Factors Affecting Mental Health Service Utilization Among California Public College and University Students

Barriers to mental health service utilisation among medical students in Saudi Arabia

Introduction

Medical students experience high levels of stress, often due to academic demands, which can adversely affect their mental health. However, they frequently hesitate to seek and underutilise available mental health services. This study aimed to assess the perceived need for mental health services and identify the barriers to seeking help among undergraduate medical students.

Materials and methods

This cross-sectional study recruited 480 undergraduate medical students from two main universities in the Eastern Province of Saudi Arabia. Data were collected through an online, self-administered questionnaire that encompassed sections on sociodemographic details, the Patient Health Questionnaire (PHQ-9), perceptions about the necessity for professional mental health care, service utilisation over the past year, and the Barriers to Access to Care Evaluation (BACE-III).

Results

The study found that 33.6% of the participants showed signs of depression. Even though 42.5% expressed a perceived need for mental health services, only 16.2% actually utilised these services in the previous 12 months. In terms of barriers, attitudinal-related barriers received the highest mean score, followed by stigma- and instrumental-related barriers. Notably, students who had previously experienced academic failure and those who had sought mental health services were more inclined to report stigma- and instrumental-related barriers.

Conclusion

Mental health challenges are notably prevalent among undergraduate medical students. Although there is a significant perceived need for professional mental health intervention, the actual utilisation rate remains low. The primary obstacles to seeking assistance are attitudinal and stigma-related barriers.

Factors Affecting Anxiety-Related Symptoms, Diagnosis, and Treatment Among Collegiate Student-Athletes in the National College Health Assessment

CONTEXT

Increased attention continues to be placed on best practices for assisting student-athletes who show symptoms of a mental health illness. One of the most common mental health concerns for student-athletes is feeling overwhelmed or anxious. Early recognition of these symptoms can help student-athletes find early intervention.

OBJECTIVE

To elucidate specific attributes associated with an increased likelihood of anxiety symptoms and treatment avoidance to help athletic trainers and other practitioners better identify and assist high-risk individuals.

DESIGN

Cross-sectional study.

SETTING

Colleges and universities in the United States.

PATIENTS OR OTHER PARTICIPANTS

A total of 51 882 varsity athletes who completed the National College Health Assessment between 2011 and 2019.

MAIN OUTCOME MEASURE(S)

Survey responses (self-report) to questions related to anxiety symptoms and disorders cross-sectioned into 9 predictors: year in school, gender, sexual orientation, race and ethnicity, international student status, school type, received information on stress reduction or depression or anxiety, anxiety about impeding academic performance, and history of mental health treatment in the last year.

RESULTS

More than three-fourths (82.9%, n = 43 016) of student-athletes reported feeling overwhelmed because of all that they had to do in their daily activities, whereas only half (47.5%, n = 24 645) of student-athletes described overwhelming anxiety as a symptom. Gender, sexual orientation, race and ethnicity, school type, and previous mental health treatment had large effects on these 2 symptoms. However, of the student-athletes who reported overwhelming anxiety as a symptom, only one-fourth (22.9%, n = 5649) indicated they received a diagnosis of anxiety with or without treatment.

CONCLUSIONS

Factors such as the year in school and availability of mental health information appeared to have little effect on the experience of anxiety-related symptoms and the propensity to seek treatment. However, other factors, including gender, sexual orientation, race and ethnicity, school type, and previous mental health treatment, did have important effects. Our study provides additional evidence that the stresses placed on collegiate student-athletes frequently led to feelings of being overwhelmed and, eventually, anxiety disorder diagnoses. However, most student-athletes experiencing anxiety-related symptoms still did not seek a diagnosis with or without treatment.

Changing the landscape of mental health among college students: a community case study of a course on learning sustainable well-being

Our society is facing an unprecedented mental health crisis, with nearly one in two people being affected by mental health issues over their lifespan. This trend is especially noticeable among college students, who undergo significant shifts in social, familial, and academic responsibilities. Exacerbating the mental health crisis is the fact that students are facing other societal crises (e.g., climate change). And, in a reciprocal fashion, students experiencing poor mental health are less likely to feel resilient enough to tackle these other crises. In response to these colliding societal crises, we need a comprehensive solution that goes beyond the current models of college mental health services. We propose an alternative preventative mental health approach, which aims to prevent the onset of mental health concerns and build resilience in the face of colliding crises. Specifically, we argue that colleges can aid in building mental health resilience by creating for-credit courses that teach students the skills they need to be conscious, responsible, and resilient human beings. Toward this end, we created an experiential, workshop-style, 1 unit, P/NP course, entitled "Learning Sustainable well-being" (LSW), which guides students to explore, improve, and sustain their mental health. The principles taught in this course combine the wisdoms of several disciplines, including mindfulness, psychology, neuroscience, philosophy, religion, poetry, and cinema. The following community case study reflects on the journey of our "LSW initiative," starting from the creation of the course in 2014 to the current mission of scaling up the offering as part of an institution-wide LSW program. To this end, we describe the LSW course modules/content, our pedagogical approach, potential limitations, and then provide data demonstrating its efficacy in improving student well-being. As a final note, we present the challenges we have faced, and the lessons learned, while on this journey. We hope that presenting this community case study will facilitate the growing dialogue across colleges about creating (and perhaps requiring) courses like LSW in order to improve students' mental health and resilience in the context of other colliding crises.

