The prevalence and predictors of mental health diagnoses and suicide among U.S. college students: Implications for addressing disparities in service use

Differences in mental health problems in LGBT+ first year college students in Chile during the pandemic

PURPOSE

To examine the differences in mental health problems by sexual orientation and gender identity in first-year university students in Chile during the pandemic.

METHODS

7,213 first-year students aged 18 years and older from five universities participated as part of the World Mental Health - International College Student initiative in Chile. Students completed an online self-report survey between 2020 and 2021 that included measures of lifetime and 12-month major depressive episode, generalized anxiety disorder, panic disorder, bipolar disorder, drug abuse/dependence, alcohol dependence, non-suicidal self-injuries, and suicidal risk. Prevalence of mental health problems were estimated and the differences by sexual orientation and gender identity were examined using logistic and multinomial logistic regression models.

RESULTS

Between 84.1% and 98% of lesbian, gay, bisexual, trans, and other sexual and gender minority (LGBT+) students screened positive for at least one lifetime mental health problem and between 67.6% and 90.6% for two or more problems. For most outcomes, non-heterosexual (Odds Ratio [OR] between 1.25 and 7.00) and trans and gender nonconforming students (OR between 1.72 and 5.81) had significantly higher odds of positive screening for lifetime mental health problems than heterosexual and cisgender students, respectively. Similar results were observed for 12-month mental health problems.

CONCLUSION

The results show differences in the prevalence of mental health problems in LGBT+ university students in Chile, which are consistent with those found in other countries. These results may be useful for planning interventions to improve the mental health of LGBT+ students.

Racial/ethnic differences in risk of suicidal ideation and suicide attempts in a nationally representative sample of U.S. adolescents

BACKGROUND

Suicidal ideation (SI) and suicide attempts (SA) are risk factors for suicide which peak during adolescence; however, evidence focused on differences in SI and SA risk among racial/ethnic minority youth is limited despite increasing suicide rates among several racial/ethnic minority groups.

METHODS

We analyzed a representative sample of adolescents aged 12-17 with prior depressive symptoms (n = 32,617) from the cross-sectional National Surveys on Drug Use and Health (2008-2019). Survey-weighted adjusted logistic regressions estimated the association of race/ethnicity with self-reported lifetime SI and SA, controlling for sociodemographics, lifetime substance use, lifetime major depressive episode, and self-rated health.

RESULTS

Compared to white adolescents, Black and Hispanic adolescents had a 2.5 % (p = 0.04) and 4.2 % (p < 0.001) lower likelihood of reporting SI. However, among participants reporting SI, Black and Hispanic adolescents had a 3.2 % (p = 0.03) and 3.1 % (p = 0.03) higher likelihood of reporting SA than white adolescents. Multiracial adolescents were 5.9 % (p = 0.03) more likely to report SA than white adolescents.

LIMITATIONS

Although racial/ethnic minority groups are less likely to self-report mental health symptoms, we could only assess SI/SA among adolescents self-reporting prior depressive symptoms, and we could only assess SA among adolescents self-reporting SI due to survey methods.

CONCLUSIONS

Variation in the racial/ethnic distribution of suicidality supports theories conceptualizing separate pathways for SI and SA. This underscores the need for greater attention to racial/ethnic differences in suicide-related research, surveillance, and prevention efforts, including ensuring that mental health risk assessments directly evaluate SA in addition to SI in order to better identify high-risk racial/ethnic minority youth.

Opioid misuse and mental health in college student populations: A national assessment

BACKGROUND

Despite growing concern about opioid misuse and mental health of college students, little is known about this population who are at high risk of co-occurrence and unmet needs. This national study aims to estimate the prevalence of opioid misuse, examine correlates with anxiety and depression symptoms, and quantify help-seeking behaviors among U.S. college students.

METHODS

Data come from students in the Healthy Minds Study between 2017 and 2020 (n = 176,191). Validated screening tools assessed mental health symptoms (PHQ-9, GAD-7). Marginal effects of logistic regression models estimate the effect of opioid misuse on mental health symptoms, help-seeking and academic performance.

RESULTS

782 students indicated past month opioid misuse. Student opioid misuse was associated with 24.1 percentage point increase in the probability of screening positive for anxiety/depression (p < 0.001) and 3.6 percentage point increase in the probability of informal help-seeking (p = 0.017). Less than half of students with opioid misuse and a positive depression/anxiety screen received any treatment in the past year.

LIMITATIONS

Limitations to this study include: possible non-response bias, as it is unknown whether students with opioid misuse may be differentially-likely to respond to the survey; differing time frame for opioid misuse and mental health questions; and data was collected prior to the COVID-19 pandemic.

CONCLUSIONS

This large, multi-campus study underlines the need for more partnership between substance use and mental health services on campus. It also highlights that college peers could receive training in ways to best help students who misuse opioids, directing them to on- or off-campus care.

Suicidal Thoughts and Behaviors Among Autistic Transgender or Gender-Nonconforming US College Students

Importance

Suicide risk is a global public health crisis, with suicide ranking as a consistent leading cause of death among adults in the US. Autistic individuals and transgender or gender-nonconforming (TGNC) individuals represent populations with notably elevated rates of suicidal thoughts and behaviors (STBs).

Objective

To characterize suicidal thoughts and behaviors among TGNC and autistic individuals, using a large, nationally representative sample.

Design, Setting, and Participants

This study is a secondary analysis of cross-sectional data from students at colleges and universities throughout the US who participated in the American College Health Association National College Health Assessment from 2019 to 2023.

Exposures

Autistic and TGNC identities were self-reported by participants.

Main Outcomes and Measures

The frequency of intersectionality of autism and TGNC identities and whether those who had intersectional marginalized identities had increased likelihood of STBs were examined. STBs were self-reported by participants. A series of moderated regression analyses were performed to examine how the interaction between autism and possessing a marginalized gender identity (ie, TGNC status) was associated with STBs.

Results

The sample included 41 507 college students with a mean (SD) age of 23.35 (6.83) years. A total of 2410 participants (5.81%) identified as being TGNC. Overall, 326 TGNC participants (13.53%) also identified as autistic, whereas 625 of those who identified as cisgender (1.58%) also identified as autistic. Gender identity and autism were associated with greater odds of STBs. For suicidal ideation, gender identity had an odds ratio (OR) of 3.34 (95% CI, 2.99-3.73), and autism had an OR of 2.06 (95% CI, 1.76-2.42). For suicide attempts, gender identity had an OR of 2.74 (95% CI, 2.13-3.52), and autism had an OR of 2.39 (95% CI, 1.62-3.52). A significant interaction existed for attempts (OR, 0.51; 95% CI, 0.27-0.97); nonautistic cisgender individuals had the lowest attempt rate.

Conclusions and Relevance

This cross-sectional study addresses the dearth of information on how intersectionality in gender and autism status impacts the risk of STBs, and the results confirm the elevated risk of STBs among TGNC and autistic populations. Interventions are needed to support college students with these identities.

Changing the narrative: Addressing American Indian/Alaska Native mental health needs through academic holistic support

American Indian/Alaska Natives (AIAN) have some of the highest health disparities and poorest outcomes of all racial or ethnic minority groups in the United States. Across all age groups, suicide is 2.5 times higher in AIANs than the national average (National Indian Council on Aging, 2019). Cultural and institutional barriers prevent AIAN undergraduate and graduate college students from seeking mental health services, and many serious mental health problems remain untreated. While numerous barriers to mental health services exist for AIAN students, Indigenous faculty and support staff who share deep understanding of history, culture and traditional view of health and wellness can reduce the barriers and promote mental health and wellness for students. Shifting the focus to introduce a new narrative gives way to greater recognition of factors that create health and may help academic institutions provide holistic support for AIAN and other underrepresented students. The new narrative includes holistic strength-based support, social support, and fostering cultural identity and pride enhances mental health and success. Indigenization of the doctoral nursing curriculum supports faculty who are committed to decolonizing course content and institutionalized pedagogy. Improved health outcomes for Indigenous individuals and other underrepresented students will positively affect communities through increasing diversity of APRNs, nursing faculty, and nursing scholars.

