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Help-Seeking and Access to Mental Health Care in a University Student Population
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.
... For instance, a study found that students who experienced significant levels of anxiety at the start of the school year ended up receiving poorer grades than those who did not [54]. Likewise, a similar study discovered that depression is a mental health issue among college students [33]. Besides being an expert and skilled person, religion is also a key component that contributes to student service in helping students with mental health problems. ...
... It has been indicated that 40% of students believe religion plays a supportive role in enhancing student services. Similar to [25,33,52,60,61,89,95,96] also found that religious help provides mentor consultation and guidelines to help reduce stress and continue fighting the challenges. The management team in MoEYS highlighted the important role of religion for HE students in mental health lessons. ...
A major policy change was made in 1997 when the Royal Government of Cambodia began to privatize higher education institutions (HEIs). As a result of this reform, there were 189 HEIs in 2024, up significantly from just 8 in the late 1990s. To uphold and ensure the quality of higher education, the Accreditation Committee of Cambodia was established in 2003 as a formal legal mechanism for accreditation. Student Service is essential for improving higher education quality and students’ learning outcomes. Student Services was the fifth of nine standard criteria used to assess the quality of higher education in Cambodia. However, researchers and relevant higher education sectors have not yet shown interest in the student service area in the higher education system in Cambodia. This qualitative research study aims to explore stakeholders involved in supporting student services in higher education in Cambodia. The semi-structured interview was deployed with a purposive sampling of ten key informants from relevant institutions. This interview was in a face-to-face format. The key finding of this research revealed that seven stakeholders support student service in Cambodia's higher education. They are parent ministry, industry and community, development partner, higher education institutions, parent and guardians, religion, and student and alumni. Based on the findings, enhancing and maintaining student service quality requires the involvement of all stakeholders, high commitment, cohesive cooperation, and the upholding of student interests. Particularly, higher education institutions (HEIs) should prioritize creating a supportive environment that facilitates seamless student service processes.
... This is consistent with prior research on nonutilization among Veterans (Kline et al., 2022). The similarly high rates of nonutilization in the two groups suggest that greater rates of utilization among sexual minority Veterans observed in past studies (Balsam et al., 2005;Burgess et al., 2007;Chakraborty et al., 2011;Eisenberg et al., 2007Eisenberg et al., , 2011Filice & Meyer, 2018;Hardesty et al., 2012;Simeonov et al., 2015) may be partially explained by the higher need among sexual minority Veterans (Chang et al., 2023;Harper et al., 2023;Livingston et al., 2019;Lynch et al., 2022;Shipherd et al., 2021). Among the perceived stigma and barriers reported, sexual minority Veterans were proportionally more likely to endorse the following as reasons for not seeking help: not knowing where to get help, not having adequate transportation, and having difficulty scheduling appointments. ...
... Among Veterans who reported using a non-VA health care source as primary, sexual minority Veterans were more likely to use mental health treatment relative to heterosexual Veterans. This finding is consistent with prior literature among non-Veteran populations which generally leans toward sexual minority people using mental health treatment more frequently than heterosexual people (Balsam et al., 2005;Burgess et al., 2007;Chakraborty et al., 2011;Eisenberg et al., 2007Eisenberg et al., , 2011Filice & Meyer, 2018;Hardesty et al., 2012;Simeonov et al., 2015). This difference may in part reflect more positive attitudes toward help-seeking among sexual minority people, which has been observed in some past research or, perhaps, residual cohort effects (e.g., greater severity, complexity; Sánchez et al., 2013). ...
This study examined mental health treatment nonutilization among sexual minority versus heterosexual Veterans with demonstrated psychiatric need. Data were analyzed from 820 Veterans with psychiatric need who participated in the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of U.S. military Veterans. Results revealed that current mental health service nonutilization did not differ between sexual minority versus heterosexual Veterans (70.5% vs. 74.0%). Significant interactions between sexual orientation and sex assigned at birth, primary source of health care (Veteran Affairs [VA] vs. non-VA), and beliefs that peers would blame them for their mental health problems were observed in analyses predicting current mental health treatment utilization. Among Veterans primarily utilizing VA health care, sexual minority Veterans were less likely than heterosexual Veterans to engage in mental treatment; among those primarily using non-VA, this pattern was reversed. Sexual minority Veterans were significantly more likely than heterosexual Veterans to report not knowing where to get help, not having adequate transportation, and having difficulty scheduling an appointment. Taken together, the results of this study suggest that rates of mental health nonutilization are high for both sexual minority and heterosexual Veterans, and that factors that influence utilization may differ by sexual orientation.
... It is crucial to establish on-campus mental health service units that provide guidance, recommendations, treatment options, and support for students experiencing symptoms of anxiety and insomnia. These services are closely related to students' satisfaction with their academic experiences, as evidenced by the research of Daniel Eisenberg, Ezra Golberstein, and Sarah E. Gollust (2007).Among students who screened positive for depression or anxiety, a significant proportion, ranging from 37% to 84%, did not receive any services, depending on the severity of their distress. Predictors of non-utilization included a lack of awareness of the need for services, unawareness of available services, concerns about the effectiveness of treatment, and financial constraints, which align with the findings of Hyun, J. K., Quinn, B. C., Madon, T., Lustig, S. (2015). ...
... To tackle such mental health issues, multiple health interventions like counselling, medical treatments and national health services have been devised globally. However, due to lack of awareness, prevailing stigma and limited access to mental health care (Eisenberg et al., 2007), majority of young adults suffering from mental health conditions fail to seek help (Macaskill, 2013;Gorczynski et al., 2017). Therefore, to improve sensitization and access towards such facilities, existing mental health technologies have incorporated mobile phone applications, mental health apps, websites and online peer support communities (Levin et al., 2016;Toivonen et al., 2017) that serves as tools to complement the services and treatments that are usually provided physically by mental health professionals. ...
With the advent of Artificial Intelligence (AI), machine learning and advancements in computer technology, there is a growing popularity of conversational agents or chatbots among young adults for seeking different forms of therapeutic and social support. Young adults are also considered to be more vulnerable to various mental health disorders and psychological disturbances. Moreover, the rapid integration of chatbot technology into modern lifestyle has sparked an increasing interest in understanding the underlying reasons behind its widespread adoption, particularly among young adults. The current research aimed to provide a comprehensive overview of the psychosocial factors driving such chatbot usage among young adults worldwide by reviewing previous relevant literature from multiple reputable academic sources such as Google Scholar. From this review paper, prominent research gaps have been identified in the areas of identifying predictors of chatbot usage among young adults of India, its long-term effectiveness in the areas of mental health intervention and its applicability in various psycho-social domains. Overall sparse works have been done on chatbot usage using the Indian population particularly focusing on young adults. Therefore the findings from this paper deem to be important for understanding the future applications of chatbots and their degree of utility in the Indian context.
... The decision to see mental health professionals may be related to perceived expensiveness, which was shown to predict the likelihood of recommending health care services (Cheng et al., 2006). It may interact with other variables such as perceived benefits, needs, ethnicity, and social class (Eisenberg et al., 2007). Future research should aim to investigate how costs, perceived expensiveness, and other variables act as barriers to mental health services. ...
Background: The choice of coping strategies by individuals is influenced by a range of internal and external factors. However, there is limited research on how different types of problems affect these preferences. Purpose: We aim to fill this gap by examining the interplay between coping strategies, problem types, and demographic factors. Method: Using a mixed-method approach, we analyzed secondary data from a survey of Indonesian university students. We analyzed 349 valid responses through three analytical methods. Content analysis was used to identify students' coping methods and the types of problems they faced. We then employed contingency tables and logistic regression to explore the associations among these variables.Findings: We found that high-income students are less likely to experience academic and social problems and more likely to use professional mental health services, that academic problems are linked to active and spiritual coping strategies, that female students are more likely to experience stress regulation problems, and that older students are less likely to employ emotion-regulation strategies. Implication: How students cope with their problems are influenced by the problem they experience and their demographic background. Future research should focus on specific problems and coping strategies to gain deep domain-specific insights.
... [14] Another study found out that in a college where psychotherapy was provided as a free in-campus service, only a small amount of students who screened positive for depression pursued therapy. [15] A qualitative study on Turkish university students revealed their opinions on seeking psychological help fall under seven themes, including costs, counsellor competency, and perception errors. Many have negative attitudes, citing high fees, unqualified counsellors, and doubts about its effectiveness. ...
Background: In recent years, there has been a lot of discussion on how social media affects the psychological well-being of young adults. The purpose of the present study is to essentially identify the relationship between attitude towards seeking professional help and usage of social media. In addition, we aim to identify the relationship between attitude towards seeking professional help and anxiety and depression and whether one affects the other in the latter two variables. Materials and methods: Using A convenience sampling technique 92 young adults, between the ages 18-25 years, from the Kolkata urban area voluntarily participated in the study. Attitude Toward Seeking Professional Help, Beck Depression Inventory, Beck Anxiety Inventory and Social Media Engagement Questionnaire, were administered using Google Form. Results: The results depicted no significant correlation between attitudes toward seeking professional help and either anxiety or depression, nor between these attitudes and social media usage. However, a significant positive correlation between anxiety and depression was identified, consistent with previous research on their comorbidity. The high variance in the data, potentially due to a diverse sample, suggests the need for larger, more representative samples in future research. Conclusion: Despite the increasing use of social media to raise mental health awareness, this has not translated into significant changes in attitudes toward seeking professional help. The study underscores the necessity of addressing the deep-rooted stigma surrounding mental health and highlights the importance of educating the next generation on prioritizing mental health.
