Be True to Our Schools-Models of Care in College Mental Health

Factorial invariance of college students' scores on the Lifestyle Practices and Health Consciousness Inventory

OBJECTIVE

The aims of the present study were to validate college students' scores on the Lifestyle Practices and Health Consciousness Inventory (LPHCI), a screening tool for appraising Global Wellness (combined mental and physical health) and test for differences in Global Wellness across key demographic variables associated with college student health.

METHOD

A non-probability sample of 708 college students across four campus locations in three different cities was recruited to test the LPHCI's psychometric properties.

RESULTS

Factorial invariance testing demonstrated psychometric equivalence in the meaning of Global Wellness between college students across ethnicity, generational status, and help-seeking history. We also found statistically, however, not practically significant demographic differences in Global Wellness between college students by ethnicity and help-seeking history.

CONCLUSION

Findings extend the generalizability of LPHCI scores to a normative sample of college students. Implications for college healthcare providers and directions for future research are discussed.

S., Menon M, Smita G. S., Shini V. S., Jose SE, Mahesh M. M., Shibu K, Sujisha T. G., Jayaprakashan K. P., Kiran P. S., Anil Kumar T. V., Vigneshwari V., Titus U. Framework and Overview of a State-Wide College Mental Health Program in Kerala, India

Background

Mental health issues are common among college students, and structured services have been proven to enhance outcomes. Despite increased enrolment for higher education in India, college mental health services remain sparse. JEEVANI is the first structured state-wide college mental health service in India. This paper describes its framework and provides an overview of its functioning during the initial five months.

Methods

In 2019-2020, the Directorate of Collegiate Education, Government of Kerala, implemented the program in 66 colleges catering to approximately 60,000 students. Qualified counsellors were trained to identify issues and provide interventions and early referrals, using a stepped-care approach. They conducted awareness programs to promote mental health and reduce stigma.

Results

The services were accessed by 2,315 students during the assessment period (October 2019 to February 2020). The beneficiaries were predominantly females (54.1%). Over a third (38.8%) belonged to the lower socio-economic strata, and 2.5% had significant vulnerabilities. Although no syndromal diagnoses were made, anxiety and depression were the most common presentations. The counsellors provided 3,758 individual sessions and facilitated support for students who reported academic difficulties or interpersonal issues. Severe mental illness was detected in 54 students, and referrals for specialist mental health input were initiated in 68.

Conclusion

Describing the framework, sharing the technical material, and providing an overview of its functioning from a resource-constrained setting in India may encourage higher education institutions in low- and middle-income countries to consider similar projects.

Psychiatric medications prescribed on-campus and off-campus for university students: Differences in demographics, types of medication, and satisfaction with services

Objective: To describe the use of psychiatric medication and related health service utilization among college students receiving care on- and off-campus. Participants and methods: 3959 students from a large southern university participated in the Healthy Minds Study in May 2018. Results: Of students surveyed, 17.6% took psychiatric medication in the last year. Of these students, 22.0% received prescriptions on-campus, 61.7% received prescriptions off-campus, 6.4% received them both on- and off-campus, and 9.9% took medication without a prescription. Nonwhite, international, and younger students were more likely to utilize on-campus rather than off-campus psychiatric medication services (p < .05). Satisfaction with health services did not differ by location. Conclusions: The majority of students received psychiatric prescriptions off- rather than on-campus. While satisfaction with both on- and off-campus health services is equally high, minority, international, and younger students are more likely to seek care on- rather than off-campus.

An intersectional approach to understanding the correlates of depression in college students: Discrimination, social status, and identity

OBJECTIVE

We assessed the impact of bearing multiple marginalized identities, experiencing discrimination and perceived social status on the prevalence of depression in college students using an intersectional approach.

PARTICIPANTS

Public health students at a diverse urban public university in Northern California (N = 338, response rate = 85%; 77% women, mean age 22).

