Discrepancies in prevalence estimates of suicidal ideation and attempts in 18- to 22-year-old US college students: a comparison of three surveys.

PURPOSE: Suicidal thoughts and behaviors (STB) have been increasing among US college students. Accurate measurement of STB is key to understanding trends and guiding suicide prevention efforts. We aimed to compare the prevalence estimates of STB among college students from two campus-based surveys (the National College Health Assessment [NCHA] and the Healthy Minds Study [HMS]) and one general population study (the National Survey on Drug Use and Health [NSDUH]). METHODS: Estimates were generated from the three surveys for past year suicidal ideation (PYSI) and past year suicide attempts (PYSA) among 18- to 22-year-old full-time college students. Data were combined from each survey to develop bivariate and multivariate regression models for odds of PYSI and PYSA. RESULTS: Estimates for PYSI varied between the three surveys: 34.3% for NCHA, 15.0% for HMS, and 10.7% for NSDUH. Estimates for PYSA were 2.6% for NCHA, 1.6% for HMS, and 1.7% for NSDUH. After adjusting for demographic and educational characteristics, odds of PYSI remained significantly lower for HMS participants (aOR 0.31, 95% CI 0.29-0.33) and NSDUH participants (aOR 0.19, 95% CI 0.19-0.30) compared to NCHA participants. The odds of PYSA for HMS participants were lower than those for NCHA participants (aOR 0.63, 95% CI 0.54-0.73). CONCLUSION: Estimates of PYSI and PYSA vary between leading sources of data on college student mental health. The differences are likely related to question wording, survey implementation, as well as institutional and individual representation. Accounting for these differences when interpreting estimates of STB can help guide suicide prevention efforts.

Responding to Suicide in School Communities: An Examination of Postvention Guidance from Expert Recommendations and Empirical Studies.

PURPOSE OF REVIEW: We review the published literature on a school's response after a student dies by suicide ("postvention"). We examine published recommendations based on expert guidance and empirical studies that have evaluated postvention measures. RECENT FINDINGS: Experts recommend careful communication with family, staff, and students that adheres to published suicide reporting guidelines. Experts also emphasize the importance of identifying and supporting high-risk students. Few robust, controlled studies have identified effective postvention measures. Effective measures tended to occur in group settings (e.g., group therapy), focus on improving grief symptoms, and involve mental health professionals. Postvention has not been robustly studied in the school context. Expert recommendations and a few evidence-backed studies provide the frame for a coherent, school-based postvention response. Further research is needed to strengthen and expand our collective understanding of effective postvention measures in the school context as youth suicide attempts continue to rise.

The ethical experiences of trainees on short-term international trips: a systematic qualitative synthesis.

BACKGROUND: Medical student and resident participation in short-term international trips for trainees (STINTTs) has increased in the past few decades. However, there has been no systematic review of trainees' actual ethical experiences. The authors sought to identify what ethical issues medical trainees encounter during STINTTs, as elicited by and reported in peer-reviewed, quantitative and qualitative research papers. METHODS: The authors systematically searched five academic databases finding 659 unique titles and abstracts. The authors applied inclusion and exclusion criteria to these titles and abstracts resulting in fourteen papers, which were analyzed using qualitative thematic synthesis. RESULTS: The qualitative analysis of the papers generated four themes: (1) Trainees' Concerns Over Perpetuating Medical Tourism; (2) Struggling to Identify and Balance the Benefits and Harms of STINTTs; (3) The Complicated Trainee Mens (mind); and (4) Ethical Situations Encountered by Trainees. The fourth theme, which was the largest, was further divided into (a) Navigating social and cultural dynamics, (b) Trainees' experiences related to the learner role, and (c) Ethical situations not qualifying for other catagories. Some of these issues reported in the empirical research papers are well represented in the broader literature on STINTTs, while others were less so-such as mistreatment of trainees. All included papers were published after 2010, and comprised a total of less than 170 medical trainees. CONCLUSIONS: Medical trainees report experiencing a wide range of ethical challenges during short-term international trips in which they engage in clinical or research activities. The authors call educators' attention to specific challenges that trainees face. The relevant literature covering US and Canadian STINTTs is relatively young and largely qualitative. The authors briefly sketch a program for expanding the research on this increasingly common educational experience.

Pre-departure preparation for international clinical work: a handbook.

International clinical experiences are increasingly popular among medical students, residents, fellows, and practitioners. Adequate pre-departure training is an integral part of a meaningful, productive, and safe international experience. At Johns Hopkins University School of Medicine, we have developed a pre-departure handbook to assist practitioners in preparing for global health work. The handbook draws from current global health education literature, existing handbooks, and expert experiences, and includes information about logistical and cultural preparations. While a pre-departure handbook cannot serve as a substitute for a comprehensive pre-departure training program, it can be a useful introduction to the pre-departure process.

Sacrifice as a Part of Medical Education: A Reflection on the COVID-19 Pandemic.