... Barriers mentioned include, stigma, lack of knowledge of where to seek help, and inadequate care once seeks help (Kessler et al., 2010;Kataoka et al., 2002). Also, for mental health and SUD services there is a lack of structural organization and cohesion between programs and agencies, thus limiting patient access to coordinated and systematic care (Seal et al., 2007;Eisenberg et al., 2007). ...
Introduction: Mental health and substance abuse disorders are two of the largest global burdens for the health care system. Management of resources is central to tackling these problems and enhance access to health. There is a great opportunity to use Business Intelligence (BI) tools and tools for predictive analytics to solve this task and form an effective decision-making system based on data. Besides, this research seeks to establish how BI can be utilised in mental health facilities in order to optimise the use of resources, patients' access of care and general patient outcomes. This paper reviews literature on the use of BI, predictive analytics and mental health resources management researches. Since the study focuses on both qualitative and quantitative analysis, extensive search was made in both Google Scholar, Emerald Insight, Wiley Online Library for articles, book chapters, and industry reports. Business intelligence, resource management, mental and substance use disorders, prediction and analytics, are the keywords used in the work with their variations. The article underscores the possibility of applying BI-driven, predictive analytics for purposes of demand forecasting for mental and substance abuse services and thereby, directing corresponding resource provisioning. BI dashboards and data visualization approaches help show current levels of service delivery, congestion, or accumulation of resources, allowing administrators to make appropriate choices. Further, BI when connected with electronic health information and other databases, can point to trends and interaction which would help deliver appropriate care with efficient efficiency of utilisation of all resources available, implementation of BI tools to address patient scheduling, medication management, and staffing needs, achieving a 25% reduction in resource waste and a 30% improvement in service delivery times. The delivery and utilization of Mental Health Resources, therefore, hinges on the BI leveraging which is a multitude of Technological, Organisational and Strategic factors. Implementation aspects include the Integration of data, analytics abilities, ease of use interfaces and a data-focused culture. Issues of data privacy, security and ethical issues pose some of the risks that need to be well managed to promote the use of BI in mental health. BI's integration in the management of mental health and substance abuse centers can open doors to improvement in terms of management of resources, accessibility and the general quality of services offered. With help of advanced methods of analytics and choosing the right solutions, these facilities will be able to allocate efforts and focus on the needs of the communities, therefore improving the quality of the people's life. These findings underscore the potential for BI-driven frameworks to mitigate risks such as staffing shortages and medication supply issues, ensuring continuity of care during crises like pandemics or natural disasters. This research contributes to the intersection of healthcare management and supply chain resilience by demonstrating how advanced analytics can create agile, scalable systems for managing resources in mental health and substance abuse services.
... Eisenberg, Golberstein, and Gollust discuss previous studies on help-seeking and access to mental health care in university student populations that have documented substantial unmet needs and identified a variety of barriers to service use. These barriers include financial constraints, attitudes and knowledge about services (including stigma), concerns about privacy, and lack of time [12]. In a survey of 96,000 students, 10% cited depression as one of 10 obstacles to academic achievement. ...
... Specifically, positive attitudes increased, and nonacceptance decreased with higher subjective social status, although the post hoc test between the high and low social status groups for the attitudes subscale narrowly missed significance in the unweighted dataset (refer to Multimedia Appendix 1). Social status has been identified as a major determinant of help-seeking behavior in the past [71,72]. However, more research is needed to determine the role of social status in attitudes toward psychotherapy. ...
Background
Prevalences of mental disorders are increasing worldwide. However, many people with mental health problems do not receive adequate treatment. An important factor preventing individuals from seeking professional help is negative attitudes toward psychotherapeutic treatment. Although a positive shift in attitudes has been observed in recent years, there is still substantial stigma surrounding psychotherapeutic treatment. First studies have linked higher health literacy with more positive attitudes toward psychotherapy, but more research is needed in this area.
Objective
This study aimed to examine how general and mental health literacy are associated with attitudes toward psychotherapeutic treatment in Germany. Additionally, associations between sociodemographic factors, experience with psychotherapy, and attitudes toward psychotherapy were explored.
Methods
A random sample was drawn from a panel representative of the German-speaking population with internet access in Germany and invited to participate in the study via email. Overall, 2000 individuals aged ≥16 years completed the web-based survey with standardized questionnaires in September and October 2022. Attitudes toward psychotherapy and both general and mental health literacy were assessed using the Questionnaire on Attitudes Towards Psychotherapeutic Treatment (QAPT) with 2 subscales (“positive attitudes” and “non-acceptance of society”), the European Health Literacy Survey instrument (HLS-EU-Q16) and the Mental Health Literacy Tool for the Workplace (MHL-W-G). Associations between the questionnaire scales were assessed with Pearson correlations. Additionally, basic sociodemographic information and information on personal and family experiences with psychotherapy were collected. Pearson correlations (age), ANOVAs (level of education and subjective social status), and t tests (experience with psychotherapy, gender, and migration background) were used to analyze how these relate to attitudes toward psychotherapy.
Results
More favorable attitudes toward psychotherapy and lower perceived societal nonacceptance were found in those with higher general (r=0.14, P<.001; r=−0.32, P<.001, respectively) and mental health literacy (r=0.18, P<.001; r=−0.23, P<.001, respectively). Participants with treatment experience for mental health problems (t1260.12=−10.40, P<.001, Cohen d=−0.49; t1050.95=3.06, P=.002, Cohen d=0.16) and who have relatives with treatment experience (t1912.06=−5.66, P<.001, Cohen d=−0.26; t1926=4.77, P<.001, Cohen d=0.22) reported more positive attitudes and higher perceived societal acceptance than those without treatment experience. In terms of sociodemographic differences, being a woman (t1992=−3.60, P<.001, Cohen d=−0.16), younger age (r=−0.11, P<.001), higher subjective social status (F2,1991=5.25, P=.005, η2=.005), and higher levels of education (F2,1983=22.27, P<.001, η2=.021) were associated with more positive attitudes toward psychotherapeutic treatment. Being a man (t1994=5.29, P<.001, Cohen d=0.24), younger age (r=−0.08, P<.001), and lower subjective social status (F2,1993=7.71, P<.001, η2=.008) were associated with higher perceived nonacceptance of psychotherapy.
Conclusions
Positive associations between attitudes toward psychotherapy and both general and mental health literacy were delineated. Future studies should investigate whether targeted health literacy interventions directed at individuals with lower general and mental health literacy might also help to improve attitudes toward psychotherapeutic treatment and help-seeking behavior.
... Esistono diverse strategie per aiutare gli studenti universitari a gestire lo stress e i problemi psicologici, come i training psicologici, i servizi di consulenza, i gruppi di supporto, la psicoeducazione e il rinvio alle figure specialistiche (Eisenberg, Golberstein, Gollust, 2007;Reavley, Jorm, 2010). Per mantenere un buon livello di salute mentale, gli studenti possono ricorrere ad attività ricreative, praticare la mindfulness, mantenere un sano equilibrio tra attività accademiche e vita personale, curare le relazioni sociali significative e accedere a servizi di supporto psicologico (Redhwan et al., 2020). ...
... According to the studies conducted by the American College Health Association (ACHA, 2009), most of the students whose academic performance dropped in the last twelve months in 2009 , suffered from stress, sleep difficulties, anxiety and depression. This study clearly showed that all the students who went through an academic degradation, 80 per cent were experiencing depression (ACHA, 2009 p 3). Eisenberg et al (2007a) point out that one out of every seven students may suffer from depression worldwide. The vast majority of students in the studies are aged between 18 to 25 years which implies that this disease has rooted strongly in young students. ...
The number of depressed college students has reached a high percentage and due to depressed mental states, suicide attempts and deaths are increasing. According to the World Health Organisation ,“depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration”. several reasons which induce depression in the students: academic pressure, lack of family support, inability to adapt to new situations easily and lack of coping skills to deal with stress. Researchers have found that the majority of college students experience depression mainly due to the stress and demands of college life. Therefore, the role of lecturers is very important in such situations. As a result of depression, students can ruin their academic performance by developing bad habits such as alcoholism and drugs dependence. However, studies have shown that depression can be treated and its effects can be prevented particularly if it is discovered early. This essay provides research that proves increasing depression among college students, discusses depression and serious problems that are related to it, and then evaluates possible solutions.
... The transition to university life marks a crucial developmental phase characterized by individuation, the establishment of new social connections, and increased autonomy and responsibility [1]. This period aligns with continued, rapid brain development at a time when university students are exposed to multiple risk factors known to affect mental health, including psychosocial stressors, recreational drug use, alcohol binging, and disruptions in sleep patterns [2]. Mental health disorders typically present before or during young adulthood, often going unrecognized for years, resulting in significant delays in receiving treatment. ...
Background:
Global concern for the mental well-being of university students is appropriately on the rise. Prevalence studies worldwide indicate that rates of mental health disorders among young adults attending university have reached 30%, with a staggering 80% of these individuals not receiving proper treatment ((Auerbach et al., 2018)). This not only adversely affects their academic performance but, more crucially, impairs their overall quality of life. In Brazil, where approximately eight million students are enrolled in universities, there exists a noticeable lack of studies addressing their mental health. In response, we created a web-based mental health survey tailored to the context of Brazilian university students. The primary objective of this paper is to outline the methods employed in designing this web-based mental health survey to provide insights into our approach to understanding and addressing mental health issues among university students in Brazil.
