Does the peer-led Honest, Open, Proud program reduce stigma's impact for everyone? An individual participant data meta-regression analysis.

PURPOSE: Many people with mental illness experience self-stigma and stigma-related stress and struggle with decisions whether to disclose their condition to others. The peer-led Honest, Open, Proud (HOP) group program supports them in their disclosure decisions. In randomized controlled trials, HOP has shown positive effects on self-stigma and stigma stress on average. This study examined individual predictors of HOP outcomes and tested the hypothesis that stigma stress reduction at the end of HOP mediates positive HOP effects at follow-up. METHODS: Six RCTs were included with data at baseline, post (after the HOP program) and at 3- or 4-week follow-up. Baseline variables were entered in meta-regression models to predict change in self-stigma, stigma stress, depressive symptoms and quality of life among HOP participants. Mediation models examined change in stigma stress (post) as a mediator of HOP effects on self-stigma, depressive symptoms, and quality of life at follow-up. RESULTS: More shame at baseline, and for some outcomes reduced empowerment, predicted reduced HOP effects on stigma stress, self-stigma, depressive symptoms, and quality of life. Younger age was related to greater improvements in stigma stress after the HOP program. Stigma stress reductions at the end of HOP mediated positive effects on self-stigma, depressive symptoms and quality of life at follow-up. CONCLUSION: Participants who are initially less burdened by shame may benefit more from HOP. Stigma stress reduction could be a key mechanism of change that mediates effects on more distal outcomes. Implications for the further development of HOP are discussed.

A meta-analysis of indicated mental health prevention programs for at-risk higher education students.

This meta-analysis found empirical support for the effectiveness of indicated prevention programs for higher education students at risk for subsequent mental health difficulties based on their current subclinical levels of various presenting problems, such as depression, anxiety, or interpersonal difficulties. A systematic literature search identified 79 controlled published and unpublished interventions involving 4,470 college, graduate, or professional students. Programs were effective at post-intervention overall (ES = 0.49, CI [0.43, 0.55]), and for both targeted outcomes (ES = 0.58, CI [0.51, 0.64]) as well as additional nontargeted outcomes assessed in the studies (ES = 0.32, CI [0.25, 0.39]). Interventions compared with a no-intervention or a wait-list control (ES = 0.64, CI [0.57, 0.71], k = 68) demonstrated significantly larger effects overall than did interventions compared with an attention-placebo control (ES = 0.27, CI [0.11, 0.43], k = 11), although both were significant. Among the former group, modality and presenting problem emerged as significant moderators of intervention effectiveness, and among the 43 of these that assessed effectiveness at an average follow-up period of 35 weeks, the positive effects from intervention remained strong (ES = 0.59, CI [0.50, 0.68]). Overall, programs were fairly brief, attracted and retained students, were positively rated by students, and effective when administered by paraprofessionals as well as professionals. Current findings are promising and stimulate recommendations for improving future research, such as expanding the range of outcomes assessed, and clarifying moderators and mediators of intervention impact. (PsycINFO Database Record

A Meta-Analysis of the Impact of Universal and Indicated Preventive Technology-Delivered Interventions for Higher Education Students.

The uses of technology-delivered mental health treatment options, such as interventions delivered via computer, smart phone, or other communication or information devices, as opposed to primarily face-to-face interventions, are proliferating. However, the literature is unclear about their effectiveness as preventive interventions for higher education students, a population for whom technology-delivered interventions (TDIs) might be particularly fitting and beneficial. This meta-analytic review examines technological mental health prevention programs targeting higher education students either without any presenting problems (universal prevention) or with mild to moderate subclinical problems (indicated prevention). A systematic literature search identified 22 universal and 26 indicated controlled interventions, both published and unpublished, involving 4763 college, graduate, or professional students. As hypothesized, the overall mean effect sizes (ESs) for both universal (0.19) and indicated interventions (0.37) were statistically significant and differed significantly from each other favoring indicated interventions. Skill-training interventions, both universal (0.21) and indicated (0.31), were significant, whereas non-skill-training interventions were only significant among indicated (0.25) programs. For indicated interventions, better outcomes were obtained in those cases in which participants had access to support during the course of the intervention, either in person or through technology (e.g., email, online contact). The positive findings for both universal and indicated prevention are qualified by limitations of the current literature. To improve experimental rigor, future research should provide detailed information on the level of achieved implementation, describe participant characteristics and intervention content, explore the impact of potential moderators and mechanisms of success, collect post-intervention and follow-up data regardless of intervention completion, and use analysis strategies that allow for inclusion of cases with partially missing data.

