Article

Help-Seeking and Access to Mental Health Care in a University Student Population

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Abstract

University students represent an important population in which to study access to mental health care. Understanding their unmet needs will enhance efforts to prevent and treat mental disorders during a pivotal period in life. To quantify mental health service use and estimate how various factors are associated with help-seeking and access in a university student population. A Web-based survey was administered to a random sample of 2785 students attending a large, public university with a demographic profile similar to the national student population. Nonresponse bias was accounted for using administrative data and a nonrespondent survey. Mental health was measured using the Patient Health Questionnaire screens for depressive and anxiety disorders. Mental health service utilization was measured as having received psychotropic medication or psychotherapy in the past year. Of students with positive screens for depression or anxiety, the proportion who did not receive any services ranged from 37% to 84%, depending on the disorder. Predictors of not receiving services included a lack of perceived need, being unaware of services or insurance coverage, skepticism about treatment effectiveness, low socioeconomic background, and being Asian or Pacific Islander. Even in an environment with universal access to free short-term psychotherapy and basic health services, most students with apparent mental disorders did not receive treatment. Initiatives to improve access to mental health care for students have the potential to produce substantial benefits in terms of mental health and related outcomes.

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... Among college students with a diagnosed mood disorder or with elevated symptoms of depression, fewer than half seek mental health treatment (Blanco et al. 2008;Eisenberg et al. 2007). The low rate of help-seeking behaviors among college students may be partially explained by students' perceptions of public stigma, lack of time, or privacy concerns, as well as a lack of concern about their symptoms (Eisenberg et al. 2009;Hunt and Eisenberg 2010). ...
... The low rate of help-seeking behaviors among college students may be partially explained by students' perceptions of public stigma, lack of time, or privacy concerns, as well as a lack of concern about their symptoms (Eisenberg et al. 2009;Hunt and Eisenberg 2010). Data also suggest that students from certain demographic groups are particularly unlikely to access mental health services, including students from lower socioeconomic backgrounds, and students who identify as Asian or Pacific Islander (Eisenberg et al. 2007). Finally, most campus counseling centers are already overwhelmed with demand. ...
... In this sample, the Cronbach's alphas are 0.82 for usefulness, 0.77 for ease of use, 0.79 for ease of learning, and 0.91 for satisfaction. Treatment Utilization Measure: This measure (Eisenberg et al. 2009) is an adaptation of that used by Eisenberg et al. (2007), which measures perceived need for mental health services in the past year and past year medication use. ...
Article
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College and university students across the United States are experiencing increases in depressive symptoms and risk for clinical depression. As college counseling centers strive to address the problem through wellness outreach and psychoeducation, limited resources make it difficult to reach students who would most benefit. Technology-based prevention programs have the potential to increase reach and address barriers to access encountered by students in need of mental health support. Part 1 of this manuscript describes the development of the Willow intervention, an adaptation of the technology-based CATCH-IT depression prevention intervention using a community participatory approach, for use by students at a women’s liberal arts college. Part 2 presents data from a pilot study of Willow with N = 34 (mean age = 19.82, SD = 1.19) students. Twenty-nine participants (85%) logged onto Willow at least once, and eight (24%) completed the full intervention. Participants positively rated the acceptability, appropriateness, and feasibility of Willow. After eight weeks of use, results suggested decreases in depressive symptoms (95% CI (0.46–3.59)), anxiety symptoms (95% CI (0.41–3.04)), and rumination (95% CI (0.45–8.18)). This internet-based prevention intervention was found to be acceptable, feasible to implement, and may be associated with decreased internalizing symptoms.
... At the same time, educational institutions offer a unique chance to promote young people's mental health and well-being. They provide a single integrated setting encompassing academic, professional and social activities, along with health and other services (Eisenberg et al., 2007). ...
... However, researchers note the gap between the need for professional mental health assistance and the utilisation of these services among youth. The degree of underutilisation might be as high as 50%-82% of the students in need (Blanco et al., 2008;Eisenberg et al., 2007;Gulliver et al., 2010;O'Brien et al., 2016;Rosenthal & Wilson, 2008;Zivin et al., 2009). ...
Article
https://onlinelibrary.wiley.com/share/author/RPVJYIDKVMICYTVMWR8F?target=10.1002/capr.12461 Objectives This study explores the factors involved in the intention to seek support from mental health services among students, emphasising the role of subjective norms in this process. Methods Factors involved in students’ intentions to seek support from mental health services were explored using regression analysis, based on survey data from 1,494 Russian students (from high schools, vocational schools and universities). Independent variables included perceived injunctive and descriptive norms towards mental health help-seeking, previous experience of utilising mental health services and mental health symptoms. Findings Less than a quarter of students had the intention to seek psychological help in case of distress. Just half of the students felt that others would support them in seeking psychological help (injunctive social norms), although only 10% believed their peers would seek help when needed (descriptive norms). Only injunctive, but not descriptive, social norms were associated with the intention to seek help. Experience of visiting a psychologist (only in the case of self-referral) was another important predictor of intention to seek help. Male students and those who considered their mental health to be bad or perfect showed less intention to seek help. Conclusion Provision of mental health services for students should be accompanied by interventions aimed at establishing positive attitudes towards mental health-seeking among the general population, particularly those whose opinion is important for students. A gender-specific approach should be introduced in delivering and promoting mental health care since male students are more hesitant to accept care and might face strong negative feedback from their social environment when doing so.
... There is a growing body of research on the nature of mental health problems in university students in the UK (Gorczynski et al., 2017;Macaskill, 2013;Dodd et al., 2021;Stewart-Brown et al., 2000) and globally (Storrie, Ahern and Tuckett, 2010;Eisenberg, Golberstein and Gollust, 2007). Evidence shows that higher education students face significant unmet needs with respect to mental health, and service provision may be inadequate in many settings (Eisenberg, Golberstein and Gollust, 2007). ...
... There is a growing body of research on the nature of mental health problems in university students in the UK (Gorczynski et al., 2017;Macaskill, 2013;Dodd et al., 2021;Stewart-Brown et al., 2000) and globally (Storrie, Ahern and Tuckett, 2010;Eisenberg, Golberstein and Gollust, 2007). Evidence shows that higher education students face significant unmet needs with respect to mental health, and service provision may be inadequate in many settings (Eisenberg, Golberstein and Gollust, 2007). Decision-makers in health care, public policy-making, and within universities require robust evidence to inform service provision and investment decisions. ...
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Background: Students in higher education often face mental health problems with inadequate treatment options. With COVID-19 only exacerbating the already high levels of mental health problems in the younger adult population, it is imperative policy makers have the relevant evidence to inform resource allocation and investment into student mental health services. Aim: We aim to identify and summarise economic evaluations of interventions that both prevent and treat student mental health within the UK. Method: We will conduct a review of all published economic evaluation literature relating to both students in higher education and interventions designed to prevent or treat student mental health. We will conduct a search in the following databases: PubMed, MEDLINE, Embase, Web of Science, EconLit, PsycINFO and the National Health Service Economic Evaluation Databases (NHS EED). The review will be conducted in accordance with the PRISMA statement guidelines 2019. A database of the literature compiled as part of this systematic literature review will be made available for transparency.
... Much of the research reveals that students do not often prefer to employ psychological counseling services to solve the problems they come across. They may not receive professional help due to reasons such as getting support from family members and friends, long waiting lists at the university counseling center, economic concerns, fear of stigma, and not knowing where or how to obtain help (Boldero, & Fallon, 1995;Downs, & Eisenberg, 2012;Eisenberg, Golberstein, & Gollust, 2007;Oliver, Reed, Katz, & Haugh, 1999;Raviv, Sills, & Wilansky, 2000;Rickwood, Deane, Wilson, & Ciarrochi, 2005;Rudowicz, & Au, 2001). Mental health literacy refers to "knowledge and beliefs about mental disorders which aid their recognition, management or prevention" (Jorm et al., 1997, p 182). ...
... It has been found that there is no significant difference between the economic income level of the participants and their attitudes towards getting help. Findings indicate that the higher the level of financial income, the higher the attitude to seek help (Parent, Hammer, Bradstreet, Schwartz & Jobe, 2016;Hammer, Vogel & Heimerdinger-Edwards, 2013;Arslantaş, Dereboy, Aştı & Pektekin, 2011;Kılınç & Granello, 2003) and some studies do not show such a relationship (Akaydin, 2002;Erkan, Cihangir-Çankaya, Özbay & Terzi, 2012;Eisenberg, Golberstein & Gollust, 2007;Dilek, 2010). Since university students can access free psychological help, their income level may not affect their attitude towards help. ...
... Barriers that prevent mental health patients from seeking professional help can be related to individual beliefs, practices, and resources, as well as factors associated with the ways that the mental health system is organized, financed, and delivered, or a combination of both [18]. Such barriers to mental health care include scepticism about treatment effectiveness [19] [20], low socioeconomic background [19], fear by students of documentation in academic records [21], and lack of time and fear of a negative impact on career [22]. ...
... Barriers that prevent mental health patients from seeking professional help can be related to individual beliefs, practices, and resources, as well as factors associated with the ways that the mental health system is organized, financed, and delivered, or a combination of both [18]. Such barriers to mental health care include scepticism about treatment effectiveness [19] [20], low socioeconomic background [19], fear by students of documentation in academic records [21], and lack of time and fear of a negative impact on career [22]. ...
Conference Paper
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The increased functionality and uses of smartphone devices can provide a means for the delivery of mental health services. This paper presents an Android smartphone application designed for Arabic users that uses the cognitive behavioural therapy (CBT) method to help patients who have been diagnosed with depression, with clinical therapist-assisted delivery. The proposed app has been developed with mental health expert input through collaboration with a medical facility. The proposed app aims to provide support beyond the formal treatment sessions to improve the completion rates of treatment.
... Much of the research reveals that students do not often prefer to employ psychological counseling services to solve the problems they come across. They may not receive professional help due to reasons such as getting support from family members and friends, long waiting lists at the university counseling center, economic concerns, fear of stigma, and not knowing where or how to obtain help (Boldero, & Fallon, 1995;Downs, & Eisenberg, 2012;Eisenberg, Golberstein, & Gollust, 2007;Oliver, Reed, Katz, & Haugh, 1999;Raviv, Sills, & Wilansky, 2000;Rickwood, Deane, Wilson, & Ciarrochi, 2005;Rudowicz, & Au, 2001). Mental health literacy refers to "knowledge and beliefs about mental disorders which aid their recognition, management or prevention" (Jorm et al., 1997, p 182). ...
