Self-reported barriers to professional help seeking among college students at elevated risk for suicide

Feasibility and acceptability of a guided internet-based stress management intervention for university students with high levels of stress: Protocol for an open trial

More than half of university students have high levels of stress. Stress management programs can help students improve coping skills and prevent psychological distress. However, studies have generally targeted all university students regardless of whether they experience high levels of stress or not, and thus more studies are needed to examine the feasibility and acceptability of e-health interventions for students with elevated stress. The present open trial aims to examine the feasibility and acceptability of a guided internet-based stress management program for university students with high levels of stress. In this study, participants are recruited via e-mail, newsletters, and flyers from four universities in the Netherlands to participate in a guided internet-based stress management program. Guidance is delivered by e-coaches who provide weekly asynchronous text-based motivational feedback after each module is completed. Primary outcomes are satisfaction with the intervention, assessed by the Client Satisfaction Scale (CSQ-8), and usability, assessed by the System Usability Scale (SUS-10). Secondary outcomes are perceived stress, quality of life, and depression, assessed by the Perceived Stress Scale (PSS-10), the EuroQol- 5 Dimension- 5 Level Scale (EQ- 5D- 5L), and the Patient Health Questionnaire (PHQ-9) respectively. Adherence rates to the program are assessed by examining the number of completed modules, time spent on the platform, and completed exercises. The Caring Universities Project was funded in (September 2019). In June 2020, the project was officially announced to the students and recruitment began immediately. As of October 2020, recruitment continues. The expected date of the publication of the results is in 2021. It is expected that the results of the proposed study will be informative for designing and implementing e-health interventions in higher education. Moreover, it is assumed that the findings will contribute to the growing literature on internet interventions by yielding preliminary evidence related to the feasibility and acceptability of an online stress management program.

TRIAL REGISTRATION

Netherlands Trial Register NL8686; https://www.trialregister.nl/trial/8686.

Searching for a Sense of Place: The Process of How Adolescent Girls Overcome Suicidality

Adolescent suicide is a preventable health problem; however, warning signs are often missed. In this study we developed a grounded theory to explore the process of how adolescent girl suicide attempters escape suicide in a sample of 12 young female adults ages 18-25. Using grounded theory methods of constant comparison, memo-writing, axial, and theoretical coding, searching for a sense of place emerged as the core process encompassing social process stages of: (1) existing in a toxic environment; (2) seeing suicide as the only way out; (3) seeing new ways to escape. Implications for nursing practice, education, and research are discussed.

Somatic presentation of mental health concerns, stigma, and mental health treatment engagement among college students

Objective: To identify mental health and treatment utilization correlates of somatic symptoms.Participants: Undergraduate students (N = 184) were recruited through an online research portal from November 2017 to May 2018. Methods: Cross-sectional survey. Results: Somatic symptoms were significantly correlated with public stigma, depression, and anxiety. Controlling for demographics, somatic symptoms, depression scores, and belief in the effectiveness of therapy emerged as concurrent predictors of mental health treatment use in logistic regression analyses. Conclusions: Given the detrimental effects of somatic symptoms on health outcomes and academic performance, universal screening of somatic and psychiatric symptoms in primary care and mental health settings serving college students is warranted. Future research should differentiate between patients who experience somatic versus affective symptoms of depression. In addition, researchers should examine the degree to which addressing the relationship between somatic and psychological symptoms can help lessen the added burden of somatic symptoms on individuals' functioning.

Exploring Suicidal Ideation Using an Innovative Mobile App-Strength Within Me: The Usability and Acceptability of Setting up a Trial Involving Mobile Technology and Mental Health Service Users

BACKGROUND

Suicide is a growing global public health problem that has resulted in an increase in the demand for psychological services to address mental health issues. It is expected that 1 in 6 people on a waiting list for mental health services will attempt suicide. Although suicidal ideation has been shown to be linked to a higher risk of death by suicide, not everybody openly discloses their suicidal thoughts or plans to friends and family or seeks professional help before suicide. Therefore, new methods are needed to track suicide risk in real time together with a better understanding of the ways in which people communicate or express their suicidality. Considering the dynamic nature and challenges in understanding suicide ideation and suicide risk, mobile apps could be better suited to prevent suicide as they have the ability to collect real-time data.

OBJECTIVE

This study aims to report the practicalities and acceptability of setting up and trialing digital technologies within an inpatient mental health setting in the United Kingdom and highlight their implications for future studies.

METHODS

Service users were recruited from 6 inpatient wards in the north west of England. Service users who were eligible to participate and provided consent were given an iPhone and Fitbit for 7 days and were asked to interact with a novel phone app, Strength Within Me (SWiM). Interaction with the app involved journaling (recording daily activities, how this made them feel, and rating their mood) and the option to create safety plans for emotions causing difficulties (identifying strategies that helped with these emotions). Participants also had the option to allow the study to access their personal Facebook account to monitor their social media use and activity. In addition, clinical data (ie, assessments conducted by trained researchers targeting suicidality, depression, and sleep) were also collected.

RESULTS

Overall, 43.0% (80/186 response rate) of eligible participants were recruited for the study. Of the total sample, 67 participants engaged in journaling, with the average number of entries per user being 8.2 (SD 8.7). Overall, only 24 participants created safety plans and the most common difficult emotion to be selected was feeling sad (n=21). This study reports on the engagement with the SWiM app, the technical difficulties the research team faced, the importance of building key relationships, and the implications of using Facebook as a source to detect suicidality.

CONCLUSIONS

To develop interventions that can be delivered in a timely manner, prediction of suicidality must be given priority. This paper has raised important issues and highlighted lessons learned from implementing a novel mobile app to detect the risk of suicidality for service users in an inpatient setting.

A sequential multiple assignment randomized trial (SMART) protocol for empirically developing an adaptive preventive intervention for college student drinking reduction

College student alcohol use and associated negative consequences are clear public health problems with consequences including damage to self, others, and institutions. This paper describes the protocol of a research study designed to answer a number of important questions in the development of an adaptive preventive intervention (API) to reduce high-risk drinking among first-year college students. The API is designed to educate students and to motivate heavy-drinking college students to engage in existing resources to support reducing high-risk alcohol use, by leveraging technology-based intervention modalities. The primary outcome is a reduction in binge drinking, with secondary outcomes of reducing negative alcohol-related consequences and increasing health services utilization. Adaptive preventive interventions have the potential to reduce the acute and long-term negative health consequences of young adult alcohol use.