METHODS

We used a cross-sectional survey to assess demographics, depression, discrimination and social standing using validated scales and estimate the relations between depression and co-factors.

RESULTS

25.4% of students reported depression. Discrimination was associated with a higher level of depression and more severe symptoms. Higher perceived social status was associated with a lower level of depression and less severe symptoms. Hispanic/Latinx first generation women had three times the prevalence of depression as non-Hispanic/Latinx non-first generation men and there was a significant disparity in depression severity.

CONCLUSIONS

Intersectional approaches can shed light on the experiences of marginalized groups.

Systematic tracking of mental health acute care visits: A model of care for college students

Objective: College students who receive an acute care visit (ACV) from an emergency or inpatient unit require mental health follow-up (MHF) to improve long-term outcomes. This study describes tracking ACVs and MHF, while identifying characteristics of multiple vs. single ACVs.Participants: 191 students who received an ACV (N = 231) at one public university - enrollment approximately 39,000.Methods: For two academic years (AYs), students were tracked and offered timely MHF. Demographics, clinical information, utilization patterns, and rates of MHF were analyzed.Results: Primary reasons for an ACV were suicidal thinking (60.6%) and psychosis (13.9%). MHF improved between AYs (65.8% to 93.3%, X² = 27.48, p < .01). Multiple vs. single visits were more likely to present with self-injurious behavior and psychosis and received more intensive follow-up yet, had similar rates of MHF.Conclusions: The primary reasons for an ACV - suicidal thinking and psychosis - underscore the importance of campus suicide prevention and psychosis-specific services.

A participatory study of college students' mental health during the first year of the COVID-19 pandemic

Introduction

The COVID-19 pandemic has negatively impacted college students' mental health and wellbeing. Even before the pandemic, young adults reported high mental health morbidity. During the pandemic, young adult college students faced unprecedented challenges, including campus closure and a pivot to fully online education.

Methods

This study employed a novel participatory approach to a Course-based Undergraduate Research Experience (CURE) in an introductory epidemiology course to examine factors students considered important regarding their experience during the pandemic. Two groups of undergraduate students enrolled in this course (one in Fall 2020 and another in Spring 2021) and participated in the CURE. A sub-group of these students continued after the class and are authors of this article. Through repeated cross-sectional surveys of college students' peer groups in northern California in October 2020 and March 2021, this student/faculty collaborative research team evaluated depression, anxiety, suicidal ideation and several other topics related to mental health among the students' young adult community.

Results

There was a high prevalence of anxiety (38.07% in October 2020 and 40.65% in March 2021), depression (29.85% in October 2020 and 27.57% in March 2021), and suicidal ideation (15.94% in October 2020 and 16.04% in March 2021). In addition, we identified the significant burden of loneliness for college students, with 58.06% of students reporting feeling lonely at least several days in the past two weeks. Strategies that students used to cope with the pandemic included watching shows, listening to music, or playing video games (69.01%), sleeping (56.70%), taking breaks (51.65%), and connecting with friends (52.31%) or family (51.21%). Many reported distressing household experiences: more than a third reporting loss of a job or income (34.27%) in the first year of the pandemic. We explain the participatory research approach and share empirical results of these studies.

Discussion

We found this participatory CURE approach led to novel, experience-based research questions; increased student motivation; real-world benefits such as combatting imposter syndrome and supporting graduate school intentions; integration of teaching, research, and service; and development of stronger student-faculty relationships. We close with recommendations to support student wellbeing and promote student engagement in research.

Knowledge Management-Based Mental Health Service Model: Sustainable Application during College Students’ Education

In order to meet the dynamic mental health needs of college students, it is important to promote quality mental health services and to improve the development view of college students’ mental health. This paper uses a knowledge management method to construct college students’ developmental mental health service model. The model is informed by knowledge management, which comprehensively considers service-related components, namely, resources, content, approach, process, personnel, and objects. Furthermore, knowledge management constructs the system structure of the model and expands the research ideas and contents of the service resource pool. Moreover, knowledge management supports the platform, core technology system, and service process in the model. Finally, using Suzhou University as an example, this study examines the implementation and application of the service model to test the effectiveness of the knowledge management method. Thus, this study provides theoretical and methodological support for the construction, implementation, and application of a sustainable mental health service model for college students.