... It has been found that there is no significant difference between the economic income level of the participants and their attitudes towards getting help. Findings indicate that the higher the level of financial income, the higher the attitude to seek help (Parent, Hammer, Bradstreet, Schwartz & Jobe, 2016;Hammer, Vogel & Heimerdinger-Edwards, 2013;Arslantaş, Dereboy, Aştı & Pektekin, 2011;Kılınç & Granello, 2003) and some studies do not show such a relationship (Akaydin, 2002;Erkan, Cihangir-Çankaya, Özbay & Terzi, 2012;Eisenberg, Golberstein & Gollust, 2007;Dilek, 2010). Since university students can access free psychological help, their income level may not affect their attitude towards help. ...
... More specifically, to make sure students have easy access to low-threshold and free-of-charge or subsidized services to consult in the case of less urgent health problems, such as mild to moderate mental distress, testing for sexually transmitted diseases (STDs) or prescriptions of contraceptives. This kind of availability and the image of supplying lowthreshold services might create the opportunity for student welfare organizations to reach students and young adults in a way than cannot be matched by other institutions, and to overcome some of the barriers to help-seeking, including e.g., fear of stigma, financial constraints, lack of information about help and mental health services available, and time constraints (27,28). ...
... Our data confirmed the established gender ratio for help seeking, particularly for mental health problems. Previous studies on help-seeking among students suffering from mental distress have found that a large share do not seek and receive help, even when low-threshold campus-based services are available (28,38). In contrast, our findings indicate that demand for mental health care was pronounced among these students, particularly non-local students. ...
Article
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Background: Existing studies have documented high levels of mental distress in University and college students, complemented with poor help-seeking behavior. Colleges and universities offer a unique setting to address mental health problems that might overcome some of the most prominent barriers to help-seeking. Objective: We aim to describe the use of campus-based health care services and health services available in the near-by community among students in Norwegian student welfare organizations. We compare health care service use between non-local (in-movers) and local students, students at large and small welfare organizations, and students with severe and medium-low levels of mental distress. Methods: Data stem from the SHoT study (Students' Health and Well-being Study), a national survey from 2018 of all students aged 18–35 undertaking higher education in Norway. Mental distress was assessed using the Hopkins Symptom Checklist-25 (HSCL-25), and we also obtained self-report data on use of health care services. Data on health care services offered at Norwegian student welfare organizations was obtained from semi-structural telephone interviews. Results: Non-local students used health care services that are low threshold, easily accessible and close to campus (health clinics and services organized by the student welfare organization) to a larger extent than local students. Students with symptoms of severe mental distress used almost all types of health services more than other students. We found big differences in reported use of health services in large and small organizations, yet these differences mirrored services available, and not necessarily student demand and preferences. Conclusion: Services offered by the student welfare organizations seem to play a particularly important role for non-local students and students reporting symptoms of severe mental distress.
... However, for younger people, experiencing psychological distress is often accompanied by perceived stigma, feelings of embarrassment, and a preference for self-reliance, which hamper formal helpseeking behaviours (24). In addition, students with depression or anxiety who fail to seek support frequently report unawareness of available services (27). Students with higher levels of distress are less able to effectively seek help. ...
... With studies proposing that informal support is generally preferred by young adults due to financial considerations, higher availability, and lower associations with stigmatisation (25), their applicability within the currents predictive models deserves further scrutiny. Moreover, research indicates that facilitators of help-seeking among students include increased education and awareness, encouragement, removal of treatment scepticism, and the provision of accessible resources such as student counselling (23,24,27). As such, HE institutes could stimulate student wellbeing by exploring relevant facilitators of student support seeking, in addition to scrutinising HE support service accessibility and availability. ...
Article
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Background: The corona pandemic has forced higher education (HE) institutes to transition to online learning, with subsequent implications for student wellbeing. Aims: This study explored influences on student wellbeing throughout the first wave of the corona crisis in the Netherlands by testing serial mediation models of the relationships between perceived academic stress, depression, resilience, and HE support. Methods: The Covid-19 International Student Wellbeing Study (C19 ISWS) was used, with a total sample of 2,480 higher education students studying at InHolland Universities of Applied Sciences in the Netherlands. Student subgroups were created, so that students with low and high perceived academic stress could be assessed, in addition to depressed and non-depressed students. Predictive model fit was tested using Macro PROCESS. Results: A significant serial mediation model for the total student sample was revealed, including protective mediating effects of resilience and HE support on the positive direct effect of perceived academic stress on depression. At subgroup level, significant (partial) predictive effects of resilience on depression scores were noted. A partial serial effect between resilience and HE support was found for students with low perceived stress levels, whereas a parallel partial mediation model was present among highly academically stressed students. Regarding non-depressed students, a full parallel mediation model was found, whereas the model for depressed students inadequately explained the data. Conclusions: Overall, resilience and HE support mediate the predictive effect of academic stress on depressive symptoms among students. In addition, substantial differences in model fit arise when inspecting the students on a subgroup level. These findings contribute to the gap in knowledge regarding student wellbeing during the Covid-19 pandemic in the Netherlands, in addition to providing novel insights on student subgroup dynamics. While Covid-19 restrictions continue to demand online learning, student wellbeing may be enhanced overall by targeting resilience and increasing awareness and availability of HE support services. The current study also highlights the need for differential approaches when examining wellbeing for specific student groups.
... e university can play an effective role in the promotion of research self-regulation skills of residents by emphasizing the research process and research skills of residents instead of emphasizing research performance and also teaching them how to use self-regulation in research. In addition, consistent with the study [25], other possible reasons for the low level of adaptive help-seeking of residents include the lack of mastery of help-seeking skills and, consequently, inability to seek help. ...
Article
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Background and Objectives. Considering the undeniable role of the help-seeking strategy in learning research skills, this study aimed to examine the situation of research help-seeking among ophthalmology residents of Mashhad University of Medical Sciences (MUMS), Mashhad, Iran. Materials and Methods. This descriptive cross-sectional study was performed on all ophthalmology residents of MUMS (n = 46). A validated research help-seeking scale was used to collect the required data. The scale consisted of 29 items and assessed the three dimensions of avoidance of help-seeking, adaptive help-seeking, and perceived benefit of help-seeking. The answers were scored based on a six-point Likert scale. Results. In total, 41 residents who responded to the electronic version of the research help-seeking scale were selected through convenience sampling. In the axes of help-seeking avoidance and perceived benefit of help-seeking, indexes were in the upper-middle level, while in the adaptive help-seeking axis, it was in the lower-middle level. Based on the results, gender and academic year of residency had no effect on research help-seeking aspects in the participants. However, age had a positive and significant correlation with the perceived benefit of help-seeking. Conclusion. Research help-seeking in residents of ophthalmology of MUMS in all three axes was around the middle level, and it is recommended that university officials and professors encourage residents use adaptive help-seeking strategy during their residency to improve their research skills.
... University students experience mental distress (anxiety and depression) more frequently as compared with the general population. 1 This could in part be attributed to their youth making them more vulnerable to mental distress, academic pressure within university, the stress and strangeness of being away from home for the first time, new peer relationships, and lower social support. [1][2][3] However, most of these students do not access professional mental health services, 4 perhaps because local explanatory models of suffering prevail and resonate more strongly than formal western biomedical understandings of mental distress. 5,6 Explanatory models describe the way people with mental distress conceptualize their distress, explanations they give for causes, the modes of expression of distress, how they rate the severity of the problem, its onset, help-seeking behavior, coping mechanisms, treatment preference, and the adverse consequences of their distress. ...
Article
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Background: Socio-culturally determined processes account for how individuals give meanings to health, illness, causal attributions, expectations from treatment, and related outcomes. There is limited evidence of explanatory models for mental distress among higher education institutions in Ethiopia. The objective of this study was to explore the explanatory models for mental distress among Wolaita Sodo University. Methods: The current study used a phenomenological research approach, and we collected data from 21 students. The participants were purposively recruited based on eligibility criteria. Semi-structured interviews were conducted from December 2017 to January 2018 using the Short Explanatory Models Interview. The interviews were audio-recorded, transcribed into the Amharic language and translated into English. Data were analyzed using framework analysis with the assistance of open code software 4.02. Results: Most students experienced symptoms of being anxious, fatigue, headaches and feelings of hopelessness. They labeled these symptoms like anxiety or stress. The most commonly reported causal explanations were psychosocial factors. Students perceived that their anxiety or stress was severe that mainly affected their mind, which in turn impacted their interactions with others, academic result, emotions and motivation to study. Almost all the students received care from informal sources, although they wanted to receive care from mental health professionals. They managed their mental distress using positive as well as negative coping strategies. Conclusion: The policy implication of our findings is that mental health interventions in higher education institutions in Ethiopia should take into account the explanatory models of students' psychological distress.
... While universities cannot perform a function or substitute public health institutions, they could still play a vital role in students' mental health by promoting the importance of well-being, helping students to navigate through difficult situations, providing information about on-campus and off-campus services and access to them (Duffy, Saunders, Malhi, Patten, Cipriani, McNevin, MacDonald, Geddes, 2019). Studies show that students do not always know about available psychological services (Eisenberg, Golberstein & Gollust, 2007) and might not recognize that they need help (Thomas, Caputi & Wilson, 2013). Many students report that they would not seek professional help even if they are in distress. ...
Preprint
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University education is recognized as an important period of life that determines the future trajectories and success of individuals. It is also the time when the onset of depression peaks. In this paper, we use data on 4,182 students from a selective university to identify the main factors associated with symptoms of depression among this cohort. Besides socio-demographic characteristics that are largely out of the university's control, we pay specific attention to the role of students’ satisfaction with various aspects of their university life. We find that controlling for potential confounders, satisfaction is negatively associated with depression. We also find that survey data routinely collected by the university could be used to identify individuals at high risk of future depression.
