental health problems. Studies suggest that these numbers have increased with the pandemic, also among university students in the Netherlands. We surveyed first- and second-year students at Erasmus School of Economics in fall 2020, fall 2021, and fall–winter 2022–2023. Of these students, 37% are female or non-binary, 39% are international students, and 14% are Dutch students with an immigrant background.

In 2020, a shocking 26% of the respondents reported that they suffered often, mostly or continuously from sadness, low mood, and depression, and a striking 72% experienced a worsening since the start of COVID-related restrictions. Consistent with existing evidence, we find that mental health problems are more concentrated among international and Dutch students with a migrant background, female and nonbinary students, as well as those with lower socioeconomic status. Additionally, our results suggest that the pandemic has widened these socioeconomic, ethnic, and gender inequalities in mental health. The 2021 survey was conducted during a period of return to campus, before a new lockdown. It shows considerable improvements, namely: 17% of the respondents reported suffering often, mostly or continuously from sadness, low mood, and depression; 55% reported an improvement over the last year; and only 16% reported worsening. We do however not observe a sustained improvement: in fall–winter 2022–2023, the proportion reporting mental health problems was 23%, while 45% reported an improvement and 18% a worsening.   

Policy recommendations

Since mental health problems among university students during this critical period for human capital accumulation have not improved enough yet, there is scope for cost-effective interventions. These could be either supply-side, for instance from the university, or demand-side policy interventions, such as tackling attitudes towards mental health care and support. On the supply side, it would be desirable to smoothen the transition from childhood mental health care to adulthood mental health care services a bit. The abrupt increase in mental health care costs at age 18 in the Netherlands has troubling implications for the mental health care-seeking behaviour of individuals in this age group. Additionally, supply-side policies should focus on reducing waiting times, which are very long in the Netherlands, and target high-risk groups. Policies facilitating digital care and self-care could partially, to the extent that they suit individual care needs, tackle insufficient supply.

There have been several initiatives at Erasmus University Rotterdam to support students’ mental wellbeing– although it should be noted that they are not adequate when mental health problems are severe and not study-related. This includes the work and initiatives of the Erasmus University Rotterdam Student wellbeing team. For example, there are workshops and guidelines for students on mental health and wellbeing, and there is a Student Wellbeing week twice a year. Additionally, students have access to a wide range of online and offline services, including university psychologists– also prevention psychologists who focus on preventative rather than curative care; coaching; helpline; and peer-to-peer support (such as The Living Room). There may be barriers to the effectiveness of some of these policies. Several factors may impact young individuals’ decisions regarding seeking mental health care, potentially contributing to a gap between experiencing mental health problems and accessing support services available at the university. These barriers may include challenges related to public and self-image concerns, as well as a lack of awareness of mental health, and feelings of reduced autonomy. It is also important to make sure that sufficient and clear (while not too overwhelming) information is provided about the available support services. Seeking and using the available care also has time costs that may be, or perceived to be, incompatible with a heavy study load. The ongoing Erasmus School of Economics curriculum revision offers an opportunity to devote attention to this issue. 

Erasmus School of Economics and Erasmus University Rotterdam are currently moving towards supporting students in their personal journey at university, changing the focus from study success to student success. Additional expertise and capacity are being created by appointing a new Student Wellbeing officer in each of the Schools. Improving mental well-being and student sense of belonging are crucial goals of this movement. Erasmus School of Economics is currently developing several policies recommended by the Student Journey working group towards these goals.