Pros and cons of mental health treatment: reports from depressed clients with suicidal ideation

BACKGROUND

Suicide is a major public health problem; rates in the US have risen significantly across all age groups over the past decade. Outpatient mental health services can help to mitigate the risk of suicide. Despite highly positive effects, fewer than half of those individuals diagnosed with a mental illness receive needed mental health treatment.

AIMS

This study aims to examine the pros and cons of mental health treatment utilization and non-utilization from the perspective of depressed individual with suicidal ideation via a decisional balance worksheet.

METHODS

Depressed adults with suicidal ideation presenting to an emergency room for treatment recorded the pros and cons they associate with mental health treatment utilization and non-utilization.

RESULTS

Participants generated pros of non-utilization the least frequently (11.6%), and the pros of treatment utilization most frequently (39.6%). The most frequently cited pro of treatment utilization was "Learning New Skills", representing 40% of identified pros of utilizing treatment.

CONCLUSION

Findings suggest that reinforcing the new skills treatment can provide and ensuring every client understands treatment strategies and the reasons that treatment can be effective for their individual case may be an effective means of increasing the treatment engagement of at-risk individuals.

Relationship of physical activity and sleep with depression in college students

Objectives: This study examined the relationship between physical activity, sleep and depression among college students and gender differences in physical activity, sleep and depression. Methods: Participants were 1143 students from a large public university in Beijing and completed three questionnaires to measure their physical activity habits, sleep patterns, and depression levels. Data from were analyzed using descriptive statistics, stepwise regression, and an independent t test. Results: Results indicated that vigorous physical activity and sleep variables significantly predicted depression levels for the overall sample (F = 77.286, p = .000). When examined by gender, vigorous and moderate physical activity variables significantly predicted depression for males (t = -2.772, p = .006; t = -2.622, p = .009), whereas no level of physical activity had a significant relationship with depression for females. Conclusions: Rigorous physical activity and quality sleep may be beneficial to helping college students reduce and regulate depressive symptoms, however may vary by gender.

Photovoice as an intervention for college students living with mental illness: A pilot study

INTRODUCTION

Photovoice is a participatory-action research method in which participants capture and collectively reflect upon photos of their lived experience. Photovoice participation may be beneficial for individuals living with mental illness, but its effects have not been quantitatively measured.

METHODS

In this pilot study, 20 college students living with a mental illness and prescribed at least 1 medication were randomized to a Photovoice group intervention or usual group counseling, which was an active control. Participants completed the BURNS Anxiety Inventory, Beck Depression Inventory, and Medication Adherence Rating Scale at baseline and 8 weeks. Between-groups comparisons were conducted.

RESULTS

Photovoice participants experienced a significantly greater reduction in the BURNS Anxiety Inventory (-8.5 vs -2.6; P = .049) compared to control participants. No difference was seen in change in the Beck Depression Inventory (6.7 in the Photovoice group vs 0.2 among controls; P = .26). Mean medication adherence scores worsened in both groups from baseline with no difference between the groups (1 vs 0.86; P = .16).

DISCUSSION

Photovoice may be a resource-efficient and effective intervention to reduce anxiety among college students with mental illness; however, it may be associated with poorer medication adherence. Further study is needed to evaluate these findings.

Testing Suicide Risk Prediction Algorithms Using Phone Measurements With Patients in Acute Mental Health Settings: Feasibility Study

BACKGROUND

Digital phenotyping and machine learning are currently being used to augment or even replace traditional analytic procedures in many domains, including health care. Given the heavy reliance on smartphones and mobile devices around the world, this readily available source of data is an important and highly underutilized source that has the potential to improve mental health risk prediction and prevention and advance mental health globally.

OBJECTIVE

This study aimed to apply machine learning in an acute mental health setting for suicide risk prediction. This study uses a nascent approach, adding to existing knowledge by using data collected through a smartphone in place of clinical data, which have typically been collected from health care records.

METHODS

We created a smartphone app called Strength Within Me, which was linked to Fitbit, Apple Health kit, and Facebook, to collect salient clinical information such as sleep behavior and mood, step frequency and count, and engagement patterns with the phone from a cohort of inpatients with acute mental health (n=66). In addition, clinical research interviews were used to assess mood, sleep, and suicide risk. Multiple machine learning algorithms were tested to determine the best fit.

RESULTS

K-nearest neighbors (KNN; k=2) with uniform weighting and the Euclidean distance metric emerged as the most promising algorithm, with 68% mean accuracy (averaged over 10,000 simulations of splitting the training and testing data via 10-fold cross-validation) and an average area under the curve of 0.65. We applied a combined 5×2 F test to test the model performance of KNN against the baseline classifier that guesses training majority, random forest, support vector machine and logistic regression, and achieved F statistics of 10.7 (P=.009) and 17.6 (P=.003) for training majority and random forest, respectively, rejecting the null of performance being the same. Therefore, we have taken the first steps in prototyping a system that could continuously and accurately assess the risk of suicide via mobile devices.

CONCLUSIONS

Predicting for suicidality is an underaddressed area of research to which this paper makes a useful contribution. This is part of the first generation of studies to suggest that it is feasible to utilize smartphone-generated user input and passive sensor data to generate a risk algorithm among inpatients at suicide risk. The model reveals fair concordance between phone-derived and research-generated clinical data, and with iterative development, it has the potential for accurate discriminant risk prediction. However, although full automation and independence of clinical judgment or input would be a worthy development for those individuals who are less likely to access specialist mental health services, and for providing a timely response in a crisis situation, the ethical and legal implications of such advances in the field of psychiatry need to be acknowledged.

Sociodemographic differences in barriers to mental health care among college students at elevated suicide risk

BACKGROUND

College student mental health (MH) problems and suicide risk have steadily increased over the past decade and a significant number of students with MH problems do not seek treatment. While some barriers to mental health care service utilization (MHSU) have been identified, very little is known regarding how these barriers differ among sociodemographic subgroups of students.

