Why do medical students suffer from depression

Fears, depression, dropping out of collegeWhen students get mentally ill

"And then you breathe in very deeply, so that your chest goes out and your stomach too. You hold the air in there a little. Those are really deep breaths. During that time you don't think about anything. You can listen to your own heartbeat, which is." yes sometimes very loud when you have a panic attack. "

Kathi is in her twenties. She suffers from anxiety disorders. The breathing exercise calms her down if she thinks she is suffocating again or if she has the feeling that part of her is about to split off.

She was already depressed when she was at school. The anxiety disorders came during high school. The first semester of her literary studies still worked quite well:

"Then I just focused on making it to university and doing my 450-euro job."

Editor's note: If you need help in a difficult situation, you can contact the free hotline of the telephone counseling at any time: 0800/1110111.
You can find a list of local contacts and psychological counseling services at your university location here.

Kathi's anxiety disorders worsened during her studies. There are many reasons for this: She couldn't make friends with her fellow students. But high demands on oneself also played a role. She was still good at university, but not as good as she was at school:

"It's just sad when you spend three months in college and you can't be proud of what you did during that time because you were just so average in the exam."

At some point the panic attacks got so bad that Kathi never left the house. It was no longer possible for them to attend a face-to-face university. She dropped out of college.

The origins of anxiety disorders

Anxiety disorders have "like many other mental disorders, basically not a single cause",

says Professor Peter Zwanzger, chief physician for general psychiatry and psychosomatics at the Kbo-Inn-Salzach-Klinikum in Wasserburg am Inn. Mental illnesses are always the result:

"... from the combination of various factors. And among these various factors, the brain function, i.e. neurobiological mechanisms, play just as much a role as the so-called psychosocial factors, which include everything, life events, biographical events, trauma, personality, etc."

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As with Kathi, mental illnesses usually have a strong impact on the educational situation of those affected. Many drop out of their studies if they suffer from depression, anxiety disorders or similar illnesses.

A third of the first-year students drop out

Avoid dropouts in general, this is what federal politics has been trying to do for many years. Ernst Dieter Rossmann, education expert of the SPD, says:

"That it is of course always in vain invested university place capacities, lifetime, income. Which is why we should be interested in limiting this drop-out rate through better study preparation, better study orientation, better introduction to the course."

According to a study, every sixth student is mentally ill. (picture alliance / Rolf Kremming)

Dropping out of studies is also rarely beneficial for self-confidence.

"When you start studying, you do so because you have a topic, a specialty of your own, in which you want to get a degree. So it is a goal that as many as possible complete it successfully can."

With this intention, around 500,000 young people in Germany are starting their studies again these days. Based on the experience of the last few years, around a third of them will drop out.

(Swen Pförtner / dpa / picture alliance) Education expert on drop-outs - "Many are not yet ready for this next requirement"
Every third first-year student in Germany drops out. François Deuber from the Ruhr University of Applied Sciences sees the reasons for dropping out primarily in the lack of preparation for the course.

According to a survey by the German Center for University and Science Research, the most common reason given for dropping out is "excessive demands". This can include mental illness.

"We have stress factors in the German higher education system, on the one hand due to the organizational structure of the university due to this tight time consolidation in Bachelor and Master courses",

says Stefan Grob, press spokesman at the Studentenwerk Deutschland.

"But I would never say that the bachelor's degree makes you sick or the bachelor's degree makes you depressed, which is what you hear again and again. But of course we also have an overall social development that a degree has become the decisive phase before entering professional life and with huge ones Expectations are connected. Study quickly, study job market-related, study successfully, learn three foreign languages ​​including Chinese business fluent and so on. "

According to its own description, the Studentenwerk Deutschland takes care of "promoting the social, economic and cultural interests of the students". The allocation of student loans, the operation of canteens, child care, all of this falls within the remit of the 57 student unions in this country. They finance themselves through the semester fees and, for the most part, through the income from the dormitories they operate. Approximately nine percent of the income comes from grants from the federal states.

The need for psychological counseling is increasing

The student unions also offer social, economic and psychological advice. According to a report published by Barmer Ersatzkasse in 2018, these are becoming increasingly important. One result of the study: Around every sixth student is mentally ill, that is 470,000 people affected.

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Like all healing methods, psychotherapy could also have undesirable side effects, said the psychologist Bernhard Strauss in the Dlf. In the course of therapy, developments could occur that were not to be expected.

