New research by a Fordham psychologist shows that more than one-third of college students report being emotionally distressed by the pandemic and that LGBTQ+ students, students of color, and women experience higher levels of stress and anxiety.

The findings were published in a paper titled “Constant Stress Has Become the New Normal: Stress and Anxiety Inequalities Among U.S. College Students in the Time of COVID-19,” published in the Journal of Adolescent Health in December and co-authored by Fordham assistant professor of psychology Lindsay Till Hoyt, Ph.D. The first part of the paper’s title is a direct quote from one of the study participants.

The study incorporates quantitative and qualitative data that was collected from more than 700 college students who were recruited on Instagram. It began back in April with a baseline survey of 707 students from 374 colleges across the U.S., including Fordham. More than 500 students returned for a follow-up survey in July.

The very first question on the survey was direct: “Tell us how the pandemic is affecting you personally, just in your own words.” Without specific prompting, 27 participants responded to that question by citing specific mental health disorders, such as anxiety.

For the paper, researchers in Hoyt’s virtual lab, called the youth Development, Diversity, and Disparities (3D) Lab,  examined the stress symptoms reported as well as inequalities found across gender, sexual orientation, race/ethnicity, and income.  Young women, in particular, reported higher stress levels than young men, said Hoyt, a developmental psychologist whose work primarily focuses on how “macro-level stressors get under the skin and influence the health and well-being” of adolescents and young adults.

Difficult to Be Living Back Home 

Some of the survey responses illustrated the problem with specific examples.

“As a daughter of immigrants, moving home is treated as a vacation by my parents, so I am tasked with several home duties and taking care of my siblings,” said a respondent who identifies as a high-income cisgender Asian woman.

And while women were more likely to report symptoms of stress, Hoyt clarified that cisgender men could well be internalizing their pain in other ways, such as increased use of alcohol or other substances.

Gender-diverse students, she said, reported worse outcomes than their cisgender, heterosexual peers.

“Many of the gender diverse and transgender students talked about a lot of stress from not feeling accepted or comfortable at home.”

A respondent who identifies as a multiracial middle-income lesbian said that being back at home was difficult.  “As a member of the LGBT+ community, it was especially hard to leave all my support at school and come back to a homophobic household where I have to remain in the closet,” she wrote.

Hoyt noted that the pandemic had thrown many of these young people off track socially. Students often come into their own at college, she said, once they find a good support network and like-minded friends.

“With COVID all of a sudden that came crashing down and they were going back to their hometowns and their families,” she said. “I think most people would say the findings align with what you would expect, such as the gender difference, but what we also found, because we had longitudinal data at two time points, is that it does seem like that the inequalities in stress and anxiety are widening, with students from traditionally marginalized groups facing greater burdens.”

Researchers for the paper came from both coasts: Co-authors include Alison K. Cohen, Ph.D., an instructor of epidemiology and population health at Stanford University in California, as well as two Fordham psychology graduate students: master’s candidate Brandon Dull and Ph.D. candidate Neshat Yazdani. Doctoral candidate Elena Maker Castro contributed from the University of California Los Angeles.

Black and Multiracial Students Showed Increase in Anxiety from April to July

Hoyt said that after the death of George Floyd and the resulting national protests, the team integrated questions on the Black Lives Matter Movement for the follow-up questionnaire conducted in July. They asked how the movement affected their stress and their civic engagement. She noted that in the April survey that white students had the highest levels of perceived stress and anxiety. But early analysis of the July survey revealed that Black and multiracial students—from across sociodemographic groups—were the only students to show an increase in anxiety from April to July.

“I think the data is reaffirming things that we know about inequalities and this is just one of many studies that will underscore that, but I also think what we’re going to learn will be about their resilience, that’s definitely what we’re seeing in the qualitative responses,” said Hoyt.

Hoyt said she is also interested in how civic engagement can be a “protective factor.”

“When something really stressful is happening in your environment, civic engagement can be empowering,” she said.

Much of the follow-up data still needs to be analyzed, but Hoyt had to slow the pace of the work while she underwent treatment for a rare form of cancer. She generally disengaged from work and the news so as to concentrate on her care and her family, particularly her toddler. But she soon found outside forces too great to ignore.

“I went off social media when I first was undergoing all this, but then during the election, I couldn’t help myself and I had to go back on Twitter, and I’ve posted about the cancer there,” she said. “I’ve learned it’s good not to be ashamed of having any disease, including cancer. Lots of people are dealing with it during this pandemic, so I am completely comfortable sharing.”

Despite Hoyt being on leave during her illness, many of the master’s and doctoral candidates continued analyzing data for the study, which is ongoing. A third survey was conducted during the fall semester that also incorporated questions about the election.

Hoyt said she’s been moved by the students’ strength in the face of adversity. She’s been particularly impressed with the students who are research assistants on this project.

“I always tell them they’re the experts on this study and they give such great feedback because this is a study about them, their generation,” she said.