Comparison of Two Approaches to Enhance Self-Esteem and Self-Acceptance in Chinese College Students: Psychoeducational Lecture vs. Group Intervention

Objective

Self-esteem and self-acceptance are not only basic features but also influential factors of mental health. The present study aimed at assessing the effects of psychoeducational lecture and group intervention on self-esteem and self-acceptance in Chinese college students.

Methods

A total of 149 Chinese college students who participated in a mental health course were randomly class-based assigned into the psychoeducational lecture group (n = 62) and the self-focused intervention group (n = 87). The lecture group received 6-session psychoeducational lectures on overview of mental health, campus adaptation, stress adjustment, self-understanding, emotion management, and interpersonal relationships. The self-focused intervention group was treated with self-related group activities involving aspects of self-knowledge, self-feeling, and self-regulation for six sessions. Pre- and post-intervention measurements were taken with Rosenberg Self-Esteem Scale and Self-Acceptance Questionnaire for both groups.

Results

Self-esteem significantly increased in both groups after six sessions. However, the enhancement of self-acceptance was more robust for the self-focused intervention group than the psychoeducational lecture group.

Conclusion

The psychoeducational lecture and self-focused intervention were effective approaches to improve self-esteem for Chinese college students. With respect to self-acceptance, self-focused group intervention might have a more prominent effect.

A Cross-Sectional Survey on the Association between Dental Health Conditions and University Personality Inventory Scores among University Students: A Single-Center Study in Japan

This study examined the association between dental health conditions and scores on the University Personality Inventory (UPI) among university students in Japan. Participants were freshmen at Yamagata University between 2010 and 2019. Dental check-ups, including dental caries, periodontal disease, malocclusion, and temporomandibular disorders (TMD), and mental health screening using the UPI were performed; 12,433 students were included in the final analysis. A logistic regression analysis was performed to confirm the association between dental health conditions and >30 UPI scores, which indicate the need to consult mental health professionals. Overall, students who required treatment for TMD had a 3.165-fold higher risk of >30 UPI scores (OR = 3.165, 95% CI = 1.710−5.857). Periodontal disease and TMD in male participants (periodontal disease: OR = 1.329, 95% CI = 1.108−1.595; TMD: OR = 3.014, 95% CI = 1.107−8.204) and TMD in female participants (OR = 2.938, 95% CI = 1.340−6.445) were significant risk factors for >30 UPI scores. Students requiring treatment for TMD were at risk of obtaining >30 UPI scores. Although our study has several limitations, students with subjective symptoms (e.g., disturbance in opening the mouth) should take the UPI test or in some cases consult mental health professionals.

The influence of diagnosed mental health conditions and symptoms of depression and/or anxiety on suicide ideation, plan, and attempt among college students: Findings from the Healthy Minds Study, 2018-2019

BACKGROUND

Approximately 11% of 18-25 year-olds report thoughts of suicide. Additionally, suicide is the second leading cause of death in college student populations. We sought to evaluate the relationship between diagnosed mental health conditions and current symptoms of depression and/or anxiety and suicidality in the past year.

METHODS

Healthy Minds Study (HMS) 2018-2019 data from 38,757 college students were analyzed. The PHQ-9, GAD-7, and prior mental health condition diagnoses were used to create a suicidality severity index and we determined how these associations varied by race/ethnicity, gender, and sexual orientation. We also assessed non-suicidal self-injury (NSSI) outcomes in the past year.