Latent Profile Analysis of Urges for Suicidal and Self-Harming Behavior: The Role of Social Support Instability

College counseling centers are seeing increasing rates of suicidal thoughts and behaviors, and nonsuicidal self-injury (NSSI) among students. The high degree of need and limited resources underscores the need for novel approaches to identify at-risk students. We used latent profile analysis (LPA) to identify subgroups of students (n = 371) with different patterns of interpersonal factors and examine whether these subgroups differed by risk for self-injurious thoughts and behaviors. The best-fitting LPA had three profiles, which differed in urges to die by suicide and engage in NSSI. The profile with low average social support and higher instability (greater day-to-day fluctuations of self-reported social support and rejection) was associated with greatest risk, suggesting that this combination leaves individuals more vulnerable to suicide and NSSI.

Dopamine and Serotonin Transporter Genes Regulation in Highly Sensitive Individuals during Stressful Conditions: A Focus on Genetics and Epigenetics

Background: Coping with stress is essential for mental well-being and can be critical for highly sensitive individuals, characterized by a deeper perception and processing of stimuli. So far, the molecular bases characterizing high-sensitivity traits have not been completely investigated and gene × environment interactions might play a key role in making some people more susceptible than others. Methods: In this study, 104 young adult university students, subjects that might face overwhelming experiences more than others, were evaluated for the genetics and epigenetics of dopamine (DAT1) and serotonin (SERT) transporter genes, in addition to the expression of miR-132, miR-491, miR-16, and miR-135. Results: We found an increase in DNA methylation at one specific CpG site at DAT1 5'UTR in highly sensitive students reporting high levels of perceived stress when compared to those less sensitive and/or less stressed. Moreover, considering DAT1 VNTR at 3'UTR, we observed that this effect was even more pronounced in university students having the 9/9 genotype when compared to those with the 9/10 genotype. These data are corroborated by the higher levels of miR-491, targeting DAT1, in highly sensitive subjects with high levels of perceived stress. SERT gene DNA methylation at one specific CpG site was reported to instead be higher in subjects reporting lower perceived stress when compared to more stressed subjects. Consistently, miR-135 expression, regulating SERT, was lower in subjects with higher perceived stress. Conclusions: We here suggest that the correlation of DAT1 and SERT genetic and epigenetic data with the analysis of stress and sensitivity might be useful to suggest possible biomarkers to monitor mental health wellness in vulnerable subjects.

Mental health help-seeking willingness among U.S. college students: A resilience factor associated with many sexual minority identities

BACKGROUND

For populations with elevated mental health risks such as college students and minority groups, understanding openness to seeking professional help can inform ways to improve service engagement. This study explores help-seeking willingness among U.S. college students by sexual orientation.

METHODS

Data were drawn from the 2021 National College Health Assessment (N = 64,079). The main outcome of interest was help-seeking willingness (i.e., reported openness to seeking professional mental health help when needed). A secondary outcome was help-seeking history (i.e., past mental health service utilization). Logistic regression analyses were conducted using R version 4.0.5.

RESULTS

Increased help-seeking willingness was detected among students with a help-seeking history, whether within the past 12 months (OR=7.40, 99%CI: 6.78-9.08) or beyond (OR=2.26, 99%CI: 2.11-2.42). Even after controlling for various covariates including help-seeking history, elevated odds of help-seeking willingness persisted for gay (AOR=2.01, 99%CI: 1.63-2.49), bisexual (AOR=1.35, 99%CI: 1.23-1.49), questioning (AOR=1.22, 99%CI: 1.04-1.45), pansexual (AOR=1.31, 99%CI: 1.06-1.63), and queer (AOR=1.78, 99%CI: 1.35-2.38), relative to heterosexual students.

CONCLUSIONS

Help-seeking willingness is a mental health resilience factor unique to several sexual minority groups. Examining what yields greater help-seeking willingness for these sexual minority student groups may inform interventions that enable all college students to seek help when they are in distress.

The Mediated Moderation of Conscientiousness and Active Involution on Zhongyong Practical Thinking and Depression

Purpose

This study integrates traditional Chinese culture, precisely the philosophy of Zhongyong () thinking, with the prevention and treatment of depression.

Samples and Methods

It involved a study with 700 undergraduate students from a college in Guangzhou, using the Negative Zhongyong Scale, the Patient Health Questionnaire-9, and the NEO Five-Factor Inventory for assessments.

Results

The findings demonstrated that negative Zhongyong thinking predicts depression inversely. Additionally, conscientiousness indirectly and positively influences this relationship through active involution, thereby enhancing its overall effect. The analysis used the 2-mediated moderation (2meMO) model, which effectively handles error heterogeneous variances and provides a detailed assessment of the interactions between these variables. The specific findings are as follows: (1) There are correlations among negative Zhongyong thinking, depression, conscientiousness, and active involution; (2) Conscientiousness can directly and positively regulate the association between negative Zhongyong thinking and depression, and it can also indirectly regulate this relationship through active involution; (3) The higher the conscientiousness, the more actively individuals engage in active involution, thereby strengthening the negative predictive effect of negative Zhongyong thinking on depression.

Conclusion

These research findings contribute to the enrichment of theoretical research on the prevention and treatment of depressive symptoms and offer a fresh perspective on the utilization of traditional Chinese culture in depression prevention and treatment.

An Institutional Approach to Equity and Improvement in Child Health Outcomes

Pediatric health inequities are pervasive. Approaches by health care institutions to address inequities often, and increasingly, focus on social needs screening without linked, robust responses. Even when actions in pursuit of health equity do occur within health care institutions, efforts occur in isolation from each other, standing in the way of cross-learning and innovation. Learning network methods hold promise when institutions are confronted with complex, multidimensional challenges. Equity-oriented learning networks may therefore accelerate action to address complex factors that contribute to inequitable pediatric health outcomes, enabling rapid learning along the way. We established an institutional Health Equity Network (HEN) in pursuit of excellent and equitable health outcomes for children and adolescents in our region. The HEN supports action teams seeking to eliminate pediatric health inequities in their clinical settings. Teams deploy targeted interventions to meet patients' and families' needs, addressing both medical and social factors affecting health and wellbeing. The primary, shared HEN measure is the equity gap in hospitalization rates between Black patients and all other patients. The HEN currently has 10 action teams and promotes rapid learning and scaling of interventions via monthly "action period calls" and "solutions labs" focused on successes, challenges, and potential common solutions (eg, scaling of existing medical-legal partnership to subspecialty clinics). In this Advocacy Case Study, we detail the design, implementation, and early outcomes from the HEN, our equity-oriented learning network.

Optimism and mental health in college students: the mediating role of sleep quality and stress

Objective

College students showed a high prevalence of stress, anxiety, and depression, with medical and nursing students experiencing particularly elevated levels of mental health challenges.Optimism significantly influences overall well-being by promoting a healthy lifestyle and cognitive responses. However, the association of optimism with sleep quality, stress, and mental health in college students remains unexplored. This study aimed to (1) explore the associations of optimism with sleep quality, stress, and mental health and (2) ascertain whether sleep quality and stress mediate the association between optimism and mental health among college students.

Methods

A cross-sectional study was conducted using online surveys with students from health science majors at a public university in the northeast United States from September to December 2022. A total of 222 students participated in the study, providing data on sociodemographics, optimism, sleep quality, stress, anxiety, and depression. Parallel and serial mediation models were utilized to examine the potential mediating roles of sleep quality and stress in the association between optimism and mental health.

Results

The study found that optimism influences anxiety and depression through both direct and indirect pathways. In line with predictions, the parallel mediation analysis revealed that the impact of optimism on anxiety (βtotal = -0.598, 95% confident interval [CI]: -0.778 to -0.392) and depression (βtotal = -0.724, 95% CI: -0.919 to -0.519) was mediated by stress and sleep quality. Furthermore, the serial mediation models revealed that stress and sleep quality co-mediated the relationship betweenoptimism and anxiety (indirect effect [IE] = -0.074, 95% CI: -0.135 to -0.029) or depression (IE = -0.084, 95% CI: -0.142 to -0.036) in a sequential manner.

Conclusion

Optimism was negatively correlated with poor sleep quality, stress, anxiety, and depression. Enhanced optimism was linked to high sleep quality and less stress, anxiety, and depression. These insights emphasize the potential for school-based optimism interventions to improve sleep quality, ameliorate stress-related concerns, and alleviate mental health challenges in college students.

Clinical outcomes for sexual and gender minority adolescents in a dialectical behaviour therapy programme

BACKGROUND

Sexuality and gender minoritised (SGM) adolescents are at increased risk of self-injury and suicide, and experience barriers to accessing mental health support. Dialectical behaviour therapy (DBT) is an effective treatment for self-injury and emotion dysregulation in adolescent populations, but few studies have published outcomes of DBT for SGM young people.

