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Home U Rising Focus on student mental health, Ep. 3: Depression


Keri Frantell, a licensed psychologist at University of Utah Counseling Center, provides a comprehensive look at depression in college life in episode 3 of this five-part series. Learn how to recognize the signs and understand the underlying causes of depression among students. Tackle one of the most pressing mental health issues on campus through hope and actionable steps for those struggling with depression. The series, Focus on Student Mental Health, is hosted and produced by Scot Singpiel of The at University of Utah Health and was created in collaboration with Student Affairs and the University Counseling Center at the University of Utah.

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Chris Nelson: This is Chris Nelson, co-host of the U Rising Podcast. For the next few episodes, we are sharing a five-episode series about student mental health produced by at University of Utah Health.

It will examine the top mental health challenges faced by college students and explore what causes them and suggest basic strategy to manage each one.

You'll also learn about the resources available at the University of Utah. Because in the end, it's not just about understanding the issues, it's about empowering you, our students, with the tools to thrive.

So, as we dive into this series, I invite you to join us in our shared journey toward a healthier future.


Scot Singpiel: College, where crazy schedules, new experiences, high expectations, a fresh social scene, and the whole identity quest come together. It's a lot. Well, sometimes it does add up and depression can sneak in. And that's where Dr. Keri Frantell, a licensed psychologist at University of Utah Counseling Center, comes in.

Today, she's our guide to understanding depression, what exactly it is, what's behind it, how to spot the signs and critically, how to tackle it head-on.

Dr. Frantell, first of all, what are some of the causes or triggers that can cause depression or increase depression for somebody who is already dealing with it in the college setting?

Keri Frantell: Yeah. Well, I think the first thing is the most obvious. It's a huge period of transition. And I think that we sometimes forget that or minimize that as a society because it's a normal transition people make.

And the idea of potentially moving away from home for the first time, being in a new environment, I think a big change for lots of people is that they maybe went to school with the same people for either all of high school or perhaps all of their entire education. And then they're now in a place where there are way more people and they are a lot of unfamiliar people.

And I think that a big challenge is we kind of don't teach people how to make friends because you make friends when you're younger and a lot of times you make them in very natural ways, but as an adult, making friends can be more difficult.

I think that that period then of transition where you're not only under stress academically, probably financially, you're also then trying to find new groups of people or new friendships and that is a big stressor for college students.

   Keri Frantell of the University Counseling Center.

I think in addition to the other things that are obvious managing a lot of different roles and responsibilities for the first time or maybe in a different way than they have in the past, certainly financial aspects.

And I think there's the comparison aspect as well of constantly comparing yourselves to other people, whether that's in classes or over social media. I think that that comparison is hard to not internalize and then impacts self-esteem, self-worth. Those are both related to depression.

Scot Singpiel: How about expectations when people come into college, either that they've had on themselves and in terms of performance or that their family or people that they know have for them?

Keri Frantell: Yeah, absolutely. I think there are expectations to "succeed" and to do that in a way that is also probably like what they've done in the past. Again, I don't think that the American public school system does a great job of teaching things like how to take notes effectively, how to study for tests. I know that those are not things that I necessarily learned. And so the ways that we learn in high school are really different from college.

And so I think especially seeing students where they're used to being really successful, maybe they haven't had to do as much work, maybe they've never had to get tutoring, and then all of a sudden maybe something is much harder or much different in college and then there's this real worry of, "I'm not good enough. I'm letting other people down. Maybe I'm doing something wrong."

Even though I think that those are all just very natural parts of becoming a college student, the expectation for ourselves and from family feels like a huge weight and then we feel like, "I'm letting people down. I'm a disappointment." I think that that certainly leads to depression.

Scot Singpiel: We talked about some of the triggers that can cause depression in college students, but then what's actually going on when these stimuli hit us as we go into college that causes depression? What is depression even?

Keri Frantell: It is often this erosion over time of different things happening that are impacting maybe our sense of self-esteem, our sense of self-worth, our feeling of connection.

And a lot of times, those things individually aren't necessarily going to lead to depression. They might make you sad, but probably aren't going to lead to depression per se. But I think it's especially when it's one thing after another and when you don't have confidence in your ability to kind of pick yourself back up from that.

And I think the thing with depression, too, is it's not just that sadness, it can be a lot of different feelings. Sadness, feeling numb, feeling empty, feeling hopeless. I think sometimes people actually feel irritable and not sad. And then it's those things also impacting sleep, appetite, not being interested in things anymore.

And that all lasting for more days than not over the course of a couple of weeks, that's when it's starting to move from sadness to, "Oh, maybe this is actually depression."