RESULTS

Students with both a mental health condition diagnosis and current moderate/severe symptoms of depression and/or anxiety had a higher prevalence of NSSI, 10 times the odds (95% CI 9.4-11.5) of suicide ideation, 28 times the odds (95% CI 23.8-33.1) of suicide ideation, with planning or attempt, and 47 times the odds (95% CI 31.1-71.4) of suicide ideation, with planning and attempt, compared to students with none/minimal depression and/or anxiety symptoms and no mental health condition diagnosis.

LIMITATIONS

We could not clinically confirm depression or anxiety diagnoses nor infer causality of associations in this cross-sectional study. Future longitudinal studies are needed to establish temporality.

CONCLUSIONS

Mental health condition diagnoses and moderate/severe symptoms of depression and/or anxiety were strongly associated with suicidality among college students. These findings identify potential opportunities to further understand and address the mental health needs of college students.

Mental health trajectories in undergraduate students over the first year of university: a longitudinal cohort study

OBJECTIVE

This study examined the association between candidate psychosocial and lifestyle variables and the trajectories of clinically significant anxiety and depressive symptoms from entry to completion of first-year university.

DESIGN

A longitudinal cohort study PARTICIPANTS: First-year undergraduate students METHODS: We analysed the responses of 1686 first-year undergraduate students attending Queen's University who completed electronic surveys at both the beginning and completion of their academic year. Predictors of change in positive anxiety and depressive symptom screens (based on exceeding validated symptom threshold scores) were identified using logistic regression.

RESULTS

Increased university connectedness reduced the odds of emergent significant depressive and anxiety symptoms in healthy students and increased the odds of recovery in students who screened positive at the start of university. Students who screened positive for depression or anxiety at university entry were less likely to recover if they had a lifetime history of internalising disorders. Healthy students who increased their drug use over their first year had higher odds of developing significant levels of both anxiety and depressive symptoms by completion of the academic year.

CONCLUSIONS

Moderate to severe levels of anxiety and depressive symptoms are common among students at entry to university and persist over the first year. University connectedness may mitigate the risk of persistent or emergent symptoms, whereas drug use appears to increase these risks. Findings have implications for university well-being initiatives.

PSYCHOSOCIAL IMPACT OF COVID-19 ON STUDENTS AT INSTITUTIONS OF HIGHER LEARNING

Students at higher institutions of learning are more susceptible to psychosocial problems compared to the general public. These may further be exacerbated by the measures put in place to curb the spread of COVID-19. This mixed methods study examined the factors associated with the psychosocial impact of COVID-19 on students’ financial stability, interpersonal relationships and worries related to achieving academic milestones. Data comprised of a series of closed and open-ended questions collected via Qualtrics from students in the United States and Africa (Central and West). The quantitative data were analyzed using frequency counts, percentages and chi-square, while the qualitative data was analyzed using thematic content analysis. More than 90% of the students resided in the United States, 72.5% were females and 78.4% were undergraduates. Financial hardship was experienced by 26.4% of the students, 55.8% indicated that COVID-19 negatively affected their relationship with friends and over 40% worried over delays in achieving academic milestones. Continent of residence, employment status and financial hardship were significantly associated with the negative impact of COVID-19 on one or more of the students’ relationships and with worries about achieving academic milestones. Qualitative data support the findings that financial hardship contributed to experience of psychological distress by students. It also revealed negative (compromised relationships – broken or fractured relationships and loneliness) and positive (bonding) impact of COVID-19 on interpersonal relationships. School administrators should provide students with resources to access economic relief packages and tele-counseling services to help meet their financial and psychosocial support needs amidst COVID-19.

