Sarah Ketchen Lipson’s research while affiliated with Massachusetts Department of Public Health and other places

Purpose of Review We evaluated the impact of digital mental health interventions (DMHIs) for college students. We organized findings using the RE-AIM framework to include reach, effectiveness, adoption, implementation, and maintenance. Recent Findings We conducted a systematic literature review of recent findings from 2019–2024. Our search identified 2,701 articles, of which 95 met inclusion criteria. In the reach domain, student samples were overwhelmingly female and White. In the effectiveness domain, over 80% of DMHIs were effective or partially effective at reducing their primary outcome. In the adoption domain, studies reported modest uptake for DMHIs. In the implementation and maintenance domains, studies reported high adherence rates to DMHI content. While recruitment methods were commonly reported, adaptations and costs of implementation and maintenance were rarely reported. Summary DMHIs for college students are effective for many psychological outcomes. Future work should address diversifying samples and considering implementation in a variety of college settings.

Objectives: We assessed the prevalence of loneliness by gender and gender-specific associations between loneliness and substance use in university students. Participants: Participants were students enrolled in colleges and universities throughout the United States (n = 84,481). Methods: Gender was self-reported and categorized as male, female, and transgender/nonbinary. Descriptive analyses were conducted, and logistic regression was used to measure associations between loneliness and substance use by gender and substance. Results: Loneliness prevalence was 58% in the sample, and loneliness was most prevalent among transgender/nonbinary students (79%). Loneliness was associated with reduced odds of alcohol use and increased odds of benzodiazepine use in all genders, and increased odds of marijuana, stimulant, and opioid misuse in females and males. Conclusions: Loneliness is prevalent in college students, especially in transgender/nonbinary students, and it is associated with increased odds of substance use. College administrators should consider implementing interventions to reduce loneliness in this population.

This cross-sectional study examines awareness of opioid overdose, the ability to administer naloxone, and the willingness to help during an overdose on college campuses across the US.

Mental health disparities experienced by sexual and gender diverse (SGD) young adults are well documented. Yet, few studies have examined mental health disparities between SGD subgroups. Even fewer have investigated disparities that may exist for individuals whose SGD identities are nonmonosexual (i.e., diverse sexual orientations besides gay/lesbian) or gender nonbinary, who may experience exacerbated marginalization and disparities. The present study examines differences in weight and shape concerns and symptoms of depression, anxiety (general, panic, social, and posttraumatic stress), alcohol use disorder, and insomnia among sexually diverse (SD) subgroups (lesbian or gay, bisexual, queer, asexual, pansexual, multiple identities, and questioning), and gender diverse (GD) subgroups (trans man, trans woman, and nonbinary) of college students. We hypothesized that nonmonosexual students would have a greater mental health symptom burden than their monosexual peers and we explored additional subgroup differences among SD and GD subgroups separately. Kruskal–Wallis tests with Mann–Whitney U post hoc tests were conducted to examine associations between mental health symptoms and sexual orientation and gender identity separately. Results show high mental health symptom levels among most subgroups. Some nonmonosexual SD subgroups were at particularly high risk; namely, pansexual students. Questioning and asexual SD subgroups had similar and lower symptom levels than their monosexual peers, respectively. SD subgroup disparities varied by mental health symptom type. No significant differences by GD subgroups were found. Clinicians and institutions should consider these disparities and future research should aim to better understand them.

Objective: To identify and describe interventions that increase access to naloxone for undergraduate students. Methods: A systematic review across 4 databases identified interventions that expand access to naloxone at colleges in the United States from 2015-2023. Three reviewers extracted the following data to create a narrative synthesis and summary of program elements: setting, rationale for intervention, timeline, intervention components, study size, collaboration, sustainability, outcomes and results. Results: Seven articles met inclusion criteria. Institutions' implemented naloxone interventions due to concerns for student safety and/or student overdose fatalities. Three universities collaborated with their School of Pharmacy for program design and/or dissemination, while two partnered with state-based naloxone distribution programs. Most programs combined opioid-overdose/naloxone training; four distributed naloxone kits. Three studies included pre/post-outcomes, and all reported increases in participant knowledge, attitudes, and/or ability to respond to an overdose. Conclusions: Our results indicates an opportunity for wide-scale implementation of undergraduate naloxone programs within US colleges. However, more rigorous implementation research is needed to identify barriers and facilitators to program feasibility, acceptability, and participation.

