By Gene Beresin, Executive Director and Khadijah Booth Watkins, Associate Director

Posted in: Hot Topics, Multimedia, Podcast

Topics: Anxiety, Culture + Society, Depression

Recent national surveys show that a significant proportion of college students report having felt overwhelmed, anxious, and lonely during college. If college is supposed to be the “best years of your life” then why are so many students lonely? That’s what Dr. Gene Beresin and Dr. Khadijah Booth Watkins dive into today: what’s contributing to feelings of loneliness, when should we worry about it, and what can we do to help? They share tips for parents and caregivers, and college students themselves.

Tune in below, or wherever you stream.

Media List

Follow along with the conversation.

• New Surgeon General Raises Alarm About the Devastating Impact of the Epidemic of Loneliness and Isolation in the United States (U.S. Department of Health and Human Services)
• Our Epidemic of Loneliness: Implementing the Surgeon General’s recommendations for parents and caregivers (Psychology Today)
• ’22-’23 Student Lifestyle Survey (Sodexo)
• Publications and Reports: ACHA-NCHA III (Spring 2023) (American College Health Association)
• Why Is College So Lonely? (The Sophian)
• The Challenges of First-Generation College Students (MGH Clay Center)
• Social Media is Killing Your Friendships (Healthline)
• Your College Student – Conversation Starters (YouTube)
• 7 Ways for Teens and Young Adults to Combat Loneliness (MGH Clay Center)
• Peer Programs in College Student Mental Health (The Mary Christie Institute & The Ruderman Foundation)
• Roy Orbison – Only the Lonely (YouTube)

Thanks for joining in this conversation. We’ll see you back the Third Thursday of every month. If you’re feeling generous, leave us a review!

Transcript

SPEAKERS: Khadijah Booth Watkins, MD, MPH; Gene Beresin, MD, MA.

Khadijah 0:00
Part of it is the expectation is the unrealistic expectation for some for many kids that you’re going to show up in college and you’re going to have this large group of friends, you’re going to be partying all the time, and it’s just going to be nothing but like, laughs and giggles. And for some of us, and for some of our young people, it’s harder to make these personal connections. So I think some of it is just lack of understanding and awareness of some of the work that’s required to be connected and to be engaged and to maintain the social relationships.

[MUSIC INTERLUDE]

Gene 0:29
Welcome back to Shrinking it Down: Mental Health Made Simple. I’m Gene Beresin.

Khadijah 0:33
And I am Khadijah Booth Watkins.

Gene 0:36
And we’re two Child and Adolescent psychiatrists at the Clay Center for Young Healthy Minds at the Massachusetts General Hospital.

Khadijah 0:43
And here at the Clay Center, mghclaycenter.org If you don’t know, we have seen increasing interest in issues related to college student mental health. Both from parents and caregivers, and from the college students themselves. So that’s what we want to spend a little bit of time on today. More specifically, though, we’re going to take a deep dive into the issue of loneliness, which has been a topic of a lot of discussion for a lot of people.

Gene 1:06
That’s right. You know, our entire country is experiencing increased rates of loneliness and isolation. And it was highlighted in our Surgeon General Vivek Murthy’s Advisory. Speaking of the Surgeon General’s advisory on loneliness, Surgeon General Murthy made seven recommendations for parents and caregivers. And what he didn’t do in his advisory was to actually give concrete tips and advice on how to implement the recommendations. So I wrote a book for parents and caregivers to basically say, Okay, so here’s how you do Recommendation one through seven. It has a lot of information. And I think it came out pretty well. And it’ll probably be out in both an E-form and in a hardcopy, and I hope everyone likes it. But we’re seeing higher rates of loneliness in teenagers and young adults, more than any other age group, even older adults. In fact, the Gen Z, and the millennials are among the loneliest ever, and in the population, even even more lonely than the elderly. So this is really quite concerning. And it’s and you combine this, with skyrocketing rates of depression, anxiety, stress, and suicidal thinking and behavior. Now, it’s a chicken and the egg thing. Loneliness contributes to these disorders, but they also contribute to loneliness. So who knows? What do you think Khadijah?

Khadijah 2:50
Yeah, I mean you and I think we both see this anecdotally, among the patients that we see in our practices. I was just taking a look at the results from 2022 national survey from about 500 college students and the mental health findings are really striking compared to the previous results from 2020. So what it shows is over 60% of college students reported having felt overwhelmed and anxious during college compared to 40% in 2020. There was a 65% increase in feelings of loneliness among college students since 2020. And they also survey 200 high school students, and found that 60% of them were anticipating feeling overwhelmed at college. This is before they even step foot on a college campus. So our college students and our kids approaching college are incredibly lonely.