 

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Dean McKay, Ph.D., a professor of psychology, specializes in anxiety, obsessive-compulsive disorder, and the connections between anxiety and disgust. With winter approaching and potentially leading to more isolation, we thought it would be a good time to talk to him about what we can do to cope effectively during what will likely continue to be a traumatic time.

Listen here:

Full transcript below:

Dean McKay: Look. Anxiety, as an emotion, it’s an important one because it does stop us from having injury and harm come to us. Unfortunately, a lot of times it’s an overcorrection, and the experience of anxiety is definitely uncomfortable. But the flip side is that it also can, when experienced properly, it’s a great problem-solving strategy. I mean, if you’re worried about anything, good effective worry leads to effective problem-solving.

Patrick Verel: the events of the last nine months have thrown us all for a loop. Schools closed, businesses shuttered, and people all over the world began dying from a mysterious airborne virus. In the ensuing months, the United States has experienced a summer of civil unrest and a brutally close and nasty election for president. Now, with the holidays approaching, the coronavirus is raging out of control again. On November 13th, the number of Americans infected with the virus surged to a staggering 181,000 in one day, and the number of deaths reached 246,000.

PV: Dean McKay, a professor of psychology at Fordham, specializes in anxiety, obsessive-compulsive disorder, and the connections between anxiety and disgust. With winter approaching and potentially leading to more isolation, we thought it would be a good time to talk to him about what we can do to cope effectively during what is likely to be a traumatic time. I’m PV, and this is Fordham News.

Let’s talk about anxiety. There are multiple kinds and they sometimes work in tandem in our minds, right?

DK: You’re right. There are several kinds of anxiety, really, several different ways that anxiety manifests. And so, for starters, the reason why we get anxious is because it’s an evolved reaction to protect us from threat. And as a result of experiencing anxiety, in small as well as major ways in the course of our lives, we end up really having basically three different kinds.

One is based on what we call a real threat. So if you have, let’s say, a near-miss accident, or you’re confronted by an assailant, the anxiety that you feel in the face of that is a bona fide reaction to a real, imminent threat that you face, some real danger.

A second kind is where you have a false alarm. We’re evolved to basically overcorrect for threat, and so since in our environment there are certain things that sound or look dangerous, it’s better to know that in advance and act, rather than have to wait until it’s verified. So if there’s, let’s say, a shadow that looks threatening and you’re approaching it, the anxiety that you feel is in response to the fact that it might be a danger. Now, it’s possible that you’ll end up learning later that it’s actually a tree in a formation that resembles an assailant, and so that’s a false alarm. It looked real, but then it ended up being, on closer inspection actually, not.

Then the third one is what we called learned alarms, and so because our environments are idiosyncratic to us, and over the course of our lives we end up having certain anxious experiences, some of those are ones that are specific to us, that we might find to be potentially dangerous. So, those are ones that we learn to be afraid of and we start to avoid those, as well. Now, those also don’t have to be bona fide dangers, but because we’ve consistently avoided them and we’ve consistently associated those with the experience of anxiety, then we have that association.

Let’s say that you were out at night and you were attacked. In fact, you survive. Now, in the future you got to, let’s say, those same places and you see shadows or figures in those places that might not be real threats. You might experience anxiety, anyway, and that would be a learned alarm.

PV: It feels like right now we’ve got all three kind of mixed up together.

DK: Well, that’s true. The issue that we face with a pandemic is that it activates anxiety in a very specific way, and it does call all three of those to bear.

First of all, there’s a real threat, so we know that in our midst there is something that is dangerous. Now, what makes it more challenging is that we can’t see it, so the examples that I used of a real alarm is where there’s like a visible danger. But now there’s an invisible one, and we have to now learn other ways to manage it. That means connected to that there are going to also be, let’s say, false alarms. So, you encounter somebody who looks sick. They’re not sick, necessarily, or they’re sick with something other than COVID. That would be a potentially false alarm.

Then there are learned alarms, because we’ve now been taught, based upon public health information and other media sources, that there are certain things that we should avoid. So, let’s say if you’re the kind of person that routinely wears a mask, a learned alarm is if you encounter somebody coming really close to you who’s unmasked. That’s going to also pose a pretty significant threat.

PV: You’ve conducted research directly connected to anxiety and the coronavirus. What can you tell me about your findings so far?

DK: First of all, given that the threat of COVID is an invisible one, that only manifests visibly in people who are ill, we really have five major dimensions that we can describe as being relevant factors that are implicated related to COVID. Those factors are what we call contamination and disease risk. So, that concern that you may have contracted an illness, or a concern that you may have come in contact with something, that would be one facet of this COVID-specific kind of reaction.

The second is because we are acutely aware of the social and economic consequences, that forms another factor that activates a lot of anxiety for people. So, we are concerned about our own well-being, but then kind of competing with it is also the concerns about social and economic consequences of the disease.