METHOD

Participants were 3,358 college students from four US universities who screened positive for elevated suicide risk (defined as 2 or more of: depression, alcohol misuse, suicidal ideation, suicide attempt) and were not actively receiving MH services. Reported barriers to MHSU were categorized into: Low perceived need, privacy/stigma concerns, questioning helpfulness of treatment, logistics, time constraints, finances, and cultural issues.

RESULTS

Adjusted odds ratios indicated that finances were a greater barrier for women, sexual and gender minority students, and Black and Hispanic students. Privacy/stigma concerns were more prominent for men and young undergraduate students. White students and older undergraduate and graduate students were more likely to report a lack of time, and cultural sensitivity issues were significant barriers for sexual and gender minority, and racial/ethnic minority, students.

LIMITATIONS

Participating sites were not nationally representative. The barriers assessment did not examine the degree to which a specific barrier contributed to lack of MHSU relative to others.

CONCLUSIONS

In light of the significant variation in barriers based on age, gender identity, race/ethnicity, and sexual orientation, efforts to increase MHSU should be tailored to meet the unique needs of specific sociodemographic student subgroups.

What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review

BACKGROUND

Increasing rates of mental health problems among adolescents are of concern. Teens who are most in need of mental health attention are reluctant to seek help. A better understanding of the help-seeking in this population is needed to overcome this gap.

METHODS

Five databases were searched to identify the principal barriers, facilitators and interventions targeting help-seeking for common mental health problems in adolescents aged 10-19 years. The search was performed in June 2018 and updated in April 2019. Two independent screening processes were made using the eligibility criteria. Quality assessment of each study was performed, and findings summarised using a narrative synthesis.

RESULTS

Ninety studies meet the inclusion criteria for this review for barrier and facilitators (n = 54) and interventions (n = 36). Stigma and negative beliefs towards mental health services and professionals were the most cited barriers. Facilitators included previous positive experience with health services and mental health literacy. Most interventions were based on psychoeducation, which focused on general mental health knowledge, suicide and self-harm, stigma and depression. Other types of interventions included the use of multimedia and online tools, peer training and outreach initiatives. Overall, the quality of studies was low to medium and there was no general agreement regarding help-seeking definition and measurements.

CONCLUSION

Most of the interventions took place in an educational setting however, it is important to consider adolescents outside the educational system. Encouraging help-seeking should come with the increased availability of mental health support for all adolescents in need, but this is still a major challenge for Child and Adolescent Mental Health Services. There is also a need to develop shared definitions, theoretical frameworks and higher methodological standards in research regarding help-seeking behaviours in adolescents. This will allow more consistency and generalisability of findings, improving the development of help-seeking interventions and ensuring timely access to mental health treatments.

Post-Secondary Stress and Mental Well-Being: A Scoping Review of the Academic Literature

Post-secondary students have been identified as an at-risk population for chronic stress and poor mental health. We conducted a scoping review of the academic literature surrounding student stress and mental well-being as the first phase of research in the development of Canada’s National Standard for the Psychological Health and Safety of Post-Secondary Students. Major thematic findings included student stress, resilience through effective coping and help-seeking, and programs or strategies to improve campus mental health. Recommendations include a call for increased mental health promotion and mental illness prevention activities that are sensitive to diverse cultures, ethnicities, religions, and sexualities.

Mental distress, perceived need, and barriers to receive professional mental health care among university students in Ethiopia

BACKGROUND

There is limited evidence on the extent of the perceived need and barriers to professional mental health service delivery to university students with mental distress in low- and middle-income countries (LMICs). This study was designed to assess the prevalence of mental distress, perceived need for professional mental health care and barriers to the delivery of services to affected undergraduate university students in Ethiopia.

METHODS

A multi-stage sampling technique was used to recruit 1135 undergraduate university students. Symptoms of mental distress were evaluated using the Self-Reported Questionnaire (SRQ-20) and a score of above seven was used to identify positive cases. The perceived need for professional mental health care was assessed using a single 'yes or no' response item and barriers to mental health care were assessed using Barriers to Access to Care Evaluation (BACE-30) tool. Percentage, frequency, mean, and standard deviation were employed to summarize demographic characteristics of the participants and to identify common barriers to mental health care service. Moreover, the association of demographic variables with total mean scores of BACE-III sub-scales was modeled using multiple linear regression.

RESULTS

The prevalence of mental distress symptoms was 34.6% and the perceived need for professional mental health care was 70.5% of those with mental distress. The top five barriers to receiving professional mental health service were (a) thinking the problem would get better with no intervention, (b) being unsure where to go to get professional help, (c) wanting to solve the problem without intervention, (d) denying a mental health problem existed, and (e) preferring to get alternative forms of mental care. Coming from a rural background, being a second and fourth-year student, and a family history of mental illness were significantly associated with barriers to receive professional mental health service.

CONCLUSION

The high prevalence of mental distress, the paucity of mental health care, and the report of barriers to access what professional mental health care there is among Ethiopian undergraduate students is a call to address the disparity.

Efficacy of the Digital Therapeutic Mobile App BioBase to Reduce Stress and Improve Mental Well-Being Among University Students: Randomized Controlled Trial

BACKGROUND

University students in the United Kingdom are experiencing increasing levels of anxiety. A program designed to increase awareness of one's present levels of well-being and suggest personalized health behaviors may reduce anxiety and improve mental well-being in students. The efficacy of a digital version of such a program, providing biofeedback and therapeutic content based on personalized well-being metrics, is reported here.

OBJECTIVE

The aim of this study was to test the efficacy and sustained effects of using a mobile app (BioBase) and paired wearable device (BioBeam), compared with a waitlist control group, on anxiety and well-being in university students with elevated levels of anxiety and stress.

METHODS

The study employed a randomized, waitlist-controlled trial with assessments at baseline, 2 weeks, postintervention (4 weeks), and follow-up (6 weeks). Participants were eligible if they were current full-time undergraduate students and (1) at least 18 years of age, (2) scored >14 points on the Depression, Anxiety, and Stress Scale-21 items (DASS-21) stress subscale or >7 points on the DASS-21 anxiety subscale, (3) owned an iOS mobile phone, (4) did not have any previous psychiatric or neurological conditions, (6) were not pregnant at the time of testing, and (7) were able to read and understand English. Participants were encouraged to use BioBase daily and complete at least one course of therapeutic content. A P value ≤.05 was considered statistically significant.

