Depression is the most common health problem among college students, a study from the National Institute of Mental Health, which reviewed data from 1987 to 2011, found. That's a time span of more than 20 years -- in which depression persistently made college students from every university in the United States feel helpless, tired, moody, guilty, empty -- or all of it at once.
Those are all symptoms a friend, roommate or maybe even a classmate would notice. And "typically, students really are the first to recognize that another student's daily routine has changed," says Kristin Conover, a staff psychologist at University of Southern California. Now, a college student isn't a trained psychologist as Conover is, and it can be hard, if not impossible, to understand what a friend suffering from depression is going through. But that doesn't mean you can't help.
I asked Conover, who has a Ph.D. in counseling, clinical and school psychology, about what you can say or do once you notice a friend or classmate is showing symptoms of depression. Here are some of her tips:
Tell your friend that you're worried
You don't need to mention the word "depression" right away. Simply telling your friend that you're concerned because he or she hasn't been acting like herself recently can make your friend realize that they may need help. Especially in stressful situations, it's sometimes hard to differentiate between stress-related problems and early symptoms of depression. "Stress affects mental health, but it comes and goes quickly," Conover says. Depression doesn't. So if you notice a persistent change, telling your friend that he or she has been acting kind of different lately can trigger the realization that it might actually be more than simply midterms. And that's an important first step.
Let your friend know that you're there
People with depression often feel left alone, sometimes even guilty for addressing others with their problems. "Say that you understand that it's hard," Conover says can help. That doesn't necessarily mean you understand what it feels like to be depressed -- but a simple acknowledgement of the uneasiness of what your friend is going through can take some of his or her guilt and negative feelings away.
Suggest treatment and direct to resources
Almost every college has a counseling center or campus psychologists to talk to once you're feeling stressed, overwhelmed or depressed. Letting your friend know that there are resources available is crucial. "At USC, we have crisis and walk-in appointments," Conover says, "in case someone doesn't calm down." Even if you're not sure whether your college counseling center accepts walk-ins as well, check online for what your university has to offer. Some schools, like USC, even have a 24-hour crisis line. Provide your friend with a list of the resources you found so he or she can choose what to do.
Call counseling services yourself
In a situation where you can't get your friend to calm down and he or she refuses to seek treatment or call a counselor for immediate assistance, remember that you can also pick up the phone yourself and call counseling services to ask for help. "Explain the situation over the phone and get some tools," Conover says. Again, you're not a trained psychologist -- but you might be able to calm your friend down using advice from a counselor you got over the phone.
Encourage breathing and relaxing
"When somebody is at a time where he's crying and can't stop, breathing and relaxation is really helpful," Conover says. She suggests going to calm.com, an online site that offers meditation and calming sounds for free -- a good tool to relax and get your friend's mind off depressing thoughts for a moment. You can access it through your laptop or download the app on your phone in case you don't have your computer with you.
Respect your friend's autonomy
Even if you think you know what's best for your friend, it's his or her mental health, not yours. "You can't force someone to get help," Conover says. Ultimately, it's up to your friend to choose which way to go, whether to seek treatment, to participate in online forums, or not to get any assistance at all. "Unless they're in imminent danger of hurting themselves or someone else," Conover says. In that case: Call 911 immediately.
Seek support from other friends or family members
Even though it's important to be there for your friend, don't forget that you're a student, too. You have papers to write, exams to take and classes to pass as well. Suggesting to your friend to talk to other people, such as family members or close friends, will take some of the burden off you. "Talking to another family member that has been through the same thing can really help," Conover says. And even if your friend doesn't know anyone who suffered from depression, "still encourage them to reach out to other people," Conover advises. It will give you some time to focus on yourself so you can truly be there for your friend once he or she needs you.
Help emailing professors
Letting professors or teacher's assistants know what's going on may take some of the pressure off your friend, especially when he or she is beginning to struggle academically. Even if it's just a two-day extension on a deadline that your friend can't meet because he or she had a breakdown -- it's worth sending out an email and see if your friend's professor can make an exception. "Teachers make the ultimate decision," Conover says, "but even if there's a pushback from the professor, you can talk to counseling services about it."
Encourage sleep, exercise and healthy nutrition
"Even if someone doesn't want to seek psychological treatment, things like getting regular exercise, eating well nutritionally can be very helpful to fight depression," Conover says. So don't hesitate to take your friend with you on your morning run or go to the gym together. It's worth the try to get them out of bed.
Try to introduce your friend back to his or her social routine
Getting back to normal -- that's the ultimate goal. Going out with friends for dinner, coffee or a drink is a part of almost every college student's social routine, so getting your friend to join you can be a first step back to normality. "Be welcoming and encouraging," Conover says, "but also acknowledge the fact that it may be hard for them to get out of bed."
Remember: It's all about the little steps
Your friend may not be comfortable to go out with a group of ten people right after his or her first therapy session. Depression doesn't go away over night. "They may be able to do coffee with just one person, though," Conover says. And even if he or she can't -- "don't make them feel bad about it." It'll take time to get someone out of depression, but in the meanwhile, you can simply stick to these steps and be a good friend.
If you -- or someone you know -- need help, please call 1-800-273-8255 for the National Suicide Prevention Lifeline. If you are outside of the U.S., please visit the International Association for Suicide Prevention for a database of international resources.