Gene 3:37
So it looks like even high school students. Well, they’re Gen Z. So I mean, they’re lonely. And then they come to college, which is a stress factor in itself. But I want to follow up on that by reading words from an actual college student to help get our conversation going about what’s going on with college students, and what can be done to help them. This is from a student perspective in the Sophian, the Smith College student run newspaper, and this student states: “the college years are supposed to be some of the best years of your life. At least that’s what I was told when I was 18. Family members praised it as, as a defining chapter, and one were lifelong friendships are made. Hollywood has contributed this image with numerous movies showing students partying, really studying and making friends for life. Why then is so many college students lonely? …I felt this way when I first came to Smith.” So I encourage everyone to read the full article, and you can find it on our media list. But Khadijah, why don’t we start with the question posed.Why are college students so lonely?

Khadijah 4:51
I mean, I think there is probably a myriad of reasons. But to kind of just go off of the little excerpt we just talked about, part of it is the expectation is the unrealistic expectation for some for many kids that you’re going to show up in college, and you’re going to have this, you know, large group of friends, you’re going to be partying all the time, and it’s just going to be nothing but like, laughs and giggles. And for some of us, and for some of our young people, it’s harder to make these personal connections. You know, you may not get the roommate of your dreams or of your choice, you may not have the people in your classes that have, you know, similar interests as you and it may be harder to connect. So I think some of it is just lack of understanding and awareness of some of the work that’s required to be connected and to be engaged. And to maintain these social relationships. It’s kind of what we talk about, you know, all the time about, you know, people kind of put forth these images of how great and wonderful things are, but they miss and they talk, they cut out the part of the hardware. So that’s one reason. I mean, I’m sure you have some thoughts.

Gene 4:51
Well, yeah, I mean, you know, homesickness, being away from home, being away from your network of friends in high school. And now you’re meeting all these new kids. And I think another another one that we’ve seen, and we’ve talked about this in other podcasts and at the Clay Center, is not fitting in. And this is particularly problematic, I think, for first generation students, international students, students who live off campus, of LGBTQ plus students, students of color, you know, the students that that tend to be on the margins, or feel that they’re on the margins, and don’t quite know how to navigate the waters of a new of a new environment.

Khadijah 6:40
Another another thing that comes to mind is thinking about those kids. And so maybe they’re using social media and online resources to remain connected to their back home families and their families, maybe that are abroad. But when that gets in the way of them being able to connect and engage and take risks to meet other kids, it really can become problematic, and it becomes this vicious cycle where they feel a little bit more comforted when they’re online and looking at their family connecting with their family, but it’s getting in the way of them being able to connect with their peers and be present. And I think similarly, you know, in a similar vein, they do see their other peers out and having fun, and they have the sense of, they have it all together. So what’s wrong with me, which again, I think fuels a sense of loneliness, and this kind of frustration that a lot of kids do feel. But again, this is just the tip of the iceberg.

Gene 7:33
Yeah, and who teach and who teaches them how to connect? You know, I mean, who do they turn to? And many of them feel like nobody cares. And and if they don’t, if they don’t know how to connect, and they don’t have avenues, role models, dorm meetings, you know, organized venues to meet. It’s just natural. And this some my patients, they just hang out in their room. They just stay away, because they’re so worried about, about the feelings. It feels terrible to be dissed. or neglected or not —

Khadijah 8:12
I don’t think they use the word dissed anymore Gene, but we can, but I think I think we get what you’re saying. [laughing] Not seen, not heard.

Gene 8:19
How about bummed out. Well, that’s an old that’s, that’s older than dissed.

Khadijah 8:24
[laughing] You took it back, but okay.

Gene 8:26
I take dissed back, but, we’re dismissed?

Khadijah 8:29
[still laughing] Okay, let’s go with it.

Gene 8:31
Okay, we’ll go with dismissed, or bummed out. But you know, I see a number of of college students that previously didn’t exhibit social anxiety. But they are self conscious, they’re worried about, you know, am I going to say things right? Am I going to talk about right things, right? Or how am I going to connect? And what if they don’t like me? And nobody likes to get hurt. So I think one default is just to kind of like, not engage, just stay away.