Examining stress and coping as a mediator for internalizing symptomatology: A comparison between sexual minority and majority first-year college students.

Sexual and gender minority (SGM) adolescents experience unique stressors and elevated internalizing symptoms. This study examines differences in coping styles between SGM and heterosexual adolescents and the potential mediating roles of stress and coping styles. Analyses indicated that SGM (N = 75) adolescents reported higher levels of internalizing symptoms (depression, anxiety, and distress), higher use of maladaptive coping styles (denial and blame), lesser use of adaptive coping styles (reframing and religion), and greater experiences of stress, compared to their heterosexual counterparts (N = 1702). Bootstrapping analyses revealed the relationship between sexual identity and internalizing symptoms measured approximately 3 months later was not mediated by stress and coping, adjusting for gender, age, and baseline symptomatology. Findings suggest that earlier adolescent differences in internalizing symptoms presage increasing symptomatology across the transition to college, and other mediators during the college transition explain the continued increases in internalizing symptoms.

The relation between eating disorder symptoms and impairment.

Although a number of studies have looked at what factors might mediate the relationship between symptoms and quality of life (QoL) in a number of psychiatric disorders, little research has addressed this issue in eating disorders. In the current study, female undergraduates (N = 339) completed questionnaires assessing eating disorder symptoms, social support, coping, QoL, and psychosocial impairment. Perceived family support and levels of substance misuse as a way of coping were identified as mediators of the symptom-impairment relationship and, in addition, maladaptive coping also mediated the relationship with QoL. These results highlight the role of coping and social support in impairment resulting from eating disorder symptoms.

A Meta-analysis of universal mental health prevention programs for higher education students.

This meta-analysis investigated the effectiveness of universal mental health prevention programs for higher education students on a range of adjustment outcomes. A systematic literature search identified 103 controlled published and unpublished interventions involving college, graduate, or professional students. As hypothesized, skill-training programs that included a supervised practice component were significantly more effective overall (mean effect size = 0.45, confidence interval (CI) = 0.39 to 0.52) compared to skill-training programs without supervised practice (0.11, CI = -0.01 to 0.22) and psychoeducational (information-only) programs (0.13, CI = 0.06 to 0.21). When comparisons on specific outcomes were possible, skill-training programs including supervised practice were significantly more effective than the other two groups of programs in reducing symptoms of depression, anxiety, stress, and general psychological distress, and in improving social-emotional skills, self-perceptions, and academic behaviors and performance. The magnitude of effects achieved in several outcome areas is comparable to or higher than that reported in other reviews of universal programs, suggesting that skill-training programs for higher education students that incorporate supervised practice now join the ranks of other effective preventive mental health interventions. This review offers several recommendations to improve the experimental rigor of future research.

Perception of control during episodes of eating: relationships with quality of life and eating psychopathology.

OBJECTIVE: Experience of loss of control (LOC) during eating is an important indicator of pathology, although this concept has not received a great deal of research attention. The present study explores how quality of life (QoL) is related to LOC during eating. METHOD: Three hundred and thirty-nine female university students completed measures of eating pathology, general psychiatric symptomatology, and QoL. They were subsequently categorized according to the degree of LOC experienced during eating into one of five groups: no binge eating (NBE); objective overeating (OOE); objective binge eating (OBE); subjective binge eating (SBE); and a mixed OBE/SBE group (Mixed). RESULTS: Individuals who experienced LOC during eating reported significantly poorer QoL and more psychiatric symptoms. DISCUSSION: In a nonclinical female sample, LOC during eating appeared to be a more important marker of pathology and poorer self-reported QoL than the amount of food eaten.

Explaining the longitudinal association between puberty and depression: sex differences in the mediating effects of peer stress.

