Distressing news of college students' suicide is shared each year. What often leads to suicide is major depressive disorder, or depression [1]. When college students are often in another state or country, without families and friends, while facing increased academic demands and stressful events such as break-ups from romantic relationships, they are more at risk for depression [2].
The symptoms of major depressive disorder include feeling sadness, losing interest in pleasurable activities that the person used to enjoy, changes in appetite, trouble sleeping, loss of energy, feeling guilt, difficulty concentrating, and frequent thoughts of death and suicide. To be diagnosed with depression, these symptoms need to affect an individual for at least two weeks [3]. In recent years, psychologists and health institutions have paid countless efforts to raise public awareness of depression. Nine years ago, the World Health Organization published a video named “I Had a Black Dog, His Name Was Depression” [4]. The video describes depression through a pertinent and intimidating metaphor of a black dog, constantly haunting and interrupting a person’s life. It also emphasizes the importance of seeking help when one recognizes that they have depression. In all, research has confirmed that depression is a largely treatable disease, and there are many ways to prevent and manage it.
Colleges should seek ways to establish mental health services that improve the overall health of their students. Childhood adversity and recent stressors increase the risk of major depressive disorder for college students, while music therapy, physical exercise, and mindfulness meditation are proven effective treatments for depression and should be applied by colleges to prevent and help students manage depression.
Research led by Professor Sumaya Mall from the University of Witwatersrand in South Africa indicated that childhood adversity and recent stressors in the past year were closely related and powerful predictors of depression. In this experiment, 686 volunteer freshman students at Stellenbosch University in South Africa were given "a health-focused e-survey that included items on childhood adversity, recent stressors and mood" [5]. The survey was anonymous and confidential. Questions about childhood adversity experiences before 17 years old include topics such as bullying, sexual assault, physical assault, and emotional and physical neglect. The answers were measured by the extent of a certain type of experience endured by the individual. Twenty recent stressors in the past year were measured by the survey, including serious illness, death of a friend, and being involved in a crime. Researchers evaluated participants’ answers based on the DSM-5 criteria, which depended on the frequency report on a scale from one to five, where one represents “never,” and five indicates “very often.”
The results exhibited that recent stressful events and childhood adversity were strongly associated with the incidence of depression. The prevalence of depression of all participants over the last 12 months was estimated to be 16.1%, which was about one in six students and showed a high risk of depression for college students. The most-reported childhood adversity events were being bullied, emotionally abused, and emotionally neglected for participants. The most impactful recent stressors were break-ups with close people, sexual or gender identity crises, and a disloyal romantic partner. Academic stress was also a prevalent recent stressor. This research suggests that college students, especially first-year students, need to be supported and encouraged to use mental health services on their college campuses. Thus, colleges should pay close attention to students' mental health, raise awareness of depression, and organize mental health services with effective intervention strategies to prevent students’ depression.
In 2017, researchers from Al al-Bayt University and Mutah University in Jordan proved that physical exercise and mindfulness meditation were effective management strategies for undergraduate nursing students with various degrees of depression [6]. In this experiment, 181 volunteering students throughout Jordan were informed that they would take a depression evaluation test and be randomly assigned to either an exercise group or meditation group to manage depression so that researchers could evaluate the effect of those methods. Results were collected by a pretest-posttest survey, which was filled out individually after three months. 90 students were in the exercise group, and 91 students were in the meditation group. Each group had a one-hour session three days a week. While the exercise group's session underwent stretching, aerobics, and strength exercises for 20 minutes each, the meditation group's session practiced mindfulness breathing, mindfulness body scan, and mindfulness walking also for 20 minutes each [7].
To measure students' depression before and after the experiment, researchers analyzed the changes in depression scores using the SPSS 21 software. The statistical analysis software is a more powerful version of Microsoft Excel, which has built-in data manipulation tools to present complex statistics. There was a significant decrease in depression scores for both groups after the experiment, which gave evidence that physical exercise and mindfulness meditation is beneficial for decreasing the symptoms of depression for nursing college students. Furthermore, the decrease of symptoms was more significant for the meditation group, which suggested that mindfulness meditation is more effective than physical exercise [8]. Thus, when colleges have a limited budget, they should open more mindfulness meditation rooms and offer more meditation classes because it seems to be more effective than physical exercise to manage depression.