Psychological impacts of COVID-19 pandemic on the university students in Egypt

University students are at elevated risk for mental health problems. The COVID-19 pandemic and subsequent public health measures taken to combat it burdened the students' life with additional dramatic psychological impacts. The aim of this study was to investigate the psychological impacts that affected the university students in Egypt during the COVID-19 pandemic. An online survey was sent to the Egyptian university students via all means of online communication during the first week of May 2020 by using a non-probability snowball sampling. A survey included a short version Depression Anxiety Stress Scale-21 (DASS-21) and socio-demographic data. Overall, 70.5, 53.6 and 47.8% of Egyptian students had depression, anxiety and stress, respectively. Being a female, having a relative or acquaintance infected with COVID-19, having a preexisting chronic disease and lacking of psychological support from families, community and universities increase the risk of depression, anxiety and stress among Egyptian students. Being a medical student is associated with depression while, spending more time to follow news of COVID-19 pandemic is associated with increased anxiety. Egyptian students experience varying levels of psychological disturbance during COVID-19 pandemic. This study suggests that mental health of the university students should be carefully, monitored during the crisis and the universities should provide psychological-oriented services, adapted to these circumstances to mitigate its emotional impact on the students.

Black college students at elevated risk for suicide: Barriers to mental health service utilization

To examine differences between Black students who do and do not screen positive for suicide risk; to describe barriers to mental health service utilization (MHSU) among participants with a positive screen and no current MHSU and; to determine if barriers vary by student characteristics. Participants: 1,559 Black students (66% female), ages 18 years and older (M = 21 years, SD = 2.61) recruited from September 2015 to October 2017 across four universities. Method: Participants completed an online survey assessing demographics, suicide risk, MHSU, and barriers to MHSU. Results: Seventeen percent of students screened positive for risk; 66% of these students were not receiving MHS. Students who screened positive were female and younger. Perceived problem severity (74%) was reported most frequently. Conclusions: Efforts to improve MHSU among Black college students at risk for suicide should address students' awareness of treatable MH problems and time concerns.

An Eight-Week, Web-Based Mindfulness Virtual Community Intervention for Students' Mental Health: Randomized Controlled Trial

BACKGROUND

Innovative interventions are needed to address the increasing mental health needs of university students. Given the demonstrated anxiolytic and antidepressant benefits of mindfulness training, we developed an 8-week, Web-based Mindfulness Virtual Community (MVC) intervention informed by cognitive behavioral therapy (CBT) constructs.

OBJECTIVE

This study investigated the efficacy of the MVC intervention in reducing symptoms of depression, anxiety, and stress among undergraduate students in Toronto, Canada. The secondary outcomes included quality of life, life satisfaction, and mindfulness.

METHODS

The first 4 weeks of the full MVC intervention (F-MVC) comprised: (1) 12 video-based modules with psycho-education on students' preidentified stressful topics and topically applied mindfulness practice; (2) anonymous peer-to-peer discussion forums; and (3) anonymous, group-based, professionally guided, 20-min live videoconferences. The second 4 weeks of F-MVC involved access only to video-based modules. The 8-week partial MVC (P-MVC) comprised 12 video-based modules. A randomized controlled trial was conducted with 4 parallel arms: F-MVC, P-MVC, waitlist control (WLC), and group-based face-to-face CBT; results for the latter group are presented elsewhere. Students recruited through multiple strategies consented and were randomized: WLC=40; F-MVC=40, P-MVC=39; all learned about allocation after consenting. The online surveys at baseline (T1), 4 weeks (T2), and 8 weeks (T3) included the Patient Health Questionnaire-9 item, Beck Anxiety Inventory, Perceived Stress Scale, Quality of Life Scale, Brief Multi-Dimensional Students Life Satisfaction Scale, and Five-Facet Mindfulness Questionnaire. Analyses employed generalized estimation equation methods with AR(1) covariance structures and were adjusted for possible confounders (gender, age, birth country, paid work, unpaid work, physical activities, self-rated health, and mental health counseling access).