This research investigated whether exposure to peer stress serves as one pathway through which pubertal development contributes to depression over time, differentially for girls and boys. Youth (N = 149; 9.6-14.8 years) and their caregivers provided information at two waves, 1 year apart, on puberty (Wave 1), peer stress (occurring between Waves 1 and 2), and depression (Waves 1 and 2). Structural equation modeling analyses examined sex differences in the extent to which peer stress mediated the impact of pubertal status and timing on subsequent depression (i.e., tests of moderated mediation). Significant sex-moderated mediation was found for both pubertal status and timing. As indicated by moderate effect proportions, in girls, heightened peer stress partially mediated the longitudinal association between (a) more advanced pubertal status and depression; and (b) linear, but not curvilinear, pubertal timing (i.e., earlier maturation) and depression. This research contributes to our growing understanding of the interplay among physical, psychological, and social processes involved in the sex difference in adolescent depression.

Finding Silver Linings: A Mixed Methods Analysis of COVID-19's Challenges and Opportunities for College Students' Functioning and Outlook.

This study examines the impact of the COVID-19 pandemic on college students' lives. A mixed methods approach, analyzing open- and closed-ended questions about challenges and opportunities, reveals numerous ways in which the pandemic has impacted students in general and differentially by gender, sexual orientation, race/ethnicity, and family income. Cisgender male and heterosexual students generally reported less of a mental health impact from the pandemic. Gender and sexual minorities, and low- to middle-income students, also noted some effects of the pandemic more often than their peers. Finally, thematic analysis revealed that where students found challenges, they also found opportunities within the broad categories of Lifestyle and Routines, Academic/Professional, Health, Interpersonal, and Societal impacts, evidencing heterogeneity and resilience in finding silver linings despite the challenging pandemic. This research has implications for equitably deploying and tailoring university and mental health resources both during and beyond the pandemic to improve student well-being and success.

The Impact of Mobile Technology-Delivered Interventions on Youth Well-being: Systematic Review and 3-Level Meta-analysis.

BACKGROUND: Rates of mental health problems among youth are high and rising, whereas treatment seeking in this population remains low. Technology-delivered interventions (TDIs) appear to be promising avenues for broadening the reach of evidence-based interventions for youth well-being. However, to date, meta-analytic reviews on youth samples have primarily been limited to computer and internet interventions, whereas meta-analytic evidence on mobile TDIs (mTDIs), largely comprising mobile apps for smartphones and tablets, have primarily focused on adult samples. OBJECTIVE: This study aimed to evaluate the effectiveness of mTDIs for a broad range of well-being outcomes in unselected, at-risk, and clinical samples of youth. METHODS: The systematic review used 5 major search strategies to identify 80 studies evaluating 83 wellness- and mental health-focused mTDIs for 19,748 youth (mean age 2.93-26.25 years). We conducted a 3-level meta-analysis on the full sample and a subsample of the 38 highest-quality studies. RESULTS: Analyses demonstrated significant benefits of mTDIs for youth both at posttest (g=0.27) and follow-up (range 1.21-43.14 weeks; g=0.26) for a variety of psychosocial outcomes, including general well-being and distress, symptoms of diverse psychological disorders, psychosocial strategies and skills, and health-related symptoms and behaviors. Effects were significantly moderated by the type of comparison group (strongest for no intervention, followed by inert placebo or information-only, and only marginal for clinical comparison) but only among the higher-quality studies. With respect to youth characteristics, neither gender nor pre-existing mental health risk level (not selected for risk, at-risk, or clinical) moderated effect sizes; however, effects increased with the age of youth in the higher-quality studies. In terms of intervention features, mTDIs in these research studies were effective regardless of whether they included various technological features (eg, tailoring, social elements, or gamification) or support features (eg, orientation, reminders, or coaching), although the use of mTDIs in a research context likely differs in important ways from their use when taken up through self-motivation, parent direction, peer suggestion, or clinician referral. Only mTDIs with a clear prescription for frequent use (ie, at least once per week) showed significant effects, although this effect was evident only in the higher-quality subsample. Moderation analyses did not detect statistically significant differences in effect sizes based on the prescribed duration of mTDI use (weeks or sessions), and reporting issues in primary studies limited the analysis of completed duration, thereby calling for improved methodology, assessment, and reporting to clarify true effects. CONCLUSIONS: Overall, this study's findings demonstrate that youth can experience broad and durable benefits of mTDIs, delivered in a variety of ways, and suggest directions for future research and development of mTDIs for youth, particularly in more naturalistic and ecologically valid settings.