... The adverse influence of both SLCs on mental health can be further underscored by students' poor practices in relation to juggling study and life demands (Badri, 2021), which causes dysfunction or a lack of engagement in what is perceived to be a less prioritised area (either study or life). Previously, mental health issues among students were frequently linked to intense academic competition, imbalances in their university life, excessive freedom, troubled family relationships, unrealistic expectations and financial problems (Eisenberg et al., 2007;Stallman, 2008). With the onset of the COVID-19 pandemic in 2020, stressful living conditions and adjustment to the sudden adoption of remote learning methods have since emerged as the new contributors to students' mental health concerns (Horita et al., 2021). ...
Article
University students learning remotely from various locations has initiated a unique challenge for higher education institutions (HEIs), especially in managing both teaching and students’ wellbeing amidst the COVID-19 pandemic due to the increased conflicts that occur when juggling study and life demands. However, little discussion is available to understand how remote learning influences the occurrence of study-life conflicts among students and its consequence to their mental health. Little evidence is also found regarding the role of students’ residency status in influencing this relationship. Hence, a study to address both shortcomings was conducted using a sample of 1005 university students in Malaysia. Findings suggested that studying remotely was related to greater occurrences of study-life conflicts, which adversely impacted the students’ mental health. Overall, study-to-life conflict had a greater influence on mental health as compared to life-to-study conflict. However, residency status did not moderate the relationship between study-life conflicts and mental health, indicating that students experienced the same level of mental health issues regardless of where they were staying. The findings offer valuable insights and suggestions on how to improve remote learning practices and student wellbeing services during and post pandemic period.
... Moreover, it may have been appropriate to find the barriers that students face in seeking help when their wellness deteriorates as recent studies have shown students who need help do not seek it even when it is readily available. 3 The authors provide an array of student perspectives, which are beneficial in seeing the extent of the issue. However, it may have been useful to prioritise the key needs of the students or the answers that were given most frequently. ...
Article
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Aanchal Gupta, Roshan Jonash Raymond Barts and The London School of Medicine and Dentistry, London, UKCorrespondence: Aanchal GuptaBarts and The London School of Medicine and Dentistry, Garrod Building, Turner Street, Whitechapel, London, E1 2AD, UKTel +44 7946769695Email a.gupta@smd16.qmul.ac.uk View the original paper by Dr Butcher and colleagues
... Many personal and academic life factors and environmental stressors precipitate college student stress [75]. Unfortunately, there are major impediments to seeking mental health services for college students, such as stigma and lack of timely and proactive care [31,32]. ...
Article
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The post-college transition is a critical period where individuals experience unique challenges and stress before, during, and after graduation. Individuals often use social media to discuss and share information, advice, and support related to post-college challenges in online communities. These communities are important as they fill gaps in institutional support between college and post-college plans. We empirically study the challenges and stress expressed on social media around this transition as students graduate college and move into emerging adulthood. We assembled a dataset of about 299,000 Reddit posts between 2008 and 2020 about the post-college transition from 10 subreddits. We extracted top concerns, challenges, and conversation points using unsupervised Latent Dirichlet Allocation (LDA). Then, we combined the results of LDA with binary transfer learning to identify stress expressions in the dataset (classifier performance at F1=0.94). Finally, we explore temporal patterns in stress expressions, and the variance of per-topic stress levels throughout the year. Our work highlights more deliberate and focused understanding of the post-college transition, as well as useful research and design impacts to study transient cohorts in need of support.
... The perceived public stigma from others (i.e. negative views from others if someone sought treatment) is one of the considerable barrier in the treatment of mental problems among young adults (Eisenberg et al., 2007). Findings of National Comorbidity Survey showed that approximately one-fifth individuals have dropped their mental health treatment due to perceived public stigma (Mojtabai et al., 2011). ...
Article
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The current study intended to find out the role of resilience on perceived public stigma and burden among primary caregivers of the psychiatric patients. The current study highlighted the psychological health of caregivers. A cross sectional study was conducted in region of Islamabad and Rawalpindi, Pakistan. A total of 250 caregivers participated in the study, whom 125 were male and 125 were female caregivers, age range was 25-60 years (M=31.61, SD=5.93). The data was collected from public and private hospitals. Three scales were used for data collection. The resilience was measured through Urdu translated resilience scale, public stigma was assessed by using Urdu version of perceived public stigma, and Burden was measured through interview. The result showed that resilience was negatively associated with burden and perceived public stigma (p< 0.01). Further, the multiple regression showed that resilience acted as moderator between public stigma and burden (? = -1.02, p< .001). The result supported a positive association between public stigma, burden and resilience among caregivers of psychiatric patients.
... The described low uptake of personal consultation for mental health support by medical students [14,21] may be explained by fears of stigmatization, shame, barriers to time and place, and distrust of support offers [1,9,[22][23][24][25][26]. New technologies have facilitated online mental health support that may overcome some of these barriers as they can be accessed anonymously from anywhere and at any time and can be used individually in a safe or well-known setting [1,9,[27][28][29]. ...
Article
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Medical students have been shown to be vulnerable to mental stress. Strengthening individual protective characteristics can be one cornerstone for promoting medical students’ mental health and thereby preventing mental disorders. Online programs are an opportunity to provide appropriate options that have the advantage of being accessible from anywhere, at any time, and with a low entry threshold. This review provides a literature overview of current online programs for medical students. The findings can serve as a point of reference for designing effective online programs for mental health-promotion and mental disorder-prevention in medical curricula. We applied a systematic literature search in PubMed, ERIC, Cochrane, and Web of Science. Programs offered had to be web-based, and the addressed group had to be medical students. Protective individual characteristics for mental health and information on the programs’ effectiveness were included in the search. As outcomes, we included mental health, burnout, symptoms of depression, anxiety, and well-being. The search yielded 723 articles; of them, 11 met the inclusion criteria. Programs found were grouped according to their focus: mental health literacy, mindfulness, based on Cognitive Behavioral Therapy, or peer support. Two studies showed significant reductions in perceived stress; one study indicated reduced burnout levels. One program had significant immediate effects on mindfulness, empathy, and resilience; two studies indicated strengthening coping strategies. Two programs were qualitatively assessed as helpful; two studies are ongoing. Nine studies lacked control groups; two randomized controlled trials were ongoing. Only a few online programs with limited evidence of effectiveness were found. They addressed protective individual characteristics, highlighting their importance for mental health. Thus, more health-promoting and mental disorder-preventing programs with high-quality effectiveness studies are necessary. An integration of such programs into curricula would allow for greater utilization and could give greater emphasis to and prioritize mental health in medical education.
... When combined with other barriers, such as low accessibility and high cost of services, it becomes clear why youth disfavour professional help, while preferring online resources or relatives (Horgan & Sweeney, 2010). The perceived need for professional help may also be hindered by scepticism around the effectiveness of professional help (Eisenberg et al., 2007;Garrido et al., 2009). For instance, students who did seek professional help reported negative and unsatisfying engagement with the mental health care system, challenged by unavailability of appropriate resources, lack of infrastructure of the mental health care system, and scarcity of available psychiatrists (Saeed, 2018). ...
Article
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Aim: Approximately half of the population in Egypt is under the age of 25. Globally, mental illness represents the highest burden of disease in this age group. Yet in Egypt, there is still no youth-specific mental health system in place and the vast majority of young people do not have access to any professional mental health support. The objective of this study was to describe the mental health needs of Egyptian youth and the resources they use when seeking help. Methods: An online cross-sectional survey was distributed among medical students at Tanta University in Egypt. Of the 707 individuals who completed the survey (90.9% response rate), 60.5% were female, 62.0% lived in urban and suburban areas, and the mean age of the sample was 20.5 (±1.8) years old. Results: More than half (54%) of the students reported that they had been affected by mental health problems at some point in their lives. Anxiety and depression were the most common problems. Regarding help-seeking behaviours, participants mainly searched the web or spoke to peers and relatives; few reported approaching medical professionals. The majority of participants (59.7%) reported being disappointed with the current mental health care system in Egypt. Conclusions: There is a high prevalence of mental challenges among Egyptian youth and the health care system is not adequately prepared to respond to their needs. E-Mental Health and online interventions seem to be a promising solution that could increase access to mental health services for Egyptian youth.
... Consistent with extant literature (Eisenberg et al., 2007(Eisenberg et al., , 2011Kam et al., 2019), we found that Asian American emerging adults were less likely to have direct and indirect experiences of mental health help-seeking compared to their White American peers. More specifically, in our sample, the Asian American group was approximately four times less likely to have a previous experience of seeking professional psychological services and 3.2 times less likely to have been prescribed or having taken a psychotropic medication than their White American peers. ...
Article
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In this cross-sectional survey, we examined the direct and indirect mental health help-seeking experiences and relevant psychological factors in Asian American, multiracial American, and White American emerging adults aged 18–25 years old. The study sample consisted of 384 Asian American (249 women, 135 men), 244 multiracial American (172 women, 72 men), and 245 White American (190 women, 55 men) emerging adults, who were recruited from a four-year public university in the state of Hawaiʻi of the United States (U.S.). Results revealed that Asian American and multiracial American emerging adults were less likely to: (a) have previous experience of seeking professional psychological services: (b) have been prescribed, or are currently taking, a psychotropic medication; (c) know someone close to them who had sought psychological services; or (d) know someone close to them who was diagnosed with a psychological disorder, compared to their White American peers. We also discuss implications of the present findings, limitations of the study, and future directions in this line of research.
... Le taux de participation obtenu dans cette étude est relativement faible (31,6 %) comparativement aux études qui ont, elles aussi, utilisé la complétion de questionnaires internet auprès d'étudiants universitaires. Elles ont obtenu des taux de participations de 55,5 % (Eisenberg, Golberstein et Gollust, 2007) (2012), comme dans l'étude actuelle, les participant.es avaient reçu le questionnaire par courriel et n'avaient pas de moment précis à leur horaire, organisé par les chercheurs ou les entraîneurs, afin de participer à l'étude. ...