AIMS

This study aimed to investigate treatment outcomes and completion for SGM adolescents and their cisgender and heterosexual peers, in the National & Specialist CAMHS, DBT service (UK).

METHOD

Treatment completion, and opting out before and during treatment were examined for sexual and gender identity groups, as well as changes by the end of treatment in emotion dysregulation, self-injury, in-patient bed-days, emergency department attendances, and borderline personality disorder, depression and anxiety symptoms.

RESULTS

SGM adolescents were over-represented in this service, even after considering their increased risk for self-injury. No statistically significant differences were found for treatment completion between the sexual orientation and gender identity groups, although there were patterns indicating possible lower treatment uptake and completion that warrant further investigation. Clinical outcomes for treatment-completers showed improvement by the end of DBT for each group, with few exceptions.

DISCUSSION

These results are from relatively small subsamples, and it was not possible to separate by sex assigned at birth. Findings should be treated tentatively and as early indications of effect sizes to inform future studies. This study suggests that DBT could be a useful treatment for SGM adolescents in a highly specialist treatment setting.

Suicidal ideation, suicide attempt, and self-injury among American Indian, Alaskan Native, and Native Hawaiian college students in the United States from 2015 to 2019

Background

Suicide is a major driver of mortality among college students and is the leading cause of death among American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) young adults.

Methods

Data on suicidal ideation, suicide attempt, and self-injury among AI/AN/NH college students (n = 8103) were analyzed via multivariable logistic regressions employing the American College Health Association National College Health Assessment survey from 2015 to 2019. Adjusted odds ratios (aORs) were used to assess how opioid misuse may act as a risk or protective factor for suicidality and self-injury.

Results

Between 2015 and 2019, suicidal ideation was the most prevalent dimension of suicidality affecting AI/AN/NH college students (ranges from 12.69% to 18.35%), followed by self-injury (7.83%-11.41%) and suicide attempt (2.40%-4.10%). AI/AN/NH college students who reported opioid misuse were significantly more likely to experience suicidal ideation (aOR: 1.417; 95% confidence interval [CI]: 1.154-1.740) and self-injury (aOR: 1.684; 95% CI: 1.341-2.116) than those who did not engage in such behavior.

Conclusions

We identified opioid misuse as a potential risk factor for suicidal ideation and intentional self-injury among populations of AI/AN/NH college students. Programs seeking to reduce suicide prevalence among Indigenous college students may benefit from the inclusion of evidence-based interventions that prevent and treat issues related to opioid use.

Profiles of mental illness in college students and associated factors: A latent class analysis

Mental illness among university students poses a pressing challenge for educational institutions, urging the need for strategies that foster health and mitigate mental distress, with an emphasis on preventing suicide. Our study sought to discern the profiles of mental illness among college students and explore the factors associated with them. We examined data from 918 students at a Brazilian Federal Institute, utilizing Latent Class Analysis and multinomial regression for our analyses. We identified three distinct mental illness profiles: Anxiety with Low Suicide Risk; Mental Illness with Moderate Suicide Risk; and Mental Illness with High Suicide Risk. We observed a reduced association of these profiles with religious beliefs. Conversely, there was a heightened association with cisgender women, individuals identifying as LGBTQI+, those with learning disabilities, and victims of sexual violence. Our findings underscore the importance of tailored prevention and health promotion programs to enhance student well-being. There's a compelling need to devise mental health strategies tailored to the specific needs of the identified groups, particularly students from the LGBTQI + community, survivors of sexual abuse, and those grappling with learning disabilities.

The Relationship Between Academic Stress, Sleep Quality, and Psychological Wellbeing in Pasifika and New Zealand European Students at the University of Otago

BACKGROUND

Pasifika students in New Zealand are overrepresented in poor academic outcomes, and their academic challenges may potentially influence their wellbeing. We aim to: 1) compare the academic stress, sleep quality, and psychological wellbeing of Pasifika and New Zealand European (NZE) anatomy students at the University of Otago, and 2) determine if academic stress mediates the association between their psychological wellbeing and sleep quality.

METHODS

We launched a brief online survey to Pasifika and NZE students in our department. The survey included basic demographics, Perception of Academic Stress Scale, Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale, a short loneliness scale, a reduced morningness-eveningness scale, and the Epworth Sleepiness Scale.

RESULTS

Perceived academic stress were comparable between NZE and Pasifika students, but Pasifika students reported poorer sleep quality than NZE students (t(113) = 14.41, P < .001). In addition, Pasifika students reported more loneliness (t(119) = 8.933, P < .001), less anxiety symptoms (t(120) = 2.469, P = .015), and less of a morning person (t(121) = 2.618, P = .010) than NZE students, but they had comparable depressive symptoms and daytime sleepiness. After controlling for age, ethnicity and gender, we found that academic stress fully mediated the relationship between anxiety or depressive symptoms and poor sleep quality. Furthermore, academic stress partially mediated the relationship between loneliness and poor sleep quality in our cohort.

CONCLUSION

Our findings highlight the importance for academic institutions to support students' wellbeing, including ethnic minority students such as Pasifika students in New Zealand.

Mental health among U.S. College students: implications of COVID-19 and roles of institutional and individual characteristics

Previous research on college campus environments, student mental health, and COVID-19 has primarily focused on individual-level factors, with limited attention to the broader institutional characteristics. Objective and Methods: Using the national survey data from the American College Health Association, this study examines the influence of both individual-level and institutional-level characteristics on college students' stress, psychological distress, and psychological well-being, before and during COVID-19. Results: (1) COVID-19 significantly impacted students' mental health; (2) institutional-level factors, such as school size, locale, region, and religiously affiliation, were significant predictors of mental health outcomes; and (3) individual-level variables, including gender, age, race/ethnicity, relationship status, moderated the relationship between COVID-19 and mental health. Conclusion: This study suggests the need to consider various institutional contexts in future efforts to understand predictors of mental health conditions and resilience.

Examining the Etiology of Asian American Suicide in the United States

Research highlights racial and ethnic disparities in suicide, but Asian American suicide receives very little attention in the literature. This is the first comprehensive, large-scale, nationally representative study of completed suicide among Asian Americans in the United States. Descriptive and multilevel regression techniques compared the risk factors for completed suicide across 227,786 Asian American, White, African American, Hispanic, and American Indian suicide decedents from 2003 to 2019. Results indicated that Asian American suicide decedents were significantly less likely than their counterparts to have several risk factors for suicide. Asian Americans were less likely to be male, uneducated, and unmarried. Asian Americans were less likely to use alcohol and drugs, to have mental health problems, and to die by firearm, relative to other suicide methods. Asian Americans were less likely to have a history of prior suicide attempts, to have intimate partner problems, and to have criminal legal problems. Conversely, Asian Americans were more likely to reside in places with higher levels of concentrated disadvantage, residential instability, racial and ethnic heterogeneity, and population density. The results underscore the need for race-specific suicide prevention strategies that, for Asian Americans in particular, take into account cultural values and barriers to help-seeking behavior.

Association between Parenting Styles and Adolescents' Mental Disorders: Findings among Pre-University Students

Background

Existing research indicated a high prevalence of mental health issues among adolescents. Gender and parenting styles are two factors that may influence adolescents' mental health. Nonetheless, most published studies focused on either secondary school or university students. In contrast, there is a dearth of similar research involving pre-university students. This study aimed to determine the prevalence of mental disorders among pre-university students and their association with parenting styles.

Methods

A cross-sectional study via online questionnaire survey was conducted among students from a pre-university college on the East Coast of Malaysia. Convenience sampling was used to recruit the participants. The questionnaire consisted of three parts: i) sociodemographic data, ii) the Parental Authority Questionnaire and Depression, and iii) the Anxiety and Stress Scale (DASS-21). An online invitation to answer the questionnaire was done via the Student Representative Council (SRC). Data were analysed using descriptive statistics and Pearson's chi-square test.

Results

A total of 431 participants responded to the online survey. The prevalence of depression, anxiety and stress was 49.0% (n = 210), 68.0% (n = 293) and 37.6% (n = 162), respectively. In addition, father's educational level (χ2 = 10.332, P = 0.001) and the authoritarian parenting style (χ2 = 10.099, P = 0.006) were significantly associated with mental health disorders among adolescents.