Mental health and help-seeking among college students during the COVID-19 pandemic: Roles of campus mental health climate and institutional support

Objective: This study aimed to examine college students' perceived mental health and help-seeking behaviors during the COVID-19 pandemic, as well as to determine the roles of campus mental health climate and institutional support on students' help-seeking behaviors and well-being. Participants: The sample included 123 students from a Northeastern United States University. Methods: Using a web-based survey and convenience sampling, data were collected in late 2021. Results: Most participants retrospectively reported a perceived decline in their mental health during the pandemic. Sixty-five percent of the participants reported that they did not receive professional help at a time when they needed it. Both campus mental health climate and institutional support were negatively related to anxiety symptoms. Greater institutional support predicted less social isolation. Conclusions: Our findings highlight the importance of campus climate and support on students' well-being during the pandemic and the need for increasing students' access to mental health care.

Psychosocial adjustment of U.S. college students in the early months of the COVID-19 pandemic

Objective: Examine the psychosocial adjustment of U.S. college and university students during the early months of the COVID-19 pandemic. Participants: Higher education students in the U.S. (N = 228), recruited between March 2020 and May 2020. Methods: Participants completed self-report measures regarding their psychosocial functioning online. Qualitative and quantitative methods were used to explore participants' psychosocial adjustment. Results: Participants reported increased concerns about such stressors as academics, job loss, health, and social isolation. They reported significantly elevated symptoms of depression, anxiety, perceived stress, and somatization, and prior history of psychological counseling was associated with greater levels of distress. Approximately one-third of participants reported inadequate perceived social support, which in turn was linked to psychosocial adjustment. Conclusions: College students reported experiencing a wide range of stressors related to the pandemic. Increasing access to mental health services and providing supportive services in such areas as social connection and employment are encouraged.

Trends in Collegiate Student-Athlete Mental Health in the National College Health Assessment, 2011-2019

CONTEXT

Recently, the athletic training community has paid increased attention to collegiate student-athlete mental health, mental health treatment-seeking behavior, and the effects of mental health factors on athletic and academic performance. Ongoing efforts to better educate and equip athletic trainers to help student-athletes in this regard should result in improved mental health-related outcomes.

OBJECTIVE

To examine changes in the mental health of student-athletes over the past decade compared with that of nonathlete students.

DESIGN

Cross-sectional study.

SETTING

Colleges and universities in the United States.

PATIENTS OR OTHER PARTICIPANTS

Varsity athletes (athletes; n = 54 479) and nonathlete students (nonathletes; n = 448 301) who completed the National College Health Assessment between 2011 and 2019.

MAIN OUTCOME MEASURE(S)

Surveys included responses (self-reported) to questions in 5 mental health-related categories: recent mental health symptoms, recent mental health diagnosis, mental health treatment-seeking behavior, receiving mental health information from the institution, and the recent effect of mental health factors on academic performance.

RESULTS

Athletes consistently described lower symptom and diagnosis rates compared with nonathletes, except for attempted suicide, substance abuse, and eating disorders. Rates of diagnosis increased over time in both groups but remained lower in athletes. Treatment-seeking behavior and openness to future treatment increased over time in both groups but remained lower in athletes. Athletes received more information on stress reduction, substance abuse, eating disorders, and handling distress or violence compared with nonathletes. Both groups received information more frequently over time. Athletes reported fewer academic effects, especially for depression and anxiety, but these effects grew over time in both groups. The effects of injuries and extracurricular activities on academic performance were greater in athletes than in nonathletes.

CONCLUSIONS

Athletes described overall lower levels of mental health symptoms, diagnoses, and academic effects compared with nonathletes. Whereas the rates in nonathletes climbed over the past decade, the rates in athletes broadly remained flat or climbed less rapidly. Increasingly positive attitudes toward treatment were encouraging, but the deficit in athletes relative to nonathletes persisted. Ongoing efforts of athletic trainers to educate athletes and guide them to mental health resources are needed to continue, or better yet to accelerate, the observed positive trends in information dissemination and treatment-seeking behavior.

An exploration of factors related to service utilization in emerging adults: Loneliness and psychosocial supports

Objective: To examine the relationships between loneliness and psychosocial supports, emerging adult service utilization, and barriers to utilization. Participants: 18 to 29-year-old students enrolled in a large Midwestern University (n = 292). Methods: Online surveys were administered to all participants involving information on loneliness, social supports, basic need satisfactions, community/university service utilization, and barriers to service use. Logistic and linear regressions, analysis of variance were conducted. Results: Emerging adults were found to have a greater likelihood of service utilization when higher in social support from friends and less likely to utilize services when high in relatedness and competence need satisfaction, specifically in regard to community services. Group differences in greater barriers to service utilization were found among the highest levels of loneliness and the lowest levels of need satisfaction. Conclusion: Overall, this study indicates psychosocial supports and loneliness are related to service utilization in a nuanced manner.

Chinese college students' help-seeking behavior: An application of the modified theory of planned behavior

Chinese college students have a high incidence of psychological problems but rarely seek professional psychological help. Despite this fact, there have been few studies of the help-seeking behavior of Chinese college students with mental health problems. This research aims to use a modified model based on the theory of planned behavior (TPB) to explore the intentions and behaviors of Chinese college students with psychological problems in seeking professional psychological help. A total of 319 Chinese college students were recruited to measure attitude, stigma, coping efficiency, help-seeking intention, help-seeking behavior, and demographic variables. The results showed that attitudes were the most powerful predictor of intentions to seek help, followed by coping effectiveness and stigma. In addition, a multigroup analysis showed that the model was valid across genders. Our research results show that the TPB-based model can effectively explain the intentions and behaviors of college students with psychological problems in seeking professional help. Using our results, families, schools, and society could design intervention measures to enhance students' help-seeking intentions and behaviors.

