Depression & Anxiety

1. Introduction and Overview

Depression and anxiety are among the most common, and most frequently hidden, conditions affecting students in higher education. Because they are rarely visible and often carry significant stigma, students experiencing them are frequently reluctant to disclose, meaning staff are likely teaching affected students in every class whether or not this has been formally identified.

This chapter draws on empirical research into the experiences of students with disabilities and mental health conditions at German universities, a wider study of disabled students’ experiences of higher education, and the Jo persona and associated Accessible Academy guidance, adapted for the Uzbekistan HE context.

2. Understanding the Disability

What this covers

• Depression and anxiety are common mental health conditions that can affect concentration, energy, motivation, sleep, and the capacity to attend and engage consistently.
• They can be lifelong, episodic, or situational, and severity varies considerably between individuals and over time for the same individual.
• They frequently co-occur with other disabilities and can be intensified by the additional demands of navigating an inaccessible environment.

Common misconceptions

• That depression and anxiety are simply about low mood or nervousness that a student should be able to manage through willpower: they are conditions with real cognitive, physical, and energy-related effects on a student’s capacity to study.
• That inconsistent attendance or output reflects a lack of commitment: research documents students describing exhaustion so severe that all available energy goes into basic functioning, leaving little for coursework.
• That mental health conditions are static: presentation can vary week to week, meaning a student who manages well one week may struggle significantly the next.
• That naming an adjustment as a mental health accommodation is itself supportive: research found that when adjustments are framed as ‘special treatment’, it can damage a student’s sense of belonging rather than help.

3. Common Challenges in Higher Education

• Attendance difficulties linked to low energy, motivation, or heightened anxiety, particularly around high-pressure or evaluative situations.
• Concentration and processing difficulties that can make sustained academic work considerably harder on some days than others.
• Assessment-related anxiety, sometimes severe enough to affect performance independent of underlying knowledge or ability.
• Social isolation, which can both result from and worsen depression and anxiety.
• Fear of stigma leading many students to avoid disclosing or seeking support, even where support exists.
• Unpredictable workloads and short-notice release of materials were identified in research as a specific, avoidable source of distress, since they make it harder for an anxious student to plan and manage their week.
• Inconsistent application of accommodations between institutions, or between school and university, can create confusion and reduce a student’s confidence in asking for support at all.

4. Barriers Faced by Students

5. Inclusive Teaching Strategies

Before class

• Upload materials on a predictable, consistent schedule, at least a week in advance where possible, so students can plan their workload.
• Set out clear expectations and structure for the course from the outset.

During lectures

• Communicate calmly and compassionately, particularly around deadlines, attendance, or performance concerns.
• Avoid singling out a student’s attendance or participation in front of the group.

Group work

• Offer flexible or lower-pressure ways to contribute, recognising that some students may find open, high-stakes participation especially difficult on a given day.

Practical sessions

• Provide clear advance notice of format and expectations, since unpredictability is a particular source of anxiety.

Online learning

• Record lectures as standard, so a missed or difficult day does not mean lost content.
• Keep the course page structure predictable and timelines clearly visible.

Assessment

• Offer low-stakes formative assessment opportunities alongside high-stakes summative ones.
• Where possible, offer flexible deadlines or a clear, simple process for requesting an extension.

6. Classroom Accommodations

• Flexible deadlines or extension processes, applied consistently and without requiring students to justify themselves extensively.
• Recorded lectures available as standard, not only on individual request.
• Low-stakes formative assessment opportunities built into course design.
• Inclusive attendance policies that allow for occasional absence without penalty or the need for repeated justification.
• A quiet wellbeing space available on campus for students who need it.
• A named, consistent contact for discussing support needs confidentially.

7. Digital Accessibility Considerations

• Upload materials on a predictable, advance schedule rather than at short notice.
• Keep course pages structured with clearly visible timelines and deadlines, so students can plan ahead.
• Record and make available all lectures and key sessions.
• Provide a clear, simple digital process for requesting an extension or flagging a difficulty, without requiring extensive justification.