Scot Singpiel: Do you have an analogy? It sounds like when you have these things that are attacking your self-esteem or causing you worry or giving you feelings that you're letting people down because maybe you're not meeting expectations, these are attacks on something.

And you keep getting these attacks, and eventually, something happens, right? Like, "I don't know how to deal with this. It makes me sad. I don't know how to fix this." Is there an analogy here that we could come up with?

Keri Frantell: Normally, we give the bridge metaphor of if we think about our life as a bridge, an overpass that has been fortified maybe in the past by feeling really good self-esteem to begin with, having a good social support network, having people that you can rely on, but also maybe having learned coping skills for even just identifying your emotion in the moment, knowing how to talk about it, knowing how to name the emotion but not have the emotion take over, we typically then are thinking about a pretty solid bridge that has no cracks in the foundation.

And then when a bulldozer comes across the bridge, you might not immediately collapse into depression, but over time, you keep getting that corrosion and the potholes grow bigger and bigger. That bridge eventually might collapse where now you can't drive on it anymore.

And I think that that's kind of a good analogy for depression where that can happen to anyone, even people where everything has gone right, everything has been good. It might take longer for them to reach a point of depression if that's the case than maybe compared to if you've already had periods of time that have worn down the road. You might not be able to sustain as many tons of pressure on the bridge.

Scot Singpiel: So, as an individual is going into college or going through college, I could picture asking myself the question, "What's attacking my bridge right now?" If something happens, if I don't get a great score on something, that's an attack to my bridge, especially if I consider myself somebody who does well in school. I can't seem to make friends, I'm not having good friend connections or I've felt like I was abandoned, that's an attack to my bridge.

So, I've got to think, "Well, now, what do I do with that?" First of all, I think identifying it's critical, right, that that is an attack. And then, second of all, what can I do about it? And knowing that those feelings are probably even okay, right?

Keri Frantell: Yeah. Well, I think that that is a big part of it, is knowing that the feelings are okay. I think that one of the other things too related to this is certainly an emphasis on perfection that I think we kind of have as a society, but we also know that perfectionism has grown significantly in the past couple decades really.

And perfectionism is not just high standards. It's also high standards where our self-worth is tied to the outcome, so the stakes are a lot higher. So, there's this idea then of seeing things of "I'm a good student. Therefore, I need to be perfect."

And, if I get a B, there's this immediate response of, "Oh, I'm a failure. That's one of the things that I'm supposed to be best at, is school, so if I am no longer good at that, that means I'm a bad person." We quickly move into these bigger statements that aren't true, but they feel very true to us.

And I think that there has to also be this recognition and almost a reframe. We talk a lot in therapy about what is the story that we tell ourselves about ourselves and the world around us? And if I tell myself that I can either be perfect or I'm a failure, I'm kind of setting myself up to fail.

It's hard to let go of, "Oh, but I've always been an A student." And I think that if we are thinking about things like doing well on tests, it's like, "This is a learning opportunity. I am trying to do the best I can, and perfection is not necessarily the goal." Then when we get a B, we don't see it as this huge threat to who we are as people. We see it as, "Yeah, I did well, I'm a student, I'm supposed to be learning and growing, and it's okay."

But we really have to consciously be telling ourselves that new version of the story over and over again, because the story that we're used to is, "I can either be perfect or I'm a failure" as opposed to seeing that gray area in between.

Scot Singpiel: One of the causes that I understand can really lead to depression in college students is the feeling of being lonely. Going to college for the first time, maybe you've got a friend or two from your hometown that are at college, but maybe you don't. Maybe you don't know anybody and you're having a hard time making friends or making connections.

And that's one of the things you deal with. You have a couple of programs that help with that. You lead a loneliness and connection program, and another one coming up called To Be So Lonely. Talk about loneliness in connection for college students and how that can play into depression and how they can protect their bridge.

Keri Frantell: I think loneliness is a very common experience, not just for college students, but in general. I think that that is even more salient after the periods of quarantine, right? I think that we feel very lonely as a society, even when we're surrounded by people too.

That's an important part to clarify because I think that there are times where even when we feel like we're surrounded by people, we still feel like we're not able to be authentically ourselves, or maybe the relationships don't feel real or deep or as connected as we want them to be. And so it feels lonely.

One of the things that's important for college students to understand is that that experience is normal. I think that there are many times when people will come in saying, "Well, I feel like I've seen everybody else make friends, find their group, find their connection and I feel different." There are a lot of people who feel that way. It is a very common concern. And even the people who maybe we're witnessing connecting, that might not actually be how they feel either.