"Managing emotion": Open label trial and waitlist controlled trial of an emotion regulation program for university students

Background: More than one-third of university students meet diagnostic criteria for a mental disorder, and three quarters experience role impairment in some aspect of their life. One determinant of whether young adults will experience mental health difficulties is their ability to regulate emotion. We conducted two pilot trials of a brief online program designed to teach emotion regulation skills to university students. Methods: In Study 1, we conducted an open-label trial (n = 104). In Study 2, we conducted a waitlist controlled trial (n = 167). In both studies, pre- and post-assessment of emotion regulation, psychological distress, and self-compassion were conducted. Results: In both trials, we observed improvements in emotion regulation, and reductions in symptoms of psychological distress. Acceptability and feasibility were also satisfactory. Conclusion: An online emotion regulation program may offer promise in improving emotion regulation and subsequent mental health concerns among university students. (ACTRN12620000390987; ACTRN12620000839909).

Collaborative mental health care: A narrative review

The Collaborative Care model is a systematic strategy for treating behavioral health conditions in primary care through the integration of care managers and psychiatric consultants. Several randomized controlled trials have demonstrated that Collaborative Care increases access to mental health care and is more effective and cost efficient than the current standard of care for treating common mental illnesses. Large healthcare systems and organizations have begun to adopt Collaborative Care initiatives and are seeing improved treatment outcomes and provider and patient satisfaction. This review discusses current research on the effectiveness and cost-efficiency of Collaborative Care. In addition, this paper discusses its ability to adapt to specific patient populations, such as geriatrics, students, substance use, and women with perinatal depression, as well as the significance of measurement-based care and mental health screening in achieving improved clinical outcomes. Current data suggests that Collaborative Care may significantly improve patient outcomes and time-to-treatment in all reviewed settings, and successfully adapts to special patient populations. Despite the high upfront implementation burden of launching a Collaborative Care model program, these costs are generally offset by long term healthcare savings.

University students' use of mental health services: a systematic review and meta-analysis

BACKGROUND

International estimates suggest around a third of students arrives at university with symptoms indicative of a common mental disorder, many in late adolescence at a developmentally high-risk period for the emergence of mental disorder. Universities, as settings, represent an opportunity to contribute to the improvement of population mental health. We sought to understand what is known about the management of student mental health, and asked: (1) What proportion of students use mental health services when experiencing psychological distress? (2) Does use by students differ across health service types?

METHODS

A systematic review was conducted following PRISMA guidelines using a Context, Condition, Population framework (CoCoPop) with a protocol preregistered on Prospero (CRD42021238273). Electronic database searches in Medline, Embase, PsycINFO, ERIC and CINAHL Plus, key authors were contacted, citation searches were conducted, and the reference list of the WHO World Mental Health International College Student Initiative (WMH-ICS) was searched. Data extraction was performed using a pre-defined framework, and quality appraisal using the Joanna Briggs Institute tool. Data were synthesised narratively and meta-analyses at both the study and estimate level.

RESULTS

7789 records were identified through the search strategies, with a total of 44 studies meeting inclusion criteria. The majority of included studies from the USA (n = 36), with remaining studies from Bangladesh, Brazil, Canada, China, Ethiopia and Italy. Overall, studies contained 123 estimates of mental health service use associated with a heterogeneous range of services, taking highly variable numbers of students across a variety of settings.

DISCUSSION

This is the first systematic quantitative survey of student mental health service use. The empirical literature to date is very limited in terms of a small number of international studies outside of the USA; studies of how services link together, and of student access. The significant variation we found in the proportions of students using services within and between studies across different settings and populations suggests the current services described in the literature are not meeting the needs of all students.

Barriers and Facilitators to Mental Health Help-Seeking and Experiences with Service Use among LGBT+ University Students in Chile

Barriers limiting access to mental health care for lesbian, gay, bisexual, trans, and other sexual and gender minority (LGBT+) university students have not yet been explored in depth. The aim of this study was to explore the barriers and facilitators to mental health help seeking and experiences with service use among LGBT+ university students. Participants were 24 LGBT+ students between 18 and 23 years of age from a university in Chile. Individual semi-structured interviews were conducted and analysed using thematic content analysis. Multiple barriers and facilitators influence mental health help-seeking of LGBT+ students, with some of these barriers being explicitly related to LGBT+ issues (e.g., fear of discrimination or accessing specialised services). Perceived effectiveness of services was closely related to access safe/affirming care. Trans students reported more barriers to help-seeking and negative experiences with professionals than their cisgender peers. Perceptions of university mental health services as safe spaces for LGBT+ students were related to a positive perception of the university regarding LGBT+ issues. Knowing the factors that either hinder or facilitate help-seeking and characterising service use experiences in this population is useful for improving access to mental health services and for the development of policies that promote affirmative care for LGBT+ people.

Coping and Resilience: PTSD Screening and Brief Intervention for Underrepresented Students at a Public University

The undetected and untreated PTSD symptoms (difficulty paying attention, nightmares and difficulty sleeping, irritability or aggression, flashbacks, diminished interest in activities, self-destructive behavior, and feeling isolated) of college students may interfere with their relationships, well-being, learning, and academic success. To examine the feasibility, acceptability, and impact of providing a short-term trauma-specific evidence-based group intervention, Coping & Resilience (C&R), an adaptation of Cognitive Behavioral Intervention for Trauma in Schools (CBITS) was implemented at a large urban public university. Fifty college students (54 percent male, 90 percent students of color), with a mean PTSD symptom score of 34 at pretest (considered in the moderate range of symptom severity) participated in C&R groups. As expected, student PTSD symptoms improved after group participation. A Quade test showed a significant decrease in the scores from pretest to follow-up for PTSD and two subscales (intrusion and avoidance). Large public universities serving underrepresented students are uniquely positioned to become trauma- and resilience-informed systems and to provide trauma support services to promote student well-being.

