Therapeutic alliance and clinical outcomes in teletherapy and in-person psychotherapy: A noninferiority study during the COVID-19 pandemic.

OBJECTIVE: The current study aimed to inform the varied and limited research on clinical variables in the context of teletherapy. Questions remain about the comparative quality of therapeutic alliance and clinical outcome in the context of teletherapy compared to in-person treatment. METHODS: We utilized a cohort design and a noninferiority statistical approach to study a large, matched sample of clients who reported therapeutic alliance as well as psychological distress before every session as part of routine clinical practice at a university counseling center. A cohort of 479 clients undergoing teletherapy after the emergence of the COVID-19 pandemic was compared to a cohort of 479 clients receiving in-person treatment before the onset of the pandemic. Tests of noninferiority were conducted to investigate the absence of meaningful differences between the two modalities of service delivery. Client characteristics were also examined as moderators of the association between modality and alliance or outcome. RESULTS: Clients receiving teletherapy showed noninferior alliance and clinical outcome when compared to clients receiving in-person psychotherapy. A significant main effect on alliance was found with regard to race and ethnicity. A significant main effect on outcome was found with regard to international student status. Significant interactions on alliance were found between cohort and current financial stress. CONCLUSIONS: Study findings support the continued use of teletherapy by demonstrating commensurate clinical process and outcome. Yet, it will be important for providers to be aware of existing mental health disparities that continue to accompany psychotherapy - in person and via teletherapy. Results and findings are discussed in terms of research and clinical implications. Future directions for researching teletherapy as a viable treatment delivery method are also discussed.

College student athlete versus nonathlete mental and social health factors during the COVID-19 pandemic.

Objective: This study investigated differences in stress, anxiety, and social support between collegiate student-athletes and nonathletes during the COVID-19 pandemic. Participants: College students enrolled at a NCAA Division III private liberal arts college in the Midwest. Methods: Participants (n = 58) completed a series of surveys each month for 4 months that included the Generalized Anxiety Disorder Questionnaire, Perceived Stress Scale Questionnaire, and Multidimensional Scale of Perceived Social Support Questionnaire. Results: There were significant main effects of time for stress and social support across the 4 months (p < 0.05), but not for anxiety. There was a significant difference in anxiety levels between athletes and nonathletes (p < 0.01), but not for social support or stress (p > 0.05). Conclusions: Nonathletes maintained support networks, or found alternate outlets of support, in addition to coping with anxiety and stress levels when compared to athletes.

Stop Asian hate: The mental health impact of racial discrimination among Asian Pacific Islander young and emerging adults during COVID-19.

BACKGROUND: The rapid surge in anti-API discrimination and assault during the COVID-19 pandemic has the potential to exacerbate mental health disparities already pervasive among API populations. The primary of this study was to understand the impact of the pandemic and COVID-related discrimination on API college and university student mental health. METHODS: Secondary data was used from three administrations (Fall 2019, Spring 2020, and Fall 2020) of the Healthy Minds Study (HMS). We conducted Chi-square analyses to analyze differences in mental health symptoms across the three academic semesters. Cross-sectional multivariable logistic regression models were utilized to examine the association between COVID-related discrimination and mental health symptoms and help-seeking behavior during Spring 2020 and Fall 2020. RESULTS: Comparing Fall 2019 to Fall 2020, we found that API students reported a 17 % increase in severe depression and a 30 % increase in severe anxiety. Mental health treatment utilization among those experiencing clinically-significant mental health problems decreased by 26 % between Fall 2019 and Spring 2020. COVID-related discrimination was associated with greater odds of severe depression in both Spring 2020. LIMITATIONS: HMS does not include a random sample of campuses as schools themselves elect to participate. Analyses rely on self-report data. CONCLUSIONS: Throughout the COVID-19 pandemic, API students reported significant increases in clinically-significant mental health symptoms and decreases in treatment utilization. Our analyses also suggest that COVID-related discrimination is correlated with greater odds of clinically-significant mental health symptoms, including severe depression and severe anxiety, as well as lower odds of treatment utilization.

Psychiatric comorbidities among undergraduate and graduate students attending spiritual-mind-body interventions.

OBJECTIVE: This study examined rates of positive screens for depression and posttraumatic stress and their comorbidity among undergraduate (N = 77) and graduate (N = 136) students who participated in on-campus Spiritual-Mind-Body (SMB) wellness interventions. METHODS: Participants completed the PHQ-9 and the PCL-C before starting an 8-week in-person SMB wellness intervention. Elevated depression was indicated by a score of ≥10 on the PHQ-9; elevated posttraumatic stress (PTS) was indicated by a score of ≥30 on the PCL-C. RESULTS: There were unexpectedly high rates of posttraumatic stress among both undergraduate (39%) and graduate (32%) students without the presence of comorbid depression. A small minority of students experienced depression apart from elevated PTS symptoms. Overall, students reported high levels of clinically relevant psychopathology. CONCLUSION: On-campus wellness centers may offer an appropriate setting for the screening of trauma-related distress and depression and their comorbidity to address the psychiatric concerns of SMB wellness-seeking students.