Another factor, so the third of these five, is traumatic stress reactions. This is a largely traumatic event for the public. It’s a pretty widely shared traumatic event, and some people experience it more acutely than others. So, if someone has contracted and survived COVID, or if someone has had someone close to them pass away or contract and remain ill with COVID, there’s a lot of ways in which COVID is experienced by sufferers.

Obviously, the biggest concern that we have is the risk to one’s life from COVID. But then there are also people who survive it, who are the so-called long-haulers that we hear about, who have neurological consequences and all kinds of lasting physical consequences, multi-systemic consequences. And so, those form the basis for a series of traumatic reactions that sufferers may have.

A fourth factor is a broader social category of xenophobia. This has been observed in prior pandemics, by the way, where the natural desire for the public, given that we want to make seen that which is unseen, so what better way to do it than to ascribe cause to a group? We’ve seen this happen in multiple ways. For example, the attribution of the disease to being brought to these shores from China has led to some xenophobic reactions to people from China. Or even to, in a smaller scale, things like not eating Chinese food.

Then finally, the last factor: that is an anxious-related response is checking. People engage in checking behavior either for themselves, to see whether or not they’re ill. It’s sort of like this internal monitoring that people might engage in. Let’s say for right now if somebody were to feel a little bit of a scratchy feeling in their throat, they might start to really pay much more attention to that than they might have pre-pandemic. Because they are now attending to whether or not maybe they’re coming down with the illness, and there will be some checking that they might engage in to see whether or not this represents the onset of illness.

So, on the one hand, there’s a constellation of individuals who have what we would call a COVID Stress Syndrome. They have elevated levels of many of those five factors, and that leads to all kinds of other mood and anxiety reactions, ones that we might see pre-pandemic. People get depressed. It’s a lot to manage if you experience all five of those factors that I just listed. That’s stressful, and people experience it in a pretty demanding way.

There’s a flip side to this, though, and it’s one that we’ve seen here. There are people who, as we’ve had well-documented in the news in this country, people who are basically denying that COVID even matters. So, you see people who are neglecting to bother with wearing masks and are not engaged in social distancing, and are basically taking the position that, really, this is nothing, and why are you making a big deal of it? They have low levels on all of those factors, and also would feel that their personal risk is just low, for reasons that have little to do with reality.

PV: I hope this doesn’t sound flippant, but it seems like this is a golden age of time to study anxiety.

DK: Well, that’s true. There is an abundance of anxiety, and rightfully so. The theory that helps to describe why we see some of these things that I’ve described as those five-factor,s is called the behavioral immune system. It’s basically an automatic process that we have evolved, which is when there’s an unseen danger, what steps can we take to try and make it as seen as possible? What ways will it be visible, and how can we protect ourselves?
DK: So, it’s an important evolved feature, and in order to do it successfully it does require anxiety. Look, anxiety as an emotion, it’s an important one because it does stop us from having injury and harm come to us. Unfortunately, a lot of times it’s an overcorrection, and the experience of anxiety is definitely uncomfortable.

But the flip side is that it also can, when experienced properly, it’s a great problem-solving strategy. If you’re worried about anything, good effective worry leads to effective problem-solving, and that’s true for everything. We would get very little done if we never, ever worried. We’d be like, “Oh, whatever. I guess that will come and go. The deadline is here and gone.”

And if we didn’t worry about getting diseases, then we’d probably get sick and die very easily. There’s a value here to this, and so it’s not flippant to say that. It’s actually accurate, and a lot of my colleagues and I, we’ve been very, very active during this time.

PV: I want to talk a little bit about this connection between the virus and xenophobia because I think that’s really interesting.

DK: There’s a lot of talk right now about tribalism in our politics, and so this does kind of cross the barrier into the political realm. In politics right now, the tribalism suggests that you have groups of people that form coherent wholes: they share attitudes and opinions and culture. But that notion of tribalism goes back also centuries; and tribes, as let’s say bubbles of groups, they would also be protective of themselves.

One way to protect themselves would be to make sure that outsiders who carried, literally, disease risks that would be foreign to them and could wipe them out, they would then be vigilant to guard against that. And so, an outsider would be deemed dangerous, just for being an outsider. So, xenophobia … We’re hardwired to be somewhat xenophobic. That doesn’t make it defensible, but it is certainly a bulwark that we have to work against.

Now, in the modern era, because in modern technology we don’t really need to have that kind of disease vigilance about outsiders the way that we once did, with the rising of a more global economy and the fact that people can travel all over the place very readily. It doesn’t change the fact that you can capitalize on that natural xenophobic impulse, at least in some individuals.

In 2018, President Trump went to great pains to talk about the caravan of people who were coming north from Central America, and his descriptions of it were very much designed to capitalize on that disease risk that people are concerned about. He’s done this all along, from the beginning of his campaign.