Objective:
The aim of this paper is to describe the methods used in the design of a web-based mental health survey to be administered in a private Brazilian University.
Methods:
In this web-based mental health survey, undergraduate students (target n = 8028) from two universities in Brazil (UNIFAJ and UNIMAX) will respond to three self-report screening questionnaires: 1) a measure of lifestyle and quality of life (SHORT-SMILE), 2) a screen for mental health disorders (DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure Adult) and 3) a summarized version of the Adult Self-Report Scale for Attention Deficit/Hyperactivity Disorder. Students that receive high scores for specific constructs (i.e., depression, mania, generalized anxiety, sleeping disorders, borderline personality disorder, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder and substance use disorders) will be administered more extensive standardized symptomatology scales. The three questionnaires and appropriate follow-up scales will be repeated every year within the same population to evaluate students over time. In addition, each year we will include new incoming students. The data will be analyzed cross-sectionally (with descriptive and association analysis between the different constructs measured) and longitudinally (with trajectory analyses at the level of the individual, area of academic concentration, and institution).
Results:
This protocol, as stated, has been underway since November 2023. The project is in the first wave of data collection. At this moment, there are 2127 participants, corresponding to more than 25% of the total number of students. Statistical analyzes will begin soon.
Conclusions:
College and university students have high rates of mental health issues. We have developed and described a web-based mental health survey that will allow us to evaluate and detect these issues with low cost and reasonable response rate in a University in Brazil. These efforts will allow us, in the near future, to monitor and test the efficiency and impact of mental health preventive programs. This model could be scaled up across other universities in Brazil to easily assess the mental health status of their students and have a significant impact on the mental health of our communities. Clinical Trial: Study registration: This study was registered in the Open Science Framework (OSF) under the https://doi.org/10.17605/OSF.IO/AM5WS
... The findings agree with existing research, indicating that SEN mothers more frequently seek support as a coping strategy compared to mothers of typically developing children (Bailey et al., 1999;Asbury et al., 2021). However, the literature suggests a contradictory relationship between stress levels and help-seeking behaviours (Eisenberg et al., 2007;Mojtabai et al., 2011). While elevated stress can act as an impetus encouraging individuals to seek help, various barriers (i.e., stigma, denial) can prevent individuals from accessing mental health services. ...
The present study qualitatively examined the experiences of caregivers of primary school children with and without SEN in relation to their socioemotional wellbeing and how they coped during the COVID-19 pandemic in England. Semi-structured qualitative interviews were conducted with 22 London-based mothers of 5–12-year-old children, half of whom had children with Special Educational Needs (SEN). The interviews were analysed using reflexive thematic analysis, allowing for a comparative exploration of the experiences of mothers with children with SEN and those without. The analysis generated four themes: (1) opportunities (2) challenges (3) post-pandemic considerations (4) coping strategies. Findings showed that caregivers of both SEN and non-SEN children experienced several opportunities or challenges after the initial lockdown in 2020. Both groups of caregivers reported similar long-term experiences in terms of opportunities. However, almost all caregivers in SEN group reported distinctive challenges about support services and mental health decline. In terms of coping strategies, SEN mothers placed a greater emphasis on the importance of adapting to change and establishing new routines. They also used more mental health services for themselves and their children during lockdowns compared to non-SEN mothers. Regarding the post-pandemic considerations, almost all caregivers, regardless of their children’s SEN status, expressed significant concerns about future uncertainties. This study highlights the unique challenges and opportunities experienced by caregivers, particularly emphasizing the nuanced needs of SEN families. The findings underscore the necessity for robust mental health support frameworks and tailored support strategies to address these needs. Implications for future research include further exploration of long-term support mechanisms for SEN families and a broader investigation into the diverse coping strategies across different caregiver populations.
... A transição para o ensino superior, caracterizada por rigor académico, ocorre tipicamente por volta dos 20 anos, uma fase em que muitos estudantes ainda não desenvolveram uma estrutura psicológica suficientemente robusta, tornando-os suscetíveis a perturbações mentais (Cía et al., 2018;Eisenberg et al., 2007;Fernandes et al., 2005;Kessler et al., 2007). ...
Contexto: A prevalência crescente do burnout entre estudantes universitários em ambientes académicos exigentes sublinha a necessidade de uma compreensão aprofundada deste fenómeno, visando orientar estratégias mais eficazes de prevenção, deteção e intervenção. Objetivo: Esta revisão narrativa visou: a) descrever as manifestações da síndrome de burnout em estudantes universitários; b) identificar os fatores de risco associados ao seu desenvolvimento; e c) determinar os fatores de proteção relevantes. Métodos: Procedeu-se a uma revisão narrativa que englobou 20 artigos científicos, englobando um total de 11.596 estudantes universitários, tanto nacionais como internacionais. Resultados: Verificou-se que estudantes com níveis elevados de baixa autoestima, ansiedade, stress e depressão apresentavam maior predisposição para o desenvolvimento da síndrome de burnout. Por outro lado, os principais fatores de proteção identificados incluíram: autoestima elevada, utilização de estratégias de coping eficazes, elevado envolvimento académico, liderança docente positiva e estatuto socioeconómico elevado. Conclusões: A integração e adaptação ao ensino superior revelam-se processos complexos, influenciados por diversas dinâmicas enfrentadas pelos estudantes. Destaca-se a importância de uma compreensão profunda das necessidades dos estudantes, permitindo uma intervenção precoce e adequada que englobe a prevenção, identificação e tratamento eficazes do burnout.
... In health promotion, encouragement of help-seeking is a common component, not least when it comes to mental health. Research suggests that a large share of the population who could potentially benefit from mental health services do not seek help even when such services are available and free of charge [37]. Lack of disclosure and help-seeking also apply to NSSI specifically, where onethird to half of adolescents with NSSI do not seek help and clinical services are rarely the preferred support system [38]. ...
Background
Programs for mental health promotion and prevention of nonsuicidal self-injury (NSSI) in schools have gained increased focus during the last decades, but less is known about adolescents’ experiences of such interventions.
Methods
A whole-school preventive intervention targeting mental health and NSSI was delivered to six secondary schools. Adolescents participated in the Youth Aware of Mental Health program combined with an NSSI-focused psychoeducation module. Caregivers and teachers were given online psychoeducation on NSSI, and school health care staff were given a workshop on self-injury. Eleven group interviews (n = 65 participants) were conducted with adolescents (ages 13–15 years, 65% females) exploring participant experiences. Interviews were analyzed using thematic analysis and interpreted in light of a biopsychosocial understanding of adolescence.
Results
The analysis generated two main themes. The first theme, Mental health in the context of adolescence, centered around adolescents’ conception of mental health, after having taken part in the intervention, framed in a context of coping with external stressors. The dilemma of autonomy versus help-seeking was also identified as part of the first main theme. The second theme, The who, when, what, and how of the intervention, described adolescents’ experiences of the intervention. This theme included increased awareness and knowledge of mental ill-health. The participants generally agreed that the topics included are important to adolescents and emphasized that the content needs to be relatable. Several factors that influence how a school-based program is received by adolescents were identified, such as who should be targeted and when. Adolescents also identified challenges and gave recommendations for future similar projects.
Conclusions
Adolescents generally perceived addressing mental health and NSSI in schools as important. Help-seeking initiatives need to be balanced against adolescents’ need for autonomy when planning mental health prevention and intervention.
... Many universities have free and confidential counseling services and mental health advisers professionally qualified to provide prompt access to therapist care. However, many studies have indicated a low prevalence of mental health service utilization among university students (Cadigan et al., 2019;McLafferty et al., 2017;Eisenberg et al., 2007;Tien et al., 2021). Increasing the number of counseling staff in universities is one of the solutions to adequately addressing the growing demand for mental health support among students to reduce waiting times and enable more personalized care tailored to individual student needs. ...
... Penelitian sebelumnya menunjukkan hasil yang beragam terkait pengaruh perceived public stigma terhadap sikap mencari bantuan profesional. Penelitian oleh (Downs & Eisenberg, 2012;Özdemir et al., 2023) menemukan adanya pengaruh perceived public stigma terhadap sikap mencari bantuan profesional psikologis sedangkan penelitian oleh (Eisenberg et al., 2007;Maya, 2021;Wodong & Utami, 2023) tidak menemukan adanya pengaruh perceived public stigma terhadap sikap mencari bantuan profesional psikologis dengan subjek mahasiswa secara umum. Oleh karena itu, peneliti hendak mengerucutkan sampel kepada mahasiswa yang memiliki maslah psikologis. ...
Students are a group that is vulnerable to experiencing mental health problems. This is because they are in a transition period towards adulthood which is one of the most stressful times in human life. However, not all students are able to face all changes in life so that every human being needs a coping to deal with the problems they experience. One of the best coping to do is to seek professional psychological help. In this study, the influence of perceived public stigma to attitudes towards professional help seeking will be tested. This research method is quantitative with a linear regression research design. The subjects in this study were 115 students of Padang State University who had psychological problems. The research data were analyzed using SPSS 25 with a simple linear regression hypothesis test. The results of this study are that there is a significant influence of perceived public stigma on the attitude of seeking professional psychological help (F = 21.573; sig = 0.000) with an influence of 16% (R Square = 0.16).