Conclusion

The prevalence of mental disorders among pre-university students is relatively high. Pre-university admission mental health screening is vital for early detection and intervention of mental disorders among this vulnerable group. Further research is imperative to establish a comprehensive plan of action that targets parental involvement in managing adolescent mental health disorders.

Mobile apps to reduce depressive symptoms and alcohol use in youth: A systematic review and meta-analysis: A systematic review

Background

Among youth, symptoms of depression, anxiety, and alcohol use are associated with considerable illness and disability. Youth face many personal and health system barriers in accessing mental health care. Mobile applications (apps) offer youth potentially accessible, scalable, and anonymous therapy and other support. Recent systematic reviews on apps to reduce mental health symptoms among youth have reported uncertain effectiveness, but analyses based on the type of app-delivered therapy are limited.

Objectives

We conducted this systematic review with youth co-researchers to ensure that this review addressed the questions that were most important to them. The objective of this review is to synthesize the best available evidence on the effectiveness of mobile apps for the reduction of depressive symptoms (depression, generalized anxiety, psychological distress) and alcohol use among youth.

Search Methods

We conducted electronic searches of the following bibliographic databases for studies published between January 1, 2008, and July 1, 2022: MEDLINE (via Ovid), Embase (via Ovid), PsycINFO (via Ovid), CINAHL (via EBSCOHost), and CENTRAL (via the Cochrane Library). The search used a combination of indexed terms, free text words, and MeSH headings. We manually screened the references of relevant systematic reviews and included randomized controlled trials (RCTs) for additional eligible studies, and contacted authors for full reports of identified trial registries or protocols.

Selection Criteria

We included RCTs conducted among youth aged 15-24 years from any setting. We did not exclude populations on the basis of gender, socioeconomic status, geographic location or other personal characteristics. We included studies which assessed the effectiveness of app-delivered mental health support or therapy interventions that targeted the management of depressive disorders and/or alcohol use disorders. We excluded apps that targeted general wellness, apps which focused on prevention of psychological disorders and apps that targeted bipolar disorder, psychosis, post-traumatic stress disorder, attention-deficit hyperactivity disorder, substance use disorders (aside from alcohol), and sleep disorders. Eligible comparisons included usual care, no intervention, wait-list control, alternative or controlled mobile applications. We included studies which reported outcomes on depressive symptoms, anxiety symptoms, alcohol use and psychological distress over any follow-up period.

Data Collection and Analysis

We standardized the PICO definitions (population, intervention, comparison, and outcome) of each included study and grouped studies by the type of therapy or support offered by the app. Whenever app design and clinical homogeneity allowed, we meta-analyzed outcomes using a random-effects model. Outcome data measured using categorical scales were synthesized using odds ratios. Outcome data measured using continuous scales were synthesized as the standardized mean difference. We assessed the methodological quality of each included study using the Cochrane Risk of Bias 2.0 tool and we assessed certainty of the evidence using the GRADE approach.

Main Results

From 5280 unique citations, we included 36 RCTs published in 37 reports and conducted in 15 different countries (7984 participants). Among the 36 included trials, we assessed two with an overall low risk of bias, 8 trials with some concern regarding risk of bias, and 26 trials with a high risk of bias. Interventions varied in the type of therapy or supports offered. The most common intervention designs employed mindfulness training, cognitive behavioral therapy (CBT), or a combination of the two (mindfulness + CBT). However, other interventions also included self-monitoring, medication reminders, cognitive bias modification or positive stimulation, dialectical behavioral therapy, gamified health promotion, or social skill building. Mindfulness apps led to short term improvements in depressive symptoms when compared to a withheld control (SMD = -0.36; 95% CI [-0.63, -0.10]; p = 0.007, n = 3 RCTs, GRADE: very low certainty) and when compared to an active control (SMD = -0.27; 95% CI [-0.53, -0.01]; p = 0.04, n = 2 RCTs, GRADE: very low). Apps delivering this type of support also significantly improved symptoms of anxiety when compared to a withheld control (SMD = -0.35; 95% CI [-0.60, -0.09]; p = 0.008, n = 3 RCTs, GRADE: very low) but not when compared to an active control (SMD = -0.24; 95% CI [-0.50, 0.02]; p = 0.07, n = 2 RCTs, GRADE: very low). Mindfulness apps showed improvements in psychological stress that approached statistical significance among participants receiving the mindfulness mobile apps compared to those in the withheld control (SMD = -0.27; 95% CI [-0.56, 0.03]; p = .07, n = 4 RCTs, GRADE: very low). CBT apps also led to short-term improvements in depressive symptoms when compared to a withheld control (SMD = -0.40; 95% CI [-0.80, 0.01]; p = 0.05, n = 2 RCTs, GRADE: very low) and when compared to an active control (SMD = -0.59; 95% CI [-0.98, -0.19]; p = 0.003, n = 2 RCTs, GRADE: very low). CBT-based apps also improved symptoms of anxiety compared to a withheld control (SMD = -0.51; 95% CI [-0.94, -0.09]; p = 0.02, n = 3 RCTs, GRADE: very low) but not when compared to an active control (SMD = -0.26; 95% CI [-1.11, 0.59]; p = 0.55, n = 3 RCTs, GRADE: very low). Apps which combined mindfulness and CBT did not significantly improve symptoms of depression (SMD = -0.20; 95% CI [-0.42, 0.02]; p = 0.07, n = 2 RCTs, GRADE: very low) or anxiety (SMD = -0.21; 95% CI [-0.49, 0.07]; p = 0.14, n = 2 RCTs, GRADE: very low). However, these apps did improve psychological distress (SMD = -0.43; 95% CI [-0.74, -0.12]; p = 0.006, n = 2 RCTs, GRADE: very low). The results of trials on apps to reduce alcohol use were inconsistent. We did not identify any harms associated with the use of apps to manage mental health concerns. All effectiveness results had a very low certainty of evidence rating using the GRADE approach, meaning that apps which deliver therapy or other mental health support may reduce symptoms of depression, anxiety and psychological distress but the evidence is very uncertain.

Authors' Conclusions

We reviewed evidence from 36 trials conducted among youth. According to our meta-analyses, the evidence is very uncertain about the effect of apps on depression, anxiety, psychological distress, and alcohol use. Very few effects were interpreted to be of clinical importance. Most of the RCTs were small studies focusing on efficacy for youth at risk for depressive symptoms. Larger trials are needed to evaluate effectiveness and allow for further analysis of subgroup differences. Longer trials are also needed to better estimate the clinical importance of these apps over the long term.

Racial/Ethnic Trends in Virtual Mental Health Care Utilization Among Undergraduate Students: A Descriptive Study

BACKGROUND

Undergraduate students are particularly in need of mental health support, but demand has far surpassed resources. This gap between mental health diagnoses and support is particularly large among Asian, Hispanic/Latinx, and Black students. Supplementing on-campus care with a virtual-only behavioral health partner may shift these trends.

OBJECTIVE

This study is aimed at comparing the number of undergraduate students from different racial/ethnic groups (White, Asian, Islander, Hispanic/Latinx, Black, Native, and Multiracial) engaging in virtual mental health visits as part of a partnership with a company providing virtual-only care, with the total enrolled undergraduate students at the same 113 institutions.

METHODS

We used de-identified visit data and self-reported race/ethnicity to define the "patient" population of undergraduates accessing care. We compared that to the full "student" population of undergraduates among the same schools, available as part of the Integrated Postsecondary Education Data System (IPEDS).

RESULTS

Patient population race/ethnicity (N = 14,870) differed significantly from student population race/ethnicity (N = 619,459). A significant effect ( χ 26 = 2258, P < .001) indicated that patient demographics differed from student demographics. We found proportionally more Asian, Black, and Multiracial patients than students. At the same time, we found proportionally fewer White and Hispanic/Latinx patients than students.

CONCLUSIONS

We conclude that, in contrast to prior literature in traditional mental health care, some racial/ethnic minority undergraduates (Asian, Black, and Multiracial) may actually access care at a higher rate under a fully virtual model. On the other hand, White and Hispanic/Latinx students may access care less frequently.

Procrastination, depression and anxiety symptoms in university students: a three-wave longitudinal study on the mediating role of perceived stress

BACKGROUND

It is generally assumed that procrastination leads to negative consequences. However, evidence for negative consequences of procrastination is still limited and it is also unclear by which mechanisms they are mediated. Therefore, the aim of our study was to examine the harmful consequences of procrastination on students' stress and mental health. We selected the procrastination-health model as our theoretical foundation and tried to evaluate the model's assumption that trait procrastination leads to (chronic) disease via (chronic) stress in a temporal perspective. We chose depression and anxiety symptoms as indicators for (chronic) disease and hypothesized that procrastination leads to perceived stress over time, that perceived stress leads to depression and anxiety symptoms over time, and that procrastination leads to depression and anxiety symptoms over time, mediated by perceived stress.