That notion is something that we see now, and now bringing it fast forward to the pandemic, Trump’s use of terms like “the China virus,” which has been roundly attacked as a xenophobic statement, is exactly for that reason. It’s to try and assign an ethnic cause to the pandemic. We see this throughout history, and politicians have known how to capitalize on it, on the left as well as the right. I mean, there are left-leaning leaders who have certainly used this.

PV: I want to move from the theoretical to the concrete for a second here. I left Brooklyn in March with my wife and our five- and eight-year-old, and we moved in with my in-laws in Vermont, so we could work remotely while they attend school online. My father, who is 72 years old, died of COVID about three weeks after we left.

I’ve had very few opportunities to see the rest of my family, and thanks to the New York City school situation it’s unclear when we’ll be able to return home. So, I have a bit of anxiety these days. Everybody’s situation is unique, of course, and I know I’m probably not alone when I describe this sort of crazy situation. So, what advice would you give to fight this kind of anxiety, which is born largely from circumstance?

DK: Sure. First of all, I’m really so sorry for your loss. I know we spoke prior to this podcast, and it’s tragic. Your life has been touched in a very specific way by this virus, and so adversely. The experience that you have of anxiety, in terms of returning to what might resemble a pre-pandemic way of life, is a hard one to imagine. So, that traumatic kind of symptom that I described before as one is particularly salient for you.

To deal with that in some way, probably it will be necessary to be able to return to your environment that you lived in originally. Just to really start to etch new memories in, that will be present to allow you to recapture some sense of normalcy, given that you experienced this loss in a rather significant way. And now it’s going to be very much crystallized with your experiences of life now, in a way that’s so abnormal from what it was prior to this.

That’s true for most sufferers, people who have lost a loved one. They’re going to face some real challenges going forward, especially when the pandemic is over. There’s going to be this really lingering memory of this event, and the way to really handle it is to honor the person that they’ve lost in a way that’s meaningful for them.

In the meantime, there are some other lingering issues, and the stop-gap measures are things like the extent that you can engage in any kind of social practices now. We do have the benefit of remote technology that allows us to stay connected with people; and it’s easy to not do that, because we get busy with things, especially if you have children. But to try and capture some of that. Like, married couples who have children, it’s very difficult now. You’re home all the time with your kids, and how do you get time alone?

Well, that’s a very significant challenge, and there needs to be some creative problem-solving around how to do that, even to steal away some time alone, because that’s something that couples usually try to do. If you routinely did that pre-pandemic, and you’re not doing it now that we’re eight months on, that’s something that should be done and really prioritized. That will help to alleviate some of the anxiety because you can share with each other some support.

If you don’t have someone in your life but you have a social network, you should definitely make sure you stay connected to people. If you are a solo person, and you’re not connected to somebody right now but you have a social network, you really want to strengthen that as much as you can, and make sure you stay connected to people. Maybe rekindle connections that have dwindled a little bit.

All of those help to buffer anxiety. You know, that shared experience so you don’t feel so isolated can put a block on it. It also allows you to share information with people that facilitates problem-solving, which is really the point of experiencing anxiety in an adaptive way.

PV: I would imagine there would be people out there even who don’t necessarily … who might not have lost somebody, who might just look back and say, “Oh, my God. What happened to the life that we had in New York City?” in particular.

DK: Right. Loss is very global right now. There’s loss in terms of not just potentially loved ones, which is maybe the most profound in this case. But loss of livelihood, change of livelihood to something that is not what was desirable before. Maybe you had an ideal or a very desirable lifestyle beforehand, and that’s been upended. Loss of time with loved ones, because of distance and inability to connect because you can’t travel. That’s something that a lot of people are experiencing.

On a personal side for me, my daughter lives in Florida. We haven’t seen her since the end of February. We happened to go to visit her in February and we really haven’t been able to travel down there since, because my mother-in-law, who’s 84 years old, we’re the sole caregivers and it’s just too risky. So, a lot of people experience these kind of losses.

PV: Yeah. I’m glad you brought up that your daughter and the holidays because that’s something that I do think is important to note for this conversation. I wonder if you have any thoughts for people who right now are hearing this, and are very anxious about whether they’ll be able to have any semblance of a holiday. Whether it’s this coming Thanksgiving, or even Christmas and New Year’s and Hanukkah, and all the other holidays that the winter months usually bring us?

DK: Yeah. This week, as we’re speaking, also brought some hopefulness. That is, it seems that there is very rapid and encouraging news on a vaccine, so maybe the first time in months that people feel a glimmer of optimism that maybe this is going to be over. So, it’s hard to do this in the moment, because you’re thinking “this year,” “this holiday,” this thing that we’re looking forward to so much, like Thanksgiving. Which … I, too. We love Thanksgiving. My family, we celebrate Hanukkah. We love the holidays to spend time with our kid, or to at least have some engagement in a real meaningful way.