A more creative way to alleviate depression can be individual music therapies. Professor Maratos, Crawford, and Procter proposed that individual music therapy is a beneficial way to manage depression in a journal published by the Cambridge University Press. This is partly because music-making offers the patient opportunities for "new aesthetic, physical and relational experiences" [9]. Maratos et al. (2011) made an analysis of an experiment that analyzed the effectiveness of music therapy on depression. Conducted by researchers from the University of Jyväskylä in Finland, the experiment proved that one-to-one music therapy that involves the therapist's co-improvisational music-making with the adult patient could significantly reduce depression symptoms [10].
Maratos et al. (2011) formulated explanations about how music therapy assists patients physically and mentally in three steps. The first step is pretty fundamental: making music is an entirely aesthetic experience and naturally provides people with pleasure. While the patient was making improvisational music, the therapist coordinated with the patient's melody purposely and led the withdrawn patient to engage in the process. One of the symptoms of depression is that people lose interest in things they are doing; however, making music co-improvisationally would be a meaningful experience and improve people's moods [11]. The process involved both catharsis and development, and players gained the confidence to adjust their mindsets.
Next, there must be physical movement involved in making music, which helps patients feel better. Physical exercise and movement are proven successful in helping reduce depression symptoms [12]. Music often engages people physically. For example, people are often unaware that they are tapping along with some random music. This demonstrates music's ability to elicit subconscious responses from people, even when they initially do not have much intention or motivation to react. In this therapy, music functions to make the process more engaging and meaningful for people with depression.
Lastly, therapists in music therapy aided participants in discovering their relational selves through melody and rhythm. Music became an active action for patients and was a more potent way to communicate rather than talking with a therapist. In playing music, people with depression could truly relate to and interact with the therapist. Just as infants interact with their mothers through sounds, participants experienced finding their identities and selves through the process of music, so they could better open their hearts to gain help from therapists.
Maratos et al. (2011) concluded that music itself did not work as a treatment. However, music-making was interpersonal and allowed for more patients participation, thereby alleviating their symptoms. Thus, colleges can offer individual music therapies with music-making in their mental health centers. Also, as clinical trials focus on interventions’ outcomes much more than process, music therapy’s proven success can possibly be applied to more creative art-making therapies and sessions [13]. For example, painting, pottery, and dance sessions may be effective treatments as long as they embody the same elements of meaningfulness, physical movement, and relational experience.
Of all the treatments discussed, mindfulness meditation requires the least facilities and is the most cost-effective. It is also easier for organizers to direct and students to participate in. As a result, opening more meditation centers that offer mindfulness classes are highly recommended on college campuses, as they can reduce stress and help students prevent and cope with depression [14]. Colleges should also offer gyms on campus in order for students to exercise and reduce anxiety and depression [15]. Therefore, colleges should organize many more meditation activities and extend gyms’ opening hours during the weeks of midterms and finals. Ultimately, building mental health centers and recruiting therapists for different therapies involving mindfulness meditation and music therapy should be incorporated into colleges’ agendas to make these effective interventions more accessible to students. These facilities will help students maintain a healthy lifestyle, and if the prevalence of depression decreases, the incidents of suicides will decrease significantly as well.
[1] Gazzaniga, M. S. (2018). Psychological Science (6th ed.). W. W. Norton & Company.
[2] Mall, S., Mortier, P., Taljaard, L., Roos, J., Stein, D. J., & Lochner, C. (2018). The Relationship Between Childhood Adversity, Recent Stressors, and Depression In College Students Attending a South African university. BMC Psychiatry, 18(1), 63. https://doi.org/10.1186/s12888-017-1583-9
[3] Ibid
[4]World Health Organization (WHO). (2012, October 2). I had a black dog, his name was depression [Video]. YouTube. https://www.youtube.com/watch?v=XiCrniLQGYc
[5] Ibid
[6] Alsaraireh, F. A., & Aloush, S. M. (2017). Mindfulness Meditation Versus Physical Exercise in the Management of Depression Among Nursing Students. Journal of Nursing Education, 56(10), 599–604. https://doi.org/10.3928/01484834-20170918-04
[7] Ibid
[8] Ibid
[9] Maratos, A., Crawford, M. J., & Procter, S. (2011). Music therapy for depression: it seems to work, but how? British Journal of Psychiatry, 199(2), 92–93. https://doi.org/10.1192/bjp.bp.110.087494
[10] Erkkilä, J., Punkanen, M., Fachner, J., Ala-Ruona, E., Pöntiö, I., Tervaniemi, M., Vanhala, M., & Gold, C. (2011). Individual Music Therapy For Depression: Randomised Controlled Trial. British Journal of Psychiatry, 199(2), 132–139. https://doi.org/10.1192/bjp.bp.110.085431
[11] Ibid
[12] Ibid
[13] Ibid
[14] Ibid
[15] Ibid