... Despite the availability of effective treatments, such as cognitive behavioral therapy (CBT) [3], accessing them remains challenging. Even when professional services are free and accessible [4], many youth avoid seeking professional support due to perceived stigma, a preference to solve problems by themselves, and fear of psychotherapeutic settings [5][6][7][8]. Interestingly, such attitudinal barriers may be more important reasons for not seeking help than structural barriers, such as limited treatment resources and long waiting periods before starting psychotherapy [8]. ...
... With an alarming number of university students facing severe mental health difficulties, university counselling services are struggling to cope as they have reported an increasing number of referrals (Association of University & College Counselling, 2011;Beiter et al., 2015;Bishop, 2006;Cooper, 2003;Davis & Humphrey, 2000;Eisenberg et al., 2007;Gallagher et al., 2000;Gallagher, 2008Gallagher, , 2012Gallagher, , 2015Hodges, 2001;Holm-Hadullaa & Koutsoukou-Argyrakia, 2015;Hunt & Eisenberg, 2010;Kitzrow, 2003;Mowbray et al., 2006;RCP, 2011;Smith et al., 2007;Stukenberg et al., 2006;Watkins et al., 2012;YouGov, 2016). There has been an increase in numbers, but worryingly, 90% of students experiencing emotional difficulties did not access their counselling service (Rosenthal & Wilson, 2008). ...
The number of students suffering from mental health problems has increased over the last decade. Previous research has aggregated students from different degree subjects, making it difficult to identify which students are more at risk and could benefit from support. The literature shows that psychology and medical students encounter unique experiences contributing to poor mental health. This study aimed to investigate whether there was a difference in the prevalence, severity and types of mental disorders experienced by psychology and medical students. The study recruited 196 undergraduate students studying either psychology or medicine. Participants completed three questionnaires online: PHQ-9, GAD-7, and the OCI-R. The results showed that psychology students had a higher prevalence of all mental disorders than medical students. Psychology students were also significantly more likely to suffer from a higher severity of OCD. The same pattern was found for the severity of depression with results only being marginally significant. There was no significant difference in the severity of anxiety between psychology and medical students. Findings from the study contributed to better understanding of student mental health and identifying which students are most at risk of certain disorders to help universities tailor support services. Future research recommendations are discussed to expand the literature in this area.
... Help-seeking behaviour is low among graduate students [19]; the provision of formalised peer support could be a useful mechanism to increase help-seeking. Lack of awareness of services available is a reason for low help-seeking among university students [43]. The transfer of knowledge from BGLs to buddies likely increases awareness and a sense of being supported. ...
Postgraduate students face significant challenges such as feelings of isolation, lack of guidance, and negotiating multiple identities. Navigating these challenges can adversely impact wellbeing, self-efficacy, and achievement. To combat these issues, a peer mentorship ‘buddy’ programme was piloted. This buddy programme formed buddy groups, consisting of one doctoral student (as the buddy group leader) with three to four pre-doctoral postgraduate students (as the buddies), which met fortnightly during the semester. Ten participants engaged in semi-structured interviews, and the transcripts were analysed using a thematic analysis approach. Identified benefits to participants of the buddy programme included improved social resources, expanded skillsets, improved confidence, increased enjoyment and motivation, career advancement, improved ability to navigate postgraduate applications, improved sense of belonging, improved coping through COVID-19 lockdowns, and increased collegiality. More specifically, benefits of the buddy programme, as voiced by the participants, included gains in wellbeing, academic attainment, and resilience. Given the estimated cost of NZD$400 per buddy group, as well as the openly provided resources developed from this study, tertiary institutions may consider implementing similar low-cost programmes to support their postgraduate student populations.
... A 2011 study considered US college students' Facebook status updates and their potential for exhibiting content that may reveal symptoms of depression [24]. It was noted that opportunities for recognition and treatment of depression were being missed, particularly among college students [125,126]. Therefore, Facebook, a social media platform that had become well-established among the student population [127], presented innovative opportunities to identify college students at risk. A manual exercise saw the collection of Facebook status updates of 200 students that spanned 1 year. ...
Background:
Mental health disorders are currently the main contributor to poor quality of life and years lived with disability. Symptoms common to many mental health disorders lead to impairments or changes in the use of language, which are observable in the routine use of social media. Detection of these linguistic cues has been explored throughout the last quarter century, but interest and methodological development have burgeoned following the COVID-19 pandemic. The next decade may see the development of reliable methods for predicting mental health status using social media data. This might have implications for clinical practice and public health policy, particularly in the context of early intervention in mental health care.
Objective:
This study aims to examine the state of the art in methods for predicting mental health statuses of social media users. Our focus is the development of artificial intelligence–driven methods, particularly natural language processing, for analyzing large volumes of written text. This study details constraints affecting research in this area. These include the dearth of high-quality public datasets for methodological benchmarking and the need to adopt ethical and privacy frameworks acknowledging the stigma experienced by those with a mental illness.
Methods:
A Google Scholar search yielded peer-reviewed articles dated between 1999 and 2024. We manually grouped the articles by 4 primary areas of interest: datasets on social media and mental health, methods for predicting mental health status, longitudinal analyses of mental health, and ethical aspects of the data and analysis of mental health. Selected articles from these groups formed our narrative review.
Results:
Larger datasets with precise dates of participants’ diagnoses are needed to support the development of methods for predicting mental health status, particularly in severe disorders such as schizophrenia. Inviting users to donate their social media data for research purposes could help overcome widespread ethical and privacy concerns. In any event, multimodal methods for predicting mental health status appear likely to provide advancements that may not be achievable using natural language processing alone.
Conclusions:
Multimodal methods for predicting mental health status from voice, image, and video-based social media data need to be further developed before they may be considered for adoption in health care, medical support, or as consumer-facing products. Such methods are likely to garner greater public confidence in their efficacy than those that rely on text alone. To achieve this, more high-quality social media datasets need to be made available and privacy concerns regarding the use of these data must be formally addressed. A social media platform feature that invites users to share their data upon publication is a possible solution. Finally, a review of literature studying the effects of social media use on a user’s depression and anxiety is merited.
... Today's young adults, including higher education students, are reporting increasingly high levels of depressive symptoms, stress, and loneliness, surpassing those of older cohorts [1,4]. Studies link these mental health issues to academic pressures, future career concerns, achievement culture, the COVID-19 pandemic, and a lack of mental health resources [10,11,26]. On average, it takes about 7.8 days for college students to get an initial appointment with a mental health professional, but the following sessions could extend to several weeks due to a shortage of mental health services on campuses [20]. ...
In response to the increasing mental health challenges faced by college students, we sought to understand their perspectives on how AI applications, particularly Large Language Models (LLMs), can be leveraged to enhance their mental well-being. Through pilot interviews with ten diverse students, we explored their opinions on the use of LLMs across five fictional scenarios: General Information Inquiry, Initial Screening, Reshaping Patient-Expert Dynamics, Long-term Care, and Follow-up Care. Our findings revealed that students' acceptance of LLMs varied by scenario, with participants highlighting both potential benefits, such as proactive engagement and personalized follow-up care, and concerns, including limitations in training data and emotional support. These insights inform how AI technology should be designed and implemented to effectively support and enhance students' mental well-being, particularly in scenarios where LLMs can complement traditional methods, while maintaining empathy and respecting individual preferences.
... The transition to higher education often coincides with significant psychological challenges, including depression, anxiety, and stress, which can adversely affect students' academic performance and overall well-being [3]. The prevalence of psychological stress problems in this population has increased substantially, with many students experiencing severe psychological distress without seeking adequate treatment [4]. Research further indicates that factors such as academic distress, financial stress, and inadequate coping skills exacerbate these issues, contributing to a high incidence of psychological disorders on college campuses [5,6,7,8]. ...
Current research has revealed significant benefits of green space exposure (GSE) on psychological stress. However, few studies have explained the cumulative effects of GSE and how these effects vary across different demographic groups, such as gender and education level. This research aims to evaluate the long-term effects of GSE on psychological stress and heart rate variability (HRV) while examining how these effects vary across different demographic groups, such as gender and education level, utilizing Apple Watch data to provide a more objective measure of these effects. In a 6-week experiment, 43 college students were required to engage in GSE at least three times a week, each lasting no less than 10 minutes, based on their schedules. During the experiment, participants wore the Apple Watch continuously to collect physiological data automatically. This study demonstrates a significant reduction in emotional disturbance and notable changes in HRV amplitude following GSE, with variations observed based on gender and education levels. These findings underscore the substantial psychological health benefits of GSE.
... Specifically, individuals with anxiety and/or depressive disorders exhibited poor understanding of emotions and their components, a high tendency to react negatively to emotional experiences, and difficulties in recovering from negative emotions (Mennin et al., 2009). Moreover, college students and young adults were found to be reluctant to seek psychological help due to general misinformation about mental health and the fear of being stigmatized (Eisenberg et al., 2007;Eisenberg et al., 2009a). ...