METHODS

To examine these relationships properly, we collected longitudinal data from 392 university students at three occasions over a one-year period and analyzed the data using autoregressive time-lagged panel models.

RESULTS

Procrastination did lead to depression and anxiety symptoms over time. However, perceived stress was not a mediator of this effect. Procrastination did not lead to perceived stress over time, nor did perceived stress lead to depression and anxiety symptoms over time.

CONCLUSIONS

We could not confirm that trait procrastination leads to (chronic) disease via (chronic) stress, as assumed in the procrastination-health model. Nonetheless, our study demonstrated that procrastination can have a detrimental effect on mental health. Further health outcomes and possible mediators should be explored in future studies.

Prevalence and Correlates of Health Risk Behaviors among University Students from a State in the Southern Region of Brazil

BACKGROUND

Surveys conducted in different regions of the world show that the prevalence rates of health risk behaviors (HRBs) in university students are sometimes higher than those found in non-university populations. This study aims to identify the prevalence rates and demographic and academic environment correlates associated with HRBs among Brazilian university students.

METHODS

In a cross-sectional epidemiological study, a random sample of 5310 university students answered an online questionnaire, with demographic (sex, age, skin color, marital status, and paid work) and academic setting information (housing type, size of campus, year, and shift of study), as well as items clustered in four HRB domains: personal safety and violence, sexual behavior and contraception, addictive substance use, eating habits, physical activity, and sleep. The data were analyzed statistically using bivariate analysis and hierarchical multiple regression.

RESULTS

The highest prevalence rates occurred in HRBs clustered in the domain of eating habits, physical activity, and sleep (>60%), while HRBs for personal security and violence were less prevalent (<15%). From 15% to 35% of university students assumed HRBs regarding addictive substance use, and approximately 50% reported risky sexual behavior. The university students most susceptible to HRBs were men, aged ≥ 22 years, living far from their family, studying on larger campuses, attending night classes, and with two or more years of study at the university.

CONCLUSION

The findings suggest that policies and interventions in the university context aimed at students' readiness to engage in a healthy lifestyle should target specific correlates associated with HRBs.

Using recursive partitioning to predict presence and severity of suicidal ideation amongst college students

OBJECTIVE

Predicting the presence and severity of suicidal ideation in college students is important, as deaths by suicide amongst young adults have increased in the past 20 years.

PARTICIPANTS

We recruited college students (N = 5494) from ten universities across eight states.

METHOD

Participants answered three questionnaires related to lifetime and past month suicidal ideation, and an indicator of suicidal ideation in a DSM-5 symptom measure. We used recursive partitioning to predict the presence, absence, and severity, of suicidal ideation.

RESULTS

Recursive partitioning models varied in their accuracy and performance. The best-performing model consisted of predictors and outcomes measured by the DSM-5 Level 1 Cross-Cutting Symptom Measure. Sexual orientation was also an important predictor in most models.

CONCLUSIONS

A single measure of DSM-5 symptom severity may help universities understand suicide severity to promote targeted interventions. Though further work is needed, as similar scaling amongst predictors could have influenced the model.

Associations between discrimination experiences and symptoms of depression and anxiety among transgender adults: a nationwide cohort study of 269 transgender adults in South Korea

PURPOSE

Recently, there has been an increase in awareness of social stigma and mental health issues experienced by transgender individuals in South Korea. To provide quantitative evidence, we conducted a nationwide cohort study of transgender adults, first of its kind in Asia. The aim of the study is to assess the prevalence of depressive and anxiety symptoms and examine their associations with discrimination experiences among transgender adults.

METHODS

We conducted a two-wave longitudinal survey of 269 Korean transgender adults, where the baseline was collected in October 2020 and the follow-up in October 2021. Experiences of discrimination in the past 12 months at follow-up were categorized accordingly: those who experienced (1) none, (2) only anti-transgender discrimination, (3) only other types of discrimination, and (4) both anti-transgender and other types of discrimination. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression scale at both waves and anxiety symptoms were measured using the Generalized Anxiety Disorder 7 only at follow-up. We used modified Poisson regression to examine the association between experiences of discrimination and mental health outcomes at follow-up and adjusted for sociodemographic characteristics and baseline depressive symptoms.

RESULTS

A total of 63.9% had depressive symptoms and 47.2% had anxiety symptoms. Participants who experienced both anti-transgender and other types of discrimination had 1.38-times (95% CI 1.06-1.81) and 1.77-times (95% CI 1.16-2.70) higher prevalence of depressive and anxiety symptoms, respectively, compared to those without any experiences of discrimination.

CONCLUSIONS

Interventions to lessen discrimination towards transgender individuals are needed for the promotion of mental health among transgender individuals.

Navigating college campuses: The impact of stress on mental health and substance use in the post COVID-19 era

The college years are one of excitement and often thought of as a dream like setting of growth, creativity, and independence. This exciting time can be marred by the onset or exacerbation of mental health conditions, alcohol, and/or drug dependence. This writing looks to explore the world of college mental health and the changes the provisions of this type of care has undergone during and after the COVID-19 pandemic. We look at the staggering rates of diagnosed mental health diagnoses and mental health related symptoms that may undermine a student's ability to meet their full growth and academic potential. We look to explore different health settings where college age students are accessing care and how that care is being delivered (e.g. community vs on-campus, telehealth vs in-person). We also aim to highlight specific mental health conditions (e.g. anxiety, depression, suicidality, PTSD) and specific student stressors (e.g. participating in athletics, socioeconomic pressures) to underscore the message that the mental health of college age students is an area that needs continued study and engagement of all parties involved in student development and well-being.

Association between sugar-sweetened beverages and duration of physical exercise with psychological symptoms among Tibetan university students at high altitude

Background

Sugar-sweetened beverages (SSBs) and duration of physical exercise are strongly associated with physical health. Unfortunately, there are few studies focused on the association with psychological symptoms, let alone Tibetan university students at high altitudes in China.

Methods

A stratified cluster sampling method was used to include 8,268 Tibetan university students aged 19-22 years in Qinghai and Tibet, both of which are high-altitude regions of China. Self-assessment questionnaires on SSBs, duration of physical exercise, and psychological symptoms were administered. The chi-square test and logistic regression analysis were used to analyze the associations among them.

Results

The detection rate of psychological symptoms among Tibetan university students in high-altitude areas of China was 16.7%, with in girls (18.2%) higher than that in boys (14.8%), and the difference was statistically significant (χ2 = 11.73, p < 0.01). The proportion of SSBs for university students ≤1 time/week, 2-5 times/week, and ≥ 6 times/week were 54.2, 24.3, and 21.5%, respectively. The proportion of duration of physical exercise for >60 min/d was only 5.4%. Logistic regression analysis showed that compared with the SSBs ≤1 time/week group of university students, SSBs 2-5 times/week (OR = 1.45, 95% CI: 1.24-1.70) and ≥ 6 times/week (OR = 3.06, 95% CI: 2.62-3.57) had an increased risk of psychological symptoms (p < 0.001). In the reference group, the risk of psychological symptoms was also significantly increased in the group of university students with duration of physical exercise >60 min/d (OR = 2.08, 95% CI: 1.48-2.93), and the risk of psychological symptoms was also significantly increased in the group with duration of physical exercise <30 min/d (OR = 2.08, 95% CI: 1.48-2.93). The risk of psychological symptoms was also significantly increased in the university students with the duration of physical exercise <30 min/d (OR = 2.08, 95% CI: 1.48 ~ 2.93) group.

Conclusion

SSBs and exercise time may be important influences on the psychological symptoms of Tibetan university students at high altitudes in China. This study has important implications for mental health planning in universities in highland areas and may also provide guidance for mental health interventions for Tibetan university students.

Motivation to change predicts college students' utilization of self-help resources

Background: Stress and mental health difficulties are common burdens on college students. College counseling centers have been overrun by demand. Thus, self-help interventions may offer a promising alternative to traditional college counseling services. Methods: The current study examined the influence of perceived stress, motivation to change, and self-efficacy beliefs on college students' use of self-help resources, to determine whether these factors would predict follow-up with self-help recommendations. Results: Results of stepwise linear regression models suggest that perceived stress and self-efficacy did not predict self-help resource utilization. Different types of self-help recommendations did not predict different levels of follow-up. However, motivation to change was a significant predictor college students' self-help resource use, and this variable was particularly important when self-help recommendations were less structured. Conclusions: These findings can help to predict which college students are likely to make use of self-help resources, and inform targeted individual treatment.