The COVID-19 pandemic demanded significant sacrifices from medical learners. We examine the meaning of sacrifice and frame it as a "side effect" of being dedicated to the good of the patient. We contend that sacrifice has played a central role in medicine, even before the pandemic, for professionals and learners alike. We identify three limits to the role of sacrifice in medical education and practice to separate healthy from harmful experiences of sacrifice. Developing an understanding of sacrifice in medical education and practice can help trainees and clinicians know when to marshal resilient responses to healthy sacrifices and reject harmful sacrifices encountered. Maintaining this balance requires a broader reflection on the nature of medical schools and their ability to support virtuous professional identity formation.

Examining NSDUH's Assessment of Fentanyl Use: A Comparison of Trends in Fentanyl Use and Fentanyl Overdose Deaths from 2015-2020.

OBJECTIVE: The National Survey on Drug Use and Health (NSDUH), as the primary source of epidemiological substance use data in the US, could illuminate trends in fentanyl use behaviors contributing to the opioid overdose crisis. We hypothesized that the trend in NSDUH prevalence of lifetime fentanyl injection would match the direction and magnitude of the trend in synthetic opioid overdose deaths. METHOD: Using logistic regression, we modeled the 2015-2020 trend in synthetic opioid overdose deaths as a proportion of all deaths. We modeled contemporary trends from cross-sectional NSDUH data for (1) lifetime fentanyl injection, (2) past year prescription fentanyl (PF) misuse, (3) prescription tramadol misuse (the other synthetic opioid counted alongside fentanyl in the overdose deaths category), and (4) combined prescription fentanyl or tramadol misuse. Average annual NSDUH weighted sample size was 272,519,038 (51.5% female, 48.5% male). RESULTS: Synthetic opioid overdose deaths increased from 2015-2020 (OR 3.39, meaning the odds of a death being from synthetic opioid overdose in 2020 were 3.39 times the odds of death from that cause in 2015, 95% CI: 3.34, 3.44). None of the substance use trends significantly increased. CONCLUSION: Per NSDUH data, the prevalence of fentanyl misuse did not significantly increase in tandem with synthetic opioid overdose deaths from 2015 to 2020. Scrutiny of NSDUH's approach to assessing fentanyl misuse casts doubt on the utility of NSDUH fentanyl data collection. We acknowledge recent changes to the survey and recommend two further changes to optimize a vital source of data on behaviors related to the opioid overdose crisis.

Variation in ADHD Treatment by Mental Health Care Setting Among US College Students from 2019 to 2022.

OBJECTIVE: To assess whether prevalence of treatment for ADHD varies by location of mental healthcare among US college students aged 18 to 25 with professionally diagnosed ADHD. METHOD: Our analysis uses cross-sectional data from the National College Health Assessment (NCHA) and evaluated the relationship between types of care received and location of mental health services received in the past year (dichotomized into "use of any on-campus services" and "use of off-campus services only"). We generated unadjusted and adjusted logistic regression models of each type of treatment. RESULTS: Students who reported receiving mental healthcare on campus were less likely to receive any medication (aOR 0.66, 95% CI [0.60, 0.72]), any therapy (aOR 0.82, 95% CI [0.75, 0.89]), and any medication or therapy for ADHD (aOR 0.63, 95% CI [0.57, 0.70]). CONCLUSION: Future research should evaluate the causes of lower prevalence of ADHD treatment among students receiving mental healthcare from campus-based clinics.

The role of arts-based curricula in professional identity formation: results of a qualitative analysis of learner's written reflections.

BACKGROUND: Professional identity formation is an important aspect of medical education that can be difficult to translate into formal curricula. The role of arts and humanities programs in fostering professional identity formation remains understudied. Analyzing learners' written reflections, we explore the relationship between an arts-based course and themes of professional identity formation. MATERIALS AND METHODS: Two cohorts of learners participated in a 5-day online course featuring visual arts-based group activities. Both cohorts responded to a prompt with written reflections at the beginning and end of the course. Using a thematic analysis method, we qualitatively analyzed one set of reflections from each cohort. RESULTS: Themes included the nature of the good life; fulfilling, purposeful work; entering the physician role; exploration of emotional experience; and personal growth. Reflections written at the end of the course engaged significantly with art - including literature, poetry, lyrics, and film. One student disclosed a mental illness in their reflection. CONCLUSIONS: Our qualitative analysis of reflections written during a visual arts-based course found several themes related to professional identity formation. Such arts-based courses can also enrich learners' reflections and provide a space for learners to be vulnerable. PRACTICE POINTS: (five short bullets conveying the main points) Arts-based courses can support learners' professional identity formationReflection themes related to professional identity formation included entering the physician role, fulfilling clinical work, and personal growthAt the end of the course, learners' reflections included significant engagement with artReflective writing in small, arts-based learning communities can provide space for learners to be vulnerableThe Role of Arts-Based Curricula in Professional Identity Formation: Results of A Qualitative Analysis of Learner's Written Reflections.

A suicide prevention initiative across a multi-campus university before and during the COVID-19 pandemic.