RESULTS

We found that a 4-week intervention with the BioBase program significantly reduced anxiety and increased perceived well-being, with sustained effects at a 2-week follow-up. Furthermore, a significant reduction in depression levels was found following the 4-week usage of BioBase.

CONCLUSIONS

This study shows the efficacy of a biofeedback digital intervention in reducing self-reported anxiety and increasing perceived well-being in UK university students. Results suggest that digital mental health interventions could constitute a novel approach to treat stress and anxiety in students, which could be combined or integrated with existing therapeutic pathways.

TRIAL REGISTRATION

Open Science Framework (OSF.io) 2zd45; https://osf.io/2zd45/.

Help-seeking behaviors and attitudes of emerging adults: How college students reporting recent suicidal ideation utilize the internet compared to traditional resources

Objective: Suicide is the second leading cause of death among emerging adults, yet little is known regarding their online help-seeking. Participants: The National Research Consortium of Counseling Centers in Higher Education's dataset (N=26,292). Methods: Students across the United States were recruited from 73 four-year institutions to participate during the 2010-2011 school year. Results: Observed the effectiveness of online and traditional help-seeking stratified by recent suicidal ideation related to their most distressful period in the past year. Females and younger students endorsed both types of help-seeking, yet those with recent ideation were less likely to disclose any help-seeking. Among those reporting recent ideation, only females reported that traditional supports were more than moderately helpful. Regardless of whether students endorsed ideation, students who were younger, engaged in risky behaviors and identified as females reported that online resources were more than moderately helpful. Conclusions: Online resources could potentially bridge barriers to traditional help-seeking for those reluctant to seek out care, yet traditional resources were reported to be the most effective among this sample.

Understanding Students' Mental Well-Being Challenges on a University Campus: Interview Study

BACKGROUND

Research shows that emerging adults face numerous stressors as they transition from adolescence to adulthood. This paper investigates university students' lived experiences of maintaining mental well-being during major life events and challenges associated with this transitional period. As we continue to design health technology to support students' mental health needs, it is imperative to understand the fundamental needs and issues particular to this phase of their life to effectively engage and lower the barriers to seeking help.

OBJECTIVE

This study first aimed to understand how university students currently seek and receive support to maintain their mental well-being while going through frequent life events during this period of emerging adulthood. The study then aimed to provide design requirements for how social and technical systems should support the students' mental well-being maintenance practice.

METHODS

Semistructured interviews with 19 students, including graduate and undergraduate students, were conducted at a large university in the Midwest in the United States.

RESULTS

This study's findings identified three key needs: students (1) need to receive help that aligns with the perceived severity of the problem caused by a life event, (2) have to continuously rebuild relationships with support givers because of frequent life events, and (3) negotiate tensions between the need to disclose and the stigma associated with disclosure. The study also identified three key factors related to maintaining mental well-being: time, audience, and disclosure.

CONCLUSIONS

On the basis of this study's empirical findings, we discuss how and when help should be delivered through technology to better address university students' needs for maintaining their mental well-being, and we argue for reconceptualizing seeking and receiving help as a colearning process.

Is Knowledge Enough? The Relationship Between Mental Health Knowledge and Stigmatising Attitudes Among Australian Adolescents

Background:

Young people carry mental health problems disproportionate to the size of their population, and rates of help-seeking are low. School mental health programs have been developed to address these issues, founded on an educational approach to target mental health literacy, and indirectly improve help-seeking. However, it has been suggested that knowledge does not necessarily predict health behaviour in young people.

Objective/Methods:

A cross-sectional study was conducted to explore whether knowledge about mental illness was related to attitudes towards mental illness and intentions to seek help in a sample of adolescent girls (N=327).

Results:

Results indicated a weak negative relationship between knowledge about mental health and stigmatising attitudes about mental illness, but no relationship between knowledge about mental health and intentions to seek help for mental health problems. When mental health was categorised (e.g., optimal vs. poorer mental health), a negative relationship between knowledge about and stigmatising attitudes toward mental health was shown in those with poor mental health, but not for adolescents categorised as having moderate or optimal mental health.

Conclusion:

Findings suggest that while the traditional adage - more information on mental health equals better attitude to mental health - may be true for those with ‘poorer’ levels of mental health (e.g., high levels of psychological distress), it may not reduce stigma associated with mental illness or motivate positive health behaviour in adolescent girls with ‘optimal’ mental health (e.g., low or no levels of psychological distress).

Barriers for the Research, Prevention, and Treatment of Suicidal Behavior

Efforts in research, prevention, and treatment of suicidal behavior have produced mixed results. One of the main barriers to combating suicidal behavior lies in the very conceptualization of suicide, a phenomenon that is at once sociological, psychiatric, and even philosophical, and one that has not always been included in the field of health care. There are also many barriers at the social level, ranging from stigma against people with suicidal behavior to stigma towards psychiatric care, as well as the controversial role of the media. The media plays an important role in society and depending on its attitude it can be either beneficial or harmful in our fight against suicidal behavior. Differences between countries - in the provision of resources, in the way of understanding the phenomenon or in the manner of providing official figures - pose an additional challenge to suicide prevention on a global level. In the field of research, predicting suicidal behavior by identifying effective risk markers is severely hampered by the low occurrence of suicide in the population, which limits the statistical power of studies. The authors recommend combining various risk factors to build predictive models. This, in addition to employing increasingly precise machine learning techniques, is a step in the right direction, although there is still a long way to go before the expected results can be obtained. Finally, adequate training of health professionals, both specialized and non-specialized, as well as gatekeeper training, is crucial for implementing suicide prevention strategies in the population.

Trends in college students' mental health diagnoses and utilization of services, 2009-2015

Objective: To examine changes in diagnoses/treatment for 12 mental health (MH) conditions, previous use of campus MH services, and willingness to seek MH services in the future. Participants: ACHA-NCHA II participants from 2009 to 2015 (n = 454,029). Methods: Hierarchical binary logistic regression with step 1 controlling for demographics and step 2 considering time. Results: Time was significant except for bipolar disorder, bulimia, and schizophrenia with increases for all conditions except substance abuse. Anxiety (OR = 1.68), panic attacks (OR = 1.61), and ADHD (OR = 1.40) had the highest odd ratios. Use of MH services at current institution (OR = 1.30) and willingness to utilize services in the future (OR = 1.37) also increased over time. Conclusions: Based on a national sample, self-reported diagnoses/treatment of several MH conditions are increasing among college students. This examination of a variety of MH issues can aid college health professionals to engage institutional stakeholders regarding the resources needed to support college students' MH.