"The most common illness among mental illnesses is depression. Of 470,000 students in Germany, 86,000 have depression and that for an age group that normally does not see a doctor at all."

says Ursula Marschall from the Barmer substitute fund. She worked on the report. The team evaluated accounts and diagnoses for this. There has been a significant increase in the diagnosis of "depression" among students over the past ten years. There are two reasons for this:

"We certainly have the issue of social change, that is, this issue of pressure to perform and requirements that have increased, that's one thing. The second factor is that as a person affected, I also perceive my own feelings much more often."

Less inhibitions about accepting advice offers

The psychologist Gaby Jungnickel also observes that young people are more likely to seek help today. She heads the advice center of the student union at the University of Cologne.

There were over 100,000 contacts between students and psychologists from the Studentenwerk in 2017. That is 60 percent more than in 2006. Gaby Jungnickel suspects that it is not only the inhibition threshold to accept professional help that is sinking. Word also gets around that these offers exist.

"The young people come here when they notice that something is stuck somewhere."

In addition to the one-on-one interviews, there are also group offers on topics such as time management and exam anxiety. According to Jungnickel, many students struggle with this in particular.

In the consultation, it is first decided whether a therapy is necessary and which form is possible. (imago / Ikon Images)

When someone who seeks advice comes to her, she starts by talking to people about their problems.

"Then of course we have a diagnostic look at it, is it a, as the saying goes, a disorder of disease value. Or is it a crisis that someone has got into, from which we can get out with one, two, three consultations and a focused look at some things can help you out. "

"I was in the middle of the master's thesis phase, I was about to move. And there was an incident in the family too, where I was simply stressed and felt overburdened and then I went to the university for psychological counseling."

Emma, ​​who doesn't want to hear her real name on the radio, is in her mid-twenties and is studying two foreign languages ​​at the University of Cologne. She never had any mental health problems. It only started shortly before the end of her studies:

"That was expressed in various fears. Much it was about my relationship, which I still have now, but also general fear of failure that I will not make it all."

At some point Emma got to a point where she realized:

"Okay, I'll just ask someone for advice now. I can't do it myself and then I just googled whether there was anything there. I knew that there was always some form of student counseling, and then there was psychological or psychosocial counseling. "

New concepts so that sick people can still finish their studies

For those affected such as Emma and Kathi, but also for people with physical limitations, the universities are currently developing guidelines so that the course can be continued and completed, says psychologist Gaby Jungnickel from the Cologne Student Union:

"Wherever you try to look, for which type of impairment we can grant which forms of disadvantage compensation. Whether you can convert a written performance into an oral one, for example, or whether there is a time extension."

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The number of sick leave due to mental illness has tripled since 1997. This may be due to the increased stress in everyday working life. However, part of the increase comes about because more affected people report.

Jungnickel has been working in the counseling center for over 24 years. She not only observed that students deal with mental health problems more openly. The professors and lecturers have also become more sensitive to this. But one thing has remained the same over the years:

"The proportion of women who come to us compared to men is always about two to one, two-thirds women one-third men."

In general, women are more likely to receive psychotherapeutic treatment or are mentally ill. Science is still debating why that is.

One theory is that puberty is more difficult for girls than for boys, which is why mental illnesses are more common. Another attempt to explain: women might be more likely to stand by it if they had mental health problems.

Gaby Jungnickel points out, however, that the gender ratio does not differ in the online advice offered by the Studentenwerk. In addition, her advice center is located near faculties where more female students are enrolled.

"From the University of Cologne 27 percent of our advice seekers come from the philosophical faculty and just as many from the human science faculty. 15 percent from the WiSo faculty, eleven percent from law and around seven percent from the medical faculty."

Differences between natural scientists and humanities scholars

From the mathematical and natural science subjects, the so-called MINT subjects, there are rather fewer students. This applies to the University of Cologne, there are no general figures from the Studentenwerk Deutschland.

It is known, however, that the MINT subjects have the highest drop-out rates. 40 percent of those who start a bachelor's degree in this field do not finish it. In the master’s program, fewer students generally leave the university prematurely.

It is also noticeable that older students are increasingly getting depressed.

"Students who are 18 years old, who are just beginning their studies, only have 1.4 percent depression there. But if you look ten years later, the same students have 3.9 percent probability of depression to get",

says Ursula Marschall from the Barmer substitute fund. This means that the students' likelihood of being diagnosed with depression is slightly increased right from the start. Because on average only every hundredth German suffers from the disease.

So the longer people study, the higher the likelihood of getting mentally ill. Gaby Jungnickel from the student union's advice center is also observing this.

There are big differences between the age groups that studied for a Magister and today's Bachelor and Master students. (imago / Westend61 / Gustafsson)

She notices a significant difference between the age groups who still studied for a master's degree and today's students. The problems used to be different:

"Long-term students had the organization of their studies or the approach to difficult perceived topics in their studies, the procrastination and then often after 15, 18 semesters had a horror exam ahead of them because they had been able to circumnavigate it. "

Permanent in exam situations

Today, with a Bachelor and Master degree, that is no longer possible. Because the organization of the courses means that the students are permanently in an examination situation.

