Opioid Overdose Knowledge Among Adolescents and Young Adults.

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.

Interventions to increase naloxone access for undergraduate students: A systematic review of the literature.

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.

Mental health among first-generation college students: Findings from the national Healthy Minds Study, 2018-2021.

A mounting body of evidence reveals that college mental health outcomes are worsening over time. That said, little is known about the mental health needs of the nearly eight million first-generation students in U.S. postsecondary education. The present study uses population-level data from the national Healthy Minds Study to compare prevalence of mental health symptoms and use of services for first-generation and continuing-generation students from 2018-2021. The sample includes 192,202 students at 277 campuses, with 17.3% being first-generation. Findings reveal a high prevalence of mental health symptoms among both first-generation and continuing-generation students. Controlling for symptoms, FG students had significantly lower rates of mental health service use. Just 32.8% of first-generation students with symptoms received therapy in the past year, relative to 42.8% among continuing-generation students, and this disparity widened during the COVID-19 pandemic. Findings have important implications for the design and implementation of higher education policies, mental health delivery systems, college persistence and retention initiatives, and public health efforts in school settings.

Preferred treatment focus among college students with eating disorders and comorbid mental health problems in a digital cognitive-behavioral guided self-help program.

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, Mage = 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.

Depression and anxiety symptoms among Arab/Middle Eastern American college students: Modifying roles of religiosity and discrimination.

INTRODUCTION: We examine mental health outcomes in a national sample of Arab/Middle Eastern college students using the Healthy Minds Study (HMS) from 2015-2018 and assess the modifying roles of religion and discrimination. METHODS: HMS is an annual web-based survey administered to random samples of undergraduate and graduate students at participating colleges and universities. A total of 2,494 Arab/Middle Eastern and 84,423 white students were included in our sample. Our primary outcomes of depression and anxiety symptoms were assessed using the Patient Health Questionaire-9 (PHQ-9) and the Generalized Anxiety Disorder 7-item (GAD-7) scale, respectively. Survey-weighted logistic regression models were fit for each outcome using an Arab ethnicity indicator. Effect modification by religiosity and discrimination was examined by adding an interaction term to the model. RESULTS: Odds of depression (adjusted odds ratio, AOR: 1.40, 95% CI: 1.24, 1.57) and anxiety (AOR: 1.41, 95% CI: 1.25, 1.60) were higher for Arab/Middle Eastern students than for white students. For Arab/Middle Eastern students, religiosity was a protective factor for both depression (AOR: 0.84, 95% CI: 0.79, 0.90) and anxiety (AOR: 0.91, 95% CI: 0.85, 0.97). Arab/Middle Eastern students who experienced discrimination had higher odds of depression (AOR: 1.41, 95% CI: 1.28, 1.56) and anxiety (AOR: 1.49, 95% CI: 1.36, 1.65) than those who had not. DISCUSSION: Arab/Middle Eastern American college students are a vulnerable subgroup on college campuses experiencing a high burden of depression and anxiety symptoms which are dampened by religiosity and amplified by discrimination.

A database of US state policies to mitigate COVID-19 and its economic consequences.

BACKGROUND: Since COVID-19 first appeared in the United States (US) in January 2020, US states have pursued a wide range of policies to mitigate the spread of the virus and its economic ramifications. Without unified federal guidance, states have been the front lines of the policy response. MAIN TEXT: We created the COVID-19 US State Policy (CUSP) database ( https://statepolicies.com/ ) to document the dates and components of economic relief and public health measures issued at the state level in response to the COVID-19 pandemic. Documented interventions included school and business closures, face mask mandates, directives on vaccine eligibility, eviction moratoria, and expanded unemployment insurance benefits. By providing continually updated information, CUSP was designed to inform rapid-response, policy-relevant research in the context of the COVID-19 pandemic and has been widely used to investigate the impact of state policies on population health and health equity. This paper introduces the CUSP database and highlights how it is already informing the COVID-19 pandemic response in the US. CONCLUSION: CUSP is the most comprehensive publicly available policy database of health, social, and economic policies in response to the COVID-19 pandemic in the US. CUSP documents widespread variation in state policy decisions and implementation dates across the US and serves as a freely available and valuable resource to policymakers and researchers.

The influence of race, sexual orientation and gender identity on mental health, substance use, and academic persistence during the COVID-19 pandemic: A cross-sectional study from a national sample of college students in the healthy minds study.