A pilot study using geospatial analysis to identify hot-spot of populations utilizing services at university based counseling centers

Objective: Our pilot study tests whether university counseling centers (UCC) can apply the concept of cluster analysis, and geospatial analysis to identify clusters of "hot spots". Participants: Study participants were university students who received services from a large mid-western UCC between August 2015 and July 2016. The study was approved by the University's Institutional Review Board (IRB). Data collected include demographics, address, educational level and declared major. Methods: Data analysis, conducted using SYSTAT 13.1, IBM SPSS Statistics, ArcGIS Desktop and 10.2, ArcOnline, Microsoft excel to clean and analyze demographic data. Analysis included optimized cluster analysis with a p-value < 0.05 as statistically significant. Results: 927 participants, average age was 21.6. We identified "hotspots" using cluster analysis based on age, address, and country of origin. Conclusions: Our study shows that UCCs can apply cluster analysis, and geospatial analysis to identify clusters of "hot spots" to target risk populations.

Physical and mental health issues facing community college students

ObjectiveTo examine health concerns among community college (CC) students by (1) identifying and coding the self-reported health issues facing CC students and (2) examining demographic and psychosocial variables associated with health categories. Participants: 946 CC students (M_age = 26.37) recruited from January 2017 to February 2017 who completed a screening survey for a larger study. Students were asked to "List three health issues facing Community College students today." Methods: Health issues were coded into broad categories and subcategories. Results: Among the 2,601 health issues reported, one-third were medical health (36%), one-third were mental health (33%), with substance use (14%), other health (14%), and access to health care (3%) also reported. The most commonly identified health issues were "general medical issues," "stress," "depression," and "sleep." Conclusions: Programmatic efforts to support CC students and promote prevention/intervention strategies for mental health, sleep, substance use, access to health care, and general medical concerns, remain essential.

Trends in mental health service utilization among LGB+ college students

OBJECTIVES

1) Compare service utilization among LGB+ and straight-identified students. 2) Assess rates of mental health concerns among LGB+ students only. Participants: Undergraduates (N = 675) reported on their sexual orientation, mental health conditions, and past service providers. Methods: Logistic regression was used for aim 1 and descriptive statistics for aim 2. Results: LGB+ students were more likely than straight-identified students to seek services for anxiety (odds ratio [OR] = 2.051; p < .01) or depression (OR = 3.058; p < .001) and from a counselor/therapist/psychologist (OR = 2.937; p < .001) or their university's counseling/health services (OR = 1.933; p < .01). Bisexual students utilized the most services. Conclusions: Colleges must ensure that programing, outreach, and overall support for the mental health needs of their LGB+ students are being met so that this vulnerable population continues to seek services.

Mental Health Conditions Among Community College Students: A National Study of Prevalence and Use of Treatment Services

OBJECTIVE

This study estimated the prevalence of self-reported symptoms of mental health problems and treatment utilization in a U.S. national sample of community college students and made comparisons with data from a sample of students at 4-year educational institutions.

METHODS

The study used data for 2016-2019 from the Healthy Minds Study, an annual cross-sectional survey. The sample included 10,089 students from 23 community colleges and 95,711 students from 133 4-year institutions. Outcomes were mental health symptom prevalence based on validated screening tools and rates of service utilization, such as use of therapy and psychotropic medication. Analyses were weighted by using survey nonresponse weights.

RESULTS

Prevalence rates were comparably high in the sample of community college and 4-year students, with just more than 50% of each group meeting criteria for one or more mental health problems. Analyses by age group revealed significantly higher prevalence for community college students ages 18-22 years, relative to their same-age peers at 4-year institutions. Community college students, particularly those from traditionally marginalized backgrounds, were significantly less likely to have used services, compared with students on 4-year campuses. Financial stress was a strong predictor of mental health outcomes, and cost was the most salient treatment barrier in the community college sample.

CONCLUSIONS

This is the largest known study to report on the mental health needs of community college students in the United States. Findings have important implications for campus policies and programs and for future research to advance equity in mental health and other key outcomes, such as college persistence and retention.

A Comprehensive Examination of Factors Impacting Collegiate Athletes' Utilization of Psychological Assessment and Intervention Services

Although collegiate athletes underutilize mental health programming, investigators have rarely examined factors that may influence their participation in such programs. The current study examined how structured interviews and demographic factors influence collegiate athletes to use psychological programming. Two-hundred and eighty-nine collegiate athletes were referred to the study. They were screened for mental health and randomly assigned to one of two semi-structured interviews based on experimental phase. Participants in Phase I received standard engagement (SE; N = 35) or SE+discussion of mental health (DMH; N = 44). Phase II participants received SE+DMH (N = 82) or SE+DMH + discussion of personal ambitions (DPA; N = 66). Phase III participants received SE+DMH+discussion about their culture of choice (DCC) (N = 25) or SE+DMH+discussion of sport culture (DSC) (N = 37). After receiving the respective interview participants were offered psychological assessment and intervention. Chi squared analyses revealed class standing, mental health symptom severity, referral type, and type of engagement interview influenced program commitment/utilization. Logistic regression analyses indicated SE+DMH+DPA and SE+DMH+DSC uniquely improved assessment attendance whereas referrals from the athletic department and coaches/teammates, participation in sport performance workshops, and senior status uniquely improved assessment and intervention attendance.

