CCMH examines the prevalence and trends of mental health concerns among students in college counseling each year. In the 2024 Annual Report, CCMH provided updated mental health data based on both students’ self-report and clinicians’ initial evaluations. Clinicians reported their assessments via the Clinician Index of Client Concerns (CLICC), which is a checklist of 54 common presenting problems experienced by clients receiving counseling services. Data from the CLICC has traditionally been used by CCMH to represent the rate of specific concerns identified by clinicians. However, to date, CCMH has not investigated the prevalence and trends of psychiatric diagnoses assigned by providers.
In the current blog, CCMH answered the following questions pertaining to psychiatric diagnoses based on the Diagnostic and Statistical Manual – 5th Edition (DSM-5) criteria:
- What was the prevalence of specific diagnostic classes (e.g., anxiety, depression) between 2021 and 2024?
- Between 2021 and 2024, what was the percentage of students with multiple diagnoses or serious mental illness (SMI)?
- What were the diagnostic trends between 2015 and 2024?
Data for the current blog included 279,583 students who were treated at 162 different college counseling centers in the United States between 2015 and 2024. Information was collected from students’ clinician-assigned DSM-5 diagnoses during their course of services.
Prevalence of Diagnostic Classes Between 2021 and 2024
The most common classes or types of diagnoses were anxiety (45.1%), depression (31.9%), and adjustment disorders (29.2%). Overall, 87.3% of students had at least one of these three disorders diagnosed while receiving services.
Other less common diagnoses included neurodevelopmental disorders (8.3%), PTSD (6.4%), eating disorders (4.3%), substance use (3.6%), OCD-related disorders (3.1%), and bipolar disorder (2.3%).
Prevalence of Multiple Diagnoses and Serious Mental Illness (SMI) between 2021 and 2024
Overall, 34.6% of students had multiple diagnoses. The proportion who received an SMI diagnosis was also examined. The conceptualization of SMI was based on previous reviews of the construct (e.g., Zumstein & Riese, 2020) and the National Institute of Mental Health’s (NIMH, 1987) definition that includes the nature of the diagnosis, the degree of disability, and duration of symptoms typically associated with the diagnosis. Results revealed that 17.3% of students were diagnosed with an SMI. A more detailed description of the diagnoses included in SMI can be found in Appendix A.
Trends in Diagnostic Classes Between 2015 and 2024
Between 2015 and 2024, the rate of anxiety and adjustment disorders slightly increased, while depression and substance use disorders notably decreased. In the most recent academic year (2023-24), Anxiety, Adjustment, Neurodevelopmental, and OCD-related disorders were at their highest prevalence rates, while depression, substance use, and bipolar were at their lowest.
The figure below displays a closer look at the lower base rate diagnostic categories from above. Notably, neurodevelopmental disorders demonstrated a decline from 2015 to 2019, followed by an increase since 2020.
Summary
- The most common classes or types of diagnoses between 2021 and 2024 were anxiety (45.1%), depression (31.9%), and adjustment disorders (29.2%). Overall, 87.3% of students had at least one of these three disorders diagnosed while receiving services.
- Overall, 34.6% of students treated at college counseling centers received multiple diagnoses during services, and the proportion who had an SMI diagnosis was 17.3%.
- Between 2015 and 2024, the rate of anxiety and adjustment disorders slightly increased, while depression and substance use disorders notably decreased. Neurodevelopmental disorders demonstrated a decline from 2015 to 2019, followed by a notable increase since 2020.
- In the most recent academic year (2023-24), Anxiety, Adjustment, Neurodevelopmental, and OCD-related disorders were at their highest prevalence rates, while depression, substance use, and bipolar were at their lowest.
Implications
- The most common psychiatric diagnoses were similar to the recurrent problems identified by clinicians on the CLICC, with anxiety, depression, and adjustment disorders demonstrating the highest prevalence rates. Nearly 90% of students had at least one of these diagnoses. Although there were consistencies between the most frequent concerns assessed by clinicians via the CLICC and the diagnoses assessed (Anxiety and Depression), the prevalence rates slightly differed. For example, CLICC anxiety and depression concerns occurred at higher rates than the corresponding diagnoses. This indicates that clinicians are likely adhering to a more conservative standard when assigning a DSM-5 diagnosis to a student compared to identifying a problem area that needs treatment. Thus, using diagnostic data alone to understand the scope of the problems treated by college counseling centers might underestimate the actual prevalence of particular concerns.
- While less than 10% of students were diagnosed with a neurodevelopmental disorder, these disorders demonstrated a marked increase since 2020 after declining for several years prior. This notable rise indicates that some centers might need to allocate resources to support students with these concerns. Further investigation into this emerging trend is needed to better understand the specific types of neurodevelopmental diagnoses that are increasing and the co-occurring problems involved.
- Nearly 1 in 5 (17.3%) students in care were diagnosed with an SMI, which demonstrates that college counseling center staff are treating a noteworthy percentage of students with serious mental health diagnoses. Given the complexity and severity of concerns typically experienced by these students, institutions can support counseling center efforts to treat this population by investing in locally informed and collaborative care, which includes psychological treatment, psychiatric care, and case management at centers, as well as adjunctive support services (e.g., Student Disability) that are crucial to support this population and increase their likelihood of academic success.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
National Institute of Mental Health (1987). Towards a Model for a Comprehensive Community-Based Mental Health System. NIMH.
Zumstein, N., & Riese, F. (2020). Defining severe and persistent mental illness—A pragmatic utility concept analysis. Frontiers in Psychiatry, 11, Article 648. https://doi.org/10.3389/fpsyt.2020.00648
Appendix A
SMI diagnoses included:
- Agoraphobia
- Attachment disorders
- Bipolar
- Recurrent major depressive disorder with psychotic symptoms
- Persistent depressive disorder
- Dissociative disorders
- Eating disorders
- OCD-related disorders
- Psychotic disorders
- Post-traumatic stress disorder
Published February 17, 2025