And I think that this loneliness then leads to kind of fear around, "Well, how do I find something different?" That idea of small talk, I think, feels very threatening to lots of people because it feels like, "Well, what should I say? Do people really want to talk to me? Is it really worth having a conversation where we're just saying something like, 'How's the weather?' Or is that feeling inconsequential?"

But I think that then there becomes this paralysis around, "Well, I don't know how to initiate conversations with other people without being 'weird' or 'awkward,' and so I'm not going to. But then I feel more and more stuck. Now I feel like I have no social support." And then that's really connecting to depression. And I think that that's just so common for college students.

Scot Singpiel: When it comes to depression in college students, how can college students differentiate between when it's just kind of normal, right? Because at times we get depressed and that's fine. Every time you get depressed isn't a major emergency. But on the other hand, sometimes they are. How can somebody differentiate between those two?

Keri Frantell: So, I'm going to make it three instead. I'm going to say that the spectrum is maybe there's sadness and kind of typical, not problematic, not harmful sadness, there's depression where it's getting a little bit more serious, and then there's an emergency.

I think the first thing I would say is we kind of want students to come in even if they're not sure. And if students are feeling like, "Yeah, something feels off. Something feels not right. I feel like something feels bad and I am worried about it," that probably is enough of a reason to come in and seek help.

And again, people coming in, we'll talk through with them what's actually going on and we'll figure out, "Is this something where therapy is the right answer? Is it something where just learning skills in a workshop could be a good option, could be a first step?"

I think that my worry will always be that I think sometimes students are like, "Well, it's not that bad. I don't want to go if it's not that big of a deal." No. Come on in. We'll help you figure it out.

Scot Singpiel: Because maybe it is a big deal. Maybe that crack in the bridge that you're thinking is not a big deal is going to turn into something big soon. And if you don't have the experience, how would you know, right?

Keri Frantell: Exactly. And maybe it is the case that it's a crack that we can address differently before it becomes a break. And I think that that is definitely the case.

I think that part of that, too, is the counseling center . . . one of the things I really love about our agency is that we have what's called a stepped care model, which means that we have different levels of intervention or ways that we can help.

And so I think that sometimes people are like, "Yeah, I'm not feeling great, but it doesn't feel like it's broken the bridge." And that's when we can say, "Yeah, we have a workshop that is designed specifically to give you new tools, new strategies to kind of fortify the bridge."

That is very low stakes. Those workshops are typically an hour a week for four weeks in a row. They're very much like a classroom setting where students aren't expected to be spilling their secrets in front of other people.

They're truly learning skills the same way that you would in a class and then being asked to kind of apply them. And you don't have to share your own personal stuff at all if you don't want to. You can just take it home, practice and you're good.

That's very low stakes. That's why if you're not even sure, come on in. We have something that can still be helpful for you.

And there are times where you might come in and maybe it is a little bit worse. Maybe the bridge is starting to have a larger crack, the pothole is bigger, we're falling in. And that's when we can address that differently.

I think that the signs that that might be the case, a lot of time, is going to be more about time as well as intensity. And so, again, I think about how much of your day are you feeling apathetic or sad or crying? Is it a large amount of your day? And is it more days than not for several weeks in a row? Months? That's probably a different issue.

And again, something that folks can come in and we get them connected to the right resources.

Obviously, I also think there are emergencies and there are times when the bridge maybe quickly moves from being okay to starting to crumble. And particularly, when we're seeing suicidal thoughts, that is the time to come to the counseling center.

If those thoughts rise to an immediate concern, as in students are wanting to kill themselves in that moment, they don't think they can keep themselves safe, then going to a crisis appointment either with us or with MH1 through the dorms or using the SafeUT app, all of those things can help. Or obviously, calling 911 if it's really about safety.

And I also think that it's important for people to know suicidal thoughts are also pretty common. Having those thoughts, but not planning to act on them, not trying to actively take steps to kill yourself, is not something that . . . We're not going to overreact to that.

I think people sometimes don't want to come in because they're afraid that we're going to call the police or call the hospital. We're going to instead work with students to talk through, "How do we give you better coping skills? How do we give you a better social support system? How do we give you the things that will help build back the bridge or kind of lay a new layer on it?"

And again, that's something where when we're having those thoughts, we should definitely be reaching out. Sometimes it's an emergency where maybe for safety you need to go to the hospital. Lots of times it's not. And it's more, "Come to the counseling center and let a therapist work with you."