But if you think about it in the course of your life, you’re going to celebrate the holiday around 75 or 80 times, and so you’re going to miss it once. It’s not even really that you’re going to miss it entirely. This is an opportunity where we might want to think about creative alternatives. Since we do have the luxury of remote technology, there is something to be said for at least making sure that you maintain contact for the holiday. Yes, it’s not the same. Absolutely, you’re going to feel the change and the difference. It is going to be abnormal.

But think about the fact that we have some measure of optimism on the horizon that you’ll be able to do it next year. And, yeah. It’s frustrating, but the other side of it is that we want to contain the spread. The danger really remains great. So this is, I think, probably the best alternative, is that we have to think in terms of how many more holidays do we get to enjoy? And we get to look forward to the fact that we can enjoy them because we’ll be hopefully making sure everybody stays healthy.

PV: Let’s talk about the future. Let’s say, fingers crossed, that a vaccine is approved this winter; and by this time next year we’ve returned to our offices, schools have reopened, and the economy has begun to crawl back out of the hole that it’s in. What kind of psychological aftereffects can we expect in the years to come?

DK: First of all, there will probably be an uptick in mood disorders, so depression is probably going to be the thing that will be a lingering aftereffect. In all likelihood, people who were anxious prior to the pandemic or prone to being anxious, it may kick it off for some people. The return to a pre-pandemic life, to whatever extent we retain that level of comparable lifestyle, I would imagine over a reasonably short timeline, in a matter of months, not years, a lot of those anxious reactions will fade.

So, let’s say there are some people who may be much, much, more attentive to washing. They’re probably not going to develop OCD, like based on contamination fear. It will probably snap back once it’s clear that it’s safe. For people who may have treatable levels of contamination fear, they probably were near to developing OCD prior to the pandemic, and this was the stressor that pushed things over the top. So, I would not think that these are pandemic-specific, but more like this was the stressor that got it going.

The other thing that I think will be left over will be probably a fair bit of alcohol and substance use problems. We see that now, and those are harder to shake. Those are habits that people develop. Alcohol is abused because people like it, and so after the pandemic is over, if you’ve been drinking a lot, you might continue to drink a lot. Maybe you’re going to carve out the time to work and do other things that you did before, but alcohol abuse will stick around.

And alcohol has a great history of alleviating anxiety. I mean, it has all kinds of horrible other consequences attached to it, but it’s well known that people engage in what they call self-medicating, to use a mental health term. And self-medicating, if we manage it effectively, it’s not universally bad, and I don’t think we should refer to it as such. It’s a mental health term when we talk about people who are alcohol abusers, and it’s what we call secondary.

So, secondary meaning like the first thing that really was there was anxiety problems, and that individual identified alcohol, or other drugs like opiates and other kinds of medications, as a way to tamp down their anxiety. So, they don’t have to necessarily deal with it through other structure coping mechanisms, they can just drink it away. And plenty of people do that. The notion of saying, “I’m going to have a drink to unwind,” that statement alone is a self-medicating statement. You don’t have to have an alcohol problem to make that statement.

PV: Okay. That makes me feel better.

DK: Yeah, good. Yeah, yeah. This doesn’t have to be like, oh, let’s reveal your psychiatric problems on the podcast. There’s a giant normal range, here.

PV: I’ve already revealed way too much in this podcast.

DK: Yeah. This was a very … Yeah, yeah. We both did a little bit of sharing here.

PV: What gives you hope right now?

DK: I probably really only felt hopeful, myself, in the last week-and-a-half. I’m trying to avoid being overly political, but I’ll be personally political right now. I think the election results point to some things that I think will change in a way that will be beneficial for us, at least in terms of the country managing COVID more effectively. I’ve had the good fortune of having a pretty large network of colleagues in other places, and what I hear about them doing in other countries, it’s stark. And it’s not political, by the way.

I have friends across the country in Canada. I have colleagues in almost every province, and in Canada … They have all kinds of political divisions in Canada, like deep, deep political divisions like we have here. But they did not politicize the virus. That’s the one thing that they did not do, and Canada is one of the countries that’s actually doing the best.

I frankly don’t blame Canada for keeping Americans out. We’re not allowed to go to Canada right now. We’re not about to be able to go anytime soon and for very good reason, because in this country, we’ve been doing a terrible job of it. The idea that maybe that’s going to change is something that I feel very optimistic about.

That and the news, I think, they would not report these promising vaccine findings without there being some reason to expect that it will be ultimately scalable so that the public at large can benefit from it. Those are the two things that give me real, true optimism about this. Had we had this conversation three weeks ago, I would have really struggled to answer that question, frankly. I don’t know that I would have been able to end on a more upbeat note, so I’m glad that we’re speaking now.

Marija Kundakovic, Ph.D., assistant professor of biology, spearheaded a study that was published in Nature Communications, the third highest-ranked multidisciplinary science journal in the world, earlier this summer. Kundakovic and her colleagues found that chromatin, a microscopic cell component, changes its shape during the ovarian cycle—especially when females experience a drop in estrogen. This changes how our genes behave. Because this occurs inside the brain area implicated in anxiety and depression, it may mediate women’s vulnerability to increased risk for these disorders. 