Investigation into the relationships between Greek life, experiences of violence, and suicidal thoughts and behaviors among undergraduate students

Introduction: This study aims to examine how involvement in Greek life impacts the relationships between violence and STBs. Methods: This study utilizes data from the American College Health Association-National College Health Assessment (ACHA-NCHA) waves IIb, IIc, and III. Analyses examine the moderating effect of involvement in Greek life on the relationship between violence and presence of STBs in the past year. Results: Main effects revealed consistent patterns across violence types, STBs and waves, with Greek life membership associated with increased odds of experiencing violence and associated with decreased odds of suicidal ideation. The relationship between violence and suicide attempts was stronger for those involved in Greek life. Discussion: Greek life may be an institution where targeted interventions for suicide and violence may be effective. It may be important to identify additional avenues to reduce STBs that are not associated with increased experiences of violence.

Relationship between Psychosocial Factors and Physical Activity among Undergraduate Students from a South African University

Psychosocial factors such as mental health, motivation, and social support are key determinants of behavior that play a significant role in physical activity participation. Limited studies have investigated the relationship between psychosocial factors and physical activity among university students in Africa. The aim of this study was to determine the relationship between psychosocial factors and physical activity participation among undergraduate university students at a historically disadvantaged university (HDU) in South Africa. This was a cross-sectional study that used convenience sampling (n = 534, majority female, 53.6% with a mean age of 20.69). The study was conducted through an online, self-administered, and hard-copy, valid questionnaire in September 2022. Data on sociodemographic information were collected. Psychosocial factors were assessed using the Depression, Anxiety, and Stress-21 Scale for mental health, the Physical Activity and Leisure Motivation Scale for motivation, and the Perceived Social Support Scale for social support. Physical activity (calculated as MET-min/week) was assessed using the international physical activity questionnaire in short form. Results revealed that almost a third (29%) of undergraduate students were physically inactive, 31.1% were minimally active, and 39.9% were in the health-enhancing category. Physical activity was positively related to stress (r = 0.11, p < 0.05) and anxiety (r = 0.10, p < 0.05). Motivational factors were positively related to psychological condition and others' expectations (r = 0.10, p < 0.05), and depression and others' expectations (r = 0.11, p < 0.05). Results from this study highlighted that psychosocial factors were related to physical activity participation among undergraduate university students. Psychosocial factors should be considered a coping mechanism when implementing health-promoting strategies.

An Interpretable Machine Learning Approach to Predict Sensory Processing Sensitivity Trait in Nursing Students

Sensory processing sensitivity (SPS) is a personality trait that makes certain individuals excessively sensitive to stimuli. People carrying this trait are defined as Highly Sensitive People (HSP). The SPS trait is notably prevalent among nursing students and nurse staff. Although there are HSP diagnostic tools, there is little information about early detection. Therefore, the aim of this work was to develop a prediction model to identify HSP and provide an individualized nursing assessment. A total of 672 nursing students completed all the evaluations. In addition to the HSP diagnosis, emotional intelligence, communication skills, and conflict styles were evaluated. An interpretable machine learning model was trained to predict the SPS trait. We observed a 33% prevalence of HSP, which was higher in women and people with previous health training. HSP were characterized by greater emotional repair (p = 0.033), empathy (p = 0.030), respect (p = 0.038), and global communication skills (p = 0.036). Overall, sex and emotional intelligence dimensions are important to detect this trait, although personal characteristics should be considered. The present individualized prediction model could help to predict the presence of the SPS trait in nursing students, which may be useful in conducting intervention strategies to avoid the negative consequences and reinforce the positive ones of this trait.

Associations between feelings of safety, concerns about firearms on campus and suicidal thoughts and behaviours among college students

BACKGROUND

Perceptions of safety on campus may be related to a variety of factors such as concerns about campus violence, especially firearm violence, and mental health, particularly suicidal thoughts and behaviours (STBs). The present analyses aim to describe associations between feelings of safety, concerns about firearms on campus and STBs among college students.

METHODS

This study uses data from the American College Health Association-National College Health Assessment wave III (n=24 682 participants across k=29 schools). Multilevel logistic regressions and cumulative link mixed models examine the associations between feelings of safety, concerns about firearm violence on campus and presence of STBs in the past year.

RESULTS

Participants who reported being concerned about firearm violence felt significantly less safe. Feeling unsafe at night was significantly associated with suicidal ideation and suicide attempts. Individuals with concerns about firearm safety on campus were up to 42% more likely to report suicidal ideation compared with those reporting they were not at all concerned about campus firearm violence.

DISCUSSION

With associations highlighting increased risk of STBs among those with reduced safety feelings and heightened concerns about firearms, there is a need for college campuses to intervene and promote campus safety, with particular consideration for the presence of firearms on campus and the implications of allowing such weapons to be present in environments with increasing instances of firearm violence.

Developing recommendations to improve identification, prevention, and response to suicide thoughts and behaviours among post-secondary students: A mixed methods study

Objective: This study aimed to generate recommendations regarding how to identify, prevent and respond to suicide thoughts and behaviors among post-secondary students. Methods: A convergent mixed-methods design with Nominal Groups Technique (NGT) was used. Post-secondary and high-school students and their caregivers generated and ranked recommendations. A Codebook Thematic Analysis approach guided analysis of the NGT-discussions and extended understanding of recommendations. Results: 88 individuals participated in 21 panels. Five key recommendations were identified: (1) increase student and staff education regarding suicide identification, prevention, and awareness of existing supports; (2) enhance rapid access to supports for those experiencing a crisis; (3) improve institutional academic supports for students following crisis; (4) reduce stigma; (5) improve communication regarding on-campus suicide. Common themes included perceived impact of attitudes, institutional barriers, and peer-support on suicide thoughts and behaviors. Conclusions: These recommendations can inform the development of student-centred interventions for improving mental health supports.

Artificial intelligence significantly facilitates development in the mental health of college students: a bibliometric analysis

Objective

College students are currently grappling with severe mental health challenges, and research on artificial intelligence (AI) related to college students mental health, as a crucial catalyst for promoting psychological well-being, is rapidly advancing. Employing bibliometric methods, this study aim to analyze and discuss the research on AI in college student mental health.

Methods

Publications pertaining to AI and college student mental health were retrieved from the Web of Science core database. The distribution of publications were analyzed to gage the predominant productivity. Data on countries, authors, journal, and keywords were analyzed using VOSViewer, exploring collaboration patterns, disciplinary composition, research hotspots and trends.

Results

Spanning 2003 to 2023, the study encompassed 1722 publications, revealing notable insights: (1) a gradual rise in annual publications, reaching its zenith in 2022; (2) Journal of Affective Disorders and Psychiatry Research emerged were the most productive and influential sources in this field, with significant contributions from China, the United States, and their affiliated higher education institutions; (3) the primary mental health issues were depression and anxiety, with machine learning and AI having the widest range of applications; (4) an imperative for enhanced international and interdisciplinary collaboration; (5) research hotspots exploring factors influencing college student mental health and AI applications.

Conclusion

This study provides a succinct yet comprehensive overview of this field, facilitating a nuanced understanding of prospective applications of AI in college student mental health. Professionals can leverage this research to discern the advantages, risks, and potential impacts of AI in this critical field.

Depression, anxiety, and suicidal behaviors in a large-scale national survey of student athletes versus non-athlete college students: risk and protective factors

OBJECTIVE

This study investigates the prevalence and risk factors of internalizing disorders and suicidal behaviors in student-athletes and their non-athlete peers.

PARTICIPANTS

The sample consisted of 223,226 college students (69,404 student-athletes [31.09%]) who participated in the NCHA-ACHA II survey (Fall 2015-2018).

METHODS

Items from the NCHA-ACHA II were used to assess severity of depression, anxiety, and suicidal behaviors. Chi-squared Test of Independence and multinomial logistic regressions were used to examine self-reported internalizing symptoms, previous diagnosis, previous use of mental health resources, and suicidal behaviors within student-athletes and non-athletes.