Purpose: This study seeks to characterize substance use, mental health, and academic persistence in college students during the COVID-19 pandemic, emphasizing variations by race, sexual orientation, and gender identity. Methods: National samples (n = 146,810) of undergraduate students from the Healthy Minds Study were compared in two time periods: Fall 2017-Winter 2020 (pre-COVID) and March-December 2020. Descriptive statistics were conducted including t-tests/chi square tests comparing differences between time periods. Logistic regressions were estimated for main outcomes: substance use (licit, illicit, none), anxiety and/or depression symptoms, and academic persistence (student confidence that they will finish their degree). Marginal effects of race, sexual orientation, and gender identity were reported for all logistic regressions. Results: In March-December 2020, students had 1.70 higher odds of screening positive for anxiety and/or depression compared to pre-COVID semesters. Latinx, Black, and "other" race/ethnicity had significantly higher probabilities of screening positive, as did transgender and gender non-conforming (TGNC) and lesbian, gay, bisexual, and queer (LGBQ) students.;Students had 0.43 times lower odds of reporting substance use in March-December 2020. Asian, Black, and Latinx students had significantly lower probabilities of reporting substance use, as did TGNC and LGBQ students.; During the pandemic, most students (86.7%) report at least 1 day of academic impairment (emotional/mental difficulties that hurt academic performance) in the last month due to mental health (up from 79.9% pre-pandemic). Conclusions: Using the most comprehensive mental health data in college student populations, this is the first study to describe the impact of the pandemic on undergraduate students' substance use, mental health, and academic persistence/impairment.

Trends in college student mental health and help-seeking by race/ethnicity: Findings from the national healthy minds study, 2013-2021.

BACKGROUND: A considerable gap in knowledge exists around mental health trends in diverse racial and ethnic adolescent and young adult populations. The purpose of this study is to examine annual trends for mental health and help-seeking by race/ethnicity in a national sample of college students. METHODS: Survey data come from >350,000 students at 373 campuses that participated in the Healthy Minds Study between 2013 and 2021. Analyses are descriptive in nature focusing on year-by-year prevalence and help-seeking rates for each racial/ethnic group. RESULTS: In 2020-2021, >60% of students met criteria for one or more mental health problems, a nearly 50% increase from 2013. Mental health worsened among all groups over the study period. American Indian/Alaskan Native students experienced the largest increases in depression, anxiety, suicidal ideation, and meeting criteria for one or more mental health problem. Students of color had the lowest rates of mental health service utilization. The highest annual rate of past-year treatment for Asian, Black, and Latinx students was at or below the lowest rate for White students. Although Arab American students experienced a 22% increase in prevalence, there was an 18% decrease in treatment. LIMITATIONS: Response rates raise the potential of nonresponse bias. Sample weights adjust along known characteristics, but there may be differences on unobserved characteristics. CONCLUSIONS: Findings have important implications for campus mental health programming and underscore the urgency of reducing mental health inequalities in college student populations through the identification and implementation of best practices both in clinical settings and through system-level change.

Help-seeking for mental health services in Asian American college students: an exploratory qualitative study.

Objective: To understand how the college environment might influence mental health help-seeking in Asian American undergraduates. Participants: Participants were 19 Asian American undergraduates recruited through Facebook. Methods: Participants were interviewed about attitudes toward mental health and mental health help-seeking, and thematic analysis with both inductive and deductive codes was used to analyze interview transcripts. Results: Several factors specific to the college environment encourage students to seek help: social support provided by peers and by campuses, psychological distance from home, and physical distance from home. However, other Asian American-specific factors discourage students from seeking help, such as cultural factors and stigma surrounding mental health issues. Conclusions: The college environment may encourage help-seeking, while Asian American-specific factors may discourage it. Potential interventions based on these findings may increase help-seeking rates by focusing on these encouraging factors in a culturally-sensitive way.

Characterizing eating disorder diagnosis and related outcomes by sexual orientation and gender identity in a national sample of college students.

OBJECTIVE: In a national sample of college students, the current study aimed to: 1) examine differences in probable diagnoses of EDs (i.e., anorexia nervosa (AN), clinical/subthreshold bulimia nervosa (BN), or binge eating disorder (BED)) and weight and shape concerns by sexual orientation and gender identity, and 2) examine differences in ED chronicity and probable comorbid psychiatric diagnoses by sexual orientation and gender identity. METHOD: Students across nine U.S. universities completed an online screener for DSM-5 clinical or subthreshold ED diagnoses, comorbid depression and anxiety disorders, and self-reported ED chronicity. Self-reported sexual orientation and gender identity were also collected. Tukey-corrected logistic and linear regressions examined differences in outcomes separately by sexual orientation and gender identity, adjusting for age, race, and ethnicity. RESULTS: A total of 8,531 students (24% sexually diverse (SD); 2.7% gender diverse (GD)) were studied. Students who identified as bisexual or other sexual orientation reported significantly greater odds of a probable ED diagnosis and greater elevations in weight and shape concerns compared to heterosexual students. Cisgender female students and GD students reported significantly greater odds of a probable ED diagnosis and greater elevations in weight and shape concerns compared to cisgender male students. Some SD students and GD students who met criteria for probable EDs were also more likely to report chronic ED symptoms and probable comorbid psychiatric diagnoses compared to heterosexual students and cisgender males, respectively. DISCUSSION: Some SGD students may be at heightened risk for EDs, highlighting the need to identify mechanisms that contribute to disparities.