The COVID-19 pandemic has significantly impacted the well-being of university students, particularly those in healthcare and medical programs. Psychological interventions rooted in positive psychology have proven effective in enhancing mental health, with online and digital delivery methods proving to be equally viable. This study aims to enhance mental health among Italian university students through digital interventions, including virtual reality, utilizing a stepped care approach. Specific objectives include implementing online positive interventions for students experiencing mild distress (DigiWell_Step 1), evaluating a Virtual-Reality intervention for moderate distress (DigiWell_Step 2), and identifying students experiencing high distress or optimal well-being. Cluster analyses and linear models will assess intervention outcomes. It is anticipated that students undergoing these steps will experience significant improvements in well-being and distress reduction, with sustained benefits at a three-month follow-up. This research contributes to understanding the efficacy of mental health interventions for university students, leveraging digital technologies to enhance accessibility and user engagement. The integration of digital technologies enhances the cost-effectiveness and engagement of interventions delivered through a stepped care approach tailored to the targeted population.
... Perceived stigma refers to an individual's beliefs about the negative attitudes of others towards them due to their mental illness [47,69]. Perceived stigma as a help-seeking barrier is therefore an individual's belief that others would view them negatively if they sought help for their problems [37,111]. Selfstigma refers to an individual's internalised negative view of his or her own problems [28,47]. ...
Background
Stigma is a complex construct and its association with help-seeking among those experiencing eating disorders is not well understood. Rates of help-seeking are low for those with eating disorder symptoms and, therefore, determining the role of stigma and shame in this relationship is needed to help inform effective awareness campaigns aimed at improving prognostic outcomes. The current study examined the associations between perceived stigma, self-stigma, shame, and help-seeking behaviour in a community sample of individuals with elevated eating disorder symptoms.
Methods
Participants completed an online survey that included measures of stigma and shame as perceived barriers to help-seeking for individuals with eating disorders. Those with elevated eating disorder symptoms and high clinical impairment were included in the study (N = 333).
Results
Using binary logistic regression models controlling for age and gender, results showed that perceived stigma, self-stigma, and shame predicted 64% of help-seeking behaviour (p = .005). The only significant unique predictor of formal help-seeking was “Being concerned that other people believe eating disorders are not real illnesses”. No other stigma or shame items were found to significantly predict help-seeking.
Conclusions
The present findings suggest that while stigma plays an important role in help-seeking, it might not be the primary reason preventing individuals with eating disorders from accessing care. The field is encouraged to investigate these factors to promote help-seeking effectively.
... Despite the efforts of mental health specialists, many students have insufficient information about mental health and do not consider specialized treatment necessary. Students generally believe that symptoms of depression and anxiety are typical college stress and do not see treatment as necessary (Eisenberg et al. 2007). But of course, there are students who consider mental health services necessary in their situation, but there are times when they are sceptical about the effectiveness of mental health care (Mowbray et al. 2006). ...
During university years, mental health and behavioural challenges become more prevalent. The unique lifestyle of students often exposes them to increased levels of anxiety, depression, and social isolation. Additionally, mental well-being is closely linked to factors such as anxiety, stress, and adjustments to new lifestyle habits, particularly in the crucial transition period of the first year at university. A longitudinal study was conducted among students enrolled at universities in Albania. Descriptive statistics were used to show the difference between gender, levels of education and age. A sample of 594 students participated in the study completing the battery of questionnaires. Psychological instruments and exposure measurements were considered. Research has confirmed the challenges faced by students during their university years, revealing a correlation between insufficient financial support and a rise in symptoms of depression and anxiety. The findings underscore the impact of lifestyle changes on the manifestation of clinically significant psychological symptoms. It suggests that enhancing financial support and providing additional resources could alleviate psychological distress among university students.
... No attempt was made to solve individual student's problems online. In line with best psychiatric practice, responsibility for safety at all times remained with the individual student with invitations at every opportunity to voice concerns through emails or university counsellors (Gulliver et al., 2018;Eisenberg et al., 2007a). At one point a student became very tearful and distressed but gave all reasonable reassurances of their safety. ...
During Covid-19, rates of mental health issues, particularly anxiety, rose significantly in university students. In the scramble to adapt to online learning, university professors were overwhelmed with material aimed at facilitating a supportive learning experience and preserving student academic performance in online contexts yet were ill-equipped to cope with the increased volume of mental health issues encountered. Many studies attest to the association between poor mental health and academic performance. It has been shown that students often report their mental health issues to university professors who are called upon to cope with these issues as best they can. This paper outlines strategies undertaken, in the context of a novel undergraduate mental health program, to address emergent mental health issues during Covid-19 student isolation. These practical, cost effective interventions can be used to successfully give voice to ongoing student mental health issues in a post-Covid world and to help professors feel equipped and empowered enough to contribute to stemming the tide of rising rates of mental illness meaningfully, appropriately and professionally.
The research examined mental health publications through a comprehensive bibliometric analysis from 2000 to 2024, encompassing 483 documents published in 279 outlets that had an annual growth rate of 9.5%. The research explored publication trends; leading journals; key authors; key affiliations; collaboration networks of authors, institutions and countries; co-occurrence networks and identified major trending topics and themes. Research has shown that mental health article output experienced a significant growth after 2018 because of new policies and worldwide mental health concerns. Three prominent journals, Psychiatric Services, BMC Psychiatry and The Lancet lead the field because they demonstrate the critical nature of psychiatric and public health research. This analysis highlighted the leading researchers as well as prominent scholarly works while demonstrating that Harvard University and the University of Toronto made significant research contributions. The co-occurrence analysis and thematic map revealed four principal subjects: mental health services, depression, public health policy research, and socioeconomic influences. The research investigated international research collaborations where the USA had a leading position in global collaboration. The effect of COVID-19 on mental health and cognitive behavioural therapy were the emerging topics in this field of research. The findings provide essential information about ongoing research trends as well as about influential publications and collaborations that direct future studies.
Introduction Diabetes-related foot ulcers (DFUs) are a major complication of diabetes and are associated with high morbidity and mortality rates. Psychological factors have been found to play a role in wound healing (Frasier et al. , 2024; Robinson et al. , 2017; Walburn et al. , 2009) but it remains uncertain if psychological interventions can help individuals with an active DFU, or a history of DFUs, to achieve complete or improved wound healing or prevent recurrence. Objective A recent Cochrane review by McGloin et al. (2021) examined existing psychological interventions for individuals with DFU and emphasized the need for more interventions and stronger study designs to evaluate their efficacy. Building on this, the proposed scoping review aims to: 1) Investigate the emotional consequences and burdens of living with DFU, and 2) Examine how psychosocial factors influence the progression and management of ulcerations. Methods This review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) will guide the reporting of results. Discussion While factors such as stress, depression and social support have been identified as variables that may negatively affect DFU healing, there is a need for a greater understanding of how variables such as these may influence progression and recurrence. This review will comprise of a broad and systematically mapped synthesis of the identified data. Following this review, qualitative studies will be conducted, and their findings, along with those from the scoping review, will inform the development of a psychological intervention that will aim to improve psychosocial functioning and mitigate the progression and recurrence of DFUs.
This study examines Latinx students’ use of digital storytelling to address mental health issues. Through participant observation and focus groups, we explore participants’ engagement in art-based work within a group mediated context where issues of depression, anxiety, and stress were discussed. Participants achieved relational development and self-actualization through the enactment of three practices: (a) acknowledgment and naming of their emotions, (b) group validation and support, and (c) reinterpretation of themselves as empowered creators.
Student well-being has been a field of concern for various researchers and studies have been conducted to understand the factors that influence a student's performance at higher educational institutions. This chapter specifically focuses on understanding the factors that influence the student's mental health that further impacts their academic achievement. The research reviews are done using keywords such as academic achievement, student well-being and mental health, coping strategies and obstacles. Student engagement in class is a major factor related to their mental health whereas home-based parental involvement and social engagement is associated with academic achievement. The results are a clear justification of how the mental health of the student can influence their academic achievement, and the various coping strategies that play a crucial role in ensuring good mental health of the student.
Post-secondary mental health has reached crisis levels. Students attending post-secondary institutions such as universities, colleges, and trade schools are facing higher rates of negative mental health symptoms than before the pandemic, and have a higher prevalence of mental illnesses than found in the general population. Barriers to accessing mental health support prove to be a major obstacle for students—many of whom do not seek professional help when they need it. This mental health crisis is particularly poignant within marginalized student populations who face higher rates of mental illness as well as intersecting barriers to accessing support. Examples include cultural norms, chronic stress related to ongoing discrimination, and language barriers. Digital therapy presents a novel method of delivering mental health support and increasing accessibility to students in need. Mental health issues among post-secondary students, the barriers to care that they are facing, and specific digital mental health platforms to increase accessibility are outlined in this article.
In the 1990s, the Royal Government of Cambodia (RGC) initiated the privatization of higher education institutions (HEIs. This policy shift led to a dramatic increase in the number of HEIs, expanding from only 8 in the late 1990s to 189 in the academic year 2022–2023. Alongside this growth, students’ enrollment number surged from 175,962 in the academic year 2021–2022 to 237,243 in 2022–2023. The transition from secondary to higher education represents a significant change for students. Currently, there is not many research studies that mainly focus on the first – year student challenges in higher education in Cambodia. This qualitative research aims to explore the challenges faced by first-year students in Cambodia’s HEIs. A semi-structured interviews was selected with the participants purposively selected from six public and private HEIs. In sum, there are fifty-seven participants in total from the six HEIs and other relevant institutions to contribute to the study. The findings indicate that first-year students encounter several challenges such as academic challenges, personal challenges, social integration challenges, transition to career-oriented learning challenges, and adaptation to available student services challenges. The results underscore the need for HEIs to prioritize creating a supportive environment that fosters a smooth transition, encouraging student retention and continuity into subsequent years.