RESULTS

Findings indicated high rates of internalizing symptoms. Student-athletes, both varsity and intramural/club, displayed decreased odds of internalizing symptoms, self-reported mental health diagnosis, and suicidal behaviors.

CONCLUSIONS

This study with a national sample expands previous studies showing concerning rates of mental health difficulties, student-athletes demonstrated lower odds. These findings highlight the importance of further research and need for targeted intervention within this population.

Weight Stigma Associated With Mental Health Concerns Among College Students

INTRODUCTION

Weight stigma is widespread and exists across numerous domains including health care, educational institutions, workplaces, mass media, and interpersonal relationships. Weight stigma experienced during the college years may be particularly consequential because the college years are a period of increased vulnerability for the development of mental health concerns. The purpose of the present study was to examine how experiences of weight stigma relate to mental health concerns, including symptoms of eating disorders, anxiety, and depression, among college students.

METHODS

Prevalence of interpersonal and anticipated weight stigma was examined among 2,707 students participating in the 2018-2019 and 2019-2020 Healthy Minds Study and tested for differences in prevalence across student characteristics. Logistic regression was used to explore relationships between measures of weight stigma and student mental health. Analyses were conducted in 2021-2023.

RESULTS

Interpersonal and anticipated weight stigma were reported by 12.3% and 15.3% of students, respectively. Experiences of interpersonal and anticipated weight stigma were generally lowest among cisgender male students, heterosexual students, those with the fewest financial concerns, and those who did not perceive themselves to be "overweight." Both interpersonal and anticipated weight stigma were associated with elevated odds of high weight concerns, past-month binge eating, past-month purging, high eating disorder risk, moderate/severe anxiety symptoms, and moderate/severe depressive symptoms.

CONCLUSIONS

Findings implicate interpersonal and anticipated weight stigma as potential risk factors for a range of mental health concerns. Weight stigma is an under-recognized and under-funded public health problem.

Effect of vicarious discrimination on race-based stress symptoms among Asian American young adults during the COVID-19 pandemic

OBJECTIVE

The COVID-19 pandemic has led to a rise in anti-Asian hate crimes in the United States. Previous work has established that experiencing racism increases one's dysfunctional anxiety and avoidance actions-key symptoms of race-based stress symptoms. However, the psychological impact of vicarious, or secondhand, discrimination (witnessing racism targeting one's own race group) remains less understood.

METHOD

We tested the hypothesis that higher reported vicarious discrimination would be associated with higher levels of race-based stress symptoms reported by Asian American young adults (n = 135) during the pandemic using a cross-sectional analysis of the COVID-19 Adult Resilience Experiences Study (CARES). Starting in April 2020, CARES assessed sociodemographic characteristics and key psychometric scales in young adults through three waves of online surveys.

RESULTS

Our multiple regression analysis showed vicarious discrimination significantly predicted race-based stress symptoms, even after controlling for direct discrimination (p < .01). This association remained significant after controlling for age, gender, subjective childhood family social status, and preexisting psychiatric disorders (p < .01). Our results demonstrate that regardless of the effect that direct discrimination might have on race-based stress symptoms, witnessing discrimination against members of one's own racial group is significantly associated with increased race-based stress symptoms (b = 2.68, p < .01). Social media was the most common source of vicarious discrimination, with one out of three participants in our sample reporting nearly daily exposure.

CONCLUSION

Providers should intentionally create a space within the therapeutic setting to discuss the effects of vicarious discrimination. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supports for university counselors impacted by student suicide: A systematic review and thematic synthesis

The purpose of this systematic review and thematic synthesis was to identify and consolidate research on the support needs of impacted Higher Education (HE) counselors that have experienced a student suicide death. When exposed to a student suicide death, counselors are often extensively involved in a postvention response. This systematic review synthesized four qualitative papers that explored the experiences of staff impacted by student suicide. Thematic synthesis revealed three core themes: The unknown, responding, and the known, and six subthemes: Gaps in knowledge of individual experience, gaps in knowledge of organizational impact, extrospective responding, introspective responding, the needs of impacted counselors, the degree of impact, and the support processes that arise from needs. The results provide a summary of the current supports available to impacted HE counselors and considerations relevant to their postvention needs.

Assessing the mindfulness predictors of mental health: does mindfulness practise or dispositional mindfulness better protect young peoples' mental health?

Background

University is an important time in a young person's life. Although it is a time of exploration, self-discovery and socialising, it is also a time of increased vulnerability to mental health problems such as anxiety and depression. Studies have shown that engagement in mindfulness activities can have a positive effect on mental health. However, research is limited in its scope in particular in relation to stressful (transitional) periods of life.

Methods

The current study aims to address this issue by providing evidence on the predictive impact of both mindfulness practice and 'dispositional' (or trait) mindfulness on students' mental health. In total, we gathered data from 190 first-year students.

Results

A multiple regression was utilised for data analysis. This showed that 'dispositional' mindfulness, but not mindful activity had a significant impact on mental health scores.

Conclusion

This provides data for future research into the effectiveness of mindfulness interventions for student adaptation to university and potential interventions.

The impact of problematic mobile phone use and the number of close friends on depression and anxiety symptoms among college students

Background

Psychological problems often occur in college students, with the most common ones being depression and anxiety symptoms. Exploring the risk factors that influence depression and anxiety symptoms in college students is essential to promote their physical and mental health.

Objective

This study aimed to investigate the independent and interaction effects of problematic mobile phone use (PMPU) and the number of close friends (NCFs) on depression and anxiety symptoms and the comorbidity of these symptoms among college students.

Methods

A cross-sectional survey was conducted in Huainan, Anhui Province, and Suzhou, Jiangsu Province in China from October to December 2022. Data from 7,617 college students were collected. The Patient Health Questionnaire and Generalized Anxiety Disorder-7 were used to evaluate depression and anxiety symptoms. The PMPU data were collected by the Mobile Phone Addiction Type Scale. Multinomial logistic regression models were performed to examine the associations of PMPU and NCFs with depression and anxiety symptoms and their interaction effects.

Results

PMPU and lack of close friends significantly increased the risk of depression and anxiety symptoms and the comorbidity of these symptoms in college students (p < 0.001). In addition, the effects of PMPU and lack of close friends on depression and anxiety symptoms in college students were interactive (p < 0.001). No significant sex differences were found.

Conclusion

PMPU and lack of close friends are important risk factors for depression, anxiety, and the comorbidity of these symptoms in college students in China.

Perceived stress and resilience among college students: The roles of self-compassion and anxiety symptomatology

OBJECTIVE

The current study explored the role of self-compassion on the relationship between perceived stress and resilience among college students experiencing different levels of anxiety symptomatology.

PARTICIPANTS

Three hundred and forty-five undergraduate students (Mage= 19.66; 74.8% female) were recruited from a public university in the northeastern United States.

METHODS

Participants completed self-report measures assessing perceived stress, self-compassion, anxiety symptomatology, and resilience.

RESULTS

Self-compassion was found to indirectly affect the association between perceived stress and resilience at both low (b = -0.06, 95% CI [-0.08, -0.04]) and high levels (b = -0.03, 95% CI [-0.05, -0.01]) of anxiety symptomatology. The index of moderated mediation was significant (b = 0.005, 95% CI [0.001, 0.01]).

CONCLUSIONS

Results of the present study suggest that interventions to enhance resilience should incorporate strategies aimed at managing stress and anxiety and increasing self-compassion.

Interventions for Strengthening General Self-Efficacy Beliefs in College Students: An Integrative Review

OBJECTIVE

To assess the evidence regarding the effectiveness of interventions aimed at strengthening self-efficacy beliefs in college students.

METHODS

Integrative Review conducted on the Lilacs, PubMed, CinahL, Cochrane Collaboration Databases, Scopus, and PsycInfo databases. The methodological quality of the studies was assessed using tools proposed by the Joanna Briggs Institute, and the results were analyzed descriptively.

RESULTS

Out of the 10 selected studies, six demonstrated that interventions aimed at strengthening self-efficacy were effective (Levels of Evidence II and III), and four revealed contrary results (Levels of Evidence I and II). Programs aimed at enhancing self-efficacy should include content on positive mental health, psychoeducation strategies, cover a period of eight to twelve weeks, and consider the completion of homework assignments.

CONCLUSION

The synthesis of evidence pointed to pathways for building an effective self-efficacy strengthening program to be implemented in universities.