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According to the German Student Union, the result: the course will be discontinued earlier. This can also have advantages for the university and those affected, university place capacities are not blocked for so long and students do not torment themselves with a course of study that affects their mental state. Gaby Jungnickel:

"Of course dropping out is something that should definitely be avoided, but sometimes it is actually the last resort when someone comes and ends up in a course of study that is not for them at all."

Studentenwerk: "The social does not play a role in university politics"

Keeping the drop-out rate as low as possible is the goal of the "University Pact 2020". It is one of three pacts between the federal government and the federal states, through which science and universities are to be promoted.

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About 30 percent of all students feel pressure to perform, fear of exams and stress, according to a recent survey. If that leads to avoidance behavior, it becomes critical, said the psychologist Franziska Klemm in the Dlf.

Originally, the federal government gave the states money to create more study places. Because ten years ago two million people studied in Germany, now there are three million:

"And what's more, these so-called university pact funds have also been linked to certain qualitative objectives. Among other things, a rate that the federal states should prove as far as possible in terms of improving teaching and supporting that there are not so many dropouts gives."

Says Ernst Dieter Rossmann, education politician and SPD member of the Bundestag.

But that's not enough, says Peter Grob from the Deutsches Studentenwerk:

"You can't call it any other way, the social has so far not played a role in university policy. It is now strongly oriented towards excellence and research funding and excellent research, which we have nothing against, but the social does not play a role in this university policy and should rather take center stage. "

If the crisis is not so severe, methods such as regular meditation or autogenic training can also help. (wishzones | photocase.de)

For most people, their studies take place at a time when they develop strongly in their private lives, says psychologist Gaby Jungnickel from the Kölner Studentenwerk. Housing situation, friends, partnership - everything can change. The university framework must therefore be such that the young students can fully exploit their potential.

"The more students manage their studies well and have a good memory that it was a valuable time for their personal but also for their spiritual and intellectual development, the more valuable their contribution will be in society and in which position will always bring in. "

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Nine-year-olds who believe their life will be over if they fail to make the transition to high school.Such phenomena are a "general social phenomenon", said the youth psychiatrist Michael Schulte-Markwort.

Kathi, who still suffers from anxiety disorders today, would like to be part of society. She now works as a freelance copywriter.

"I define myself very, very much by working and by having something of value in this society, to perform well. But not only because of that, I also really like to work."

Many students who are mentally ill have a hard time in the job market.

The phenomenon can also be observed among older employees: 71,000 people in Germany received early retirement due to mental illnesses in 2017. In the early 1990s there were only 41,000 people.

"You can see a very clear trend in recent years," says Andrea Benecke, Vice President of the Board of Directors of the Federal Chamber of Psychotherapists.

"That disability pensions and periods of incapacity for work due to mental illnesses increase massively and continuously. And that in turn means a really great economic damage."

Weighing up whether therapy is really necessary

But Benecke does not assume that generally more people in Germany suffer from depression, anxiety disorders and the like than before:

"Well, we have shown through a lot of research that a percentage of around 30 percent of the adult population will develop mental illness within a year. And that has basically remained very stable over many years."

This also applies to students. The fact that depression and anxiety disorders are now being diagnosed is due, among other things, to the fact that doctors are now more sensitive when it comes to recognizing these diseases.

An average psychotherapy costs the health insurance company 3,700 euros. Ursula Marschall from the Barmer Ersatzkasse believes that students with mild depression do not need a therapist or medication straight away.

Sometimes the demands on yourself are just too high. (dpa / picture alliance / Klaus-Dietmar Gabbert)

"Meditation is one possibility. One can mention in the same breath: autogenic training, yoga, tai-chi, qigong, muscle relaxation according to Jacobsen. These are definitely offers that are enough for me with milder forms of illness. "

It was different with Kathi. After dropping out, she only got back on her feet with the help of many therapy sessions, and at the distance university she was able to finish her studies in literature.

"I was tied to my home for a long time. And I could hardly go out at all. And if the Fernuni didn't exist, then I would have ended up in nowhere."

In the advice center of the Cologne Student Union, the foreign language student Emma was finally recommended to start psychotherapy. To deal with the fears that arose while studying for a Masters.

The counseling center had already helped her a lot beforehand, for example by recommending that she not move to another city that was causing her a lot of stress.

"I don't understand why you want to cope so much yourself when you feel that you need help somehow. I think you should definitely go there."