Association between Mental Health Knowledge Level and Depressive Symptoms among Chinese College Students

This study aimed to explore the association between mental health knowledge level and the prevalence of depressive symptoms among Chinese college students. A cross-sectional study was conducted in six universities in Jinan, Shandong Province, China, and a total of 600 college students were recruited to self-complete a series of questionnaires. The Mental Health Knowledge Questionnaire (MHKQ) was used to investigate the level of mental health knowledge. Depressive symptoms were investigated with the depression subscale of the Depression Anxiety Stress Scale (DASS-21). The prevalence rate of depressive symptoms among college students was 31.2%. Compared with MHKQ scoring in the 1st quartile, college students with MHKQ scoring in the 3rd quartile and in the 4th quartile reported lower levels of depressive symptoms after adjusting for potential confounding factors. Since mental health knowledge level was related to depressive symptoms among college students, increased efforts to promote the level of mental health knowledge in Chinese college students are critical.

Associations of physical activity and screen time with suboptimal health status and sleep quality among Chinese college freshmen: A cross-sectional study

This study aimed to investigate the associations of physical activity (PA) and screen time (ST) with physiological, psychological, and social health-particularly regarding effects on sleep quality-among Chinese college freshmen. A cross-sectional survey was conducted at Renmin University of China, in Beijing. A total of 5,233 students were surveyed in September 2015. Participants completed a self-report questionnaire on their demographic characteristics, tobacco and alcohol use, PA, ST, sleep quality, and health status. Multivariate logistic regression was performed to examine the independent and interactive associations between PA and ST with sleep quality and suboptimal health status. In total, 10.43%, 13.18%, and 13.26% of the 5,233 students had physiological, psychological, and social suboptimal health status, respectively. The prevalence of poor sleep quality was 37.94%. High ST and high PA were significantly associated with physiological suboptimal health status (aOR = 1.39, 95% CI: 1.16-1.68, and aOR = 0.55, 95% CI: 0.45-0.71), psychological suboptimal health status (aOR = 1.43, 95% CI: 1.21-1.69, and aOR = 0.57, 95% CI: 0.47-0.69), social suboptimal health status (aOR = 1.27, 95% CI: 1.08-1.50, and aOR = 0.63, 95% CI: 0.52-0.77), and poor sleep quality (aOR = 1.20, 95% CI: 1.03-1.39, and aOR = 0.64, 95% CI: 0.55-0.76). Additionally, low ST and high PA were interactively negatively associated with poor sleep quality (aOR = 0.56, 95% CI: 0.45-0.70), physiological suboptimal health status (aOR = 0.49, 95% CI: 0.40-0.59), psychological suboptimal health status (aOR = 0.48, 95% CI: 0.39-0.58), and social suboptimal health status (aOR = 0.49, 95% CI: 0.40-0.59). These findings suggested there are independent and interactive associations of low ST and high PA with poor sleep quality and suboptimal health status among Chinese college freshmen.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

DISCUSSION

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

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

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

Young Adult Mental Health: a Prospective Examination of Service Utilization, Perceived Unmet Service Needs, Attitudes, and Barriers to Service Use

Most young adults with mental health symptoms do not receive treatment or access services. It remains important to identify barriers to service utilization to improve access to care. The current study was a prospective analysis examining predictors of (a) mental health service utilization and (b) perceived unmet need for mental health services. Barriers to service utilization were examined by prior depression severity status and college student status. Participants included a subsample of young adults ages 18-23 at time of recruitment who were participating in a longitudinal monthly study who completed both baseline and a 15-month follow-up assessment (N = 622, 80% of larger study). At month 15, 23% of young adults reported receiving mental health services in the past 12 months; 26% of young adults reported a perceived unmet need for mental health services at some point in the past 12 months. There were differences in demographic and mental health predictors of service utilization and perceived unmet need for services. Women, sexual minorities, those with moderate depression, those with more impairment from depression, and perceived past year poor mental health were associated with greater likelihood of receiving services. Similar demographic characteristics were associated with greater likelihood of perceiving unmet need for services. Barriers to service utilization differed by severity of depression symptoms and student status. Young adults have distinct reasons for not accessing mental health services; addressing these to improve accessibility to care remains critical.

The relationship between on-campus service utilization and common mental health concerns in undergraduate college students

Little research exists into the trends associated with on-campus service utilization for mental health concerns of college students. Rates of broad service utilization exist, but no published study has examined the direct relationship between a range of common mental health symptoms and on-campus service utilization. The aims of the present study are to explore (1) which common mental health concerns are associated with specific on-campus service utilization in undergraduate students and (2) whether endorsement of more mental health concerns will predict a higher number of services utilized. Data were utilized from 3,734 undergraduates at a large (more than 20,000 undergraduates), urban university (Mage = 19.94 years, SD = 0.55 years; female = 66%). Four on-campus services (University Counseling Services, University Health Services, The Wellness Resource Center, and Disability Support Services) were regressed onto mental health concerns associated with symptoms of three disorders (anxiety, depression, alcohol use disorder [AUD]) and two mental health risk factors (stressful life events [SLEs], antisocial behaviors [ASBs]). AUD symptoms predicted the most overall and specific service utilization, followed by depression symptoms and SLEs. Anxiety symptoms and ASBs were not significant predictors when combined with other variables. This is the first study to investigate trends specific to on-campus college student service utilization. Findings will be helpful to mental health professionals on similar college campuses by providing insight into programming and outreach initiatives for these or related services. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Under the face mask: Racial-ethnic minority student-athletes and mental health use

Objective: To investigate racial-ethnic minority student-athletes' (REMSA) symptoms of distress (mental health need), mental health use (usage rate), and factors that influence mental health usage. Participants: There were 241 varsity athletes (African American = 108, Latinos = 66, Asian American= 67) from the American College Health Association Fall 2015 data set. Results: Seventy-eight percent of REMSA reported some form of mental health need and only 11% of these athletes in need reported using mental health services in the past year. Additionally, a binominal logistic regression was run to identify demographic and mental health predictors of mental health use. Higher stress (β = 1.58, OR = 3.49, p < .01) and having upperclassman standing (β = 1.07, OR = 3.91, p < .05) predicted service use for athletes. Conclusions: Mental health professionals should be aware of the high mental health need for REMSA and the low usage rate of mental health services.