Depression and Anxiety among Undergraduate Health Science Students: A Scoping Review of the Literature

Background: Health science students in post-secondary institutions experience high levels of depression and anxiety due to increased stress levels, workload, low socioeconomic status, and history of family mental illness, among other factors. Given the significant negative impact that depression and anxiety can have on undergraduate health science students, it is essential to understand the prevalence and correlation of these conditions in this population. In light of this, this scoping review aims to identify, document, and analyze the literature on the prevalence and determinants of anxiety and depression among undergraduate health sciences students and identify gaps in knowledge for future research. Methods: This scoping review was planned and executed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for the Scoping Reviews statement. A comprehensive and systematic search was carried out for five databases, namely MEDLINE, Scopus, EMBASE, CINAHL, and PubMed. Results: From the literature identified by our search strategy, the lowest prevalence for anxiety was 5.8%, and the highest was 82.6%, with a median of 44.25%. The prevalence of depression ranged from a high of 88.8% to a low of 2.1%, with a median value of 34.8%. Our analysis revealed that correlates of anxiety and depression among health science students include sociodemographic factors such as age, sex, gender, relationships, ethnicity, and family history, personal health conditions, and academic and socioeconomic issues. Conclusions: With the high incidence of anxiety and depression among health science students, there is an increasing need to find practical remedies to support these students. It is also essential for policymakers and university authorities to implement interventions such as supportive text messages and other strategies geared toward providing support and improving the psychological well-being of health science students.

Gender Differences in Risks of Suicide and Suicidal Behaviors in the USA: A Narrative Review

PURPOSE OF REVIEW

We review recent research (2018-2023) on gender differences in suicidal behaviors (i.e., suicidal ideations and attempts, death by suicide). We examine research studies in the following areas: developmental period, substance use, and special populations (Veterans, sexual and gender minorities).

RECENT FINDINGS

Novel results were found in these different areas. For example, suicide rates for female youth are increasing at a faster rate relative to male youth. Further, some evidence suggests that heavy alcohol use/binge drinking is a significant and growing risk factor for suicidal behaviors in women. Military service may be a more significant risk factor for suicidal behaviors among male Veterans compared to female Veterans. Additionally, suicide rates are rising for gender minority youth/young adults. Recent research on gender differences in suicide outcomes demonstrates findings that align with previous research, as well as new insights on this important topic.

The Mediating Roles of Affect Lability and Experiential Avoidance Between Distress Tolerance and Suicidal Ideation Among College Students

Objective: Suicidal ideation (SI) is highly prevalent among college students. Research has shown that college students are also more likely to experience low distress tolerance, affect lability, and experiential avoidance, which have been linked to SI. There is a critical need to examine the mechanisms that increase the risk of SI among college students. It is hypothesized that distress tolerance will be a strong predictor of SI, and affect lability as well as experiential avoidance will mediate this relationship. Participants and Methods: Participants (n = 820) from a Southeastern University completed an online survey, inquiring about demographic information, affect lability, SI, experiential avoidance, and distress tolerance. Data were analyzed utilizing structural equation modeling. Results: Distress tolerance was not directly related to SI. However, affect lability and experiential avoidance were found to mediate this relationship. Conclusions: Affect lability and experiential avoidance may be important predictors of SI among college students.

Social problem solving moderates emotion reactivity in predicting suicide ideation among college students

Objective: To evaluate the hypothesis that social problem solving (SPS) moderates strong emotion reactivity (ER) to stressful events in predicting suicide ideation (SI). Participants: 200 college students: mean age = 20.33; 75% women; 58% white. Methods: Participants completed the following self-report inventories: Beck Scale for Suicide Ideation, Emotion Reactivity Scale, and Social Problem-Solving Inventory-Revised. Results: Regression and slope analyses found SPS to moderate the association between ER and SI. Specifically, (a) as ER increased, SI increased significantly less for average problem solvers as compared to ineffective problem solvers, and (b) SI increased only slightly for effective problem solvers as ER increased. A secondary exploratory analysis found 20 college students who previously attempted suicide reported more negative ER, less effective SPS, and higher SI, as compared to a group of 20 sex-and age-matched peers. Conclusions: Effective social problem solving serves to decrease the likelihood that college students will experience higher levels of suicide ideation even when their negative emotion reactivity is high. Clinical implications for treatment and prevention are discussed.

Health-Risk Behaviors and Experiences Among Asian American and Native Hawaiian/Pacific Islander Adolescents in the United States, 2011-2019

OBJECTIVES

Understanding the health-risk behaviors of racial and ethnic groups when disaggregated is an important step in improving the health outcomes of racial and ethnic minority groups. We compared national prevalence estimates for selected health-risk behaviors and experiences of Asian American and Native Hawaiian/Pacific Islander (NHPI) students with those of non-Hispanic White, non-Hispanic Black, and Hispanic students.

METHODS

We analyzed data from the Youth Risk Behavior Survey, a nationally representative survey of US high school students. To generate a sufficient sample of Asian American and NHPI students for analyses, we combined data from 5 survey administrations, conducted in 2011, 2013, 2015, 2017, and 2019 (N = 73 074). We calculated the prevalence and 95% CIs; we analyzed data on Asian American and NHPI adolescents separately to unmask important differences.

RESULTS

Compared with students of other races and ethnicities, Asian American students had the lowest prevalence of alcohol use (16.7%) and marijuana use (10.3%). In contrast, NHPI students were more likely than Asian American students to participate in several health-risk behaviors and experiences, such as substance use (ranging from 4.8% for ever injecting an illegal drug to 31.5% for current alcohol use), having been in a physical fight (15.4%), and having been threatened or injured with a weapon (11.6%). Differential patterns in the prevalence of ever having missed school due to feeling unsafe among NHPI and Asian American students were observed among male and female students.

CONCLUSION

Further disaggregating racial subgroups within broad categories of Asian American and NHPI populations may reveal differences from overall group prevalence, and additional strategies to identify these differences should be investigated.

Cultural family processes, depressive symptoms, and suicidal ideation: A longitudinal study of Asian American youths

INTRODUCTION

This prospective study examined the direct and interactive effects of depressive symptoms and cultural family processes (i.e., intergenerational cultural conflict, academic parental control, cultural socialization parenting) on Asian American youths' suicidal ideation from adolescence to young adulthood.

METHODS

We utilized three-wave data of 408 Korean American and 378 Filipino American youths (M = 15.00 years, SD = 1.91 at Wave 1). For each ethnicity, we tested (1) whether depressive symptoms and cultural family processes predicted past-year suicidal ideation; and (2) whether cultural family processes moderated the depressive symptom-suicidal ideation link.

RESULTS

Across ethnicities, depressive symptoms significantly predicted suicidal ideation after controlling for cultural family processes. For Filipino youths, intergenerational cultural conflict significantly predicted suicidal ideation after controlling depressive symptoms and exacerbated the depressive symptom-suicidal ideation link. For Filipino youths, depressive symptoms were significantly associated with suicidal ideation only at lower levels of cultural socialization parenting. For Korean youths, academic parental control exacerbated the depressive symptom-suicidal ideation link.

CONCLUSION

Findings suggest that while depressive symptoms have a robust effect on Asian American youths' suicidal ideation, this effect may be moderated by cultural family processes. Different findings for Korean and Filipino youths highlight the importance of disaggregating analyses by ethnicity to guide prevention efforts.

Sexual Assault, Posttraumatic Stress, Alcohol Use, and Suicidality Among Diverse College Students

Suicide is the second leading cause of death among college-aged populations. This study examined the association of demographics (sexual orientation, gender identity, age, and race), sexual assault, posttraumatic stress symptoms (PTSS), and alcohol use with suicidality, current urge to self-harm, and current suicidal intent among a diverse sample of college students (n = 2,160) from two universities. Over half of participants reported any suicidality (63.5%), 12% reported current urge to harm themselves, and 5% reported current suicidal intent. A linear regression indicated that participants who identified as a sexual minority, gender minority, consumed more drinks per week, and had more severe PTSS reported higher levels of suicidality. University also was associated with suicidality. A negative binomial regression demonstrated that participants who identified as a sexual minority and had more severe PTSS had more current urge to harm themselves. Further, a negative binomial regression demonstrated that first-generation college students, students with more severe sexual assault histories, and students with more severe PTSS had higher current suicidal intent. Findings suggest that risk factors may differ for college students' general suicidality, self-harm urges, and suicidal intent, suggesting that these may be separate constructs. More comprehensive models, incorporating multiple risk factors and multiple ways of assessing suicidality, are needed to better understand the range of college student suicidal behavior and risks.