Increasing rates of depression, anxiety, substance use, and suicidal thoughts and behaviors among college students were exacerbated by the COVID-19 pandemic. This report describes how components of the Johns Hopkins Suicide Prevention Awareness, Response and Coordination (JH-SPARC) Project aligned with a multi-faceted strategy for suicide prevention. Key programs included suicide screening, gatekeeper trainings, and the use of third-party mental health services. Regarding suicide screening outcomes, staff sent 36,148 individual emails inviting students and trainees to participate in stress and depression screening. This approach garnered 2,634 responses and connected 130 students to care, 66 of whom (50.8%) indicated suicidal thoughts, plans, or behaviors. We estimate this screening cost $2.97 per student. Important lessons included the reliance on virtual platforms and the need to coordinate efforts across multiple campuses. Our manuscript provides an example of a transferable strategy for suicide prevention on college campuses in the pandemic era.

Pre-departure Training for Healthcare Students Going Abroad: Impact on Preparedness.

BACKGROUND: Many medical and nursing schools offer opportunities for students to participate in global health experiences abroad, but little is known about the efficacy of pre-departure training in preparing students for these experiences. OBJECTIVES: The primary aim was to identify characteristics of pre-departure training associated with participants' reporting a high level of preparedness for their global health experiences. Secondary objectives included identifying students' preferred subjects of study and teaching modalities for pre-departure training. METHODS: A questionnaire was distributed to all medical and nursing students at our institution from 2013 to 2015. Questions addressed prior global health experiences and pre-departure training, preferences for pre-departure training, and demographic information. Findings: Of 517 respondents, 55% reported having a prior global health experience abroad, 77% of whom felt prepared for their experience. Fifty-three percent received pre-departure training. Simply receiving pre-departure training was not associated with perceived preparedness, but pre-departure training in the following learning domains was: travel safety, personal health, clinical skills, cultural awareness, and leadership. Perceiving pre-departure training as useful was also independently associated with self-reported preparedness. Students' preferred instruction methods included discussion, lecture, and simulation, and their most desired subjects of study were travel safety (81%), cultural skills (87%), and personal health (82%). CONCLUSIONS: Incorporating travel safety, personal health, clinical skills, cultural awareness, and/or leadership into pre-departure training may increase students' preparedness for global health experiences. Student perceptions of the usefulness of pre-departure training is also associated with self-reported preparedness, suggesting a possible "buy-in" effect.

Global Health Career Interest among Medical and Nursing Students: Survey and Analysis.

BACKGROUND: Global health experiences undertaken in international settings (GHEs) are becoming an increasingly prevalent aspect of health professions education and, as such, merit comprehensive analysis of the impact they have on students and host communities. OBJECTIVE: To assess the associations between demographic/experiential factors and the interest of health professions students in careers involving global health. METHODS: A cross-sectional survey was administered online to a convenience sample of medical and nursing students at Johns Hopkins University. Questions addressed level of interest in a global health career, prior GHEs, and demographic information. Items were either Likert scale or multiple choice. Various regression analyses were performed. FINDINGS: Of 510 respondents, 312 (61.2%) expressed interest in a global health career and 285 (55.9%) had prior GHEs. Multivariate logistic regression found female sex, age ≥27 years, household income <$100,000/y, and a prior research-related GHE independently associated with higher interest in global health careers. On subset analysis of participants with one or more prior GHEs: age ≥27 years, household income <$100,000/y, a prior research-related GHE, and having multiple GHEs were each independently associated with increased interest in a global health career. CONCLUSIONS: Simply participating in a global health experience abroad is not significantly associated with interest in a global health career. However, sex, age, household income, and research-related GHEs are significantly associated with global health career interest. These findings may inform the development of global health programs at medical and nursing schools and can guide efforts to increase the number of health care professionals entering global health careers.

Development of global health education at Johns Hopkins University School of Medicine: a student-driven initiative.

Global health is increasingly present in the formal educational curricula of medical schools across North America. In 2008, students at Johns Hopkins University School of Medicine (JHUSOM) perceived a lack of structured global health education in the existing curriculum and began working with the administration to enhance global health learning opportunities, particularly in resource-poor settings. Key events in the development of global health education have included the introduction of a global health intersession mandatory for all first-year students; required pre-departure ethics training for students before all international electives; and the development of a clinical global health elective (Global Health Leadership Program, GHLP). The main challenges to improving global health education for medical students have included securing funding, obtaining institutional support, and developing an interprofessional program that benefits from the resources of the Schools of Medicine, Public Health, and Nursing. Strategies used included objectively demonstrating the need for and barriers to more structured global health experiences; obtaining guidance and modifying existing resources from other institutions and relevant educational websites; and harnessing institution-specific strengths including the large Johns Hopkins global research footprint and existing interprofessional collaborations across the three schools. The Johns Hopkins experience demonstrates that with a supportive administration, students can play an important and effective role in improving global health educational opportunities. The strategies we used may be informative for other students and educators looking to implement global health programs at their own institutions.