Now, thanks in part to the research conducted by Kundakovic’s team, scientists are closer to figuring out which molecules should be targeted with drug treatments, particularly for women with anxiety or depression. 

“This is really important for us to show at the molecular level—the molecular basis of this is what we now, with our study, are starting to understand,” Kundakovic said.

Part of the reason why this study is important is that it focuses on the female brain. Tell me more about that. 

The majority of neuroscience experimental studies were done on males. It’s been like that for decades. We know very little about the female brain, and this is particularly a problem for the disorders that are more frequent in women than men, like depression and anxiety. So this is why we basically don’t understand anything about the mechanism that tells us why this sex difference exists. 

Our study was designed to try to understand how—at a molecular level—these fluctuating sex hormone levels might increase the risk of anxiety and depression in women.

Why is there such a stark difference between men and women regarding their risk for anxiety and depression?

When you look at boys and girls before puberty, there’s really no difference in risk for depression. This risk really becomes two times higher in females when they get their first period —when the hormones start fluctuating. And then around perimenopause, this difference becomes even more profound because there are more extreme fluctuations. You can have very high or very low sex hormones. And then after menopause, when women achieve these very stable, low sex hormone levels, the sex difference becomes almost nonexistent. So this really tells us that this is not about low or high hormones, but the fluctuations in hormones that might be increasing women’s vulnerability to anxiety and depression.

What’s an extreme example of hormone fluctuations? 

Postpartum depression, a period when you have very high progesterone and estrogen (sex hormones), and then a drop after pregnancy. It often triggers a serious depression. There are a lot of lines of evidence showing that this drop in sex hormones, particularly estrogen, may increase the risk for anxiety and depression.

There’s another interesting phenomenon. Women who are depressed and on antidepressant treatments often report that just before their period, they experience worsening of their symptoms. The symptoms seem to be in control with the treatment, but all of a sudden, in this particular period, their symptoms worsen.

All these human findings are consistent with our findings in mice (women experience the menstrual cycle; female mice experience a similar process called the estrous cycle), showing that a drop in estrogen during the estrous cycle leads to increased anxiety levels in females.

You studied brain cells from both female and male mice, and also included female mice in different stages of the estrous cycle. What did you find? 

DNA is six-and-a-half feet long in a single cell. You have to package it very nicely so you can put this huge piece of DNA into every cell. The way this is accomplished is through a special structure called chromatin. 

This is important to package our DNA, but not only for that. By opening and closing chromatin, you can turn genes on or off. You have to have this open structure for some factors to bind and to turn the genes on. If this is closed, you can’t do that. People use libraries as an analogy. You can have a huge library. There are certain books you can’t even access. But if something’s accessible, you can potentially read it. That’s how our genome works as well. 

What we show—and this is really the biggest discovery of this study—is that as hormones fluctuate, they’re actually changing the organization of chromatin. This changes gene expression. 

Can you provide an example that explains these chromatin changes? 

Serotonin is a neurotransmitter—a chemical in the brain that has been implicated in anxiety and depression. What we show in our study is that the genes that are important for serotonin function, their expression, and their chromatin organization changes with the estrous cycle. Basically, now we are providing a possible molecular mechanism for why we could have those changes in anxiety levels across the ovarian cycle. 

What’s the difference between chromatin in male and female mice? 

In terms of how many open chromatin regions we have, the numbers are pretty similar. What is different is which regions are open or closed. They change with the estrous cycle, and they differ between males and females, meaning some genes that were closed will open up. And some genes that were open will close. What we didn’t expect is that we would find as many differences across the estrous cycle as we see when we compare chromatin in males and females. 

Women and men currently have the same treatment for anxiety and depression. But might your study results lead to the development of sex-specific treatments for these disorders? 

Yes. We are starting to understand what are the players involved, what are the mechanistic factors—like receptors, regulators of chromatin—that are leading to this opening and closing. It may help us identify a candidate that we could possibly target with drugs. 

Many women take birth control. How can that affect sex hormones and treatment? 

We don’t know enough about that. There are different contraceptives. I think we need more studies in humans to understand how exactly contraceptives would affect this. 

What implications does this research have for transgender people? Or is there not enough data yet? 

That’s another important question that I’m getting more nowadays. What we’re talking about here are biological changes that are induced by hormones. When we talk about transgender people, you might think about certain hormonal treatments that they are receiving. Our brain, even in adulthood, is responsive to these hormones. But sexual differentiation of the brain is very complicated, and it starts very early during life. So as you said, I think we would need more information and funding to try to understand how exactly this would affect transgender people. 

This interview has been edited and condensed for clarity.

In her early years at Fordham, she struggled with an abusive relationship, a falling out with friends, and a breakup with a different boy she loved. She started school as a chemistry major on the pre-med track—but she wasn’t happy.

