بهداشت روانی دانش آموزان و توسعه آن بین سال های 1994 و 2012

The present study investigated the prevalence of psychological distress in medical and psychology students (n=293) at a German University. Sampling structure, questionnaire and process of this study were a reproduction of a prior study carried out at the same university in 1994 (n=346) which allowed for assessing changes over time. Results show that 12% of students suffered from clinically relevant psychological complaints. Compared to 1994, self-reported mental health problems have significantly decreased. Possible explanations such as an improvement of health care, economic conditions and study conditions are discussed.

Stimulated in part by the implementation of the Bologna-Process that led to the introduction of the Bachelor-/Master-degrees to the German educational system and entailed significant changes in most study paths, concerns were voiced that many students might have difficulties adapting to the new system. Consequently, the mental health of students has received growing attention in the last few years. Mass media coverage focused on seemingly increasing demands that students have to face and reported that many would either drop out completely or risk mental health issues, also pointing at the increasing incidence of mental illness in Germany. Health insurance companies have indeed recorded an increase of psychological disorders in the German population since the 1990s (Grobe and Dörning, 2011 and Techniker Krankenkasse, 2012). Whether this development is due to an actual increase of morbidity or rather to methodical distortions, e.g. through modified diagnostic criteria, remains unclear (Jacobi, 2013). A recent study has found a 12-month prevalence of 27.7% for any kind of psychological disorder (Jacobi, Höfler, & Strehle, 2014) in the German general population. Studies on the prevalence of psychological disorders in university students remain scarce, however. In the United States of America, research on student׳s mental health was strongly stimulated by the fact that suicide constitutes the second leading death cause in American college students (Garlow et al., 2008, Hunt and Eisenberg, 2010, Van Orden et al., 2008 and Wilcox et al., 2010), hinting at severe mental problems in this population. In their most recent survey based on data from over 80,000 college students, the American College Health Association found that a total of 14.9% of students reported having been diagnosed with a depressive disorder at some point during their studies while 32% (n=3746) of those had been diagnosed within the past 12 months ( ACHA, 2009). In Germany, a representative survey carried out by the German Student Services (“Deutsches Studentenwerk”, DSW) found that 27% of students reported to have been impaired in their studies by psychological distress, while 10% of all students felt severely impaired. The prevalence of depressive symptoms varied between 14% and 22% depending on age and gender. Participants mostly complained about difficulties with academic performance, lacking self-esteem, depressiveness, test anxiety and general anxiety (Hahne, 1999). A more recent survey initiated by the DSW showed that 7% of the participating students rated themselves as significantly impaired in their studies due to health problems, 42% of which mentioning mental disorders (Middendorff, Apolinarski, Poskowsky, Kandulla, & Netz, 2013). In another study that focused solely on disabled students and students suffering from chronic diseases, 45% of the participants indicated that mental disorders had a debilitating effect on their studies with depression, anxiety disorders, eating disorders, and personality disorders being the most prevalent (Unger et al., 2012). In a screening survey conducted at a German university, about 22% of the students met the criteria for at least one psychological disorder as defined by the PHQ-D (Bailer et al., 2008). Compared to the general population students seem to be rather more affected by psychological complaints. In a meta-analysis including 40 studies on psychological complaints of medical students in the USA and Canada, prevalence rates for depression and anxiety were consistently higher than in the general population between 1980 and 2005 (Dyrbye, Thomas, & Shanafelt, 2006). The DEGS1-survey on the health of German adults showed that psychological disorders in the German population are most frequent in the age group of 18–35, which includes students as well (Jacobi et al., 2014). European studies largely confirm these results (Seliger and Brähler, 2007 and Bíro et al., 2012). Studies finding no difference between students and non-student peers are only sporadic (Hunt & Eisenberg, 2010). Scientific literature on the development of mental health problems in students over time is scarce and results are heterogeneous. According to an investigation on the development of psychological distress in samples taken of a campus counselling center in Kansas between 1988 and 2001 (n=13,257 in total) most complaints increased, including anxiety, depression, suicidal ideas and personality disorders ( Benton et al., 2003). In contrast to that, both type and extent of psychological distress in clients consulting the psychosocial counselling center of the University of Heidelberg remained rather stable between 1993 and 2008 (Holm-Hadulla et al., 2009). Only some problems such as somatoform disorders and test anxiety showed an increase. The evaluation of two field samples that had been investigated in the scope of that survey as well (n=471 in total) resulted in stable prevalence rates over time ( Holm-Hadulla et al., 2009). An up-to-date study analyzing data of the psychotherapeutic ambulance for students at the University of Goettingen even found a slight decrease of mental health problems between 2006 and 2010 ( Klug, Strack, & Reich, 2013). On the other hand studies focusing on the impact of the Bologna reform on students self-reported distress levels present rather high distress levels in Bachelor students after the implementation of the reform (e.g. Middendorff et al., 2012 and Ortenburger, 2013). According to a large survey on 4037 German Bachelor students 59% reported to have currently experienced nervous and anxious feelings and about half of the students felt overstrained. The present study was motivated by the deficient data situation concerning the development of mental health problems in field study populations of students and the contradicting results from different psychotherapeutic counselling centers. A detailed survey at the University of Heidelberg contributes new data to student׳s mental health problems, accounting for the satisfaction with life and studies and socio-demographic factors as well. A comparison with data of a very similar study carried out in Heidelberg in 1994 (Soeder, 1995) allowed for assessing changes over time.

Constituting the first study of its׳ kind in Europe the present paper compares psychological distress levels found in two analogously conducted cross-sectional studies on student samples of a German university collected at different points in time featuring very similar sample sizes and – structures. The observed decrease of psychological complaints in students represents the central finding of this study and hints to a new epidemiological development. Although sample-related distortions have to be taken into account and other recent surveys hint to increasing complaints about study-related stress and excessive demands at universities, the results are in accordance with some new data existing on the topic in Germany. The diversity in the discussed results may be caused by the fact that the compared findings nearly always have their origin in self report data of students. These reports are influenced by many different factors and trends. To increase the validity and reliability of research-outcomes in the topic of mental health problems of students we need a representative study that is based on psychodiagnostic instruments and interviews applied by psychological experts and that would refer to the diagnostic categories of international classification systems. Possibly, the observed development is due to an improvement of health care utilization, economic conditions and study conditions or to an unwillingness of communicating mental health problems in the face of a growing pressure to perform.