Thesis
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Les attitudes et comportements alimentaires problématiques (ACAP), tout comme les troubles des conduites alimentaires, réfèrent à des préoccupations envahissantes pour l’alimentation, l’apparence et le poids, à une influence du poids et de l’apparence sur l’estime de soi ainsi qu’à des perturbations des comportements alimentaires. Les ACAP entraînent des conséquences importantes (ex: détresse psychologique, dépression, anxiété, altération de la qualité de vie et des relations familiales et sociales, augmentation des risques de présenter des troubles des conduites alimentaires). Les étudiant.es-athlètes universitaires sont à risque de présenter des ACAP, car ils doivent surmonter au même moment des enjeux en lien avec le début de l’âge adulte, les études universitaires et la pratique de sport universitaire élite. L’étude actuelle a comme objectifs de 1. Déterminer la proportion d’étudiant.es-athlètes universitaires présentant des ACAP ; 2. Déterminer les différences sur le plan des caractéristiques psychologiques entre les étudiant.es-athlètes présentant ou non des ACAP ; 3. Évaluer quelles sont les variables psychologiques les plus fortement associées à la présence d’ACAP chez les étudiant.es-athlètes universitaires. L’échantillon est composé de 133 étudiant.es-athlètes faisant partie de l’équipe sportive de leur université québécoise, lors de l’année scolaire 2018-2019. Trois outils ont été employés pour mesurer les ACAP, soit l’Eating Disorder Inventory-3 (EDI-3), le Questionnaire for a diagnosis of orthorexia et le Muscle Dysmorphic Disorder Inventory. Trois outils ont été utilisés pour évaluer les caractéristiques psychologiques, soit l’EDI-3, le Sociocultural Attitudes Towards Appearance Questionnaire-3 et l’Indice de détresse psychologique de l’enquête santé Québec. En lien avec le premier objectif, 19,5 % de l’échantillon total présente des ACAP (21,1 % chez les femmes et 15,8 % chez les hommes, p > 0,05). Ensuite, les participant.es ayant des ACAP présentaient significativement (p ≤ 0,05) plus d’ascétisme, de difficulté de régulation émotionnelle, d’aliénation interpersonnelle, de problèmes cognitifs et une plus faible estime de soi que les participant.es exempts d’ACAP (second objectif). En lien avec le troisième objectif, une régression linéaire multiple a été réalisée, permettant d’observer que le sexe et le surcontrôle explique 36,3 % de la variance (p ≤ 0,01) du score d’ACAP. De ces deux variables, c’est le surcontrôle qui contribue le plus au modèle (ß = 0,595, comparativement au sexe ß = 0,208 ). En résumé, en contrôlant pour le sexe, plus un ou une étudiant.e-athlète universitaire aurait de surcontrôle, plus il ou elle présenterait un score d’ACAP élevé. Face à ces résultats, il est nécessaire de conscientiser les entraîneurs à la problématique des ACAP afin qu’ils en connaissent les manifestations et les conséquences permettant de repérer des étudiant.es-athlètes plus à risque et de leur offrir un soutien supplémentaire en prenant le temps de discuter avec eux ou en les référant à des professionnels spécialisés.
... Depression is also found to be linked to some chronic diseases, such as cancer (Spiegel & Giese-Davis, 2003), diabetes (De Groot et al., 2001) and asthma (Di Marco et al., 2010) and has been considered by some to have a causal role (e.g., Maghout-Juratli et al., 2010). It is also argued that people with mental illness may find it difficult to access adequate healthcare (Eisenberg et al., 2007), compounding their physical health status. Vaillant (1979) showed that better mental health in the past was strongly linked to good current physical health. ...
Article
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... 25 For instance, college students dealing with severe or recurrent depression were reluctant to seek treatment due to fears of being judged if they seek help. 26 More recently, a study across 2009 through 2015 revealed that college students' greater perception of stigma toward mental health treatment was negatively associated the use of mental health service. 27 Against this backdrop, the convenience and confidentiality that MHA provides may appeal to students with concerns about stigmatization. ...
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Background: The advance in digital media technologies has enabled the development of technologically mediated health care solutions. Mobile health app for mental health care is one of such innovative tools to monitor and manage users' mental health and psychological well-being. Objective: This study examines the factors predicting the acceptance of mental health app (MHA) that are: technological (i.e., perceived ease of use and perceived usefulness) and sociocultural (i.e., perceived stigma toward mental health treatment and prior experience of face-to-face mental health service utilization). Methods: Using structural equation modeling, we tested an extended Technology Acceptance Model with data from the Healthy Minds Study, a web-based national survey of U.S. college students (N = 429). Results: In addition to the technological factors, the sociocultural factors significantly influenced MHA acceptance. Notably, college students with higher levels of stigma toward mental health treatment were less likely to have experience of using face-to-face mental health service. This, in turn, led to more openness to accepting MHA that does not involve in-person visits but rather private and mediated communication. Conclusions: Findings of this study provide critical insight into the increasing needs for and use of mobile apps for mental health care. Implications are discussed and future research directions are suggested.
... Research suggests that such attitudes impact negatively on self-esteem [17,18], self-efficacy [19], and physical health [20], and that they are a significant obstacle to treating mental health. These socio-cognitive barriers are among the leading obstacles for helpseeking behaviours, followed by mental health knowledge and awareness [21][22][23][24][25][26]. While studies have shown that mental health literacy is associated with more positive attitudes towards mental health [27], only 1% of Czech medical students are genuinely interested in pursuing careers in psychiatry [28]. ...
Article
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High rates of mental health problems are a growing concern in Czech higher education; negatively impacting on students' performance and wellbeing. Despite the serious nature of poor mental health; students often do not seek help due to negative attitudes and shame for mental health problems. Recent mental health research reports self-compassion is strongly associated with better mental health and reduced shame. However, relationships between those constructs remain to be evaluated among Czech students. This study aimed to appraise the relationships between mental health problems; negative mental health attitudes; mental health shame; and self-compassion in this population. An opportunity sample of 119 psychology students from a Czech university completed questionnaires regarding these constructs. Correlation, regression and path analyses were conducted. Mental health problems were positively associated with neg-ative mental health attitudes and shame; and negatively associated with self-compassion. Self-compassion negatively predicted mental health problems, while negative attitudes and shame did not. Lastly, self-compassion fully mediated the negative attitudes-mental health problems relationship, and partially mediated the shame-mental health problems relationship. Findings suggest self-compassion is essential for mental health in Czech students; and associated with negative mental health attitudes and mental health shame. Czech universities can benefit from incorporating self-compassion training in their curriculum to protect students' mental health.
... No significant differences in age or socioeconomic status were found between NSSI Online and NSSI Only groups; however, regarding educational level, participants in the NSSI Online group had significantly lower educational levels compared to the NSSI Only group (high school graduate or lower, 31.3% vs. 14.2%). Although the literature on online NSSI postings and educational level is currently limited, multiple findings point to the role of universities in the accessibility of mental health care for young adults (Eisenberg, Golberstein, & Gollust, 2007;Prince, 2015). Those who enter college, relative to those who undertake economic activity after high school graduation, may have higher accessibility to free mental health services and additional opportunities to incubate cognitive and social resources. ...
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While posting self-injurious content online has skyrocketed over the past decade and is a salient concern among mental health professionals, the stigma surrounding these postings is still prevalent. This study aimed to reduce the stigma by investigating the clinical and psychosocial correlates of posting nonsuicidal self-injury (NSSI) content online. The study participants comprised 249 women who had engaged in five or more episodes of NSSI in the past 12 months. Among them, 67 had posted NSSI content online (NSSI Online), whereas 182 did not (NSSI Only). The two groups were compared using the MANCOVA analysis based on demographic data and clinical and psychosocial features. Additionally, Spearman's correlation and multiple linear regression analyses were used to investigate potential risk factors associated with NSSI postings. Compared to the NSSI Only group, the NSSI Online group showed higher intrapersonal functions of NSSI, self-injury craving, suicidal ideation, and past suicide attempts, along with lower resilience and self-esteem. The clinical risk factor, suicidal ideation, was closely associated with the frequency of these postings. The results suggest that posting NSSI content online is not an attention-seeking behavior, but rather an act that warrants clinical attention.
... Students experience individual-and system-level barriers that may impede timely access to age-appropriate care. Low mental health literacy, poor system navigation support, and service saturation (e.g., wait-times) all impede help-seeking (15)(16)(17)(18). National Canadian standards for student mental health and well-being call for institutions to have early identification and preventative infrastructures (19), which can improve longterm mental health outcomes and timely connectedness into services (20). ...
Article
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Background Mental health challenges are highly prevalent in the post-secondary educational setting. Screening instruments have been shown to improve early detection and intervention. However, these tools often focus on specific diagnosable conditions, are not always designed with students in mind, and lack resource navigational support. Objective The aim of this study was to describe the adaptation of existing psychosocial assessment (HEARTSMAP) tools into a version that is fit-for-purpose for post-secondary students, called HEARTSMAP-U. Methods We underwent a three-phase, multi-method tool adaptation process. First, a diverse study team proposed a preliminary version of HEARTSMAP-U and its conceptual framework. Second, we conducted a cross-sectional expert review study with Canadian mental health professionals ( N = 28), to evaluate the clinical validity of tool content. Third, we conducted an iterative series of six focus groups with diverse post-secondary students ( N = 54), to refine tool content and language, and ensure comprehensibility and relevance to end-users. Results The adaptation process resulted in the HEARTSMAP-U self-assessment and resource navigational support tool, which evaluates psychosocial challenges across 10 sections. In Phase two, clinician experts expressed that HEARTSMAP-U's content aligned with their own professional experiences working with students. In Phase three, students identified multiple opportunities to improve the tool's end-user relevance by calling for more “common language,” such as including examples, definitions, and avoiding technical jargon. Conclusions The HEARTSMAP-U tool is well-positioned for further studies of its quantitative psychometric properties and clinical utility in the post-secondary educational setting.
... [5] A barrier to young people and students seeking help for their mental health includes a lack of physical access to services and knowledge of how to access services. [8][9][10] Similar results have been found in athlete populations. [11,12] In a sample of Canadian athletes, 47.3% chose not to seek services for mental health when desired, with lack of available services as the main reason. ...