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.

Harnessing mobile technology to reduce mental health disorders in college populations: A randomized controlled trial study protocol.

About a third of college students struggle with anxiety, depression, or an eating disorder, and only 20-40% of college students with mental disorders receive treatment. Inadequacies in mental health care delivery result in prolonged illness, disease progression, poorer prognosis, and greater likelihood of relapse, highlighting the need for a new approach to detect mental health problems and engage college students in services. We have developed a transdiagnostic, low-cost mobile mental health targeted prevention and intervention platform that uses population-level screening to engage college students in tailored services that address common mental health problems. We will test the impact of this mobile mental health platform for service delivery in a large-scale trial across 20+ colleges. Students who screen positive or at high-risk for clinical anxiety, depression, or an eating disorder and who are not currently engaged in mental health services (N = 7884) will be randomly assigned to: 1) intervention via the mobile mental health platform; or 2) referral to usual care (i.e., campus health or counseling center). We will test whether the mobile mental health platform, compared to referral, is associated with improved uptake, reduced clinical cases, disorder-specific symptoms, and improved quality of life and functioning. We will also test mediators, predictors, and moderators of improved mental health outcomes, as well as stakeholder-relevant outcomes, including cost-effectiveness and academic performance. This population-level approach to service engagement has the potential to improve mental health outcomes for the millions of students enrolled in U.S. colleges and universities.

Gender Minority Mental Health in the U.S.: Results of a National Survey on College Campuses.

INTRODUCTION: The purpose of this study was to examine mental health status by gender identity among undergraduate and graduate students. METHODS: Data came from the 2015-2017 Healthy Minds Study, a mobile survey of randomly selected students (N=65,213 at 71 U.S. campuses, including 1,237 gender minority [GM] students); data were analyzed in 2018. Outcomes were symptoms of depression, anxiety, eating disorders, self-injury, and suicidality based on widely used, clinically validated screening instruments. Bivariable and multivariable analyses explored differences between GM and cisgender (non-GM) students as well as by assigned sex at birth. RESULTS: Across mental health measures, a significantly higher prevalence of symptoms was observed in GM students than cisgender students. Compared with 45% of cisgender students, 78% of GM students met the criteria for 1 or more of the aforementioned mental health outcomes. GM status was associated with 4.3 times higher odds of having at least 1 mental health problem (95% CI=3.61, 5.12). CONCLUSIONS: Findings from this largest campus-based study of its kind using representative data with both gender identity and mental health measures underscore the importance of recognizing and addressing GM mental health burdens, such as by screening for mental health and providing gender-affirming services. There is broad urgency to identify protective factors and reduce mental health inequities for this vulnerable population.

Technology and College Student Mental Health: Challenges and Opportunities.

In recent years, there has been an increase in symptoms of depression, anxiety, eating disorders, and other mental illnesses in college student populations. Simultaneously, there has been a steady rise in the demand for counseling services. These trends have been viewed by some as a mental health crisis requiring prompt investigation and the generation of potential solutions to serve the needs of students. Subsequently, several studies linked the observed rise in symptoms with the ubiquitous rise in use of personal computing technologies, including social media, and have suggested that time spent on these types of technologies is directly correlated with poor mental health. While use of personal computing technologies has dramatically shifted the landscape in which college students connect with one another and appears to have some detriments to mental health, the same technologies also offer a number of opportunities for the enhancement of mental health and the treatment of mental illness. Here, we describe the challenges and opportunities for college student mental health afforded by personal computing technologies. We highlight opportunities for new research in this area and possibilities for individuals and organizations to engage with these technologies in a more helpful and wellness-promoting manner.

Increased Rates of Mental Health Service Utilization by U.S. College Students: 10-Year Population-Level Trends (2007-2017).