The emerging sex difference in adolescent depression: interacting contributions of puberty and peer stress.

This research investigated the developmental stages (pubertal status) and contexts (early or late timing relative to peers, and a context of stressful versus supportive peer relationships) in which the sex difference in depression unfolds. A sample of 158 youth (ages 9.6-14.8) and their caregivers provided information at two waves, 1 year apart, on puberty, peer stress, and depression. Pubertal status and timing (actual and perceived) interacted with sex to predict depression. Sex differences in depression were evident at particular levels of pubertal status and timing, both actual and perceived. Depression was associated with more mature pubertal status and early timing (both actual and perceived) in girls, but with less mature pubertal status and late timing (actual and perceived) in boys. These patterns held concurrently, and often over time, particularly in a context of stressful peer relationships (peer stress moderated sex-differentiated associations between puberty and depression). Of note, there were no significant sex differences in depression at any particular age. Thus, this research highlights important distinctions among the contributions of age, pubertal status, pubertal timing, and perceived timing to the sex difference in adolescent depression. More broadly, these findings contribute to our growing understanding of the interactions among physical, social, and psychological processes involved in the sex difference in adolescent depression.

Explaining the pathway from familial and peer social support to disordered eating: Is body dissatisfaction the link for male and female adolescents?

OBJECTIVE: This study examined if familial and peer social support longitudinally predicted disordered eating for late adolescents in the transitional first year of college, and if body dissatisfaction mediated this relation. Gender differences between support types and disordered eating, and body dissatisfaction as a mediator, were also examined. PARTICIPANTS/METHODS: 651 late adolescent males and females (Mage=18.47) completed measures of social support at the end of the first semester of college and of disordered eating and body image approximately five months later, at the end of the first year. RESULTS: Lower levels of familial social support prospectively predicted greater disordered eating, but not greater body dissatisfaction, and lower levels of peer social support prospectively predicted greater body dissatisfaction but not greater disordered eating, above and beyond the other type of social support type, prior levels of body dissatisfaction, disordered eating, and BMI. Body dissatisfaction did not mediate the relation between familial social support and disordered eating; however, it did significantly mediate the non-significant relation between peer social support and disordered eating, which was further moderated by gender. CONCLUSION: These findings suggest that parental social support remains a significant predictor of disordered eating for late adolescents even after they transition to college, and has a stronger relation to disordered eating than peer support. In contrast, peer social support seems to be especially linked to feelings of body dissatisfaction and may be an avenue for intervention of this type of negative self-perception that is a risk factor for later disordered eating.

The cost of perfection with apparent ease: Theoretical foundations and development of the Effortless Perfectionism Scale.

Effortless perfection is a term used to describe an intense pressure to be perfect without visible effort (Yee, 2003), and is thought to be linked to several indicators of maladjustment among college-age youth (Ruane, 2012; Yee, 2003). Although effortless perfectionism (EP) is a phenomenon referenced in popular culture, empirical support for this construct is needed. In addition to conceptualizing and discussing the theoretical underpinnings of EP, this paper describes the development of an instrument to assess EP: the 10-item Effortless Perfectionism scale (EPS). The responses of a large sample of students from a Midwestern university (N = 1,270) were used to develop a 1-factor measurement model for the EPS. The EPS showed good internal consistency and test-retest reliability, and demonstrated convergent, discriminant, and incremental validity in relation to other perfectionism scales, as a predictor of psychosocial adjustment, and as a mediator of the effects of gender on adjustment. The present study supports the reliability and construct validity of the EPS as a self-report measure of EP, a distinct type of perfectionism that warrants future investigation.

Optimizing the perceived benefits and health outcomes of writing about traumatic life events.

Expressive writing, which involves disclosing one's deepest thoughts and feelings about a stressful life event by using a first-person perspective, has been linked to gains in health and well-being, though effect sizes range widely. Assuming a third-person perspective is a natural and effective way of coping with highly distressing events. Therefore, the current study examined whether a distanced, third-person approach to expressive writing might be more beneficial than a traditional, first-person intervention for high baseline levels of event-linked intrusive thinking. Randomly assigned participants wrote expressively about traumatic life events by using a first-person or third-person-singular perspective. Linguistic analyses showed that assuming a first-person perspective is linked to higher levels of in-text cognitive engagement, whereas a third-person perspective is linked to lower cognitive engagement. However, in a context of higher levels of intrusive thinking, third-person expressive writing, relative to a traditional first-person approach, yielded (1) greater perceived benefits and positive, long-lasting effects as well as (2) fewer days of activity restriction due to illness. Although more research is needed, these results suggest that third-person expressive writing may be an especially fitting technique for recovering from traumatic or highly stressful life events.

