JUST earlier this month, the country was shocked by a suicide — a 20-year-old, a former Sijil Pelajaran Malaysia high achiever, jumped off a building in Seremban, Negri Sembilan.
It was reported that the tertiary student had just transferred to Seremban from an education institution in Kedah in the hope of doing better in her studies at the new place. Apparently she could not deal with the pressure to excel in her studies and succumbed to depression.
From suicide bids to self-harm and sleeping disorders to no-show at lectures and exams, such behaviours seem to be increasingly common at universities. The niggling question in the public’s mind is: Why is this happening? Is this indicative of the state of mental wellness among students on campus and, if so, how can the problem be dealt with?
Universiti Putra Malaysia (UPM) counselling division senior counsellor Siti Fatimah Abdul Ghani said mental illness needs to be defined before delving into the issue.
“Everyone experiences stress from time to time and this is normal. Mental illness, on the other hand, is any condition that makes it difficult to function in daily life. It can affect your relationships, your job or prevent you from reaching an otherwise attainable goal,” she added.
If that sounds like a wide definition, Siti Fatimah said it is because the human mind is complex.
“Mental illness can range from anxiety and mood disorders, which have a severe and tangible effect on your emotions and motivation, to psychotic disorders such as schizophrenia which affect perceptions or senses, with symptoms like delusions or hallucinations. Living with any of these can be debilitating. We rely on our senses, emotions and perceptions to get us through the day. When any of those fail, it can make life difficult.”
A study by researchers from Universiti Kebangsaan Malaysia’s Department of Community Health, Department of Psychiatry and Department of Family Medicine published in the Asian Journal of Psychiatry in 2013 sought to assess the prevalence of depression, anxiety and stress, and identify their correlates among university students.
It covered 506 students between the ages of 18 and 24 years from four universities in the Klang Valley, who answered an anonymous, self-administered questionnaire.
Analysis showed among all the respondents, 27.5 per cent had moderate, and 9.7 per cent had severe or extremely severe depression; 34 per cent had moderate, and 29 per cent had severe or extremely severe anxiety; and 18.6 per cent had moderate and 5.1 per cent had severe or extremely severe stress scores based on the Depression Anxiety Stress Scale-21 inventory.
Both depression and anxiety scores were significantly higher among older students (20 and above) and those born in rural areas. Stress scores were significantly higher among older students (20 and above), females, Malays and those whose family had either low or high incomes compared to those with middle incomes.
The study concluded that the prevalence of anxiety is much higher than either depression or stress, with some differences in their correlates except for age. It was recommended that these differences be further explored for development of better intervention programmes and appropriate support services targeting this group.
ABILITY TO COPE
UPM Psychiatry Department head Associate Professor Dr Firdaus Mukhtar said, in general, undergraduates undergo challenges in managing their daily lives in a university environment.
The changes experienced in transitioning from a secondary school student to an undergraduate may affect them in the biological, physical, spiritual and psychological aspects.
Students who cannot manage the challenges — which can be due to high expectations, poor social support, lack of coping skills, financial and academic struggles, family factor and so on — may experience emotional distress.
“Whether overseas or at local universities, there are no exceptions where students experiencing emotional turmoil — including mental disorders — are concerned. This distress may lead to other extreme conditions such depression, anxiety, trauma and more.
“However, difficulties in adjusting to university life do not generally lead to psychiatric disorders such as schizophrenia, bipolar and personality disorder.”
Dr Firdaus added that everyone reacts differently to a new environment.
“Adjustment is unique to each of us. The process of adjustment starts at the beginning of the semester after enrolment and when attending classes, making friends, moving into new accommodation, living far away from parents, and facing different attitudes of lecturers and the academic and university culture.
“Therefore, it is important to expose students to mental health education such as stress management, emotion regulation programme and coping skills training for them to identify and be aware of the symptoms — stress and related illnesses — that may prevent them from functioning normally,” she said.
Symptoms of mental health problems include difficulty in sleeping, lack of focus, inability to make decisions, lack of motivation, withdrawal from friends and activities, low self-esteem, sadness and fear for no reason.
“The earlier treatment is sought, the better.”
For serious cases that involve major psychiatric illnesses, a referral to psychiatrists and clinical psychologists is needed.
“The counselling section or the university’s health care centre may refer those cases that need psychiatric evaluation and psychotherapy.”
In certain cases, those who have been diagnosed with learning or anxiety disorders may get certain exemptions or be allowed more time during examinations or submission of assignments. Dasar Kesihatan Negara provides that those who have been diagnosed with mental disorders should be given their rights just like others regardless of age, gender, religion or ethnicity.
“Many students, who had sought the help of counsellors, psychologists or psychiatrists, were able to finish their studies, graduate and hold a good post in their career. Once students are aware of their illness, get treated and motivated to excel academically, nothing can stop them from achieving their dreams.”
So, how best can students take preventive measures so as not to succumb to mental illness?
Marian.E Arumugam, the head of Counselling and Psychological Services Centre and Health Services Centre at Taylor’s University, said students should take time to explore the university, understand the expectations of the programme, be confident to ask questions and find out as much information as possible on the programme they are interested in from course advisers and faculty staff on open days.
“Time management is important: maintaining a sense of routine for self-care, studies and delivering the course work. Learn to manage and limit communication technology, as too much becomes a distraction and can isolate the student and interfere with academic performance. Keep socially engaged with peers. Be open-minded, accepting of individual differences and non-judgmental,” she said.
Lee Siok Ping, director of Student LIFE at Sunway Education Group, underlined the importance of self-awareness and self-care.
“Self-awareness is about having knowledge of one’s thoughts, feelings, coping mechanisms, preferences, skills and strengths. It is the ability to be aware of what is happening to oneself, what leads one to feel or think that way, and what can you do about it.
“Meanwhile, self-care is being able to take care of one’s needs both on a daily basis as well as in a crisis. Many a time, students neglect to take care of their own needs such as making sure they eat proper meals, have enough time for leisure activities, sleep adequately and socialising regularly, when they are preoccupied with studies or when they are experiencing stressful life events,” she said.
It is paramount that students take care of themselves especially during challenging times as it allows them to restore emotional energy which then boosts their capacity to deal with challenges more effectively.
Dr Firdaus highlighted there are three roles that can help prevent mental illness during university life: students, family and the relevant authority at the institution.
“Students need to have rational expectations and a realistic perception of university life and the courses that they sign up for. Join orientation week to get to know the university lifestyle, balance academic and non-academic activities, socialise with healthy peers and get in touch closely with the management of the university to improve personal, academic and career development.
“For families, consider the child’s opinion too in making decisions on the course to enrol in. Pressuring a child to enrol in a course that is not suitable can contribute to the student being unable to cope with the challenges at university and affect academic achievement. Give children an opportunity to grow up with minimal guidance but empower their coping ability and resilience skills to ward off negative influence.
“Finally, the university should do early screening of mental health at the recruitment level and the subsequent years of studies. Early detection may help the management to offer early intervention for students to reduce stress and improve coping skills. Mentor-mentee programmes should be revised to improve their implementation as students may take such services for granted.”