OBJECTIVE: This study aimed to document population-level trends in mental health service utilization by college students. METHODS: The study drew on 10 years of data from the Healthy Minds Study, an annual Web-based survey, with a sample comprising 155,026 students from 196 campuses. Analyses focused on past-year mental health treatment and lifetime diagnoses of a mental health condition. Changes in symptoms of depression and suicidal ideation and levels of stigma were hypothesized as potential explanatory factors. RESULTS: Rates of treatment and diagnosis increased significantly. The rate of treatment increased from 19% in 2007 to 34% by 2017, while the percentage of students with lifetime diagnoses increased from 22% to 36%. The prevalence of depression and suicidality also increased, while stigma decreased. CONCLUSIONS: This study provides the most comprehensive evidence to date regarding upward trends in mental health service utilization on U.S. campuses over the past 10 years. Increasing prevalence of mental health problems and decreasing stigma help to explain this trend.

Mental Health Disparities Among College Students of Color.

PURPOSE: Understanding the mental health needs of students of color is a growing priority on college and university campuses nationwide. This study aims to capture the state of mental health among students of color, including the prevalence of mental health problems and treatment utilization. METHODS: The sample is comprised of 43,375 undergraduate and graduate students at 60 institutions that participated in the survey-based Healthy Minds Study from 2012 to 2015. These data include over 13,000 students of color; we look separately at African-American, Latinx, Asian/Asian American, and Arab/Arab American students. Data are analyzed at the individual level using bivariate and multivariate modeling to elucidate variations across race/ethnicity. We examine symptom prevalence (measured by validated screens such as the Patient Health Questionnaire-9 for depression), help-seeking behaviors, and related factors (including knowledge and stigma). RESULTS: Across race/ethnicity, we find modest variation in symptom prevalence and larger variation in service utilization. Overall, treatment use is lower among students of color relative to white students, even when controlling for other variables in regression models. Asian/Asian American students have the lowest prevalence of treatment, at only 20% among those with apparent mental health conditions. Attitudes related to mental health treatment also vary significantly and help to explain the primary findings. CONCLUSIONS: College students of color represent a disparities population based on greater levels of unmet mental health needs relative to white students. This paper takes an important step toward understanding these needs and points to implications for future research and practice.

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.

Mental health apps in a college setting: openness, usage, and attitudes.

BACKGROUND: The ubiquity of smartphones and the development of mental health apps (MHAs) calls for evaluation of consumers' attitudes towards and usage of MHAs. Due to the increasing demand for mental health services on college campuses, research is especially needed to evaluate MHAs as a potentially viable treatment modality in that setting. METHODS: The study team developed survey questions related to MHAs, added these to the Healthy Minds Study, and used Qualtrics as the platform. The participants were 741 students, age 18 and older, from a large Midwest public university. Students could answer a varying number of multiple choice questions based on embedded display logic, and the survey required 20-25 minutes for most participants to complete. Based on embedded display logic in the survey and how questions were answered, students could receive anywhere from 1-20 questions. Questions were primarily categorical (e.g., "Yes", "Maybe", "No"), with the remaining questions in free response format. The survey was fielded in April, 2016. RESULTS: 26.1% of respondents were open to using an MHA yet only 7.3% had used an MHA. 9.0% of respondents preferred to use an MHA versus seeing a mental health professional. 13.2% of respondents felt that MHAs do have an evidence base. 23.8% of users felt that MHAs helped with their mental health. Those who reported receiving mental health services within the past 12 months were significantly more open to using MHAs than those who had not received services. Convenience, immediate availability, and confidentiality were common reasons for interest in MHAs. CONCLUSIONS: There is interest in, but limited usage, of MHAs among university students, providing evidence of MHAs as a potentially untapped treatment modality for this population. Further research could help assess how best to integrate this technology into the university and college mental health system.

Mental health and academic attitudes and expectations in university populations: results from the healthy minds study.

BACKGROUND: Mental health problems are highly prevalent in university populations and have been shown to impair academic performance. Yet little is known about the ways in which mental health influences academic outcomes in higher education. AIMS: This study seeks to offer new insight into the relationship between mental health and academic performance, focusing on students' academic experience and expectations as interrelated mechanisms. METHOD: Data come from 3556 students at four campuses that participated in the Healthy Minds Study. We explore unadjusted and multivariable relationships between mental health and academic experiences, expectations and impairment. RESULTS: We find significant differences by mental health status, including that one-in-four students with symptoms are dissatisfied with their academic experience, relative to one-in-ten without (p < 0.001). Approximately 30% with symptoms doubt whether higher education is worth their time, money and effort, compared to 15% without (p < 0.001). In multivariable models, mental health problems were a significant predictor of academic dissatisfaction and drop out intentions, while positive mental health was a significant predictor of satisfaction and persistence. CONCLUSIONS: This descriptive study offers further evidence of the importance of mental health for university success, identifying pathways related to students' experiences and expectations that may help to explain this relationship.