Service provision for depressed children and youth: a survey of the scope and nature of services in Ontario

BACKGROUND

The worldwide prevalence of depressive disorders among children and youth has been reported in ranges from just under 3% to over 10%. In Canada, 7% of youth report past year depression, which is higher than any other age demographic. Yet, many of these youth do not receive evidence based interventions, increasing their risk for serious lifetime consequences. To better understand low service use, it is crucial to map and evaluate current services. This study aimed to determine the scope and nature of services available to depressed children and youth, and compare services to best evidence treatment guidelines.

METHODS

Several government and non-government resources were utilized to develop a new multi-sectoral database of depression services for children and youth across Ontario. An online survey was sent to program managers serving children/youth with depression, examining agency characteristics, populations served, services provided, patterns of service use, evaluation activities, and research priorities.

RESULTS

413 agencies with 869 program managers participated, representing mental health, addictions and other sectors. Age groups served included children up to 12 years of age (31%), adolescents aged 13-17 (70%) and transition aged youth (18-25 years) (81%). Over half of respondents worked in the mental health (43.4%) or mental health and addiction (24.4%) sectors. The most frequently provided services were assessment, psychotherapy, case management, and psychoeducation; the most common types of psychotherapy provided included cognitive behavioral therapy, social skills training, and solution-focused therapy. Psychotherapies are offered in widely varying formats, frequencies and durations. Discontinuation rates varied, with higher discontinuation among transition aged youth as compared to children. Respondents identified effective treatment, improving access, and reducing service gaps as top future research priorities.

CONCLUSIONS

This study provides important new data on service provision and uptake for depressed children and youth. Comparing these results with best-evidence practice guidelines raises significant concerns about the services most commonly offered and their delivery formats. In addition, high early discontinuation rates raise questions about the service experiences of children, youth and their families. Other factors which may contribute to ongoing treatment engagement challenges include access barriers, service or client characteristics, and unintentional treatment impacts.

Mental health and stigma on campus: Insights from students' lived experience

The JED Campus framework presents a multi-faceted approach to how colleges and universities can provide quality mental health services to their students and enhance the support of the campus community. However, research has suggested that a significant barrier to students seeking help and utilizing on-campus resources is the fear of stigma associated with mental illness. The current study was interested in learning more from students with mental health diagnoses about their experiences on campus. Focus groups were conducted and topics discussed included stigma, impact of university policies, and how resources could better address student needs. The findings suggest that students feel stigma is a significant barrier in how mental health is addressed on campus and that universities need to be more proactive in their approach to create a safe and inclusive campus for all members of the community.

Predicting mental health help seeking orientations among diverse Undergraduates: An ordinal logistic regression analysis✰

BACKGROUND

Recent years have seen a steady increase in college students reporting mental health issues, though only approximately one-third of these students seek treatment. The present study examines: a) students' perceptions of access to campus provided mental health care; b) student stigma attitudes based on social distance and willingness to disclose mental health issues to campus members who might support help-seeking efforts; and c) the predictive value of five factors (aged older than 22, female gender, completed two or more psychology courses, low stigma, and high perception of access) on help-seeking orientation (HSO).

METHODS

We performed an ordinal logistic regression (OLR) on data from a diverse sample of undergraduates (n = 1,272). The OLR statistical model is more appropriate for measurement of Likert style data than commonly employed statistical models, which may oversimplify attitudinal data by assuming equal intervals between response categories.

RESULTS

Most students did not know that campus-provided counseling was free or confidential, and almost half did not perceive these services as timely or adequate. Students reported more stigma related to disclosing their own problems than to supporting someone else. All five study predictors retained positive and statistically significant slope associations with a positive HSO. Unexpectedly, we found a statistically significant gender interaction with psychology coursework.

LIMITATIONS

Data were obtained through self-report measures.

CONCLUSIONS

Results are discussed in relation to the possibility that campus-based mental health interventions may remove roadblocks to healthy help-seeking behaviors, particularly for male students.

Factors related to suicide's unpredictability: a qualitative study of adults with lived experience of suicide attempts

Purpose: In recent decades, suicide prevention initiatives have increased substantially, yet the suicide rate has continued to rise, and suicide deaths are still generally perceived as unexpected. This study sought to identify factors that might account for this discrepancy by focusing on the exhibition of suicide warning signs.

Methods: Qualitative interviews were conducted with 15 adults [mean age = 36 (SD = 14), 93% female] who had attempted suicide at least once in their lifetime.

Results: A disconnect between participants and their environment emerged as a central theme. Many expressed ambivalence about whether they wanted others to intervene before their attempts, resulting in either expression or inhibition of warning signs. Regardless of whether they wanted their attempt to be predictable, most participants expressed disappointment if they perceived a lack of intervention before their attempt. In some cases, this disappointment exacerbated distress and may have contributed to the attempt itself. Participants also expressed difficulty disclosing their suicidal ideation to others. Thus, even if they wanted help, participants were unsure how to effectively attain it.

Conclusions: Findings underscore the complexity of predicting and preventing suicide; however, engaging individuals with lived experience in these efforts facilitates greater understanding toward outreach and intervention approaches.

Undergraduate students survey their peers on mental health: Perspectives and strategies for improving college counseling center outreach

Objective: The purpose of the study was to examine student perspectives about college mental health including the primary mental health issues affecting students, common college student stressors, student awareness of campus mental health resources, and mental health topics students want more information about. Participants: Participants were 822 undergraduate and graduate students enrolled in a private university. The study was conducted during September 2016. Methods: As part of a public health course in program planning, undergraduate students surveyed their peers about their experience with mental health and mental health resources. Results: Stress was perceived as the largest mental health issue. Students most wanted more information about school/work/life balance followed by stress management. Electronic newsletters, social media, and on-campus seminars were the top strategies that students suggested as ways to reach them. Conclusions: The results provide student perspectives on mental health that may be useful in developing effective outreach efforts.