Introduction There are documented inequities in eating disorders (EDs) by gender and race/ethnicity, yet, little is known about population‐level prevalence of ED risk factors, symptoms, and diagnosis at the intersection of diverse gender and racial/ethnic identities. Methods Data from the Healthy Minds Study 2015–2019 ( N = 251,310 U.S. university students) were used in a multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Participants were nested in 35 intersectional strata given by all combinations of 5 gender and 7 racial/ethnic categories. Multilevel logistic models with participants at level 1 and intersectional strata at level 2 were used to estimate stratum‐specific predicted prevalence estimates for self‐reported thin‐ideal internalization, ED symptoms, and ED diagnosis. The variance partition coefficient (VPC) was calculated to quantify the contextual effect of the strata. Results There was considerable heterogeneity in the predicted prevalence of our ED outcomes across the strata (e.g., .3%–18.3% for ED diagnoses). There were large disparities in all three outcomes, with transgender participants of color having a higher predicted prevalence than expected based on the additive effects of gender and race/ethnicity. Moderation by race/ethnicity was also apparent, such that racial/ethnic disparities were wider within the cisgender groups relative to the transgender groups. VPCs indicated that ~10% of the total variance in ED outcomes was due to intersectionality between gender and race/ethnicity, over and above variance due to individual‐level differences. Conclusion Findings suggest that gender and racial/ethnic disparities in EDs are interrelated, underscoring the need to develop preventive interventions centering health equity. Public significance Despite evidence that sexism, racism, and cissexism (i.e., anti‐transgender prejudice) can impact EDs risk, little research examines the social patterning of EDs at the intersection of diverse gender and racial/ethnic identities. Using data from a sample of 250,000 U.S. university students, this study found that gender and racial/ethnic disparities in eating disorder risk are interrelated, highlighting the need to develop health equity centered preventive interventions.

Objective To examine the mental health problems that college students with eating disorders (EDs) and comorbid depression and/or anxiety disorders preferred to target first in a digital treatment program and explore correlates of preferred treatment focus. Methods Four hundred and eighty nine college student users of a digital cognitive‐behavioral guided self‐help program targeting common mental health problems (76.7% female, M age = 20.4 ± 4.4, 64.8% White) screened positive for an ED and ≥one other clinical mental health problem (i.e., depression, generalized anxiety disorder, social phobia, and/or panic disorder). Students also reported on insomnia, post‐traumatic stress, alcohol use, and suicide risk. Before treatment, they indicated the mental health problem that they preferred to target first in treatment. Preferred treatment focus was characterized by diagnostic profile (i.e., ED + Depression, ED + Anxiety, ED + Depression + Anxiety), symptom severity, and demographics. Results 58% of students with ED + Anxiety, 47% of those with ED + Depression, and 27% of those with ED + Depression + Anxiety chose to target EDs first. Across diagnostic profiles, those who chose to target EDs first had more severe ED symptoms than those who chose to target anxiety or depression ( ps < .05). Among students with ED + Depression + Anxiety, those who chose to target EDs first had lower depression symptoms than those who chose to target depression, lower generalized anxiety than those who chose to target anxiety, and lower suicidality than those who chose to target anxiety or depression ( ps < .01). Conclusions Students with EDs and comorbid depression and/or anxiety disorders showed variable preferred treatment focus across diagnostic profiles. Research should explore specific symptom presentations associated with preferred treatment focus. Public Significance Findings indicate that a sizable percentage of college students with depression/anxiety who also have EDs prefer to target EDs first in treatment, highlighting the importance of increasing availability of ED interventions to college students. Students with EDs and comorbid depression and/or anxiety disorders showed variable preferred treatment focus across diagnostic profiles, and preference to target EDs was associated with greater ED psychopathology across diagnostic profiles.