Preprint
Introduction Athletes are not immune to mental health issues but are less likely to seek help than nonathletes and experience barriers including lack of access to services, lack of knowledge as to how to access services and negative past experiences for help-seeking. Formal and semi-formal sources of support (e.g. support provided in healthcare, sporting context, and higher education systems) are key places for athletes to seek help for mental health, and there is a need to synthesise the evidence on athletes’ access, attitudes to, and experiences of, these services. This protocol outlines a scoping review that will be used to map the evidence, identify gaps in the literature, and summarise findings on athletes’ access, attitudes to and experiences of help-seeking for their mental health. Methods and analysis The methodological frameworks of Arksey and O’Malley (2005), Levac et al. (2010), and the Joanna Briggs Institute (2020 & 2021) were used to inform this scoping review protocol alongside the PRISMA-P checklist and published scoping review protocols within sport and health. This protocol outlines the background evidence, need for this scoping review, and the steps that will be taken. Dissemination The evidence will be mapped numerically and thematically to describe studies and highlight key concepts, themes, and gaps in the literature. The published scoping review will be disseminated to relevant stakeholders and policymakers including those in healthcare, the sporting context, and the higher education system. The resulting outputs will be in the form of both peer-reviewed and non-peer reviewed publications (e.g. multimedia in the form of a blog post and at conferences). Strengths and limitations Strength: The protocol outlines a novel scoping review that will contribute to a gap in the literature, and impact further research directions. Strength: Informed by best practice methodological frameworks to ensure rigour. Limitation: Lack of quality assessment of papers. Limitation: The review will only focus on formal and semi-formal sources of help-seeking (e.g. healthcare, the sporting context and higher education) and will not include research on informal or self-help sources.
... One possible explanation for this could be that anxiety sensitivity and attempting suicide appear to be negatively related. 48 Anxiety sensitivity is when an individual notices physical sensations more often and is more likely to interpret those symptoms are harmful or dangerous. Future research would benefit from carefully examining these two symptoms to better understand the differences between feeling nervous, anxious or on edge and symptoms of restlessness. ...
... Typically, those who harbor stigma toward persons with mental illness may not necessarily be aware of the harmful effects of their actions and inherent discriminatory behaviors (Goffman, 1963); Pescosolido et al., 2008). Indeed, they themselves may express discomfort, victimization, or fear of social contagion (Cutler et al., 2009;Eisenberg et al., 2007Eisenberg et al., , 2013. Mental illness stigma is therefore independent of insight into one's prejudice, it affects all societal groups, including health professionals as well as medical students in nations worldwide. ...
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The study investigated behavioral measures of social distance (i.e., desired proximity between self and others in social contexts) as an index of stigma against those with mental illness among medical students in Republic of North Macedonia, Turkey, Azerbaijan, Kazakhstan, and Poland, using the Reported and Intended Behavior Scale (RIBS), a standardized, self-administered behavioral measure based on the Star Social Distance Scale. The students’ responses to standardized clinical vignettes on schizophrenia, and depression with suicidal ideation, were also assessed. A total of 257 North Macedonian (females, 31.5%; 1-4 grades, 189; 5-6 grades, 68); 268 Turkish (females, 43.3%; 1-4 grades, 90; 5-6 grades, 178); 450 Kazakh (females, 28.4%, 71.6%; 1-4 grades, 312; 5-6 grades, 138); 512 Azerbaijani (females, 24%; 1-4 grades, 468; 5-6 grades, 44; females, 24%), and 317 Polish (females, 59.0%; 1-4 grades, 208; 5-6 grades, 109) students were surveyed. The responses on the RIBS social distance behavior measures did not improve with advancing medical school grade, but students across at all sites viewed schizophrenia and depression as real medical illnesses. The results support the development of greater opportunities for medical student to socially interact with persons with mental illness sharing their experiences with them.
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This paper discusses alternatives to on-campus teaching laboratories, to allow for hands-on learning for remote students. Wholly online practical equivalents have become increasingly popular post-COVID (online simulations or processing experimental data only) which can offer lower overheads and easy scale-up, but often miss hands-on learning outcomes. This paper reviews opportunities for mail-out practicals, where the equipment is delivered to students’ homes, combined with live synchronous learning activities via video streaming or online software. The combination of mail-out experimental kits plus synchronous interactive learning activities creates a host of new opportunities for teaching to remote students. Complimentary online teaching activities could include direct interaction with teaching staff or other students, but it can also be real-time simulations of their experiment. The paper presents a specific case study for a 2nd year undergraduate chemical engineering heat exchanger practical, that facilitated hands-on practical learning with synchronous online activities during COVID-19 campus closure. The paper uses a mixed methods approach in a 2 year study to assess student learning outcomes.
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Background: University students are four times more likely to experience elevated levels of psychological distress compared to their peers. The psychosocial needs of university students are associated with high psychological distress, stressful life events, and academic performance. Our study focuses on developing a measure to help universities identify these psychosocial needs. Aims: The study aimed to develop and validate the factor structure of the University Needs Instrument and identify the relationship between psychosocial needs, psychological distress and academic performance among university students. Sample: Undergraduate university students (N = 511) currently studying at university. Method: Participants completed demographic questions, the University Needs Instrument and the Kessler-10 Psychological Distress scale. The University Needs Instrument comprises 30 items within six psychosocial factors (academic support, financial support, support from family, support from friends, practical support and emotional support), each consisting of five items. Results: Confirmatory factor analysis showed that all items significantly loaded on the six hypothesized factors. The hypothesized model was supported by the data displaying excellent model fit and psychometric properties. Our analysis determined that the UNI has strong internal consistency. The results also confirmed that university students' high levels of psychological distress and their academic performance may be affected by their psychosocial needs. Conclusions: Our findings have provided an initial validation of the UNI to help screen and identify the psychosocial needs of university students. This scale can be used to identify the appropriate psychosocial support that can be offered to students and in turn could help reduce their psychological distress, improve their psychosocial well-being and increase academic performance.
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The purpose of this study was to investigate the effectiveness of attribution retraining program on help seeking and academic procrastination in underachievement gifted students. The method of this study was quasi-experimental from pretest- posttest control group. The statistical population consisted of all students in the early high school of gifted students of Isfahan in the academic year 2019-2020, among which the statistical sample was selected targeted and based on criteria of underachievement and then randomly assigned to experimental and control groups. The tools used in this research were help seeking questionnaire of ryan and Pintrich (1997) and academic procrastination questionnaire of Savari (2011). Data were analyzed using descriptive statistics (mean and standard deviation) and inferential statistics. The finding show that there is a significant difference between the help seeking and academic procrastination of the experimental group compared to the control group (p< 0/001). The result showed that attribution retraining program is an effective educational program for increasing help seeking and reducing academic procrastination for underachievement gifted students
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We examined whether the “friendliness” of college counseling center websites to students with lesbian, gay, bisexual, transgender, and queer, plus other identities (LGBTQ+) varied by state-level structural policies on hate crime, employment nondiscrimination, and religious exemption. Results from our analyses of variance showed that website friendliness was significantly higher in states that offered hate-crime and employment nondiscrimination protections to LGBTQ+ individuals. Our findings highlight the need to intervene at multiple ecological levels to build inclusive college communities.
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Objective: Examine the effects of a relaxation course with a mindfulness meditation component in a two-group pre-test and post-test non-randomized study design. Participants: Participants included 219 undergraduate students (experimental group: n = 103; control group: n = 116), 18-43 years old. Methods: Completion of measures of stress, resilience, coping and mindfulness at the beginning and end of the intervention. Results: The independent sample t-test analysis revealed a statistically significant decrease in stress and maladaptive coping, and an increase in resilience in the experimental group compared to the control group. Conclusion: Benefits were observed following the intervention by positively impacting factors associated with increased functioning in life. Classroom-based interventions could be considered beneficial for students.
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Emerging adults face significant risk of experiencing mental health problems, especially since most lifetime mental problems have first onset by age 24. Despite the pervasiveness of these issues, emerging adults face barriers in receiving help including stigma surrounding help-seeking behavior and negative attitudes about perceived usefulness of therapy. Creative and expressive art therapies (CATs) can address these needs by providing potentially destigmatized, non-invasive approaches to mental health care. To examine how this population can benefit from CAT, we conducted a systematic review of the literature to understand the types of CAT interventions that have been empirically tested among emerging adults. From a total of 7,276 articles published between 1985 and 2020, we filtered down to 11 studies, both qualitative and quantitative, meeting our inclusion and exclusion criteria. Results showed art therapy and poetry therapy were the most frequently studied CATs for the emerging adult population; and art therapy studies comprised the largest proportion of studies reporting statistical significance on its efficacy among all CATs reviewed. We highlight the need for more studies using replicable, generalizable methods in evaluating CAT. We then discuss implications for counselors, practitioners, and clinician-researchers interested in using CAT to improve mental health care among emerging adults.
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Mental health issues reported among college‐aged individuals have increased. Prevalence of these issues has an established impact on students' personal, professional, and academic outcomes. Graduate students experience unique stressors that impact their mental health. In particular, engineering graduate students have lower help‐seeking tendencies, which can impact the severity and length of their mental health problems. We investigate the literature concerning engineering graduate students' mental health, focusing on academic outcomes, mental health measures, and mental health findings, to highlight gaps in current literature and the need for further research. Five research databases, EBSCO: CINAHL, EBSCO: PsycINFO, ProQuest: ERIC, PubMed, and Scopus, were searched in a scoping literature review. Inclusion and exclusion criteria were applied during the screening process. Peer‐reviewed publications (i.e., articles and conference papers) were identified and coded for study focus, keywords, participants and institution(s), journal discipline, study type, methods used, and work referenced, in addition to academic outcomes, mental health measures, and mental health findings. Nineteen of the 4,826 unique studies identified were included in the review. Ten academic outcomes and 13 mental health measures were discussed. Mental health findings were grouped into five themes: social support and sense of belonging; student–advisor relationship; cultural barriers faced by international students; gender and racial stereotypes; and generalized findings. Research on engineering graduate students' mental health is limited. Given that mental health has direct ties to students' well‐being and ultimately their success, engineering education researchers should focus on studying students' experiences, sharing these findings, and communicating best practices for all stakeholders.
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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.