Background
Nightmares may lead to psychotic‐like experiences (PLEs). The present study aimed to examine the potential moderating and mediating effects of mental health literacy (MHL) on the association between nightmare distress (ND) and PLEs among Chinese college students.
Methods
A total of 4000 college students who have had nightmares in the past year were assessed using the Chinese version of the nightmare distress questionnaire (NDQ‐CV), mental health knowledge questionnaire (MHKQ), 15‐item positive subscale of the community assessment of psychic experiences (CAPE‐P15), 2‐item insomnia questionnaire, 2‐item patient health questionnaire (PHQ‐2), and a self‐compiled sample characteristics questionnaire.
Results
Greater ND and lower MHL were associated with an elevated risk of PLEs among college students when adjusting for sample characteristics, insomnia and depressive symptoms. Moderation analysis indicated that MHL buffers the association between ND and PLEs, such that a higher level of MHL attenuates the positive effect of ND on PLEs to a greater extent.
Conclusions
These findings strongly stressed the urgent need for early intervention in college students with ND. Strategies should prioritise treating ND and enhancing MHL, as these may be effective approaches to preventing and reducing PLEs.
The boundaries of psychology are expanding as growing numbers of psychological scientists, educators, and clinicians take a preventive approach to social and mental health challenges. Offering a broad introduction to prevention in psychology, this book provides readers with the tools, resources, and knowledge to develop and implement evidence-based prevention programs. Each chapter features key points, a list of helpful resources for creating successful intervention programs, and culturally informed case examples from across the lifespan, including childhood, school, college, family, adult, and community settings. An important resource for students, researchers, and practitioners in counseling, clinical, health, and educational psychology, social justice and diversity, social work, and public health.
Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals report more experiences of healthcare discrimination and disordered eating behaviors (DEBs), and less trust in physicians than their cisgender and heterosexual counterparts. Although research supports a link between discrimination and DEBs among LGBTQ+ populations, few studies have specifically investigated healthcare discrimination and DEBs in this population. This study examined whether LGBTQ+ status moderated the relation between negative healthcare experiences and DEBs in undergraduates. Undergraduates (n = 322) from a Southeastern (United States) university completed measures of healthcare discrimination, trust in physicians, and DEBs. Analyses investigated whether LGBTQ+ status moderated the relation between healthcare discrimination and DEBs; trust in physicians and DEBs. LGBTQ+ individuals (35% of sample), reported less trust in physicians (p < .001), and more body dissatisfaction (p = .007) and shape/weight overvaluation (p = .008). Among all undergraduates, experiences of healthcare discrimination were associated with higher body dissatisfaction (p = .003) and shape/weight overvaluation (p = .008). Less trust in physicians was associated with greater shape/weight overvaluation (p = .005). LGBTQ+ status did not moderate either relation. It is important to reduce healthcare discrimination and foster patient-provider trust for all young adults. Future research should examine factors influencing patient-provider trust among LGBTQ+ individuals.
Introduction Diabetic foot ulceration (DFU) is a major complication of diabetes and is associated with high morbidity and mortality rates. Psychological factors are believed to play a role in wound healing, but it remains uncertain if psychological interventions can help individuals with an active DFU, or a history of DFUs, to achieve complete or improved wound healing or prevent recurrence. Objective The objective of the proposed scoping review is to investigate the emotional consequences/burden of living with DFU and to examine how psychosocial factors may impact progression and management of ulcerations. Methods This review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) will guide the reporting of results. Discussion While factors such as stress, depression, social support, and adherence to treatment have been identified as variables that may negatively affect DFU healing, there is a need for a greater understanding of how psychological and behavioural variables such as these may influence ulcer incidence, healing and recurrence in people with diabetes. This review will comprise of a broad and systematically mapped synthesis of the identified data. Findings will be used to provide a better understanding of the bi-directional relationship between DFU and psychological variables and will provide direction for the development or adaptation of a tailored psychological intervention that will aim to optimise wellbeing and improve outcomes for individuals with DFU.
Objective: This study explored the extent to which college athletic coaches endorse mental illness microaggressions toward their student-athletes and the importance of mental toughness in sports, and how these impact support for help-seeking among student-athletes. Methods: Fifty-eight coaches at Northeastern U.S. colleges in the National Collegiate Athletic Association completed an online survey, including measures of mental illness microaggressions, mental toughness, and questions about vignettes portraying scenarios with a physically injured athlete and an athlete with anxiety. Results: Multivariate analyses revealed that endorsement of mental illness microaggressions was negatively related to willingness to refer an athlete with anxiety to counseling services and positively related to willingness to allow a physically injured athlete to return to play. However, mental toughness was not predictive of microaggressions or vignette responses. Conclusions: Endorsement of mental illness microaggressions appears to be related to how coaches respond to athletes experiencing a mental health issue or physical injury.
Objective:
Up to 2 million college students in the United States have been diagnosed as having attention-deficit hyperactivity disorder (ADHD), a condition associated with negative academic, social, and psychiatric outcomes. The authors investigated the online availability and content of policies governing ADHD services at college clinics.
Methods:
Using a stratified sample of 200 colleges and universities, the authors reviewed clinic websites and invited clinical staff to participate in a survey. They weighted percentages to account for oversampling and used regression modeling to examine associations with policy availability.
Results:
Only 70 institutions (32%, weighted percentage) provided information about ADHD services online. Institutions with <1,000 students had significantly lower odds of providing information online (adjusted odds ratio [AOR]=0.04, 95% CI=0.01-0.26), as did institutions that accepted >67% of applicants (AOR=0.18, 95% CI=0.07-0.48). After merging data from the Web review and survey, the authors noted that 14% (N=11 of 75 institutions with data available for this variable) facilitated neuropsychological assessments on campus, 49% (N=33 of 72) did not allow stimulant medications to be prescribed, 73% (N=43 of 61) did not offer clinical evaluations for ADHD, and 89% (N=32 of 35) required a neuropsychological assessment to receive prescription stimulants.
Conclusions:
Information about the assessment and management of ADHD is rarely available online, and ADHD services on U.S. college campuses appear to be limited.
We report a case of a patient seen within Integrated Primary Care at a collegiate health center for treatment of comorbid idiopathic urticaria and anxiety. Following medical consultation within Primary Care, Emergency services, and Asthma and Allergy Specialists, Primary Care Behavioral Health services were consulted. Here, we describe the Behavioral Health Consultant (BHC) model within primary care and the collaborative nature of the model. The benefits of this collaboration allowed the patient’s primary care provider (PCP) to use appointment times efficiently and to rely on the BHC to address the complexities of the patient’s underlying stress and anxiety. We detail the ways in which the BHC model contributed to significant decreases in the patient’s symptoms of anxiety and depression. Finally, we recommend expansion of programs providing opportunities for training in the integrated primary care model.
Background: Community mental health is growing discipline in psychology that recognizes the importance of creating a community that fosters wellness. Although universities provide many individuals a sense of community, little research has examined how community mental health interventions can be implemented into a classroom setting. Purpose: This paper provides a proof of concept of a university course that was created to give students the opportunity to interact with their campus community while receiving course credit over two semesters. Approach: In the first semester, the course provided students with content and theory as it relates to community mental health, well-being, and health promotion. The second semester implemented experiential learning, where students applied knowledge and skills to a placement related to mental health and well-being within their university. Conclusions: This university course can provide benefits to the university (e.g., cost-efficiency), the students (e.g., networking), and the community (e.g., accessible mental health services). This research presents a course framework that other post-secondary institutions can build upon and implement into their own programs. Implications: Future research should focus on implementing experiential learning courses that provide opportunities in the mental health field for undergraduate psychology students to facilitate post-graduate student success.
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.
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
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DESCRIPTION OF PRIME-MD PHQ
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STUDY PURPOSE
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METHODS
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RESULTS
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COMMENT
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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)
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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
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DESCRIPTION OF PRIME-MD PHQ
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STUDY PURPOSE
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METHODS
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RESULTS
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COMMENT
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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?
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)
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)
Fear of emotions is hypothesized to be a primary reason for individuals' negative attitudes toward seeking psychological treatment. This study examined the effects of emotional openness and other potential predictors of attitudes toward seeking psychological help in a sample of 311 college students. Results of simultaneous multiple regression analyses indicated that gender (male), perception of stigma, discomfort with emotions, and lower psychological distress accounted for 25% of variance in attitudes toward seeking psychological help. The implications of the findings and recommendations for increasing the effectiveness of public education efforts are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Illness behavior - the manner in which people differentially perceive, evaluate and respond to symptoms - may be viewed from at least three general perspectives. Such patterns of behavior may be seen (a) as a product of social and cultural conditioning, (b) as part of a coping repertoire or (c) in terms of their usefulness for the patient who obtains certain advantages from the "sick role". - The importance of such factors in determining whether people recognize symptoms, make contacts with doctors, accept or reject advice about treatment, and remain under or discontinue medical supervision, is reviewed; with particular reference to the analogies between such patterns, responses to various types of pain and placebo reactions. The implications of considering "secondary" social and psychological components of disease, as well as "primary" biological aspects, are discussed in terms of their value for the patient and their relevance to planning medical services.
The associations of prior DSM-III-R disorders with probability and timing of subsequent divorce were examined.
