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.

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.

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.

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.

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.

Understanding and promoting treatment-seeking for eating disorders and body image concerns on college campuses through online screening, prevention and intervention.

While there have been important recent advances in the development of effective universal prevention and intervention programs, it is not yet clear how to engage large numbers of students in these programs. In this paper, we report findings from a two-phase pilot study. In the first phase, we used a population-level, online survey to assess eating disorder symptom level and habits/attitudes related to service utilization (N=2180). Using validated screening tools, we found that roughly one in three students has significant symptoms of eating disorders or elevated weight concerns, the vast majority of whom (86.5%) have not received treatment. In the second phase, we referred students to online prevention and selective/indicated intervention programs based on symptom classification (N=1916). We find that program enrollment is highest for students in the indicated intervention (18.1%) and lowest for students in the universal prevention (4.1%). We find that traditionally-emphasized barriers such as stigma, misinformation, and financial limitations do not appear to be the most important factors preventing treatment-seeking. Rather students report not seeking help for reasons such as lack of time, lack of perceived need, and a desire to deal with the issue "on my own." Findings offer insight into the treatment-seeking habits and attitudes of college students, including those barriers that may be overcome by offering online programs and those that persist despite increased access to and convenience of relevant resources.

Gatekeeper training and access to mental health care at universities and colleges.

PURPOSE: Gatekeeper training (GKT) programs are an increasingly popular approach to addressing access to mental health care in adolescent and young adult populations. This study evaluates the effectiveness of a widely used GKT program, Mental Health First Aid, in college student populations. METHODS: A randomized control trial was conducted on 32 colleges and universities between 2009 and 2011. Campus residence halls were assigned to the intervention (Mental Health First Aid plus pre-existing trainings) or control condition (pre-existing trainings only) using matched pair randomization. The trainings were delivered to resident advisors (RAs). Outcome measures include service utilization, knowledge and attitudes about services, self-efficacy, intervention behaviors, and mental health symptoms. Data come from two sources: (1) surveys completed by the students (resident advisors and residents; N = 2,543), 2-3 months pre- and post-intervention; and (2) utilization records from campus mental health centers, aggregated by residence. RESULTS: The training increases trainees' self-perceived knowledge (regression-adjusted effect size [ES] = .38, p < .001), self-perceived ability to identify students in distress (ES = .19, p = .01), and confidence to help (ES = .17, p = .04). There are no apparent effects, however, on utilization of mental health care in the student communities in which the trainees live. CONCLUSIONS: Although GKT programs are widely used to increase access to mental health care, these programs may require modifications to achieve their objectives.