Can the Academic and Experiential Study of Flourishing Improve Flourishing in College Students? A Multi-University Study.

Objectives: Significant concerns have been raised about the "mental health crisis" on college campuses, with attention turning to what colleges can do beyond counseling services to address students' mental health and well-being. We examined whether primarily first-year (89.1%) undergraduate students (n=651) who enrolled in the Art and Science of Human Flourishing (ASHF), a novel academic and experiential for-credit elective course on human flourishing, would demonstrate improved mental health and strengthen skills, perspectives, and behaviors associated with flourishing relative to students who did not enroll in this course. Methods: In a two-wave, multi-site, propensity-score matched controlled trial (ASHF n=217, Control n=434; N=651), we used hierarchal linear models and false discovery rate corrected doubly robust estimates to evaluate the impact of the ASHF on attention and social-emotional skill development, flourishing perspectives, mental health, health, and risk behavior outcomes. Results: ASHF participants reported significantly improved mental health (i.e., reduced depression) and flourishing, improvements on multiple attention and social-emotional skills (e.g., attention function, self-compassion), and increases in prosocial attitudes (empathic concern, shared humanity; Cohen's ds= 0.18-0.46) compared to controls. There was no evidence for ASHF course impacts on health or risk behaviors, raising the possibility that these outcomes take more time to change. Conclusions: This research provides initial evidence that the ASHF course may be a promising curricular approach to reduce and potentially prevent poor mental health while promoting flourishing in college students. Continued research is needed to confirm these conclusions.

Chemical imbalance and etiological beliefs about depression among college students.

Etiological beliefs of depression have differing impacts on motivation, hope, and treatment expectations. However, it is unclear where people are exposed to these beliefs. Objective: This study examined beliefs about depression and their relations to symptoms, attitudes about depression, and treatment preferences. Participants: 426 undergraduates attending a large midwestern university. Methods: Participants completed an online survey asking about causes of depression, if and where they had heard about the "chemical imbalance" explanation of depression, attitudes about depression, as well as measures of their symptoms, treatment history, and hypothetical treatment preferences. Results: Sixty-two percent of the sample had heard of the chemical imbalance explanation, most commonly from the classroom. Biochemical beliefs about depression were most strongly endorsed among participants with a family history of depression and who had had personal experience with treatment. The chemical imbalance belief was uniquely related to dysfunctional beliefs about depression. Etiological beliefs were largely unrelated to treatment preferences. Conclusion: College students are exposed to models of mental health that may not be ideal for treatment and recovery.

Anxiety and depression among US college students engaging in undergraduate research during the COVID-19 pandemic.

OBJECTIVE: The objective was to examine mental health of undergraduate researchers (UGRs) during the COVID-19 pandemic. PARTICIPANTS: We surveyed 962 UGRs who were conducting research in Spring 2020 at over 100 US universities. METHODS: We conducted an online survey in July 2020. We analyzed data using descriptive statistics and multivariable generalized estimating equations. RESULTS: 63% reported at least mild anxiety and 73% reported at least mild depression based on GAD-7 and PHQ-9 scores; 15.2% reported severe anxiety (score ≥ 15) and 23.4% reported severe depression (score ≥ 15). More COVID-19-related adverse event experiences were associated with more severe anxiety and depression, as were first-generation status, woman gender, and LGBQ status. Greater social support was protective, and significantly more so for men (vs. women) and continuing generation (vs. first generation) students. CONCLUSION: Faculty have an important role in the mental health of their mentees. Additional interventions are needed to better support women and first-generation students.Supplemental data for this article can be accessed online at.

Mediating Model of College Students' Chinese Zhongyong Culture Thinking Mode and Depressive Symptoms.

BACKGROUND: College is a key period for students' learning and development, as they begin independently to face life's adversities. The essence of China's zhongyong culture is to provide a practical way of thinking, a basic principle of the Chinese people. However, empirical research on psychopathology is lacking. The present study investigated Chinese college students to explore and explain the psychological mechanism of depressive symptoms via the zhongyong practical thinking mode. METHODS: The study examined the relationship between zhongyong practical thinking and depressive symptoms, coping style, and ruminations of 501 Chinese college students. The statistical software SPSS was used to establish an intermediary model between moderate zhongyong practical thinking and depressive symptoms. RESULTS: Rumination partially mediated the relationship between zhongyong practical thinking and depressive symptoms, but coping style had no mediating effect. Therefore, reducing the negative rumination behaviours of college students may be more conducive to alleviating their depressive symptoms. The chain mediating effect of coping style and rumination was significant. The college students with high levels of zhongyong thinking adopted positive coping styles to cope with various pressures and situations, reducing negative coping and rumination and thereby reducing their depressive symptoms. DISCUSSION: The results of the study could help universities to provide courses and activities that promote students' mental health from the perspective of zhongyong psychological interventions. The results provide a model for further studies of the influence of zhongyong practical thinking on depressive symptoms amongst college students.