Self-Esteem and Non-Medical Use of Prescription Drugs among College Students: Coping as a Mediator

Objectives: Non-medical use of prescription drugs (NMUPD) has become a threat to public health. In the United States, NMUPD is especially common in young adults (aged 18-25). Self-esteem is a robust psychosocial factor of substance use. The substance use literature also documents that self-esteem is associated with alcohol use through other cognitive factors, such as coping. Given the important role of coping in substance use intervention, it is important to understand how coping alters mechanisms underlying the effects of self-esteem on NMUPD. However, little research has explored mediational mechanisms among self-esteem, coping, and NMUPD. The current study sought to examine a hypothesized mediation model among self-esteem, coping, and NMUPD in college students. Methods: Data were collected online from 1052 undergraduates (aged 18 to 25; 723 females) in a large public university in Virginia. Participants reported their past-three-month NMUPD (i.e. opioids, sedatives, anxiolytics, and stimulants), self-esteem, and coping (13 domains; e.g. active coping and self-blame). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to identify the factorial structure of coping. Structural equation modeling (SEM) was employed for examining the hypothesized mediation model. Results: EFA and CFA identified a two-factor structure of coping (i.e. adaptive coping and maladaptive coping). SEM suggested that adaptive coping together with maladaptive coping completely mediated the relationship between self-esteem and NMUPD. The goodness-of-fit indicators suggest a good model fit (RMSEA = .04; CFI = .95; TLI = .93; WRMR = 1.11). Conclusion: Self-esteem appears to be a protective factor for NMUPD in college students, and its relationship with NMUPD is mediated by two types of coping. Future interventions targetting NMUPD among college students should attend to self-esteem and coping.

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

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

Evaluation of Mental Health First Aid skills in an Australian university population

AIM

University students have high rates of mental health problems; however, most delay or fail to seek help altogether. Tertiary settings can offer educational and social programmes to increase mental health awareness and in turn increase the number of students seeking help for their problems. This study aimed to explore students' and staffs' knowledge of mental health issues, confidence to intervene and application of skills following Mental Health First Aid (MHFA) training.

METHODS

Students and staff at an Australian university who had completed MHFA training in the previous 24 months were invited to complete a validated online questionnaire.

RESULTS

Of the 566 eligible participants, 107 (19%) completed the questionnaire. The majority (65%) had applied their skills to someone in need, with the highest number applying it to students. Notably, of those who had applied their skills 23 participants (33%) had applied them in a crisis situation, the most common being panic attacks followed by suicidal thoughts. Although most (98%) applied their skills in a face-to-face capacity, 53% also reported assisting someone via electronic mediums and social media. The mean score for the literacy test was considered high, 12/16 (SD = 1.7) for students and 13/16 (SD = 2.5) for staff. The majority (94%) reported more confidence in providing support following training.

CONCLUSION

This study demonstrated that MHFA training on a university campus is associated with a high level of knowledge, confidence to intervene and apply MHFA skills to assist a student or friend in need, potentially impacting their long-term health outcomes and future professional careers.

Exploring the implications of a self-care assignment to foster undergraduate nursing student mental health: Findings from a survey research study

BACKGROUND

Nursing students experience numerous personal, academic, and practice-related stressors, impacting their mental health. Nursing programs often contribute to student stress and should incorporate strategies to support students' mental health. Self-care has the potential to enhance students' ability to manage current stressors and to build capacity for addressing future stress and burnout; however, the concept has been limitedly integrated into nursing education.

OBJECTIVES

To examine students' responses to a self-care assignment integrated into core nursing coursework.

DESIGN

Cross-sectional study using an online survey.

SETTINGS

An accelerated two-year undergraduate nursing program in Western Canada.

PARTICIPANTS

Undergraduate nursing students in first- and second-year of a two-year program.

METHODS

A 16-question survey, including closed- and open-ended response fields was developed by the research team. Survey questions were grounded in Bloom's Cognitive, Psychomotor, and Affective learning domains to comprehensively examine the impact of the assignment on students' learning and self-care capacity.

RESULTS

89 participants completed the survey (49% response rate). Participants' increase in self-care practices pre- and post-assignment was statistically significant (p = 0.023). Results further demonstrate that students' knowledge of self-care and capacity to identify and manage stressors were enhanced. Participants reported that overall the assignment supported their well-being. However, some participants described that aspects of the assignment detracted from well-being, including challenges with grading and feelings of guilt when not practicing self-care.

CONCLUSIONS

A self-care assignment is an effective strategy for nursing educators to foster students' capacity to cope with stressors.

Resilience and psychiatric symptoms as mediators between perceived stress and non-medical use of prescription drugs among college students

Background: Due to the high prevalence of non-medical use of prescription drugs (NMUPD; i.e., use of these drugs without a doctor's prescription) among college students, it is important to identify psychosocial factors relevant to NMUPD. Prior research shows a link between perceived stress, psychiatric symptoms and NMUPD. Resilience is an essential concept in adaptive coping that emphasizes that resilience protects people against stress. Substantial evidence shows the mediation effect of resilience on the relationship between stress, psychiatric symptoms, and substance use. However, scant literature has examined associations between resilience and NMUPD.Objectives: The current study explored the relationship among perceived stress, psychiatric symptoms, resilience, and NMUPD in college students.Methods: Online data were collected from 1,052 undergraduates (68.7% females) with an average age of 19.8 years in 2016 in Virginia, United States, using anonymous surveys assessing perceived stress, psychiatric symptoms (i.e., depression and social anxiety), resilience (i.e., tenacity, tolerance, acceptance, control, and spirituality), and past-three-month NMUPD (i.e., opioids, sedatives, anxiolytics, and stimulants). Structural equation modeling was employed for data analysis.Results: Resilience together with psychiatric symptoms completely mediated the effects of perceived stress on NMUPD. Resilience completely mediated the relationship between perceived stress and psychiatric symptoms. The goodness-of-fit indicators suggested a good fit of data (RMSEA = .04; CFI = .97; TLI = .96; WRMR = 1.37).Conclusions: Resilience appears to offer protection that can mitigate the effects of perceived stress and psychiatric symptoms on NMUPD. Future interventions related to NMUPD among college students should attend to resilience.