Article
Background A considerable gap in knowledge exists around mental health trends in diverse racial and ethnic adolescent and young adult populations. The purpose of this study is to examine annual trends for mental health and help-seeking by race/ethnicity in a national sample of college students. Methods Survey data come from >350,000 students at 373 campuses that participated in the Healthy Minds Study between 2013 and 2021. Analyses are descriptive in nature focusing on year-by-year prevalence and help-seeking rates for each racial/ethnic group. Results In 2020–2021, >60% of students met criteria for one or more mental health problems, a nearly 50% increase from 2013. Mental health worsened among all groups over the study period. American Indian/Alaskan Native students experienced the largest increases in depression, anxiety, suicidal ideation, and meeting criteria for one or more mental health problem. Students of color had the lowest rates of mental health service utilization. The highest annual rate of past-year treatment for Asian, Black, and Latinx students was at or below the lowest rate for White students. Although Arab American students experienced a 22% increase in prevalence, there was an 18% decrease in treatment. Limitations Response rates raise the potential of nonresponse bias. Sample weights adjust along known characteristics, but there may be differences on unobserved characteristics. Conclusions Findings have important implications for campus mental health programming and underscore the urgency of reducing mental health inequalities in college student populations through the identification and implementation of best practices both in clinical settings and through system-level change.
Article
Indians comprise a distinct cultural community within the United States (U.S.). In this population, research suggests that differing levels of adherence to ethnic cultural values relate to mental health symptoms, treatment preferences, and treatment-seeking barriers. Uniquely, the current study examined ethnic cultural value typologies and their relationship with mental health parameters (distress, mental health severity, internal/institutional barriers to seeking treatment, and treatment preference domains of therapist directiveness, emotional intensity, past orientation, and support). The sample included 231 Indians (55.40% females; Mage=34.70) recruited at local cultural events. Latent profile analysis (LPA) indicated a best-fitting 3-class solution: Family-Oriented and Collectivistic, Moderate Traditionalists, and Integrated Cultural-Self. Multinomial logistic regressions indicated that endorsing greater distress, internal barriers to seeking treatment, and a treatment preference for therapist directiveness increased the chances of being in the Moderate Traditionalist Class vs. the Integrated Cultural-Self Class. Endorsing greater institutional barriers to seeking treatment and a preference for past orientation increased the chances of being in the Integrated Cultural-Self Class vs. the Moderate Traditionalist Class. Endorsing internal barriers to seeking treatment increased the chances of being in the Moderate Traditionalist Class vs. the Family-Oriented and Collectivistic Class. Findings highlight diversity in ethnic cultural value patterns and the importance of providing support, outreach, and intervention services especially to Indians in the Moderate Traditionalist Class who experience greater distress and internal barriers to seeking treatment. Psychotherapy with Indians should address and accommodate culturally-influenced treatment preferences of this group.
Article
Suicide is an important public health issue in France, where the suicide rate is among the highest in Europe. While suicidal thoughts and behaviors are prevalent among young adults including college students, an important gap exists between the presence of psychological difficulties and the use of mental health services. Using data drawn from the French portion of the World Mental Health International College Student survey initiative (WMH-ICS), the current study investigates the use of mental health services among college students with 12-month suicidal ideation and examines the barriers identified by students who did not receive care, and include cohorts enrolled pre-pandemic and during the pandemic. Only one quarter received services and among those who did not, one half reported a perceived need. Prior services use, any anxiety disorder, depressive disorder, and suicide attempt were associated with the use of services in the past 12 months. The most frequently reported barriers were wanting to handle the problem on their own, being unsure of where to go or who to see, and being too embarrassed. The pandemic context was associated neither with services use nor with greater reported barriers. These findings underline the gap in mental health services use among college students despite the accessibility of mental health services in France. Identifying the barriers which restrict the use of mental health services among students could contribute to identifying specific targets for prevention, and facilitate access to appropriate services.
Article
Background: Depression and anxiety are growing issues for college students, with both aerobic resistance training and mindfulness yoga exercises known to be effective in reducing symptoms and severity. However, no known research is available comparing these 2 depression and anxiety interventions simultaneously and in a web-based environment. Objective: This study aims to determine the effects of a web-based aerobic resistance exercise intervention (WeActive) and a web-based yoga mindfulness exercise intervention (WeMindful) on depression and anxiety symptoms in college students. Methods: The participants were 77 college students who anonymously completed a Qualtrics survey, including the Generalized Anxiety Disorder Scale and the Major Depression Inventory at baseline and after the intervention. Participants were randomly assigned to either the WeActive or WeMindful group and underwent two 30-minute web-based aerobic resistance exercise lessons or yoga mindfulness lessons per week for 8 weeks. Results: The results of analysis of covariance with repeated measures indicated that although not statistically significant, both groups showed a notable decrease in anxiety with a marginally significant main effect of time (F1=3.485; P=.07; η2=0.047) but no significant main effect of group and no significant interaction effect of time with group. The 2 intervention groups experienced a significant decrease in depression with the main effect of time (F=3.892; P=.05; η2=0.052). There was no significant main effect of group or interaction effect of time with group for depression. Conclusions: College students in both WeActive and WeMindful groups experienced a significant decrease in depression symptoms and a decrease, although not significant, in anxiety as well. The study suggests that web-based WeActive and WeMindful interventions are effective approaches to managing US college students' depression and anxiety during a pandemic.
Article
The increase in psychological disorders and suicidal behaviour in students is a reason for growing concern. Some may start university with pre-existing problems, while others develop problems during this time. It is important to evaluate mental health and wellbeing early, identifying those at risk. The aim of this study was to compare mental health problems and help-seeking behaviour between students in Northern Ireland (NI) and the Republic of Ireland (ROI). Whilst geographically proximate, the institutions span a cross-border region with distinct education and healthcare systems. First-year undergraduate students (n=1828) were recruited in September 2019 as part of the World Mental Health International College Student Initiative. Suicidal behaviour, mental health and substance disorders were investigated using the World Mental Health- Composite International Diagnostic Interview. Prevalence of disorders was high, with more ROI students experiencing problems than NI students. Students were significantly more likely to experience mental health problems if they were female (p<0.001), non-heterosexual (p<0.0001), and over the age of 21 (p<0.0001). These findings show that many students are starting university with high levels of psychopathology and suicidal behaviour, highlighting the importance of early intervention which may need to be tailored to different student populations.
Article
Objective: Worsening student mental health, along with more complex mental illness presentation and increased access to campus mental health services, has led to a mental health “crisis” on campuses. One way to address student mental health needs may be through mental health programs which have been found to increase resiliency and help-seeking, and reduce stigma. Participants: The effectiveness of The Inquiring Mind (TIM), a mental health promotion and mental illness stigma reduction program, was examined in 810 students from 16 Canadian post-secondary institutions. Methods and Results: Using a meta-analytic approach, TIM improved resiliency and decreased stigmatizing attitudes from pre to post, with medium effect sizes (d > .50). Analyses with those that completed the follow-up (about one-third of the sample) showed that effects were mostly retained at three months. Other outcomes also point to the program’s effectiveness. Conclusion: TIM appears to be an effective program for post-secondary students. However, additional research, including randomized control trials, is needed to address study limitations.
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Context Mental health is a significant issue in the United States, with approximately 18.5% of adults and 22% of adolescents having a diagnosable mental illness. Athletic trainers are in a prime position to recognize signs of mental health illness in their patients and to facilitate referral to a mental health professional. Objective To introduce interactive approaches for developing mental health first aid and referral skills in professional athletic training students. Background Although the 2020 Commission on Accreditation of Athletic Training Education curricular content standards require programs to educate students about identification and referral for mental health conditions, the standards do not provide specific suggestions for instructing this content. Description Three educational activities have been implemented into the curriculum: an exploratory counseling session, Mental Health First Aid certification, and a standardized patient encounter. Clinical Advantage(s) The exploratory counseling session improves athletic training students' empathy for individuals living with mental illness. The Mental Health First Aid curriculum has been shown to raise awareness of mental health conditions and positively influence the number of people who receive professional help. Standardized patient scenarios have been shown to increase critical thinking and confidence with mental health cases and to increase knowledge in mental health assessment. Conclusion(s) Students' reflections support that these components have increased their competence and confidence in recognizing, intervening, and making referrals for individuals with suspected mental health concerns.
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Los adolescentes tienen un alto riesgo de mortalidad por suicidio, pero su uso de servicios profesionales de salud mental es muy bajo. El objetivo fue indagar las barreras que perciben para solicitar ayuda profesional. Para esto se realizó un estudio observacional de enfoque mixto en el que se evaluó el riesgo suicida mediante la escala Plutchik. Las barreras percibidas se indagaron con una pregunta abierta que se sometió a un análisis temático de codificación abierta. Participaron 403 estudiantes de bachillerato de Aguascalientes cuyo riesgo suicida fue de 19%. Se reconocieron 14 diferentes barreras de las que predominaron las de tipo interno: miedo y vergüenza. A mayor riesgo suicida cobraron más importancia las barreras externas como problemas familiares o las burlas. Al contrastar este con otros estudios queda de manifiesto que la perspectiva cualitativa abona una mejor comprensión de fenómenos subjetivos que subyacen a la prevención del suicidio.
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Previous research demonstrated that spiritually sensitive psychotherapy is an effective treatment for clients with depression or anxiety, with outcomes equivalent to secular control interventions. The goal of this study was to evaluate the efficacy of spiritually sensitive logotherapy intervention in the treatment of depression, anxiety, and stress symptoms in university students in Iran. Sixty students with elevated depression symptoms (Beck Depression Inventory II, BDI-II, 22 or greater) were randomly assigned to either a twelve-session group logotherapy programme or a control group. Results showed that spiritually sensitive logotherapy significantly reduced depression, anxiety, and stress, and significantly more so than in the control group (e.g. interaction effect for BDI-II: F = 56.8, p < 0.001, with a large effect size).
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The chapter examines current trends in the prevalence of mental health issues for American college students. The use of mental health services is discussed, along with insights into barriers to treatment and harm-reduction efforts. The chapter closes with recommendations for future directions in addressing mental health challenges across campuses in the United States.
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This study examined the mental health needs, knowledge, and utilization of counseling services among graduate students at a large university in the western United States. Almost half of graduate student respondents reported having had an emotional or stress-related problem over the past year, and over half reported knowing a colleague who had had an emotional or stress-related problem over the past year. Self-reported mental health needs were significantly and negatively related to confidence about one s financial status, higher functional relationship with one s advisor, regular contact with friends, and being married. Utilization of counseling services was positively associated with an index of depression symptoms, the number of semesters in school, and identifying as female. those students who had experienced a significant mental health event in the past year and had higher functional relationships with their advisors were significantly more likely to utilize counseling services. Findings suggest a need for increased attention to graduate student mental health needs, especially the role of financial confidence in student well-being and the relationship of graduate students with their advisors.