In the fall semester of her junior year, Govindan decided to take her life. On a cold day in October 2017, she sat at a Starbucks a few blocks away from Fordham’s Lincoln Center campus, drafting suicide letters to her family. Then she got a life-changing phone call from her mother.

Govindan’s parents—a pediatric anesthesiologist and a bank vice president who pulled themselves out of poverty in India—had refused to let her pursue stand-up comedy, something she had loved since middle school. But after hearing the pain in her daughter’s voice, her mother changed her mind.

“She [had]told me, ‘Indian girls don’t become comedians. They become doctors and scientists and biologists and engineers,’” Govindan, a Fordham College at Rose Hill senior, said at a Fordham event last fall. “But this time around, she said yes. And to me, that just meant so much because what she was telling me is, I don’t care what we think. I don’t care what other Indian families think. What matters to me right now the most is your happiness.”

Now, Govindan is a young comedian who has performed around the world, from Ireland to Houston, Texas. At the age of 21, she was invited to apply as a writer for a TV show. And after receiving therapy, she’s determined to destigmatize mental illnesses through candid discussions on social media.

“Happy #WorldSuicidePreventionDay,” she wrote on social media. “What ultimately ended up helping me was seeking out therapy and medication and investing in a hobby I found happiness in (comedy!!!).”

Last year, Govindan applied for a fall production internship at the Emmy Award-winning show Full Frontal with Samantha Bee—and got it. She transcribed news and TV clips, answered phone calls, and went out on coffee runs. In conversations with senior colleagues, Govindan said, she received “uncensored advice” that will help her develop as a stand-up comedian. And, thanks to one of those mentors, she was able to meet one of her biggest idols—Hasan Minhaj, an Indian-American comedian who co-created and hosts the Netflix series Patriot Act.

“Every day as I continue to pursue stand-up comedy,” Govindan said, “I thank the heaven and the stars that on that cold, crisp day in October of 2017, I chose my own happiness instead of choosing to end my life.”

Finding Humor in the Darkness

Govindan’s jokes begin with observations. If she makes a friend laugh, she said, she’ll record what she said in her phone. Those notes might make it to the official notebook that she brings and refers to on stage—the book that holds all her organized sets.

One of those stand-up sets is about her experience with being suicidal. When Govindan performs the set, she speaks about a much more private notebook—the place where she wrote why she should stay alive. One reason: never being able to taste another Cheez-it cracker again. Another: never knowing what would happen in the season finale of her favorite TV show Brooklyn Nine-Nine.

“Probably my favorite reason—and perhaps the most ridiculous reason—was Kylie Jenner,” she recalled. “I was like, I can’t die without knowing whether or not Kylie Jenner is pregnant.”

More seriously, comedy gave her a reason to live. 

“Every time I was emotionally distressed, every time I went to this dark place, I would open up my notebook and force myself to write a comedy set,” she said. “I think that’s really what carried me through the darkness of it all … Being able to find the humor in everything.”

College Comedy and Beyond

Govindan’s first stand-up comedy show was a five-minute slot on December 2017 at Carolines on Broadway—a place where legendary performers like Jerry Seinfeld got their start. Since then, she has performed nearly 40 times in New York City; her home state of Texas; and Ireland, where she studied abroad for a semester. She says her shows usually run from five to 10 minutes, and her audience size is around 40 people.

In each show, she segues into bits and pieces of her own life: her identity as an Indian-American, dating, her struggles with mental illness, her experiences with therapy.

“I’m there to make you laugh—not talk about my own life,” she said. “But I also put enough of myself and my own truths in there that I feel good at the end of the day about what I’ve done … that I feel like I’ve been authentic with myself.”

Govindan reflected on two of her past shows this January. In the first one, she bombed. No one laughed except for her two high school friends, she said. Later that night, she performed the same seven-minute set somewhere else. But this time was different. She recalled two young Indian girls who came up to her and said, “We’ve never seen an Indian woman perform stand-up comedy live. Seeing you there, seeing you talk about the Indian-American experience, and seeing everyone else laugh just felt … amazing.”

In a few months, Govindan will graduate from Fordham with a degree in psychology; industry knowledge from classes in sitcom writing, documentary television, and screenwriting; and several internships under her belt. She says she’ll pursue a full-time job in either comedy writing or entertainment marketing. And she dreams of someday hosting her own late-night talk show. She’s even picked out a name for it—The Low Down. But in the end, she says, what matters most is the impact she has on the people around her.

“I hope I can be that salvation for someone else,” Govindan said. “If I can be that reason—if I can be the light at the end of the tunnel for anyone else, in the same way that stand-up comedy was for me—then I will be doing my job.”

Guidance for Students Experiencing Anxiety or Depression

Govindan isn’t alone in her struggles with depression and mental health. More than 63 percent of college students reported experiencing overwhelming anxiety within the last year, according to the American College Health Association’s 2018 National College Health Assessment. And almost 42 percent of surveyed students said they felt so depressed that it was difficult to function.