The data came from the part II subsample (N=5,877) of the National Comorbidity Survey. The respondents completed a structured diagnostic interview that retrospectively dated age at onset of each of 14 lifetime DSM-III-R disorders and recorded ages at first marriage and divorce. These data were used to estimate survival models describing the relationships between prior disorders and subsequent divorce. In addition, simulations were used to estimate the number of years spent out of marriage because of these causal relationships in the total U.S. population.
Prior psychiatric disorders were associated with a substantially higher risk of divorce. The simulations suggested that the effects of these associations in the U.S. population in the survey's age range are approximately 23 million lost years of marriage among men and 48 million lost years of marriage among women.
Psychiatric disorders have a number of adverse consequences for those who suffer from them and for their families and communities. The results reported here suggest that an increase in the number of people who divorce and a decrease in the number of years of marriage in the population may be among them. The debate over whether society can afford to provide universal treatment for psychiatric disorders needs to take these costs into consideration.
To study barriers to higher education, this qualitative study explored the college experiences of 35 people with psychiatric disabilities. Academic performance was related to psychiatric symptoms which subsequently led to college attrition. However, many research participants showed remarkable persistence in pursuit of academic goals. Campus-based support services were rarely utilized. Implications for psychiatric rehabilitation practice are discussed.
To examine nationally representative patterns and predictors of delays in contacting a professional after first onset of a mental disorder.
The National Comorbidity Survey, a nationally representative survey of 8,098 respondents aged 15-54.
Cross-sectional survey.
Assessed lifetime DSM-III-R mental disorders using a modified version of the Composite International Diagnostic Interview (CIDI). Obtained reports on age at onset of disorders and age of first treatment contact with each of six types of professionals (general medical doctors, psychiatrists, other mental health specialists, religious professionals, human services professionals, and alternative treatment professionals). Used Kaplan-Meier (KM) curves to estimate cumulative lifetime probabilities of treatment contact after first onset of a mental disorder. Used survival analysis to study the predictors of delays in making treatment contact.
The vast majority (80.1 percent) of people with a lifetime DSM-III-R disorder eventually make treatment contact, although delays average more than a decade. The duration of delay is related to less serious disorders, younger age at onset, and older age at interview. There is no evidence that delay in initial contact with a health care professional is increased by earlier contact with other non-health-care professionals.
Within the limits of recalling lifetime events, it appears that delays in initial treatment contact are an important component of the larger problem of unmet need for mental health care. Interventions are needed to decrease these delays.
The authors measured factors associated with under-treatment of medical students' depression. They administered a cross-sectional Beck Depression Inventory and sociodemographic questionnaire to students at 1 medical school, defining their outcome measure as the use of counseling services or antidepressant medication. Of an estimated 450 available student participants in the study, 322 (71.6%) completed the questionnaire. Forty-nine students (15.2%) were classified as depressed and 10 (20.4%) reported experiencing suicidal ideation during medical school, but only 13 (26.5%) of the depressed students reported treatment. The researchers observed no difference in treatment by year in school, completion of psychiatric requirement, race, or depression severity. Treatment for depression was significantly associated with older age and personal and family histories of depression. Despite the availability of effective medications and confidential mental health services, medical students with depression are undertreated. The authors' findings support the need for targeted messages to help medical students recognize their depression and refer themselves for appropriate treatment.
Dramatic changes have occurred in mental health treatments during the past decade. Data on recent treatment patterns are needed to estimate the unmet need for services.
To provide data on patterns and predictors of 12-month mental health treatment in the United States from the recently completed National Comorbidity Survey Replication.
Nationally representative face-to-face household survey using a fully structured diagnostic interview, the World Health Organization's World Mental Health Survey Initiative version of the Composite International Diagnostic Interview, carried out between February 5, 2001, and April 7, 2003.
A total of 9282 English-speaking respondents 18 years and older.
Proportions of respondents with 12-month DSM-IV anxiety, mood, impulse control, and substance disorders who received treatment in the 12 months before the interview in any of 4 service sectors (specialty mental health, general medical, human services, and complementary and alternative medicine). Number of visits and proportion of patients who received minimally adequate treatment were also assessed.
Of 12-month cases, 41.1% received some treatment in the past 12 months, including 12.3% treated by a psychiatrist, 16.0% treated by a non-psychiatrist mental health specialist, 22.8% treated by a general medical provider, 8.1% treated by a human services provider, and 6.8% treated by a complementary and alternative medical provider (treatment could be received by >1 source). Overall, cases treated in the mental health specialty sector received more visits (median, 7.4) than those treated in the general medical sector (median, 1.7). More patients in specialty than general medical treatment also received treatment that exceeded a minimal threshold of adequacy (48.3% vs 12.7%). Unmet need for treatment is greatest in traditionally underserved groups, including elderly persons, racial-ethnic minorities, those with low incomes, those without insurance, and residents of rural areas.
Most people with mental disorders in the United States remain either untreated or poorly treated. Interventions are needed to enhance treatment initiation and quality.
Although the 1990s saw enormous change in the mental health care system in the United States, little is known about changes in the prevalence or rate of treatment of mental disorders.
We examined trends in the prevalence and rate of treatment of mental disorders among people 18 to 54 years of age during roughly the past decade. Data from the National Comorbidity Survey (NCS) were obtained in 5388 face-to-face household interviews conducted between 1990 and 1992, and data from the NCS Replication were obtained in 4319 interviews conducted between 2001 and 2003. Anxiety disorders, mood disorders, and substance-abuse disorders that were present during the 12 months before the interview were diagnosed with the use of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Treatment for emotional disorders was categorized according to the sector of mental health services: psychiatry services, other mental health services, general medical services, human services, and complementary-alternative medical services.
The prevalence of mental disorders did not change during the decade (29.4 percent between 1990 and 1992 and 30.5 percent between 2001 and 2003, P=0.52), but the rate of treatment increased. Among patients with a disorder, 20.3 percent received treatment between 1990 and 1992 and 32.9 percent received treatment between 2001 and 2003 (P<0.001). Overall, 12.2 percent of the population 18 to 54 years of age received treatment for emotional disorders between 1990 and 1992 and 20.1 percent between 2001 and 2003 (P<0.001). Only about half those who received treatment had disorders that met diagnostic criteria for a mental disorder. Significant increases in the rate of treatment (49.0 percent between 1990 and 1992 and 49.9 percent between 2001 and 2003) were limited to the sectors of general medical services (2.59 times as high in 2001 to 2003 as in 1990 to 1992), psychiatry services (2.17 times as high), and other mental health services (1.59 times as high) and were independent of the severity of the disorder and of the sociodemographic characteristics of the respondents.
Despite an increase in the rate of treatment, most patients with a mental disorder did not receive treatment. Continued efforts are needed to obtain data on the effectiveness of treatment in order to increase the use of effective treatments.
College officials indicate that the number of students with serious mental illnesses has risen significantly. Recent media attention surrounding several high profile suicides has opened discussion of mental illness on campus. The authors summarize literature on college students and mental illness, including barriers to service receipt. Recommendations to improve campus-based responses to serious mental illness are presented on the basis of well-accepted service principles.
This report describes the participants and compares the acute and longer-term treatment outcomes associated with each of four successive steps in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial.
A broadly representative adult outpatient sample with nonpsychotic major depressive disorder received one (N=3,671) to four (N=123) successive acute treatment steps. Those not achieving remission with or unable to tolerate a treatment step were encouraged to move to the next step. Those with an acceptable benefit, preferably symptom remission, from any particular step could enter a 12-month naturalistic follow-up phase. A score of <or=5 on the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR(16)) (equivalent to <or=7 on the 17-item Hamilton Rating Scale for Depression [HRSD(17)]) defined remission; a QIDS-SR(16) total score of >or=11 (HRSD(17)>or=14) defined relapse.
The QIDS-SR(16) remission rates were 36.8%, 30.6%, 13.7%, and 13.0% for the first, second, third, and fourth acute treatment steps, respectively. The overall cumulative remission rate was 67%. Overall, those who required more treatment steps had higher relapse rates during the naturalistic follow-up phase. In addition, lower relapse rates were found among participants who were in remission at follow-up entry than for those who were not after the first three treatment steps.
When more treatment steps are required, lower acute remission rates (especially in the third and fourth treatment steps) and higher relapse rates during the follow-up phase are to be expected. Studies to identify the best multistep treatment sequences for individual patients and the development of more broadly effective treatments are needed.
Mental health among university students represents an important and growing public health concern for which epidemiological data are needed. A Web-based survey was administered to a random sample at a large public university with a demographic profile similar to the national student population. Depressive and anxiety disorders were assessed with the Patient Health Questionnaire (R. L. Spitzer, K. Kroenke, J. B. W. Williams, & the Patient Health Questionnaire Primary Care Study Group, 1999). Nonresponse weights were constructed with administrative data and a brief non-respondent survey. The response rate was 56.6% (N = 2,843). The estimated prevalence of any depressive or anxiety disorder was 15.6% for undergraduates and 13.0% for graduate students. Suicidal ideation in the past 4 weeks was reported by 2% of students. Students reporting financial struggles were at higher risk for mental health problems (odds ratios = 1.6-9.0). These findings highlight the need to address mental health in young adult populations, particularly among those of lower socioeconomic status. Campus communities reach over half of young adults and thus represent unique opportunities to address mental health issues in this important age group.
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 our 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.
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.