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Context The Primary Care Evaluation of Mental Disorders (PRIME-MD) was developed as a screening instrument but its administration time has limited its clinical usefulness.Objective To determine if the self-administered PRIME-MD Patient Health Questionnaire (PHQ) has validity and utility for diagnosing mental disorders in primary care comparable to the original clinician-administered PRIME-MD.Design Criterion standard study undertaken between May 1997 and November 1998.Setting Eight primary care clinics in the United States.Participants Of a total of 3000 adult patients (selected by site-specific methods to avoid sampling bias) assessed by 62 primary care physicians (21 general internal medicine, 41 family practice), 585 patients had an interview with a mental health professional within 48 hours of completing the PHQ.Main Outcome Measures Patient Health Questionnaire diagnoses compared with independent diagnoses made by mental health professionals; functional status measures; disability days; health care use; and treatment/referral decisions.Results A total of 825 (28%) of the 3000 individuals and 170 (29%) of the 585 had a PHQ diagnosis. There was good agreement between PHQ diagnoses and those of independent mental health professionals (for the diagnosis of any 1 or more PHQ disorder, κ = 0.65; overall accuracy, 85%; sensitivity, 75%; specificity, 90%), similar to the original PRIME-MD. Patients with PHQ diagnoses had more functional impairment, disability days, and health care use than did patients without PHQ diagnoses (for all group main effects, P<.001). The average time required of the physician to review the PHQ was far less than to administer the original PRIME-MD (<3 minutes for 85% vs 16% of the cases). Although 80% of the physicians reported that routine use of the PHQ would be useful, new management actions were initiated or planned for only 117 (32%) of the 363 patients with 1 or more PHQ diagnoses not previously recognized.Conclusion Our study suggests that the PHQ has diagnostic validity comparable to the original clinician-administered PRIME-MD, and is more efficient to use. Figures in this Article Mental disorders in primary care are common, disabling, costly, and treatable.1- 5 However, they are frequently unrecognized and therefore not treated.2- 6 Although there have been many screening instruments developed,7- 8 PRIME-MD (Primary Care Evaluation of Mental Disorders)5 was the first instrument designed for use in primary care that actually diagnoses specific disorders using diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition9(DSM-III-R) and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition10(DSM-IV). PRIME-MD is a 2-stage system in which the patient first completes a 26-item self-administered questionnaire that screens for 5 of the most common groups of disorders in primary care: depressive, anxiety, alcohol, somatoform, and eating disorders. In the original study,5 the average amount of time spent by the physician to administer the clinician evaluation guide to patients who scored positively on the patient questionnaire was 8.4 minutes. However, this is still a considerable amount of time in the primary care setting, where most visits are 15 minutes or less.11 Therefore, although PRIME-MD has been widely used in clinical research,12- 28 its use in clinical settings has apparently been limited. This article describes the development, validation, and utility of a fully self-administered version of the original PRIME-MD, called the PRIME-MD Patient Health Questionnaire (henceforth referred to as the PHQ). DESCRIPTION OF PRIME-MD PHQ ABSTRACT | DESCRIPTION OF PRIME-MD PHQ | STUDY PURPOSE | METHODS | RESULTS | COMMENT | REFERENCES The 2 components of the original PRIME-MD, the patient questionnaire and the clinician evaluation guide, were combined into a single, 3-page questionnaire that can be entirely self-administered by the patient (it can also be read to the patient, if necessary). The clinician scans the completed questionnaire, verifies positive responses, and applies diagnostic algorithms that are abbreviated at the bottom of each page. In this study, the data from the questionnaire were entered into a computer program that applied the diagnostic algorithms (written in SPSS 8.0 for Windows [SPSS Inc, Chicago, Ill]). The computer program does not include the diagnosis of somatoform disorder, because this diagnosis requires a clinical judgment regarding the adequacy of a biological explanation for physical symptoms that the patient has noted. A fourth page has been added to the PHQ that includes questions about menstruation, pregnancy and childbirth, and recent psychosocial stressors. This report covers only data from the diagnostic portion (first 3 pages) of the PHQ. Users of the PHQ have the choice of using the entire 4-page instrument, just the 3-page diagnostic portion, a 2-page version (Brief PHQ) that covers mood and panic disorders and the nondiagnostic information described above, or only the first page of the 2-page version (covering only mood and panic disorders) (Figure 1). Figure 1. First Page of Primary Care Evaluation of Mental Disorders Brief Patient Health QuestionnaireGrahic Jump Location+View Large | Save Figure | Download Slide (.ppt) | View in Article ContextCopyright held by Pfizer Inc, but may be photocopied ad libitum. For office coding, see the end of the article. The original PRIME-MD assessed 18 current mental disorders. By grouping several specific mood, anxiety, and somatoform categories into larger rubrics, the PHQ greatly simplifies the differential diagnosis by assessing only 8 disorders. Like the original PRIME-MD, these disorders are divided into threshold disorders (corresponding to specific DSM-IV diagnoses, such as major depressive disorder, panic disorder, other anxiety disorder, and bulimia nervosa) and subthreshold disorders (in which the criteria for disorders encompass fewer symptoms than are required for any specific DSM-IV diagnoses: other depressive disorder, probable alcohol abuse or dependence, and somatoform and binge eating disorders). One important modification was made in the response categories for depressive and somatoform symptoms that, in the original PRIME-MD, were dichotomous (yes/no). In the PHQ, response categories are expanded. Patients indicate for each of the 9 depressive symptoms whether, during the previous 2 weeks, the symptom has bothered them "not at all," "several days," "more than half the days," or "nearly every day." This change allows the PHQ to be not only a diagnostic instrument but also to yield a measure of depression severity that can be of aid in initial treatment decisions as well as in monitoring outcomes over time. Patients indicate for each of the 13 physical symptoms whether, during the previous month, they have been "not bothered," "bothered a little," or "bothered a lot" by the symptom. Because physical symptoms are so common in primary care, the original PRIME-MD dichotomous-response categories often led patients to endorse physical symptoms that were not clinically significant. An item was added to the end of the diagnostic portion of the PHQ asking the patient if he or she had checked off any problems on the questionnaire: "How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?" As with the original PRIME-MD, before making a final diagnosis, the clinician is expected to rule out physical causes of depression, anxiety and physical symptoms, and, in the case of depression, normal bereavement and history of a manic episode. STUDY PURPOSE ABSTRACT | DESCRIPTION OF PRIME-MD PHQ | STUDY PURPOSE | METHODS | RESULTS | COMMENT | REFERENCES Our major purpose was to test the validity and utility of the PHQ in a multisite sample of family practice and general internal medicine patients by answering the following questions: Are diagnoses made by the PHQ as accurate as diagnoses made by the original PRIME-MD, using independent diagnoses made by mental health professionals (MHPs) as the criterion standard?Are the frequencies of mental disorders found by the PHQ comparable to those obtained in other primary care studies?Is the construct validity of the PHQ comparable to the original PRIME-MD in terms of functional impairment and health care use?Is the PHQ as effective as the original PRIME-MD in increasing the recognition of mental disorders in primary care patients?How valuable do primary care physicians find the diagnostic information in the PHQ?How comfortable are patients in answering the questions on the PHQ, and how often do they believe that their answers will be helpful to their physicians in understanding and treating their problems?
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In meeting the legal and judicial requirements for admitting students with disabilities (SWD), both institutions of higher education and the SWDs they serve face a variety of problems. These problems are discussed in five categories: tepid involvement by the administration, accessibility, supportive services, attitude of faculty members and the university community, and other general problems. (MKA)
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Objective: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. Measurements: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. Results: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. Conclusion: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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Are suicidal thoughts and depression increasing or decreasing among college students? What life circumstances are the most critical to explore with depressed or suicidal college students? This article focuses on the rate of self-assessed depression and suicide among college students and examines contributing factors and help-seeking behavior. Results of the study indicated that 53% of the sample stated that they experienced depression since beginning college, with 9% reporting that they had considered committing suicide since beginning college. Suggestions for college mental health practitioners related to programming, prevention, and psychoeducation are described. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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OBJECTIVE: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. MEASUREMENTS: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. RESULTS: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. CONCLUSION: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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Social selection in seeking care for psychological problems from psychiatric services, counseling services, clergymen, medical services, and other formal agencies was explored among 1,502 randomly selected university students, and their analysis was partially replicated in a prospective analysis of a subgroup of 274 students who were followed up two years later. Special samples were also studied of applicants for service from a university psychiatric unit and a counseling center. Sociocultural characteristics, attitudes, knowledge, reference group orientations, and degree of psychological problems all had independent effects on use of helping services. However, some of these variables affected generalized help seeking behaviors while others had an effect primarily on the specific types of help consulted. While psychological distress plays a major role in seeking help, its influence is largely independent of sociocultural, attitudinal, and reference group factors.
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The authors used the somaticization scale of the Brief Symptom Inventory to study Asian and American college students' propensity for seeking counseling at an American university. They found that the Asian students were more likely than the American students were to report that they would seek counseling services when they experience somatic discomfort. The Asian students scored significantly higher on inclination for seeking counseling than did the American students.
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The Behavioral Model of Health Services Use was initially developed over 25 years ago. In the interim it has been subject to considerable application, reprobation, and alteration. I review its development and assess its continued relevance.
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This is the first in a series of investigations of the social consequences of psychiatric disorders based on the National Comorbidity Survey. Data on the relationship between preexisting psychiatric disorders and subsequent educational attainment are presented. The National Comorbidity Survey is a nationally representative survey of 8,098 respondents in the age range 15-54 years. A subsample of 5,877 respondents completed a structured psychiatric interview and a detailed risk factor battery. Diagnoses of DSM-III-R anxiety disorders, mood disorders, substance use disorders, and conduct disorder were generated, and survival analyses were used to project data on school terminations to the total U.S. population. Early-onset psychiatric disorders are present in more than 3.5 million people in the age range of the National Comorbidity Survey who did not complete high school and close to 4.3 million who did not complete college. The most important disorders are conduct disorder among men and anxiety disorders among women. The proportion of school dropouts with psychiatric disorders has increased dramatically in recent cohorts, and persons with psychiatric disorders currently account for 14.2% of high school dropouts and 4.7% of college dropouts. Early-onset psychiatric disorders probably have a variety of adverse consequences. The results presented here show that truncated educational attainment is one of them. Debate concerning whether society can afford universal insurance coverage for the treatment of mental disorders needs to take these consequences into consideration.