Khadijah 9:03
And then there’s the, so we’re talking about loneliness. But we’ve also talked a lot about how stressed out our kids are. And so we also have this group of kids that really struggle with time management. And now the new this new balance that they have to kind of achieve of the work the classes, getting the homework done. And so they might choose because they’re so stressed out about getting the grades and performing, they may choose, you know, in an excessive way to prioritize only academics and neglect the social aspect, and we do know that you’d have to have a balance of both in order to be healthy. You know, we’ve understood we’ve understood painfully, you know, COVID, how important connection is.

Gene 9:42
Yeah, there’s another element of this, and that is is the overuse and reliance on social media. So, for example, you know, people on Tik Tok basically are showing themselves partying and having fun and you know, and it’s It’s when they see these images. And again, number of my patients say this, you know, what I see online? What I see on my phone, you know, looks like everybody else is having fun. Looks great. Feels great. Not me. So how can I how can I become one of them? I’m not so sure it’s the best thing to do. And when I say that to them, they say, well, it’s easy for you to say, you know, I just want to be a part of something.

Khadijah 10:29
That’s incredibly hard to transition to college, for a lot of kids from the standpoint of connection and finding their their people, there group of kids their group of peers that have similar interests and have similar values. And, you know, that they just clicked with. And that’s so important to find that early on.

Gene 10:46
Yeah. So, so let’s, let’s turn to the parents, and the caregivers, and other other other adult figures, and get back to the basics from the Clay Center, the three W’s. You know, what to look for, when to worry, and what to do about loneliness. So what do you think? How would a parent know, or a caregiver know that their adult child is lonely at college? Especially if they go into school, away from home?

Khadijah 11:17
Well, well, we would have to have conversations with our kids, we’d have to have a way to communicate with them to hear about what they’re doing, how they’re spending their time. You know, some kids might just come right out and say, you know, I’m feeling lonely. I don’t have friends, I can’t connect. Some of it might be reading between the lines, like, you know, “What did you do today?” “I was in my room, I was on social media.” You know, “Who did you eat with at the cafeteria?” “Nobody.” So some of it might just be reading in between the lines of hearing what they do, how they spend their time on a day to day basis. You might also start to notice that they’re starting to be a little bit more down, they start, they start to not even talk about wanting to engage with peers, and another or another of their classmates. So some of it might be, a lot of it’s going to be through the conversations because especially if your kid is not coming home with a chicken in, you know, it really has to come through your, you know, direct conversations and through what is also not being said.

Gene 12:17
Yeah, and many and many parents and caregivers need to ask questions about, specifically about feeling down feeling anxious, feeling stressed. How are they coping, you know, without being intrusive, without giving them the third degree? I mean, that’s a that’s a tough one. To kind of, like, not be intrusive, but to kind of have a check in. But how would the students themselves know that they’re lonely? Or is that pretty obvious?

Khadijah 12:50
I mean, so you can’t define a question with a question. Because my answer would be like, they feel lonely. They feel like they are, they are feeling isolated. They’re feeling like they don’t have a connection. They’re feeling like they don’t have you know, someone that gets them that understands them that sees them. I don’t know if that’s a great way to describe how a student would know. But that’s the way I would think about it. If they just feel lonely. But Gene, you probably can say it better than I did.

Gene 13:16
Well, no, I can’t say it better than you. I mean, it’s it’s somewhat rhetorical to ask a question with a question. I’m not a rabbi. But but, you know, I think one issue is, if they’re aware of their loneliness, I think a key question is, is it a problem for them? I mean, there’s some kids I know, that just don’t see there’s a problem at all, they just hang out their rooms, they watch movies, they’ll occasionally bump into somebody, and it doesn’t trouble them. And then there are other kids who are really, really distressed at not making connections, you know, some of that has to do with the personality of the young person, and some of it has to do with their level of distress. So I think this is also a matter of, of our helping our younger people to kind of be more self aware.

Khadijah 14:12
Right. Because I would, I would dare to say that the person who is on the outside to us, they seem like they should be lonely, but don’t feel lonely. Like maybe they’re not lonely based on you know, again, their, their character, you know, their interests, that, you know, some kids, they may prefer this, and they feel happier this way. Whereas I think we’re kids who are feeling lonely and feeling isolated and feeling this lack of connection, they start to notice, and then they also start to notice if they’re feeling more anxious, that they’re feeling sad, maybe they start to have trouble with sleep and appetite. And so this is really, you know, when we think about loneliness and loneliness, really becoming an interference. You know, we can all feel lonely from time to time, you know, but when loneliness becomes a persistent theme and a problem and it gets in the way of us feeling good and doing the things we need to do this is when, you know, and this is what our young people need to be aware of when it crosses over to being a problem, because they might feel lonely initially when they get to school.