Digital Mental Health Interventions for Depression, Anxiety, and Enhancement of Psychological Well-Being Among College Students: Systematic Review

BACKGROUND

College students are increasingly reporting common mental health problems, such as depression and anxiety, and they frequently encounter barriers to seeking traditional mental health treatments. Digital mental health interventions, such as those delivered via the Web and apps, offer the potential to improve access to mental health treatment.

OBJECTIVE

This study aimed to review the literature on digital mental health interventions focused on depression, anxiety, and enhancement of psychological well-being among samples of college students to identify the effectiveness, usability, acceptability, uptake, and adoption of such programs.

METHODS

We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092800), and the search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) from the date of inception to April 2019. Data were synthesized using a systematic narrative synthesis framework, and formal quality assessments were conducted to address the risk of bias.

RESULTS

A total of 89 studies met the inclusion criteria. The majority of interventions (71/89, 80%) were delivered via a website, and the most common intervention was internet-based cognitive behavioral therapy (28, 31%). Many programs (33, 37%) featured human support in the form of coaching. The majority of programs were either effective (42, 47%) or partially effective (30, 34%) in producing beneficial changes in the main psychological outcome variables. Approximately half of the studies (45, 51%) did not present any usability or acceptability outcomes, and few studies (4, 4%) examined a broad implementation of digital mental health interventions on college campuses. Quality assessments revealed a moderate-to-severe risk of bias in many of the studies.

CONCLUSIONS

Results suggest that digital mental health interventions can be effective for improving depression, anxiety, and psychological well-being among college students, but more rigorous studies are needed to ascertain the effective elements of these interventions. Continued research on improving the user experience of, and thus user engagement with, these programs appears vital for the sustainable implementation of digital mental health interventions on college campuses.

Who is willing to come back? College students' willingness to seek help after using campus mental health services

OBJECTIVE

To examine characteristics of college students who have previously received mental health (MH) services on campus and are willing to seek help again in the future.

PARTICIPANTS

Spring 2015 ACHA-NCHA II (N = 12,501) undergraduate respondents who had previously used MH services on their current campus.

METHODS

Binary logistic regression with willingness to seek MH services in the future as the dependent variable.

RESULTS

Among students who had already utilized campus MH services, significant predictors for future help-seeking were: female, white, gay/lesbian, those not working for pay, having the college/university health insurance plan, and not currently/previously serving in the military (p < .05).

CONCLUSIONS

The predictors for willingness to use services in the future were consistent with the existing literature related to initial use. Colleges and universities need to consider factors that influence openness to MH services after a previous experience in addition to initiating care. Implications for college MH professionals are provided.

Identifying Barriers to Mental Health Service Utilization Among Heavy Drinking Community College Students

There are limited findings on mental health prevalence and service utilization rates among community college (CC) students. Utilizing a heavy drinking CC sample, the current study examined: 1) prevalence of mental health symptoms, 2) mental health service utilization and perceived unmet service need, and 3) barriers to service utilization. Participants were 142 CC students who were heavy alcohol users (70% female; 59% White) from three public CCs in the Pacific Northwest who were participating in a larger study designed to adapt a brief intervention for high-risk alcohol use. Findings of the current study revealed that 32% of CC students had a positive screen for depression; 25% had a positive screen for anxiety; a total of 28% received mental health services in the past 12 months; a total of 41% reported a perceived unmet need for mental health services at some point in the past 12 months (i.e., needing mental health services but not receiving it). Students with mental health symptoms reported more barriers to receiving services, and were more likely to not receive services due to cost, compared to students without mental health symptoms. There were differences in type of barrier as a function of alcohol use severity, although there was no difference in number of barriers. Campuses may benefit from understanding mental health service utilization barriers their students report and to effectively advertise the services offered. Training of student services personnel staff and faculty in screening for mental health or substance use may be a worthwhile and cost-effective endeavor.

Implementing a college mental health program - an overview of the first twelve months

OBJECTIVE

To evaluate the demographics and clinical utilization patterns among college students during the initial 12 months of a novel, multi-disciplinary, collaborative, college mental health program (CMHP).

PARTICIPANTS

Undergraduate and graduate students receiving treatment at the CMHP from Jan-Dec 2015.

METHODS

De-identified data was obtained via electronic health records for all students receiving care through the CMHP.

RESULTS

1.2 FTE clinical providers treated 278 undergraduate and graduate students during the year (65.1% < age 26, 53.6% female, 49.6% caucasian). There were 1822 CMHP outpatient visits, 318 other medical visits and 103 total emergency room (ER)/inpatient visits. Ten students were identified as high utilizers of ER/inpatient services, while charges to the CMHP totaled $470,157 and total charges to the Health System were $2,378,315.

CONCLUSIONS

Students with complex psychiatric/medical co-morbidities received cost effective, convenient and integrative treatment. Over time, we hope to intervene earlier and decrease ER/inpatient visits.