Article
To examine (1) whether there is any consistency among medical schools in mental health services provided and (2) how these services are perceived by student affairs deans, mental health service providers, and the students themselves. Questionnaires were sent in October 1991 to the student affairs dean (or director), the individual responsible for student mental health services, and a student representative in each of the 126 U.S. and Canadian medical schools. Data were sought regarding personnel, individuals served, location, hours, administration, funding, confidentiality, administrative referrals, and respondents' suggestions for improvement. Possible differences among the three groups of respondents were tested by chi-square. Responses were received from 75 student affairs deans, 53 mental health providers, and 30 students. There was much diversity among schools in services provided, especially in the areas of administration and funding. Although perceptions of the three respondent groups were often the same, they differed significantly in a number of areas. Suggestions for improvement of services involved funding, personnel, hours, confidentiality and privacy, specialty services, preventive and support programs, and visibility. The suggestion most frequently made by the students was for increased information and visibility. The differences among schools coupled with the differing perceptions within schools indicate a need for a comprehensive consideration of what kinds of mental health services are needed and how they can best be made accessible to a diverse body of students experiencing a variety of academic and personal challenges.
Article
From the Zurich cohort study (n = 591), the association of major depressive episodes and recurrent brief depression (RBD) with other psychiatric disorders is presented cross-sectionally at age 28 and 30 years, and over ten years (age 20 to 30 years). Longitudinally, the odds ratios of major depression are highest with dysthymia (4.4), generalised anxiety disorder (4.4), panic disorder (2.7), hypomania and agoraphobia (2.6), and social phobia (2.4). There is a significant association with cannabis consumption and smoking. Follow-up data over nine years are available for 41 patients with a major depressive disorder (MDD) and 62 with RBD: approximately 20% of MDD patients did not receive a diagnosis during follow-up. Major depression reoccurred in 32%, became bipolar in 24%, or developed into RBD in 24%. RBD remitted in 41%, reoccurred in 35%, turned into major depression in 22%, and became bipolar in only 7%. Longitudinally, MDD and RBD show a symmetrical diagnostic change in a quarter of the cases. There is no substantial development of MDD or RBD into minor depression or generalised anxiety disorder. Thirteen per cent of those with RBD later developed panic disorder.
Article
Observational studies of demand for mental health services showed much greater use by those with more generous insurance, but this difference may have been due to adverse selection, rather than in response to price. This paper avoids the adverse selection problem by using data from a randomized trial, the RAND Health Insurance Experiment (HIE). Participating families were randomly assigned to insurance plans that either provided free care or were a mixture of first dollar coinsurance and free care after a cap on out-of-pocket spending was reached. We estimate that separate effects of coinsurance and the cap on the demand for episodes of outpatient mental health services. We find that outpatient mental health use is more responsive to price than is outpatient medical use, but not as responsive as most observational studies have indicated. Those with no insurance coverage would spend about one-quarter as much on mental health care as they would with free care. Coinsurance reduces the number of episodes of treatment, but has only a small effect on the duration and intensity of use within episodes. Users appear to anticipate exceeding the cap, and spend at more than the free rate after they do so.
Article
Depressive and anxiety disorders are prevalent and cause substantial morbidity. While effective treatments exist, little is known about the quality of care for these disorders nationally. We estimated the rate of appropriate treatment among the US population with these disorders, and the effect of insurance, provider type, and individual characteristics on receipt of appropriate care. Data are from a cross-sectional telephone survey conducted during 1997 and 1998 with a national sample. Respondents consisted of 1636 adults with a probable 12-month depressive or anxiety disorder as determined by brief diagnostic interview. Appropriate treatment was defined as present if the respondent had used medication or counseling that was consistent with treatment guidelines. During a 1-year period, 83% of adults with a probable depressive or anxiety disorder saw a health care provider (95% confidence interval [CI], 81%-85%) and 30% received some appropriate treatment (95% CI, 28%-33%). Most visited primary care providers only. Appropriate care was received by 19% in this group (95% CI, 16%-23%) and by 90% of individuals visiting mental health specialists (95% CI, 85%-94%). Appropriate treatment was less likely for men and those who were black, less educated, or younger than 30 or older than 59 years (range, 19-97 years). Insurance and income had no effect on receipt of appropriate care. It is possible to evaluate mental health care quality on a national basis. Most adults with a probable depressive or anxiety disorder do not receive appropriate care for their disorder. While this holds across diverse groups, appropriate care is less common in certain demographic subgroups.
Article
This study estimates unmet need and barriers to alcohol, drug, and mental health (ADM) services in 1997 to 1998 using data from a national household survey (n = 9,585). In 1997 to 1998, 10.9% of the population perceived a need for ADM services, with 15% obtaining no treatment and 11% experiencing delays or obtaining less care than needed. The rate of unmet need due to no treatment is similar to earlier studies, but the group experiencing delays/less care is almost as large. This finding emphasizes the importance of defining access to care more broadly by including timeliness and intensity of care. Economic barriers are highest for the uninsured, but also are high among the privately insured. Individuals with unmet need are significantly more likely to use complementary and alternative medicine (CAM). Those with no conventional mental health care rely on self-administered treatment, while those with delayed/insufficient conventional care use CAM providers and self-administered treatment.
Article
To determine whether the Spanish version of the patient health questionnaire (PHQ) has validity and utility for diagnosing mental disorders in general hospital inpatients. Participants in the study were 1003 general hospital inpatients, randomly selected from all admissions over an 18-month period. All of them completed the PHQ, the Beck Depression Inventory (BDI), and measures of functional status, disability days, and health care use, including length of hospital stay. They also had a structured interview with a mental health professional. A total of 416 (42%) of the 1003 general hospital inpatients had a PHQ diagnosis. There was good agreement between PHQ diagnoses and those of an independent mental health professional (for the diagnosis of any PHQ disorder, kappa = 0.74; overall accuracy, 88%; sensitivity, 87%; specificity, 88%), similar to the original English version of the PHQ in primary care patients. Patients with PHQ diagnoses had more functional impairment, disability days, and health care use than did patients without PHQ diagnoses (group main effects for functional status measures and disability days, p < .001; group main effects for health care use, p < .01). The group main effect for hospital length of stay was not significant. An index of depression symptom severity calculated from the PHQ correlated significantly both with the number of depressive symptoms detected at interview and the total BDI score. PHQ administration was well accepted by patients. The Spanish version of the PHQ has diagnostic validity in general hospital inpatients comparable to the original English version in primary care.
Article
To identify the number of people in the United States with untreated serious mental illness (SMI) and the reasons for their lack of treatment. DATA SOURCE/STUDY DESIGN: The National Comorbidity Survey; cross-sectional, nationally representative household survey. An operationalization of the SMI definition set forth in the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act identified individuals with SMI in the 12 months prior to the interview. The presence of SMI then was related to the use of mental health services in the past 12 months. Of the 6.2 percent of respondents who had SMI in the year prior to interview, fewer than 40 percent received stable treatment. Young adults and those living in nonrural areas were more likely to have unmet needs for treatment. The majority of those who received no treatment felt that they did not have an emotional problem requiring treatment. Among those who did recognize this need, 52 percent reported situational barriers, 46 percent reported financial barriers, and 45 percent reported perceived lack of effectiveness as reasons for not seeking treatment. The most commonly reported reason both for failing to seek treatment (72 percent) and for treatment dropout (58 percent) was wanting to solve the problem on their own. Although changes in the financing of services are important, they are unlikely by themselves to eradicate unmet need for treatment of SMI. Efforts to increase both self-recognition of need for treatment and the patient centeredness of care also are needed.
Article
A majority of adults with common mental disorders do not seek professional help. To better understand why not, we examined the correlates of various stages of help-seeking, including perceived need for professional help, seeking such help, and from which professionals participants sought help. The sample for this study comprised 1792 participants in the National Comorbidity Survey, conducted from 1990-1992, who were diagnosed with a 12-month DSM-III-R mood, anxiety, or substance disorder. In this sample, we assessed correlates of perceived need for professional help, seeking professional help among those with a need, and, among those who did seek professional help, seeking help from mental health professionals. Mood disorders, comorbid mood and anxiety disorders, and mental disorders associated with impairment in role functioning or suicidality were strong predictors of perceived need. Psychopathology was also associated with the decision to seek help from mental health professionals, but not with the decision to seek professional help overall. After controlling for the nature and severity of psychopathology, various sociodemographic and attitudinal factors appeared to be associated with perception of need, help-seeking, and participants' choices of professionals. Unmet need for mental health care is a serious public health problem. Meeting this need requires expanding our attention beyond psychopathology to various evaluations and decisions that affect help-seeking. Our results suggest the importance of attitude and behavior change strategies in reducing the gap between need and care.
Article
Depression is an underrecognized yet common and treatable disorder among medical students. Little is known about the rate of mental health service use by depressed medical students. This study sought to determine the level of mental health service use by depressed medical students and their reported barriers to use. In the spring of 1994, a one-time survey of 194 first- and second-year medical students was conducted in the School of Medicine at the University of California, San Francisco. Outcome measures were self-reported use of counseling services, barriers to use, suicidal ideation, and depressive symptoms as measured by the 13-item Beck Depression Inventory (BDI). Twenty-four percent (n = 46) of the medical students were depressed by BDI criteria. Of the depressed students, only 22% (n = 10) were using mental health counseling services. The most frequently cited barriers to using these services were lack of time (48%), lack of confidentiality (37%), stigma associated with using mental health services (30%), cost (28%), fear of documentation on academic record (24%), and fear of unwanted intervention (26%). These data demonstrate that depression among medical students may be undertreated. Medical schools can assist depressed students by addressing issues such as the stigma of using mental health services, confidentiality, and documentation. Early treatment of impaired future caregivers may have far-reaching implications for the individual students, their colleagues, and their future patients.