Gene 15:10
And it also has to do with expectations, as you were pointing out earlier and standards. I mean, the standards are is that you’re going to have a bazillion friends, you’re gonna be partying all the time. And, you know, I just think of, you know, what I, I have a number of patients who were beginning college, or who were in college, and I let them know that, you know, I probably have five or six friends. I mean, I knew a lot of, I had a lot of acquaintances in college. But I really got close with a handful, who I still stay close with today. You don’t need that many friends. But it seems to me that the perceived norm is that you’ve got a lot of friends that you’re really close with.

Khadijah 16:01
Like, like a whole team of people like you guys travel as a team, like gets to the cafeteria, when you go out on the weekends, when you go back to school events, if you have to have a whole team and that an entourage that’s not really necessary.

Gene 16:13
No, it’s not. So let’s look at what parents or family members can do to help support their adult child in college. What do you think?

Khadijah 16:26
So we did. So we did what, what to look for, when we need to worry. And so now we’re thinking about what we need to do. And so I think as a parent, really, we just need to establish from the outset, some of these consistent routines. Like we’re going to have regular check ins, because I think when you have a set, regular check in when the check ins don’t happen. That’s, that’s an automatic, you know, flag for you. And so being able to have these regular times when we talk, or we video call, or we or even if you decide to text, but having these regular check ins where we kind of get a sense of how they’re doing academically, how they’re doing socially how they’re doing physically and emotionally, it’s really, really important, so that it doesn’t feel like they have to call you, or you have to call them only when there’s a problem. That’s one thing parents can do.

Gene 17:15
Yeah. And I think they can encourage them to make connections. And, you know, a number of of my patients have asked me well, how do I how do I do that? The first thing I say is, first of all, you’re not alone, everybody, whether they show it or not, is self conscious, is worried about their image is concerned about being disliked or not included. And, and what I say is just just focus on yourself. And you can do a number of things, usually people meet each other through common interests. So join a club. Join, join a cause that you want to be an activist on. Volunteer. You know, go to office hours and connect with, with, with, with mentors, with with advisors. I mean, you know, loneliness is not just friends that are peers. But some of the people I remember most vividly in college, were some of my professors, and other other graduate students, you know, who were part of a community. Now, for me, it was around music. So it was that’s kind of a natural thing, you know, to kind of join in with other people. But you know, what I say to some of my patients is, think of some things that you really passionate about, or things that you want to learn. You know, like, have you ever played Ultimate Frisbee? You know, there can’t be anything more social. Right, right, than Ultimate Frisbee. Sorry.

Khadijah 18:53
No, no, I was gonna say, but, yeah, stepping outside of the box and doing things that you wouldn’t ordinarily do. You know, spending time outside of the room, whether it’s to study, you know, have your meals. Really just trying to put yourself – which can feel really uncomfortable, you know, initially – but putting yourself out there so that you can have the opportunity to be social because, you know, like, like, a wise person once said, no one’s gonna just come knocking on your door, ask him to come out and play. You know, some of it is, you know, positioning yourself which, again, can feel uncomfortable when you don’t feel like you know, anyone. You know, start with your roommate, you know, sometimes again, that’s not a good click, but are there other people in the dorm? Are there people in your classes? Just begin to have conversations and you don’t have to be friends and be best friends with the people that you meet early on? Like that kind of evolves over time. And so I think setting that expectation is also really important.

Gene 19:44
So I think, you know, when I think of things that are inherently social, besides parties, I think of athletics. There are all kinds of pickup games. And I think of creative arts, going to a concert, going to the museum, going to an exhibit, you know, being involved in an art project. Essentially group activities. So it’s kind of the interactive component is built in, right, you can’t just go there and be a solo pilot. And there’s one other thing that I wanted to mention before we, before we wrap this up. And that is, you know, sometimes loneliness is the tip of the iceberg of a psychiatric or mental health challenge. So if you’ve got depression, or anxiety, a learning challenge, it may be very helpful to talk with with, to get an evaluation and talk with a counselor. Because your inhibition, your loneliness, may be an expression of something that’s, that’s deeper, or if you’ve had a history of trauma, or if there’s trouble in the family, or if there’s something that’s really bothering you about a relationship breakup. I mean, there’s so many things that can tip the scales to make you feel alone. Sometimes, talking with somebody professional, is extraordinarily important.

