Campus counseling centers reported an increase in clients with severe psychological problems last year, but anxiety was students' top complaint, according to an annual report by the Association for University and College Counseling Center Directors.
Directors from 424 counseling centers responded to the survey, which was conducted in the fall of 2010.
Seventy-seven percent of respondents said the number of students with severe psychological problems had increased on their campuses in the past year, up from 71 percent who said the same in the 2008-9 academic year.
The student-to-paid-staff ratio at the centers remained stable, at 1,786 to 1, and anxiety and depression were again the top two student complaints. About 40 percent of clients came to counseling centers for anxiety, compared with 36.8 percent in 2008-9.
Anxiety surpassed depression as the top student complaint this year for the first time since the association's initial survey, in 2006; depression accounted for 38 percent of the counseling caseload in 2009-10.
"That's a change that's kind of been inching up for several years," said Victor W. Barr, the survey's coordinator and director of the counseling center at the University of Tennessee at Knoxville. "I'm not really sure what's driving it. This trend started well before the economy took the last downturn, but it's a relatively small change in two significant issues for college students."
The findings about depression and anxiety mirror the latest results of a survey of incoming freshmen done annually by the University of California at Los Angeles. It, too, found that depression has fallen behind anxiety among students' mental-health issues.
Some experts say students are feeling more anxious than ever as they feel greater pressure to succeed in college and make the most of their investment in a college education.
The percentage of directors who reported an increase in clients with severe problems jumped by 6 percentage points this year, to 77 percent, but Mr. Barr said the increase didn't necessarily mean that students' problems had become more severe in a one-year span. Instead, it was more likely that directors were beginning to acknowledge a continuing increase in severity over the past several years.
"We believe that the severity curve has kind of topped out," he said.
The survey also shows a new staffing trend. Many institutions have hired case managers to help address more-complex student concerns.
Directors from 74 institutions said they had a case manager who typically worked in the counseling center or student-affairs department to coordinate resources for students with severe mental-health problems. The previous year, only 49 institutions reported having such a case manager.
Counseling centers have also added to the psychiatric services they offer, but nearly 75 percent of directors said they still needed more psychiatric services.
Mr. Barr said the increase in those services—and the belief among many directors that the services are still insufficient—probably was related to the more complex nature of students' mental-health problems.