8. Communication Guidelines

9. Environmental Adjustments

• A quiet wellbeing space on campus for students who need time away from busy or high-pressure environments.
• Predictable, consistent scheduling of classes and materials, reducing avoidable uncertainty.
• Reasonable flexibility around seating, room choice, or the ability to step out of a session briefly if needed.
• Clear, calm communication of any changes, with as much advance notice as possible.

10. Assistive Technologies

11. Real-Life Example / Case Study

Case Study: Unpredictable scheduling and an undisclosed anxiety disorder

Nodira (a composite, illustrative example, drawing on themes from published research) manages an anxiety disorder and relies heavily on structure and advance planning to manage her workload. Her course frequently uploads readings only one to two days before each session rather than a week ahead. This unpredictability makes it difficult for her to plan her week, and she describes finding it hard to process long readings at short notice, which increases her anxiety significantly.

Poor practice

• Materials are uploaded inconsistently, sometimes only a day or two before class.
• There is no visible, predictable schedule for when material will be released.

Inclusive practice

• The course team commits to uploading all materials at least a week in advance, as standard practice for the whole cohort.
• A clear, visible schedule is published for the semester so students can plan their workload ahead of time.
• Nodira is made aware of a confidential route to discuss further support without needing to justify her request in detail.

Lessons learned

• A change made for predictability benefited the entire course, not only Nodira, echoing the research finding that ‘all students would benefit’ from more structured material release.
• Simple scheduling discipline addressed a significant source of anxiety without requiring individual disclosure.

12. Practical Scenarios

Scenario A

A student’s attendance has become inconsistent over the semester with no explanation given. What do you do?

• Reach out privately and without judgement to check in, and signpost confidential wellbeing support rather than raising it publicly or assuming a lack of commitment.

Scenario B

A student asks for an extension close to a deadline, visibly anxious about asking. What do you do?

• Respond calmly and without requiring extensive justification, and let the student know the process for requesting this in future without needing to ask each time from scratch.

Scenario C

A colleague suggests a student is getting an ‘unfair advantage’ from a flexible deadline policy. What do you do?

• Explain that the adjustment addresses access to demonstrating learning under difficult circumstances, and is available to any student who needs it through the same simple process.

13. Do’s and Don’ts

14. Lecturer Checklist

• Do I upload materials on a predictable schedule, well in advance of each session?
• Do I communicate calmly and without judgement around deadlines, attendance, or performance concerns?
• Have I offered low-stakes formative assessment alongside high-stakes summative assessment?
• Is there a simple, non-judgemental process for a student to request an extension or flexibility?
• Do I record lectures and share materials in a way that doesn’t penalise a difficult day?
• Am I avoiding singling out a student’s attendance or participation in front of the group?

15. Student Support / Disability Services Checklist

• Is there a confidential, low-stigma route for a student to access mental health or wellbeing support?
• Are flexible deadline and attendance policies applied consistently across staff, not dependent on who a student happens to ask?
• Is a quiet wellbeing space available and clearly signposted on campus?
• Are staff given basic training in responding to disclosures of depression or anxiety calmly and appropriately?
• Is there a predictable, published schedule for material release across courses, reducing avoidable uncertainty?

16. Quick Reference Guide

17. Key Takeaways

• Depression and anxiety are common, frequently hidden, and often under-disclosed due to stigma — assume affected students are present in every class.
• Much of the difficulty students describe stems from how learning is scheduled and structured, not solely from the underlying condition — unpredictable workloads and short-notice materials were specifically identified as an avoidable source of distress.
• Framing an adjustment as ‘special treatment’ can undermine a student’s sense of belonging; framing it as standard good practice benefits everyone and reduces stigma.
• Consistency matters: support that depends on which staff member a student happens to ask damages confidence in seeking help at all.
• Predictable scheduling, recorded lectures, and low-stakes assessment opportunities are simple, low-cost changes with a strong evidence base for reducing student distress.

18. References

Bartz, J. (2020). All Inclusive?! Empirical Insights into Individual Experiences of Students with Disabilities and Mental Disorders at German Universities and Implications for Inclusive Higher Education. Education Sciences, 10(9), 223. https://doi.org/10.3390/educsci10090223

Brewer, G., Urwin, E., & Witham, B. (2025). Disabled student experiences of Higher Education. Disability & Society, 40(1), 108–127. https://doi.org/10.1080/09687599.2023.2263633