Emerging trends in suicide prevention research

PURPOSE OF REVIEW

The purpose of this article is to present notable findings and developments in suicide prevention research and in particular, strategies to detect persons at risk for suicide as well as strategies to reduce suicide risk among the general population and specific risk groups.

RECENT FINDINGS

Popular strategies to detect persons at risk for suicide include scanning social media posts, prediction models using electronic health record data as well as the use of experienced sampling methodology to enhance our understanding of the suicidal process. Emerging approaches to reduce suicide risk include the development of media reporting recommendations, mass media campaigns to improve knowledge, attitudes and behaviour as well as technology-enhanced interventions.

SUMMARY

Recently, promising approaches to detect individuals at risk for suicide as well as effective strategies to reduce suicide risk emerged. Whether these new opportunities will translate into an effective reduction in suicide rates remains to be demonstrated.

Readiness to change and barriers to treatment seeking in college students with a mental disorder

BACKGROUND

College students have high prevalence of mental disorders and suicidal thoughts and behaviours, and low rates of treatment uptake. This study assesses treatment access, intentions to seek help, and perceived barriers to help-seeking, considering gender and suicidal thoughts or behaviours (STBs) as predictors.

METHODS

Data is from the Ulster University Student Wellbeing study (2015) conducted in Northern Ireland (NI), as part of the WHO World Mental Health Surveys International College Student Project. Participants are 392 new college entrants (162 males (41.3%)/230 females (58.7%)), who all reported some lifetime mental disorder or STBs.

RESULTS

Receipt of treatment was low (37.8%), particularly among males and those with no STBs. Males were less likely to intend to access external professional services and were less likely than females to rate embarrassment (OR = 0.60) or worry about being treated differently (OR = 0.63) as important reasons for not seeking treatment. Those with STBs rated wanting to handle things on their own as a more important barrier those with no STBs (OR = 0.55 for non STBs group) and rated being unsure where to go as a less important barrier than those with no STBs (OR = 1.80 for non STBs group).

LIMITATIONS

Data is correlational and concerns lifetime criteria for mental disorder, with no consideration of current mental status nor disorder type.

CONCLUSIONS

These findings have implications for the active screening and intervention for vulnerable college students, particularly males and those with mental disorders but no STBs.

An examination of PTSD symptoms and their effects on suicidal ideation and behavior in non-treatment seeking veterans

This study sought to examine the effect of general PTSD symptoms as well as specific PTSD symptom clusters on suicidal ideation and suicidal attempts. We first compared a correlated factors solution consistent with the DSM-5 symptom clusters for PTSD with a bifactor solution comprising a General PTSD factor and orthogonal specific factors. Using the best fitting model (i.e., bifactor solution), we then investigated the effect of specific PTSD symptom clusters on severity of suicidal ideation and suicide attempts above and beyond the effect of general PTSD symptoms. A sample of 773 veterans who have never sought professional mental health treatment were screened for suicidal ideation within the past two weeks. One month after the baseline measurement, the participants completed a follow-up assessment, again by telephone. A bi-factor solution was used to account for a general PTSD factor as well as the specific DSM-5 PTSD symptom clusters. After controlling for baseline suicidal ideation and behavior, it appeared that the Anxious Arousal factor was predictive of changes in the magnitude of severity of suicidal ideation and the General PTSD factor was predictive of the onset of new suicidal behavior at the one-month follow-up. Additionally, the Re-experiencing factor of PTSD also significantly predicted new suicidal behavior at the one-month follow-up. These results suggest that it may beneficial for clinicians, who are assessing individuals with PTSD for suicidality, to be aware of the frequency, duration, and content of their clients' repetitive, intrusive thoughts as these thoughts may increase their capability to inflict non-lethal or lethal forms of self-injury.

Impact of integrated care and co-location of care on mental help-seeking perceptions

BACKGROUND

Integrated care may offer a solution to subpar mental health referral adherence, but people's openness to receiving psychological treatment in this setting is understudied.

AIMS

The present study examined the influence of the integrated care context and co-location of care on people's help-seeking perceptions.

METHOD

This study (N = 397) used an experimental vignette design to compare the impact of treatment type (integrated care vs. traditional psychotherapy) and distance (close vs. far) on help-seeking perceptions.

RESULTS

The integrated care environment (significant effect on perceived behavioral control) and closer proximity of the psychologist (significant effect on intention, attitudes, perceived effectiveness of treatment, self-stigma) only improved help-seeking perceptions among those with prior experience with mental health treatment. In the overall sample, treatment type and distance only demonstrated an effect among women, but not men.

CONCLUSIONS

Pending replication with samples from diverse populations, these findings provide a cautionary tale about lay perceptions of integrated care's anticipated utility. However, co-location and, to a lesser degree, the common attributes of the integrated care format (e.g. team approach, flexible scheduling) may represent a potential pathway for reducing resistance to help seeking that can accompany traditional psychotherapy referrals among those with past exposure to behavioral healthcare.

Help-seeking behavior of Jimma university students with common mental disorders: A cross-sectional study

BACKGROUND

Globally, the mental health help-seeking behavior of university students is reported to be poor; less than one-third of university students with common mental disorders (CMDs) report having sought help from formal sources. Failure to seek treatment is associated with prolonged disability and poor mental health outcomes, including suicide. In Ethiopia, little is known about the help-seeking behavior of university students for CMDs.

OBJECTIVE

This study aimed to assess the prevalence and determinants of help seeking, and sources of help sought by Jimma University undergraduate students with CMDs.

METHOD

Seven hundred and sixty students were selected to participate in this cross-sectional study using multi-stage sampling. Sources of help were identified using the Actual Help-Seeking Questionnaire. CMDs were assessed using the 10-item Kessler Psychological Distress Scale. Binary logistic regression analysis was used for both univariate and multivariable analysis.

RESULTS

Of the sampled students, 58.4% were found to have current CMDs. Of those with current CMDs, 78.4% had sought help for their problems. The majority (83.8%) of participants who sought help did so from informal sources. Compared to students who had 'very good' overall levels of satisfaction with life, those who had 'good', 'fair', and 'poor or very poor' overall level of satisfaction with life were less likely to seek help (p-value = 0.021, 0.014, and 0.011, respectively). Lastly, having no previous history of help-seeking was significantly associated with seeking help for CMDs (p-value<0.001).