RESULTS

Of the 113 students who provided T1 data, 28 were males and 85 were females with a mean age of 24.8 years. Participants in F-MVC (n=39), P-MVC (n=35), and WLC (n=39) groups were similar in sociodemographic characteristics at T1. At T3 follow-up, per adjusted comparisons, there were statistically significant reductions in depression scores for F-MVC (score change -4.03; P<.001) and P-MVC (score change -4.82; P<.001) when compared with WLC. At T3, there was a statistically significant reduction in anxiety scores only for P-MVC (score change -7.35; P=.01) when compared with WLC. There was a statistically significant reduction in scores for perceived stress for both F-MVC (score change -5.32; P<.001) and P-MVC (score change -5.61; P=.005) compared with WLC. There were statistically significant changes at T3 for quality of life and mindfulness for F-MVC and P-MVC vs WLC but not for life satisfaction.

CONCLUSIONS

Internet-based mindfulness CBT-based interventions, such as F-MVC and P-MVC, can result in significant reductions in symptoms of depression, anxiety, and stress in a student population. Future research with a larger sample from multiple universities would more precisely test generalizability.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number ISRCTN92827275; https://www.isrctn.com/ISRCTN92827275.

Recovering in Place: Creating Campus Models of Care for the High-Risk College Student

PURPOSE OF REVIEW

Over the last decade, the number and severity of mental health problems among college students has continued to rise. Universities are struggling to dedicate enough resources to meet the mental health needs of students. In this article, we review on-campus innovative programs designed to promote recovery in high-risk college students.

RECENT FINDINGS

Colleges respond in a variety of ways to students on campus with serious mental health problems, from encouraging or requiring students to take a leave of absence, to creating treatment programs and reducing course loads to treat in place. On-campus programs that address the needs of high-risk students can include post-hospitalization programs, intensive outpatient groups, and specialized treatment for diverse populations such as athletes. Some universities are developing unique programs that enable high-risk college students to recover on campus. More research is needed to determine how best to deliver this care.

Perceived impact of contextual determinants on depression, anxiety and stress: a survey with university students

Background

Young adults starting college or university education encounter multiple stressors related to transitional life-stage and novel environments. Current studies reveal high rates of symptoms related to common mental health problems like depression, anxiety and stress. However, limited knowledge exists on the determinants on these problems among Canadian students. The primary aim of the study was to investigate the impact of contextual determinants, as perceived by students, on self-reported mental health, and how these impacts varied by depression, anxiety and stress.

Methods

A cross-sectional survey was conducted with students attending a large university in Toronto, Canada. Participants completed a self-administered online questionnaire as part of a larger project. The questions asked about contextual determinants related to personal, interpersonal, family, social, socio-economic and political factors along with levels of depression, anxiety and stress as measured by Patient Health Questionnaire-9, Beck Anxiety Inventory and Perceived Stress Scale.

Results

A total of 148 students completed the questionnaire (37 males and 111 females) with an age range of 19–54 years (median 22, IQR 21–24.8). English was reported as first language by 62.8% while 34.5% self-identified as white and 58.1% reported being born in Canada. Overall, 39.5% reported symptoms of moderate to severe depression, 23.8% reported moderate–severe anxiety and 80.3% reported moderate–severe levels of perceived stress, with no significant differences between males and females. In the final multivariate analysis, variables significantly associated with depression were grade-point-average (aOR 2.46, 95% CI 1.017–5.97), family factors (aOR 3.46, 95% CI 1.50–7.94), social factors (aOR 3.24, 1.30–8.1), self-rated health (aOR 0.34, 95% CI 0.14–0.82) and political factors (aOR 0.40, 95% CI 0.16–0.97). Anxiety was significantly associated with family factors (aOR 2.79, 1.09–7.18), socioeconomic factors (aOR 2.59, 95% CI 1.05–6.42) and age (aOR 0.33, 95% CI 0.11–0.98). The significant factors for stress were grade-point-average (aOR 2.41, 1.01–5.75) and social factors (aOR 3.87, 95% CI 1.59–9.43).

Conclusion

The study found strong to moderate impact of several determinants on depression, anxiety and stress. The results suggest a need to address a variety of factors affecting students’ mental health.

Trial registration Parent trial: http://www.isrctn.com/ISRCTN92827275