Annual report shows national and international college mental health trends

January 14, 2020

UNIVERSITY PARK, Pa. — The 2019 Center for Collegiate Mental Health (CCMH) Annual Report released this week summarizes the state of U.S. and international college counseling centers and treatment outcomes from the 2018-19 academic year. In addition, the report presents mental health trends for college students seeking mental health treatment from 2010 to 2019.

Housed at Penn State, the Center for Collegiate Mental Health is an international practice-research network of more than 620 colleges and universities focused on understanding and describing college student mental health. CCMH collects and analyses de-identified data on college students seeking mental health treatment at colleges and universities in the U.S. and internationally.

Overall, while anxiety and depression continue to be a top concern experienced by students, the 2019 report shows that the growth of these concerns has slowed, with anxiety showing a minimal increase and depression showing a slight decrease. Meanwhile, trauma as a primary presenting concern has increased over the past six years and particularly since 2016-17.

Self-reported rates of “threat-to-self” characteristics — non-suicidal self-injury, serious suicidal ideation, and suicide attempts — have continued to increase over the past 9 years. The overall rate of students seeking treatment who report serious suicidality in the last month is 8.2% and clinicians report suicidality as a presenting concern for just over 10% of students.

"The 2019 Annual Report shows that colleges and universities are continuing to succeed in identifying and referring at-risk students to counseling centers. This raises the critical question of whether we are growing service capacity quickly enough to care for the students being referred,” said Ben Locke, senior director of Penn State Counseling and Psychological Services, and executive director of CCMH. “In addition, for the first time in 8 years, this year’s report suggests that anxiety and depression may finally be slowing in their growth as the primary concerns of students.”

The 2019 CCMH Annual Report also introduces the Clinical Load Index (CLI), which CCMH developed during the 2018-1019 academic year to better measure and compare staff levels and related impacts across counseling centers nationally. 

The CLI was developed with support from the Association for University and College Counseling Center Directors and the International Accreditation of Counseling Services. It provides counseling centers with a standardized score that can be thought of as the standardized caseload. The score, which essentially describes the relationship between the demand for and supply of mental health services in college and university counseling centers, can be used to inform decisions around the resourcing of mental health services.

The 2019 report presents findings that show colleges and universities with higher CLI scores — higher annual standardized caseloads — are associated with significantly fewer appointments with more days between appointments, and significantly less improvement in depression, anxiety and general distress by students receiving treatment. These institutions tend to have larger enrollments and counseling centers that serve a greater number of students.

The report recommends institutions consider several key factors when deciding how to respond to increased demand on counseling centers, including institution size; impact on staff in counseling centers; and treatment dosage, student outcomes, and institutional philosophy.

"Over the last 15 years, U.S. and international colleges and universities have faced an explosion in demand for mental health services but have lacked an accurate metric to inform their decisions about staff adjustments and the implications for students,” Locke said. “The CLI offers institutions a powerful tool to guide policy and funding, understand the implications for students seeking treatment, and set transparent expectations for community members. We look forward to continuing to develop the CLI in the coming years.”

Below is a summary of the some of the findings in the 2019 CCMH Annual Report:

  • As assessed by clinicians, anxiety and depression continue to be the most common general or top concerns experienced by students. However, the growth of anxiety and depression has slowed over the past year, while trauma, as both a general and top concern, has increased over the past six years.
  • The self-reported lifetime prevalence rates of “threat to-self” characteristics increased for the ninth year in a row among students receiving counseling services.
  • The rate of students who report having prior counseling (56%) has trended upwards over the last four years. The number of students who have taken a medication for psychological reasons slightly increased in the past year, and hospitalization for mental health concerns decreased slightly.
  • Average rates of student self-reported anxiety and depression increased over the past eight years. In the past two years, eating concerns has increased, while family distress has increased over the past 4 years. Academic distress, hostility and substance use have remained flat or slightly decreased over the past several years.

The 2019 Annual Report describes 207,818 unique college students, nationally and internationally, seeking mental health treatment; 4,059 clinicians; and more than 1,580,951 appointments from the 2018-19 academic year. This is the 11th year the report has been produced.

The full report can be found online at

(Media Contacts)

Last Updated September 23, 2020