Khadijah 21:21
I think that is really an important thing to bring up. Because we talked about on the one hand, it’s common to feel lonely from time to time managing and setting expectations when you start school that that there may be, you know, a transition period where you might have trouble connecting. But also, or and also, this could become something that’s persistent. And really, we shouldn’t let it linger and fester. And so the idea of talking to someone early on, it’s really important for our young people to know our parents also know to encourage our young people to do.

Gene 21:57
Yeah, we’ve talked about the idea that we would, can’t get into right now, but I just want to remind our listeners is that there are numerous barriers to seeking professional help. You know, whether it’s a being a black mark on your record, or feeling stigmatized, or being culturally incongruent, or not being accepted by a family member, because they don’t believe in in therapy or mental health. I mean, there’s so many obstacles. I just want everyone to know that, you know, seeking professional help, is protected, it’s private, it’s confidential. And I would not, it’s easy for me to say, but try not to let cultural societal or other worries, hold you back. It can only enhance your wellbeing to engage in that. And the other thing I wanted to mention is that, you know, sometimes we have to remember that principles of wellbeing whether it’s good diet, exercise, nutrition, good sleep, hygiene, not looking at screens late at night, you know, taking care of yourself, put you in the best in the best place to actually combat loneliness among all sorts of other things.

Khadijah 23:26
And often, or not often, but there are many schools, if you don’t want to go to the, to the to seeking mental health in a professional capacity. A lot of schools, they do have support groups, for kids who are, you know, maybe kids who are away from home, or kids who are first generation college students. So that’s also a place to be able to get a little bit of additional support. But also, I think, to your point, mental health is health. And so really taking care of your health, your mental health is super important. And if you need to see a therapist or a psychiatrist or counselor that’s really important to prioritize. And there may be some things that you can do along the way prior to that. And if it’s needed, it’s needed, and it’s okay.

Gene 24:09
And the other element of that is that there’s peer counseling groups. Many colleges themselves have peer counseling groups. So talking to peer counselors, who are supervised, is often a really good way to kind of talk about your feelings and, and, and get get some perspective from another human being.

Khadijah 24:31
And it often is in those groups that are on the campuses, where they’re led by other students, it really does feel a little bit more relatable because someone maybe who’s just went through this last year, and it’s given you some suggestions and advice or things that worked for them can really sometimes hit a little bit differently than if, you know, an adult or a parent or even a therapist or to give that same advice. And so I think the peer groups are really, really not talked about enough and really are a tremendous value.

Gene 25:02
So, we hope this has been a helpful conversation for those of you listening. And please be sure to see the MEDIA list for this episode and for other resources to end. Khadija, what do you plan to do this weekend? To help you not feel so lonely?

Khadijah 25:22
Well, I was hoping you would just ask me what I’m gonna plan to do this weekend. I’m hoping to stay dry and stay warm because it’s freezing outside and it’s raining. But to not stay lonely. Like I might force my son to like watch movies with me. I don’t know. It’s gonna be tough.

Gene 25:36
Is the weather going to be big be cloudy and rainy or cold?

Khadijah 25:40
I think I think we’re I think we’re now into the Boston fall and winter. It feels like.

Gene 25:45
I mean, I like Well, I’m a gardener. So rain and clouds. And as a photographer, rain and clouds actually bring out the colors and the it’s a good time to watch a movie. Okay.

[MUSIC STARTS]

Well, I don’t care if the weather’s bad. I’m going to play I’m going to play outside this weekend with my dog, which is something that I really love to do. And she and she doesn’t care if she gets muddy or wet or, which is great, you know, muddy up the whole house. So Well, thanks, everybody. Don’t forget that New episodes come out every third Thursday of every month. Please subscribe whenever you stream. And if you’re feeling generos, generOS, generous, generous. Please leave a review. And we hope that our conversation will help you have yours. I’m Gene Beresin.

Khadijah 26:45
And I’m Khadijah Booth Watkins. Until next time.

[MUSIC INTERLUDE]

Khadijah 27:07

All I could think about throughout this whole thing is that song that says, [singing] “Lonely. I am so lonely.” Do you guys know that song? [singing] “I have nobody to call my own.”

Gene 27:28
But who did that? That wasn’t a Roy Orbison song was it?

 

Music clip credit: ‘Only the Lonely’ by Roy Orbison; Publication date, 1961;

Original music by Gene Beresin

Episode produced by Sara Rattigan