The effect of Imaginary Working Qigong on the psychological well-being of college students: Study protocol for a randomized controlled trial

INTRODUCTION

College students are special populations that are particularly prone to have significantly high level of psychological distress than their community peers. Apparently, the best way to manage stress and mental state is through self-care. The characteristic of Qigong is self-directed and self-healing, which is a traditional Chinese mind-body exercise, which has the potential as a stress management intervention. Imaginary Working Qigong, as a kind of static Qigong, is more perception-oriented and can bring about benign sensations of mind and body so as to eliminate stress completely and induce physiological and mental relaxation. In this study protocol, we will systematically examine the feasibility and acceptability of Imaginary Working Qigong on psychological outcomes of the college students and deeply explore molecular biological mechanisms underlying the effects of mind adjustment induced Imaginary Working Qigong.

METHODS/DESIGNS

We will conduct a randomized, assessor and statistician-blinded, parallel-controlled trial exploring the beneficial mind adjustment of Imaginary Working Qigong in college students.A total of 80 eligible college students from Beijing University of Chinese Medicine will be recruited and randomly allocated into Imaginary Working Qigong training or unaltered lifestyle control group according 1:1 allocation ratio with allocation concealment. Imaginary Working Qigong training will last 8 weeks. The study period is 12 weeks including a 4-week supervised training, 4-week independence training, and a 4-week follow-up. Relevant psychological outcomes measurement will take place at baseline, 5 weeks (at the end of supervised training), 9 weeks (at the end of independence training), and 13 weeks (after the 4-week follow-up period) by blinded independent outcome assessors.

CONCLUSION

This is the first randomized controlled trial protocol from the perspective of Qigong connotation to systematically evaluate the effects and relevant molecular mechanism of Imaginary Working Qigong for the mental health of a college student population. If our study demonstrates a significant intervention effect, this would provide preliminary higher-quality evidence and establish a further guidance for the application of Imaginary Working Qigong program among a college student population.

ETHICS AND DISSEMINATION

The study protocol and consent forms have been approved by the medical and animal experiment ethic committee of BUCM (approval number: BJZYYDX-LL2014005).

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

PURPOSE OF REVIEW

To review and synthesize the previous, current, and proposed models of care in college mental health in order to identify best practices that will address the mental health needs of today's students. To highlight data that supports existing or proposed models and describe areas where more data is needed.

RECENT FINDINGS

Despite the potentially appealing attributes of integrated care, empirical evidence supporting these systems and structures in campus settings is mixed. Recent surveys show less than half of campuses have an integrated mental health care model. Overall, there is only partial consensus on optimal models of campus mental health care. Mental health needs in college student populations are greater and more complex than ever. While the resources available are vast and varied, there is limited evidence to support which models and programs can best meet students' needs.

Strengthening College Students' Mental Health Knowledge, Awareness, and Helping Behaviors: The Impact of Active Minds, a Peer Mental Health Organization

OBJECTIVE

To examine the relationship between college students' familiarity with and involvement in Active Minds, a student peer organization focused on increasing mental health awareness, decreasing stigma, and affecting mental health knowledge, attitudes, and behaviors.

METHOD

Students (N = 1,129) across 12 California colleges completed three waves of a web-based survey during the 2016-2017 academic year to assess familiarity with and involvement in Active Minds and mental health attitudes, behaviors, and perceived knowledge. Fixed-effects models assessed relations between changes in organization familiarity and involvement and changes in mental health-related outcomes over time overall and stratified by students' baseline engagement (ie, familiarity/involvement) with Active Minds.

RESULTS

Overall, increased familiarity with Active Minds was associated with increases in perceived knowledge (0.40; p < .001) and decreases in stigma over time (-0.33; p < .001). Increased involvement was associated with increases in perceived knowledge (0.40; p < .001) and a range of helping behaviors. Associations differed by students' baseline engagement with Active Minds. For students with low engagement, increased familiarity with Active Minds was associated with decreased stigma and improved perceived knowledge. For students with moderate baseline engagement, increasing involvement with Active Minds was associated with increases in helping behaviors (eg, providing emotional support, connecting others to services) over time.

CONCLUSION

Student peer organizations' activities can improve college student mental health attitudes and perceived knowledge and significantly increase helping behaviors. Such organizations can complement more traditional programs and play an important role in improving the campus climate with respect to mental health.

Mental Health Service Utilization Among Lesbian, Gay, Bisexual, and Questioning or Queer College Students

PURPOSE

College students are at high risk for mental health problems, yet many do not receive treatment even when services are available. Treatment needs may be even higher among sexual minority students, but little is known about how these students differ from heterosexual peers in terms of mental health needs and service utilization.

METHODS

A total of 33,220 California college students completed an online survey on mental health needs (e.g., current serious psychological distress and mental health-related academic impairment) and service utilization. Using logistic regressions, we examined differences in student characteristics, mental health service use, and perceived barriers to using on-campus services by sexual minority status.

RESULTS

Approximately 7% of students self-identified as sexual minorities. Compared with heterosexual students, sexual minority students endorsed higher rates of psychological distress (18% vs. 26%, p < .001) and mental health-related academic impairment (11% vs. 17%, p < .001) but were 1.87 (95% confidence interval: 1.50-2.34) times more likely to use any mental health services. Sexual minority students were also more likely to report using off-campus services and to endorse barriers to on-campus service use (e.g., embarrassed to use services and uncertainty over eligibility for services).

CONCLUSIONS

Sexual minority individuals represent a sizeable minority of college students; these students use mental health services at higher rates than heterosexual peers but have high rates of unmet treatment need. Efforts to address commonly reported barriers to on-campus service use, foster sexual minority-affirmative campus environments, and promote awareness of campus services may help reduce unmet treatment need in this population.