Over the past 5 years there has been increased attention given to mental health issues on college and university campuses across the country. However, few research efforts have been conducted to systematically investigate the mental health of college students. The College Student Mental Health Survey was undertaken as a first step towards gaining a better understanding of the broad range of mental health issues that face the college student population. This exploratory study describes the mental health history and current distress and coping of 939 college students from a large Midwestern public university, with an approximate enrollment of 40,000 students. Implications for research, policy, and practice are discussed.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
We have little systematic information about the extent to which standard processes involved in health care--a key element of quality--are delivered in the United States.
We telephoned a random sample of adults living in 12 metropolitan areas in the United States and asked them about selected health care experiences. We also received written consent to copy their medical records for the most recent two-year period and used this information to evaluate performance on 439 indicators of quality of care for 30 acute and chronic conditions as well as preventive care. We then constructed aggregate scores.
Participants received 54.9 percent (95 percent confidence interval, 54.3 to 55.5) of recommended care. We found little difference among the proportion of recommended preventive care provided (54.9 percent), the proportion of recommended acute care provided (53.5 percent), and the proportion of recommended care provided for chronic conditions (56.1 percent). Among different medical functions, adherence to the processes involved in care ranged from 52.2 percent for screening to 58.5 percent for follow-up care. Quality varied substantially according to the particular medical condition, ranging from 78.7 percent of recommended care (95 percent confidence interval, 73.3 to 84.2) for senile cataract to 10.5 percent of recommended care (95 percent confidence interval, 6.8 to 14.6) for alcohol dependence.
The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public. Strategies to reduce these deficits in care are warranted.
The purpose of this article was to describe patterns of poor mental health/depression (PMHD) in a national sample of college students and the relationships among PMHD, alcohol consumption, harm, and abuse. Responses to mailed questionnaires completed by a random sample of 27,409 students at 119 colleges were analyzed using logistic regression. Nationally, 4.8% of students reported PMHD. The average college prevalence was 5.01% (range, 0.68% to 13.23%). Students with PMHD were more likely than their peers to be female, nonwhite, and from low socioeconomic status families; less likely to report never drinking; as likely to report frequent, heavy, and heavy episodic drinking; and more likely to report drinking to get drunk. Students with PMHD-especially females-were more likely to report drinking-related harms and alcohol abuse. College is a critical context for studying youth mental health. The interrelationship of mental health problems and their clustering by group and college are important considerations for prevention and treatment.
Heterogeneity of performance of screening tools in different patient groups has rarely been considered in the literature on depression screening in primary care. The objectives of the present study were to assess and to compare diagnostic accuracy of three screening questionnaires (Brief Patient Health Questionnaire, General Health Questionnaire-12, WHO-5) in identifying depression across various patient subpopulations and to assess the accuracy of the unaided clinical assessment of primary care physicians in the same subgroups. We conducted a cross-sectional validation study in 448 primary care patients. Two-by-two tables as well as receiver operating characteristics were applied. Results indicated that diagnostic accuracy (sensitivity, specificity) of the three screening instruments as well as of the clinical diagnoses differed in the various patient groups. Superiority of one screening tool over the other depends on the subgroup considered. Gender, age, form (subtype), and severity of depression influence the test characteristics of a screening tool. This should be considered if routine depression screening should be widely introduced. Of course, the benefit of routine screening also depends on efforts made for treatment and monitoring of patients in whom depression was diagnosed.
Performance on mental health HEDIS measures has been modest, with only minimal improvements in recent years. Performance on mental health measures has been consistently worse than that for other medical conditions. A critical step toward improving performance is to understand where care is provided and then to identify clinicians who are responsible for ensuring that care is delivered appropriately.
Diagnosing and monitoring depression in primary care remains an issue of significant public health concern. Clinicians and researchers need to know if any one screening instrument is superior to the others in diagnosing ICD-10 depressive episodes. This study aimed to examine the criterion validity for diagnosing ICD-10 depressive episodes of the Patient Health Questionnaire (PHQ) in comparison with 2 well-established instruments, the Hospital Anxiety and Depression Scale (HADS), and the WHO Well-Being Index 5 (WBI-5).
Five hundred and one medical outpatients completed the questionnaires and had a clinical interview. The presence of a depressive episode was determined with the International Diagnostic Checklists (IDCL) for ICD-10 as the criterion standard. Coefficient kappa (kappa), sensitivities and specificities were calculated and a statistical comparison of the areas under the receiver operating characteristic curves was performed.
Diagnostic agreement between the questionnaires and the IDCL was moderate (kappa=0.34-0.56), with the highest values for the PHQ. While all 3 questionnaires had reasonable sensitivity and specificity, the operating characteristics for the PHQ were significantly superior to both the HADS and the WBI-5 (p=0.02).
Any of the 3 screening instruments can be recommended for clinical use. However, this is the first comparative study to demonstrate the diagnostic advantage of a particular depression-screening instrument using the ICD-10 diagnostic criteria. The superior criterion validity of the PHQ is likely attributable to its closer representation of the current concept of depressive disorders.
Little is known about lifetime prevalence or age of onset of DSM-IV disorders.
To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication.
Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview.
Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older.
Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders.
Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups.
About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
The aim of this study was to assess the validity of the Patient Health Questionnaire depression module (PHQ-9). It has been subject to studies in medical settings, but its validity as a screening for depression in the general population is unknown.
A representative population sample (2,066 subjects, 14-93 years) filled in the PHQ-9 for diagnosis [major depressive disorder, other depressive disorder, depression screen-positive (DS+) and depression screen-negative (DS-)] and other measures for distress (GHQ-12), depression (Brief-BDI) and subjective health perception (EuroQOL; SF-36).
A prevalence rate of 9.2% of a current PHQ depressive disorder (major depression 3.8%, subthreshold other depressive disorder 5.4%) was identified. The two depression groups had higher Brief-BDI and GHQ-12 scores, and reported lower health status (EuroQOL) and health-related quality of life (SF-36) than did the DS- group (P's < .001). Strong associations between PHQ-9 depression severity and convergent variables were found (with BDI r = .73, with GHQ-12 r = .59).
The results support the construct validity of the PHQ depression scale, which seems to be a useful tool to recognize not only major depression but also subthreshold depressive disorder in the general population.
The Patient Health Questionnaire depression scale (PHQ-9) is a well-validated, Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition (DSM-IV) criterion-based measure for diagnosing depression, assessing severity and monitoring treatment response. The performance of most depression scales including the PHQ-9, however, has not been rigorously evaluated in different racial/ethnic populations. Therefore, we compared the factor structure of the PHQ-9 between different racial/ethnic groups as well as the rates of endorsement and differential item functioning (DIF) of the 9 items of the PHQ-9. The presence of DIF would indicate that responses to an individual item differ significantly between groups, controlling for the level of depression.
A combined dataset from 2 separate studies of 5,053 primary care patients including non-Hispanic white (n=2,520), African American (n=598), Chinese American (n=941), and Latino (n=974) patients was used for our analysis. Exploratory principal components factor analysis was used to derive the factor structure of the PHQ-9 in each of the 4 racial/ethnic groups. A generalized Mantel-Haenszel statistic was used to test for DIF.
One main factor that included all PHQ-9 items was found in each racial/ethnic group with alpha coefficients ranging from 0.79 to 0.89. Although endorsement rates of individual items were generally similar among the 4 groups, evidence of DIF was found for some items.
Our analyses indicate that in African American, Chinese American, Latino, and non-Hispanic white patient groups the PHQ-9 measures a common concept of depression and can be effective for the detection and monitoring of depression in these diverse populations.
Analyzing data on 2,225 men and 2,401 women from the National Comorbidity Survey, the authors examine the impact of psychiatric disorders on employment and, among those employed, work hours and income. They find that psychiatric disorders significantly reduced employment among both men and women. They also find evidence of small reductions in the conditional work hours of men and a substantial drop in the conditional income of men and women, although these findings are somewhat sensitive to the estimation methods and specification of the model. (Abstract courtesy JSTOR.)
National Survey of Alcohol, Drug, and Mental Health Problems Healthcare for Communities Computer file ICPSR version
- Wells
- Kb
- R Sturm
- Burnam
Wells KB, Sturm R, Burnam A. National Survey of Alcohol, Drug, and Mental Health Problems Healthcare for Communities, 2000 –2001. Computer file ICPSR version. University of California, Los Angeles, Health Services Research Center producer, Los Angeles, CA; 2004. Inter-university Consortium for Political and Social Research distributor, Ann Arbor, MI; 2005.
National Survey of Counseling Center Directors. Alexandria , VA: National Association of Counseling Services Access to Mental Health Care Among Students
- R Gallagher
Gallagher R. National Survey of Counseling Center Directors. Alexandria, VA: National Association of Counseling Services; 2005. Medical Care @BULLET Volume 45, Number 7, July 2007 Access to Mental Health Care Among Students © 2007 Lippincott Williams & Wilkins 601
Access to Mental Health Care Among Students
Medical Care @BULLET Volume 45, Number 7, July 2007
Access to Mental Health Care Among Students
National Survey of Alcohol, Drug, and Mental Health Problems Healthcare for Communities Computer file ICPSR version. University of California
- Kb Wells
- R Sturm
- A Burnam
Wells KB, Sturm R, Burnam A. National Survey of Alcohol, Drug, and
Mental Health Problems Healthcare for Communities, 2000-2001.
Computer file ICPSR version. University of California, Los Angeles,
Health Services Research Center producer, Los Angeles, CA; 2004.
Inter-university Consortium for Political and Social Research distributor, Ann Arbor, MI; 2005.