CONCLUSION

More than half of Jimma University students were found to have a high risk of CMDs and the majority of those with CMDs sought help from informal sources. Future studies are needed to explore the barriers of seeking help from formal resources, and the effects of not receiving help from formal sources for CMDs symptoms.

Parental Educational Attainment and Academic Performance of American College Students; Blacks' Diminished Returns

BACKGROUND

As suggested by the Minorities' Diminished Returns (MDR) theory, socioeconomic status (SES) systemically results in smaller outcomes for non-Whites compared to Whites. We still know very little about diminished trans-generational returns of SES resources such as parental educational attainment (PEA).

PURPOSE

This cross-sectional study explored racial variation in the effect of PEA on the college students' grade point average (GPA) in the US.

METHODS

The Healthy Mind Study (HMS, 2016-2017) is a national telephone of college students in the US. The total sample was 18,072 domestic undergraduate college students who were either non-Hispanic Whites (n = 16,718; %92.50) or non-Hispanic Blacks (n = 1,354; %7.50). The independent variable was PEA. The main outcome was GPA measured using self-reported data. Age, gender, sexual orientation, transgender status, and financial difficulty were covariates. Race/ethnicity was the effect modifier. Linear regression models were used to analyze the data.

RESULTS

Overall, higher PEA was associated with a higher GPA, independent of all possible confounders. Race/ethnicity, however, showed a significant interaction with PEA on students' GPA, indicating a smaller positive effect of PEA on non-Hispanic Blacks compared to non-Hispanic Whites college students' GPA. Race/ethnicity stratified models also showed a larger effect for White than Black students.

CONCLUSIONS

The boosting effect of PEA in GPA is smaller for Black compared to White college students. US should systematically reduce extra costs of upward social mobility for racial and ethnic minority families.

Seeking professional help for suicidal ideation: A comparison between Chinese and Australian university students

Suicide is the second leading cause of death in Chinese university students and research examining their professional help-seeking is limited. This study aims to investigate: (i) professional help-seeking intentions for suicidal ideation among Chinese university students, with comparison to Australian university students, (ii) relationships between suicide literacy, social support, suicide stigma, self-reliance and help-seeking intentions, and (iii) self-recognised barriers to help-seeking. Chinese (N = 208) and Australian (N = 128) university students were recruited to complete an online cross-sectional survey assessing their intentions to seek professional help if they experienced suicidal ideation. One-third of the surveyed Chinese and Australian students expressed reluctance to seek professional help. Self-reliance was endorsed by both countries' university students as an important barrier. Suicide literacy, suicide stigma, and social support were not found to have a significant relationship with help-seeking intentions. The high costs of mental health services (Australian university students) and informal support from family and friends (Chinese university students) were identified as critical barriers to help seeking by participants. Results from this study suggest self-reliance is a potentially important barrier to professional help-seeking, whereas, suicide literacy and suicide stigma may have limited influence on help-seeking intentions among student populations.

Perceived need for care and mental health service utilization among college students with suicidal ideation

OBJECTIVE

This study aimed to identify correlates of service utilization and perceived need for care among college students with suicidal ideation.

PARTICIPANTS

Respondents were recruited from introductory psychology courses at an undergraduate college during the Fall 2014 semester.

METHODS

Independent correlates of (1) mental health service utilization, (2) self-perceived need, and (3) other-perceived need for mental health services among college students (N = 190) with suicidal ideation were identified.

RESULTS

Service utilization was associated with need for care as perceived by others. Perceived need for care by others was associated with suicidal ideation intensity and suicide attempt history. Perceived need by the respondents themselves was correlated with depression severity, sex, and race but was not independently associated with actual service utilization.

CONCLUSIONS

Perceived need by others was the sole significant correlate of service utilization, suggesting it is an important target for public health interventions aimed at facilitating pathways into mental health treatment.

The Duration of Untreated Psychosis: A Phenomenological Study

Mounting evidence has indicated that early intervention leads to improved clinical and functional outcomes for young persons experiencing recent onset psychosis. As part of a large early detection campaign, the present study aimed to investigate subjective experiences during the duration of untreated psychosis (DUP), or time between psychosis onset and treatment contact. Participants were 10 young adults participating in early intervention services for psychosis. After DUP was estimated during standardized baseline assessment, participants engaged in qualitative interviews focused on their life experiences prior to treatment and leading up to the present. Mixed methods data analyses compared standardized DUP estimates with participants' subjective narratives. Findings revealed that participants experienced and conceptualized a longer trajectory of subjective difficulties (TSD) beginning before and extending beyond standardized DUP estimates. Participants emphasized striving for independence and social belonging. The majority of participants reported benefiting from their current services and believed that earlier support of some kind would have been beneficial. These findings support previous research on subjective barriers to early detection and treatment seeking in young adults experiencing psychosis. Implications and future research directions include further efforts to differentiate the struggles unique to early psychosis from psychosocial risk factors and other challenges of young adulthood.

Acceptance and Commitment Therapy and Motivational Interviewing in the Treatment of Alcohol Use Disorder in a College Woman: A Case Study

Alcohol abuse is common among college students. Acceptance and commitment therapy (ACT) is widely supported as a treatment of alcohol abuse. However, little research has examined how ACT may be paired with other techniques traditionally applied to treat substance abuse, such as motivational interviewing (MI). This clinical case study describes the use of ACT and MI to facilitate treatment of a 20-year-old woman who was referred for treatment for alcohol abuse. The client remained in treatment in spite of her initial self-reported belief that treatment was unnecessary. At follow-up, the client reported increased present moment awareness, particularly of her drinking habits, and demonstrated the ability to behave in ways consistent with her values. At the completion of treatment, the client reported fewer episodes of alcohol consumption and less severe drinking. Implications of these findings are discussed, with an emphasis on the potential benefits of pairing MI techniques with ACT.