Promoting psychosocial adjustment and stress management in first-year college students: the benefits of engagement in a psychosocial wellness seminar.

OBJECTIVE/METHODS: This research evaluates the effectiveness of a psychosocial wellness seminar for first-year college students, from 2009 to 2011, using an 8-month prospective quasi-experimental design. PARTICIPANTS/RESULTS: Compared with controls (n = 22) involved in an alternative seminar, intervention participants (n = 29) showed no differences at baseline, but reported significantly greater perceived improvements over the course of the intervention, in psychosocial adjustment and stress management. Furthermore, specific aspects of intervention engagement (attendance and student-rated skills practice, but not didactic mastery or facilitator-rated skills practice) differentially predicted beneficial outcomes: (1) psychosocial adjustment (increases in psychosocial well-being, decreases in psychological distress), after adjusting for baseline levels of these outcomes; (2) college-related stress management (lower college-related stress, greater adaptation to college); and (3) perceived improvements in psychosocial adjustment and stress management. CONCLUSIONS: This research indicates promising avenues for programmatic efforts to promote psychosocial adjustment and stress management in college students, during this critical developmental juncture.

An evaluative review of outcome research on universal mental health promotion and prevention programs for higher education students.

OBJECTIVE: This review is the first large-scale attempt to evaluate the effectiveness of universal promotion and prevention programs for higher education students on a range of adjustment outcomes. PARTICIPANTS/METHODS: The current review examined 83 controlled interventions involving college, graduate, and professional students, with a focus on 3 main outcomes: social and emotional skills, self-perceptions, and emotional distress. RESULTS/CONCLUSIONS: Skill-oriented programs that included supervised practice demonstrated the strongest benefits, thus showing promise as a successful mental health promotion and preventive intervention. In comparing different intervention strategies, mindfulness training and cognitive-behavioral techniques appear to be the most effective. Furthermore, interventions conducted as a class appear to be effective, suggesting the potential for exposing higher education students to skill training through routine curricula offerings. This review offers recommendations for improving the experimental rigor of future research, and implications for enhancing campus services to optimize student success in psychosocial--and thus ultimately academic--domains.

The socioemotional costs and benefits of social-evaluative concerns: do girls care too much?

This research investigated the hypothesis that girls' heightened concerns about social evaluation contribute to sex differences in depression and interpersonal competence during early adolescence. A short-term longitudinal study was conducted with 474 adolescents to examine the consequences of heightened social-evaluative concerns. Adolescents reported on their levels of social-evaluative concerns and depressive symptoms. Teachers provided ratings of adolescents' competence with peers (displays of prosocial and aggressive behavior). As anticipated, girls demonstrated higher levels of social-evaluative concerns, depressive symptoms, and interpersonal competence than did boys. Moreover, path analysis confirmed that heightened social-evaluative concerns were associated both concurrently and over time with higher levels of depression, as well as with higher levels of interpersonal competence. Notably, social-evaluative concerns accounted fully for the sex difference in depression and partially for the sex difference in interpersonal competence. These findings highlight the need to consider both the socioemotional costs and benefits of sex-linked relational orientations.

Need for approval and children's well-being.

This research examined the hypothesis that a tendency to base one's self-worth on peer approval is associated with positive and negative aspects of children's well-being. A sample of 153 fourth through eighth graders (9.0 to 14.8 years) reported on need for approval, global self-worth, social-evaluative concerns, anxiety and depression, and exposure to victimization. Teachers reported on social behavior. Results confirmed that need for approval is a two-dimensional construct composed of positive (enhanced self-worth in the face of social approval) and negative (diminished self-worth in the face of social disapproval) approval-based self-appraisals. Need for approval had trade-offs for well-being that depended on the dimension (positive vs. negative), the psychological domain (emotional vs. social adjustment), children's sex and age, and children's social context (high vs. low peer victimization).