“Anxiety and depression are the most common presenting problems in our office as well,” said Jeffrey Ng, Psy.D., director of counseling and psychological services (CPS) at Fordham. “Student utilization of on-campus mental health services has been trending upwards for the past 10 years nationally, including at Fordham.”

But there are many different ways to combat anxiety and depression, both on one’s own and with help from loved ones and professionals. Ng offered some suggestions for students struggling with their mental and emotional health and those who care about them:

Practice self-compassion. “Students often have perfectionistic and unrealistic demands and standards for themselves—standards that they likely wouldn’t apply to others,” Ng said. “We encourage our students to try to be as kind to themselves as they would to someone you love or care about.”

Exercise. “Engage in physical activity or exercise,” Ng said. “Physical activity and exercise are incredibly effective for reducing mild to moderate anxiety and depression.”

Practice digital and social media literacy. “Social media constantly exposes and bombards us with airbrushed or curated versions of people’s lives. When we compare ourselves to what we see on social media, we may get the sense that ‘we’re not good enough or doing enough.’ This can contribute to lower self-esteem, which can increase our vulnerability to mental health problems,” he said. “We encourage our students to try to be more intentional, thoughtful, and discerning about how they perceive and relate to social media.”

Don’t forget the essentials. “Attend to basic needs like sleeping, eating, and playing,” Ng said. “Having social relationships and social interactions—those are basic needs as well.”

Remember that there are multiple routes to healing. “It’s important for students to remember that there are many, many different pathways or routes for healing and feeling better. Acceptance from our parents (as in Govindan’s case) is just one of those paths,” Ng said. “Unconditional acceptance is obviously very important for our mental and emotional health, but for some students, they may unfortunately never experience that level of acceptance from their parents. So it’s especially important for them to recognize that there are multiple pathways and possibilities for healing.”

Normalize vulnerability. “One of the most important things we can do to support our students is to normalize vulnerability, imperfection, and struggle as part of the human experience,” Ng said.

Seeking help. One local resource is Fordham’s Counseling and Psychological Services Center, with offices on the Rose Hill, Lincoln Center, and Westchester campuses. To make an appointment, students can call or simply stop by. During non-business hours, students can reach out to public safety or residential life staff for emergencies.

Off-campus, 24/7 resources include the National Suicide Prevention Lifeline, 1-800-273-TALK (8255) and, for those who would rather type than talk, the Crisis Text Line.

“It’s important for our students to recognize that help-seeking is a sign of strength and maturity rather than weakness,” said Ng.

But what if the trauma is not a one-time event? What if a person’s entire world is filled with adversity, flooding her with constant stress and anxiety and preventing her brain from ever recovering?

This the challenge that underlies the treatment of complex, or chronic, trauma, says Amelio D’Onofrio, Ph.D., a clinical professor and director of the Psychological Services Institute in the Graduate School of Education (GSE).

In general, a traumatic experience is one that is so distressing that it overwhelms the brain’s ability to process the event and triggers a set of survival-oriented physiological and psychological responses. Acute trauma refers to a singular event such as a car accident, an assault, or a natural disaster. Complex trauma, though, is more pervasive.

“For instance, if a parent chronically abuses substances and cannot meet a child’s basic needs, that is a traumatic environment for the child. Or if there is violence in the home or in the neighborhood and kids are constantly trying to protect themselves, that is traumatic,” said D’Onofrio, who is also a practicing psychotherapist.

“We expect kids to focus on doing schoolwork and solving complex problems, but they’re so worried about self-protection that their nervous systems have been activated to the point that they can’t focus.”

This year D’Onofrio received a $311,000 grant from the Department of Health and Human Services to design an intervention program for inner-city students who have experienced complex trauma and who otherwise would not be able to receive specialized psychological services.

The grant-funded program, which was implemented in two Bronx middle schools this fall, is divided into ten-week increments over the course of two years. For each set of ten weeks, doctoral students from GSE’s counseling and counseling psychology program run structured group treatment with at-risk students. The team also meets with each student individually at least twice and meets with parents to educate them on the effects of trauma and how it impacts their children.

The goal is to help students start to understand the impact of stressful and traumatic environments and to teach them healthy coping skills so that they will be less likely to turn to gangs or drugs.

“We worked closely with GSE’s Center for Educational Partnerships to select the two schools. One of the schools is serving many recent immigrants from all over the world, and the other school recently had a gang-related stabbing,” D’Onofrio said, referring to an incident this summer in which a 14-year-old student stabbed and killed another student outside their middle school.

D’Onofrio hopes to later develop internships and externships in the schools so that Fordham counseling students can continue working with the middle school students once their ten sessions come to an end.

“I think this a powerful interface between a Jesuit university and the community, a way of giving back and working toward social justice,” he said.