Perceptions of mental health and mental health services among college students in Vietnam and the United States

The global burden of mental health disorders is a significant public health issue. One population that has a risk for mental health issues is college students. Little is known about perceptions of mental illness and mental health services among college students in Vietnam. The purpose of this study is to describe perceptions of mental illness and mental health services among college students in Vietnam, and to compare them with those in the United States (US). The cross-sectional data were collected using a self-administered survey from January to March in 2018 at a national university in Vietnam, and a state university in the US. The study revealed differences in perceptions of causes of mental health between Vietnamese and US participants. Vietnamese participants tended to believe that individuals with mental illness were dangerous and need to be kept out from the community, while US participants perceived that mental illnesses are the same as other illnesses. An important indicator of Vietnamese perceptions of mental health was the low likelihood of seeking formal help because of preference for seeking help from family or friends for mental illness. Interventions, such as mental health awareness campaigns or training courses should be provided for college students in Vietnam. Some strategies to improve mental health among college students used in the US may help to reduce stigma toward mental illness in Vietnam.

Associations among trauma, depression, and alcohol use profiles and treatment motivation and engagement in college students

OBJECTIVE

This study examined how profiles of alcohol use and symptoms of common mental health disorders (depression and posttraumatic stress disorder [PTSD]) influenced the perceived need for and actual seeking of different types of treatment (for alcohol versus psychological distress) in college student drinkers.

PARTICIPANTS

Undergraduate students (n = 164) were assessed between September 2009 and August 2015.

METHODS

We classified students into different symptom profiles using model-based clustering and compared these profiles on a variety of variables.

RESULTS

The cluster model yielded three profiles: Low Risk (n = 66), Concomitant (n = 35), and Heavy Drinking (n = 63). Students in these profiles significantly differed in alcohol consumption, alcohol-related cognitions and problems, and perceptions of need and prior engagement in treatment.

CONCLUSION

A variety of strategies can be used to engage students experiencing heavy drinking and/or mental health problems into treatment on campus.

Shifting Beliefs about Suicide: Pre-Post Evaluation of the Effectiveness of a Program for Workers in the Construction Industry

Suicide is a significant health problem that is known to disproportionately affect those employed in manual occupations, including construction workers and tradespeople. Universal General Awareness Training (GAT) was part of a multi-component suicide prevention program in the Australian construction industry. The program’s aims were to increase awareness of mental health and suicide, reduce stigma, and encourage help-seeking and help-offering behaviours. This paper sought to examine the effectiveness of the GAT program in shifting suicide beliefs. Pre- and post-training survey data of 20,125 respondents was obtained from a database of GAT evaluation results between 2016 and 2018. Generalized estimating equation (GEE) models were fitted to examine belief changes, and predictive margins and their SEs were computed. Mean differences in belief change were obtained for the overall sample, and by occupation. Modest but significant favourable shifts in three of the four beliefs assessed were observed following GAT. Managers and professionals showed greater propensity to shift beliefs, and Labourers and Machinery Operators and Drivers showed least. Results suggest that GAT can successfully shift some beliefs regarding suicide and mental health at least in the short term, but highlight the need to tailor communication to vulnerable occupational groups.

The I Will Help You mental health initiative: A pedagogy for nursing leadership and a call to action for nurses

Mental illness is a major cause of morbidity and mortality in society. Undergraduate nursing students designed and implemented a mental health awareness campaign called the I Will Help You initiative as part of their senior leadership nursing course. The aims of the initiative were to: spread awareness on mental illness; give the general public the skills and resources needed to identify and assist individuals who are struggling with mental illness; and decrease the stigma surrounding mental illness. A website, four online educational modules, four social media accounts, and two videos were designed by the students in order to promote the initiative. One month following the initiative's launch, the website had over 4000 page views, the videos had over 20,000 views, there were over 200 pledges, and the educational modules had 60 users. The initiative received substantial media attention and was featured via a variety of platforms including: a local news story, numerous health blogs, the state nurses' website and across the university campus. The I Will Help You initiative provided real life application of nursing leadership to an undergraduate student population while building a sustainable, evidence-based tool that can be used as a public health resource for mental illness.

Computer-Guided Problem-Solving Treatment for Depression, PTSD, and Insomnia Symptoms in Student Veterans: A Pilot Randomized Controlled Trial

Depression is a highly prevalent psychological disorder experienced disproportionately by college student military veterans with many deleterious effects including risk for suicide. Treatment can help, but the debilitating nature of depression often makes seeking in-person treatment difficult and many are deterred by stigma, inconvenience, concerns about privacy, or a preference to manage problems themselves. The current study examines the efficacy of a computer-guided Problem-Solving Treatment (ePST^®) for reducing symptoms of depression, posttraumatic stress disorder (PTSD), and insomnia in student military veterans. Twenty-four student veterans (Mean_age = 32.7) with symptoms of depression were randomly assigned either to a treatment group receiving six weekly sessions of ePST or to a minimal contact control group (MCC). Participants completed the Patient Health Questionnaire-9 (PHQ-9) depression scale at baseline and then weekly through post-ePST or post-MCC. PTSD and insomnia questionnaires were also completed at baseline and posttreatment. A linear mixed model regression showed a statistically significant Group (ePST vs. MCC) × Time (pretreatment through posttreatment) interaction for depression, with the ePST showing substantial improvements in depressive symptoms over the 6-week period. Significant improvements were also seen in PTSD and insomnia symptoms. Results suggest that ePST can effectively treat depression, PTSD, and insomnia symptoms in student military veterans and may be a viable alternative for those who are not able to access live therapy. Future work should examine the durability of treatment effects and utility for more severe depression and suicide prevention.

Smartphones, Sensors, and Machine Learning to Advance Real-Time Prediction and Interventions for Suicide Prevention: a Review of Current Progress and Next Steps

PURPOSE OF REVIEW

As rates of suicide continue to rise, there is urgent need for innovative approaches to better understand, predict, and care for those at high risk of suicide. Numerous mobile and sensor technology solutions have already been proposed, are in development, or are already available today. This review seeks to assess their clinical evidence and help the reader understand the current state of the field.

RECENT FINDINGS

Advances in smartphone sensing, machine learning methods, and mobile apps directed towards reducing suicide offer promising evidence; however, most of these innovative approaches are still nascent. Further replication and validation of preliminary results is needed. Whereas numerous promising mobile and sensor technology based solutions for real time understanding, predicting, and caring for those at highest risk of suicide are being studied today, their clinical utility remains largely unproven. However, given both the rapid pace and vast scale of current research efforts, we expect clinicians will soon see useful and impactful digital tools for this space within the next 2 to 5 years.