Introduction: A Demographic With a Challenging Set of Problems

December 30, 2015
Jerald Kay, MD

Psychiatric Times, Vol 32 No 12, Volume 32, Issue 12

The challenges in providing mental health care to the college community are significant. Here's a brief look at the issues.


Arnett1,2 proposed a new period of the life cycle in the US-emerging adulthood. According to this theory, distinct features characterize young people who are roughly 18 through 25 years old. This stage differs from the developmental stages of late adolescence and young adulthood. Differences include, but are not limited to, instability from successive changes in residence and romantic partners, intense introspection about future careers and intimate relationships, significant struggles in identity consolidation, and persistent ambivalence about reliance on others.

Despite the fact that there is now a professional society and journal devoted to the study of emerging adulthood and that those in child and adolescent psychiatry/psychology and college mental health, for example, wish to demarcate an area of specialty practice, emerging adulthood as a concept remains controversial and without robust research support.3 In part, this lack of research reflects that the study of adult development takes many years, is inextricably linked with cohort effects, and is highly dependent on the era in which people live. Poverty, family constellation shifts, trends in substance use, demographic changes, ethnic and gender diversity, and economics are but a few of the factors we face during our rapidly changing lifetime.

This 2-part Special Report on Young Adult Psychiatry reflects my belief that many of the clinical challenges in the treatment of young adult patients are developmentally continuous with and heavily influenced by pre-existing vulnerabilities. The challenges in providing mental health care to the college community, for example, are significant and have been well documented given the large number of students matriculating to institutions of higher education with previous psychiatric diagnoses and treatment in conjunction with those seeking mental health services for the first time.4

[[{"type":"media","view_mode":"media_crop","fid":"44412","attributes":{"alt":"© Sergey Nivens/","class":"media-image media-image-right","id":"media_crop_414655566936","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4960","media_crop_rotate":"0","media_crop_scale_h":"124","media_crop_scale_w":"175","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"© Sergey Nivens/","typeof":"foaf:Image"}}]]Epidemiologically, many psychiatric disorders are disorders of young people and occur in precollege students. These include those related to substance abuse, mood and anxiety disorders, attention disorders, eating disorders, phobias, personality disorders, gender identity issues, maltreatment and abuse experiences, and schizophrenia. Although the prevalence of some of these disorders does increase between the ages of 18 and 25-and others decrease-I remind clinicians to examine childhood and adolescent development prior to high school graduation to appreciate gene-environment contributions that place youths at risk.5

Many of the clinical challenges in the treatment of young adult patients are developmentally continuous with and heavily influenced by pre-existing vulnerabilities.

The 2013 Youth Risk Behavior Surveillance System conducted by the CDC sampled more than 13,500 9th through 12th graders and demonstrated, among many findings, that before the 12 months of the survey6:

• 14.8% had been electronically bullied, and 19.6% had been bullied on school property

• 29.9% felt so sad or hopeless almost daily for at least 2 weeks that they discontinued some usual activities

• 17% seriously considered suicide; 13.6% made a suicide plan; and 8.0% made an attempt, of which 2.7% were treated by a health care professional for either overdose, injury, or poisoning

• 18.6% drank alcohol for the first time before the age of 13, and 20.8% had 5 or more drinks in a row on at least one occasion (the definition of binge drinking)

• 23.4% used marijuana on at least one occasion

• 47.7% tried to lose weight, and approximately 5% vomited, took laxatives, or used diet pills

• 7.3% were forced to have unwanted intercourse, and 17.8% had taken non-prescribed drugs (painkillers, stimulants, benzodiazepines) at least once in their life

It is undoubtedly true that the transition from high school to college is a critical time for many. Yet the identification of students who are emotionally unprepared for higher education is a major public health focus, since college mental health services are increasingly struggling to provide care to all who are in need.7

As the articles in this Special Report illustrate, access to psychiatric care is critical, but so too is the identification of young persons at risk-both those in college and their non-college peers (including active armed forces members and veterans)-because the consequences of untreated problems pose significant threat for lifelong success. Mindfulness and positive-psychology–based interventions are common and often helpful to many students who access college mental health programs. However, as the evidence cited in this article also reinforces, psychiatrists must treat complex disorders and behavioral problems that require sophisticated clinical psychotherapeutic and psychopharmacologic interventions, beyond stress reduction approaches.


Dr Kay is Emeritus Professor in the department of psychiatry at the Boonshoft School of Medicine of Wright State University in Dayton, OH, and Clinical Professor of Psychiatry at Tulane University School of Medicine in New Orleans. He reports no conflicts of interest concerning the subject matter of this Special Report.


1. Arnett JJ. Emerging adulthood: a theory of development from the late tweens through the twenties. Am Psychol. 2000;55:469-480.

2. Arnett JJ. Emerging Adulthood: The Winding Road From the Late Teens Through the Twenties. 2nd ed. New York: Oxford University Press; 2014.

3. Beardslee WR, Vaillant G. Adult development. In: Tasman A, Kay J, Lieberman JA, et al, eds. Psychiatry. 4th ed. Chichester, UK: John R. Wiley and Sons, Ltd; 2015. In press.

4. Kay J, Schwartz VH. Mental Health Care in the College Community. London: John R. Wiley and Sons, Ltd; 2010.

5. Tanner JL, Reinherz HZ, Beardslee WR, et al. Change in prevalence of psychiatric disorders from ages 21 to 30 in a community sample. J Nerv Ment Dis. 2007;195:298-306.

6. Kann L, Kinchen S, Shanklin SL, et al. Youth risk behavior surveillance-United States, 2013. MMWR Surveill Summ. 2014;63(suppl 4):1-168.

7. First year college experience. National survey of 1,502 first-year college students examines challenging transition from high school to college [press release]. New York: The Jed Foundation; October 8, 2015.