Scot Singpiel: You gave us some great examples of some resources on campus that range from low stakes, kind of introductory, just some additional skills to keep that bridge safe, to interventions that might mean maybe one-on-one with a counselor or beyond.

What are some things, though, that somebody could do right now to protect their bridge that you think would be useful? Let's give somebody at the end of this podcast something actionable that they could take into their life to put another layer on that bridge.

Keri Frantell: Yeah. So, there are a few things and a lot of them are going to sound so basic, but it is building a routine and taking care of the basics. So, I think about sleep as a really big one. Having enough, but not too much. We don't want to see oversleeping.

But the number of times I've seen people come in and I'm like, "Hey, how much sleep are we getting?" and the answer is, "Well, I've only slept for three hours a night for the last week because I'm studying." No, that's not going to help.

Scot Singpiel: That can compromise a bridge's integrity . . .

Keri Frantell: Yeah, quickly.

Scot Singpiel: . . . more than you might think.

Keri Frantell: Quickly it will start to kind of break that bridge down.

I think the same thing about eating as well. I mean, I think for college students, are they eating three healthy meals a day? Probably not. But I think having some approximation of that, right? Thinking about have you eaten recently? Have you given yourself energy? That is a really important one and so making sure that that is something that you're building in time for and being consistent about.

Certainly, limiting alcohol or drug use or abstaining from it for a period of time is going to be important.

But I think that one of the other things that we see a lot is that college students don't necessarily make time for self-care. And I think there are a lot of reasons for this. There are a lot of demands on their time. And so making time for that can feel like, "Oh, this is a waste. I have other things to do." But if we don't have that opportunity to recharge, a lot of times, we're not doing as well.

So, one of the parts of the day that I think that students can do this the most is at night, having some version of a routine that is between stopping doing work and actually going to bed, whether that is having time that is taking a shower, being able to do . . .

I think sometimes people are like, "I'm going to do a facial and that makes me feel better." For other people, it's like, "I'm going to read not schoolwork and that makes me feel better." Having some version of something that is stepping away from the demands and responsibilities in your life, even if it's 15 minutes, 20 minutes every night, because that's also going to break up the time between the different activities that you have.

And then the last one is really related to social connection, finding social connection and making time for it, whether that is texting or calling friends who aren't here if you haven't made friends here yet or if it is trying to go to different club meetings or going to different resource centers on campus to find connection with people. It's doing something where you are finding other people.

We are social creatures and we need social beings in our life, even when they make us feel anxious. It's an important part of our mental health, is having that connection to other people.

Scot Singpiel: Those do sound incredibly simple and I think they could be dismissed as such.

Keri Frantell: Yep.

Scot Singpiel: But if you really sit and critically think . . . Sometimes you go to bed stressed and you wake up the next day feeling so much better. Why is that? Well, because you got some sleep and your brain is a lot better equipped to handle that.

What you're talking about with those routines and when you ask, "Are you doing it?" is the bridge maintenance, right? How do you expect anything to be able to stay in good condition if you're not doing that maintenance?

I think sometimes we can forget that maintenance is sleep, maintenance is diet, it's caffeine, it's alcohol. It's taking a moment just to be with yourself, taking a moment to connect with other people. You've got to do that bridge maintenance.

Keri Frantell: Absolutely.

Scot Singpiel: Mental health bridge maintenance.

Keri Frantell: Yes.

Scot Singpiel: Keri, if somebody's made it to the end of the podcast, what's the last thing you would want them to know? What would you want them going away with, I should say?

Keri Frantell: I think if I had to pick one thing, it's probably that a lot of our experiences are very normal. And I mean that in the sense that they are common, that we are not alone, that other people have felt those things.

And that should never be a reason of like, "Oh, well, we all feel this, so I guess I don't need help," but instead should be, "Yeah, a lot of other people have felt this, too."

We just don't talk about it enough as a society, so we feel like we're the only ones. We feel like we're the only one that has a difficult time transitioning to college. We feel like we're the only one that doesn't have friends.

And I know for a fact that that's not true because for anything that people have brought into the counseling center, there's never something where I'm like, "Whoa, this is brand new." It's always like, "Yeah, this feels very familiar. This feels like something that I . . ."

Part of why I like running the loneliness and connection group is I like people being able to see, "Oh, other people feel this, too. I'm not alone. And we all want something different. We want to feel better."

Scot Singpiel: Yeah, we all have the same bridge maintenance issues, so maybe even talking about, "Hey, what do you do?" That's some good small talk, right, maybe? "Hey, when it gets tough, what do you do? What works for you?" Who knows? You might get a perspective that you never thought of before.

Keri Frantell: Absolutely.