The Relationship between Pet Ownership, Social Support, and Internalizing Symptoms in Students from the First to Fourth Year of College.

Internalizing symptoms are prevalent in students as they enter and complete college. Considering research suggesting mental health benefits of pet ownership, this study explores the relationship between pet ownership, social support (SS), and internalizing symptoms (IS) in a cohort of students across their 4-year college experience. With no differences at college entry, students growing up with pets had greater IS through the fourth year, and greater SS through the third year, than those without pets. Currently living with a pet, gender, SS and personality predicted IS in the fourth year. Females experiencing higher IS in their first year are more likely to live with pets in their fourth year, and fourth year females living with pets or greatly missing absent pets have higher IS than females without pets or missing pets less. Findings suggest a unique relationship between IS in female students and their pet relationships not seen in males.

A randomized dismantling trial of the open and engaged components of acceptance and commitment therapy in an online intervention for distressed college students.

This dismantling trial compared the effects of a full online Acceptance and Commitment Therapy (ACT) intervention to the isolated effects of the Open (i.e., acceptance, cognitive defusion) and Engaged (i.e., values, committed action) components of ACT. A sample of 181 distressed college students were randomized to one of four conditions: a 12-session full ACT website (Full), a version targeting the Open components (Open), a version targeting the Engaged components (Engaged), or waitlist. Participants in active conditions were also randomized to receive phone coaching or just email prompts to increase program adherence. All three ACT conditions significantly improved over time relative to the waitlist condition on the primary outcome of mental health symptoms. The Engaged and Full conditions had greater rates of reliable change on the primary outcome relative to waitlist, but not the Open condition. Similarly, only Engaged and Full conditions improved on positive mental health relative to waitlist. The Full condition had greater improvements on a few ACT process measures relative to Engaged and Open conditions, particularly cognitive fusion. Overall, results indicate targeting only the Open components of ACT was somewhat less effective, and that including both the Open and Engaged components led to greater decreases in cognitive fusion.

Eating Disorders in Transitional Age Youth.

Eating disorders are common in children and adolescents, and may continue, resurface, or present anew in young people making the transition to adulthood. This may affect the young person's academic or occupational trajectory, and patients and parents/families need to recognize the supports that may be necessary to allow the emerging adult to be successful in navigating independent living, increased work or educational autonomy, and adult relationships. Colleges and universities are able to provide some support, but patients, families, and clinicians must be aware of limitations and must be thoughtful about options available to promote successful transition wherever possible.

Comparing cognitive fusion and cognitive reappraisal as predictors of college student mental health.

Transdiagnostic cognitive behavioral interventions target different cognitive processes to promote mental health, including cognitive fusion and cognitive reappraisal. Determining the relative impact of cognitive fusion and reappraisal on a range of student mental health concerns could help interventions target psychopathological cognitive processes more effectively. Therefore, this study examined the longitudinal impact of cognitive fusion and reappraisal on mental health and functioning outcomes. A series of hierarchical regression models tested the effects of cognitive fusion and reappraisal in a sample of college students (n = 339). When controlling for reappraisal and baseline symptoms, fusion predicted distress, depression, generalized anxiety, social anxiety, hostility, academic distress, and student role problems 1 month later. Reappraisal predicted only student role problems longitudinally when controlling for fusion. These results suggest that cognitive fusion is a stronger predictor than reappraisal for a range of student mental health concerns and may be a particularly important target for improving student mental health.

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 disorder comorbidity and suicidal thoughts and behaviors in the World Health Organization World Mental Health Surveys International College Student initiative.

OBJECTIVES: Comorbidity is a common feature of mental disorders. However, needs assessment surveys focus largely on individual disorders rather than on comorbidity even though the latter is more important for predicting suicidal thoughts and behaviors. In the current report, we take a step beyond this conventional approach by presenting data on the prevalence and correlates (sociodemographic factors, college-related factors, and suicidal thoughts and behaviors) of the main multivariate profiles of common comorbid Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV disorders among students participating in the first phase of the World Health Organization World Mental Health International College Student initiative. METHOD: A web-based mental health survey was administered to first year students in 19 colleges across eight countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, United States; 45.5% pooled response rate) to screen for seven common DSM-IV mental disorders: major depression, mania/hypomania, generalized anxiety disorder, panic disorder, attention-deficit/hyperactivity disorder, alcohol use disorder, and drug use disorder. We focus on the 14,348 respondents who provided complete data; 38.4% screened positive for at least one 12-month disorder. RESULTS: Multivariate disorder profiles were detected using latent class analysis (LCA). The least common class (C1; 1.9% of students) was made up of students with high comorbidity (four or more disorders, the majority including mania/hypomania). The remaining 12-month cases had profiles of internalizing-externalizing comorbidity (C2; 5.8%), internalizing comorbidity (C3; 14.6%), and pure disorders (C4; 16.1%). The 1.9% of students in C1 had much higher prevalence of suicidal thoughts and behaviors than other students. Specifically, 15.4% of students in C1 made a suicide attempt in the 12 months before the survey compared with 1.3-2.6% of students with disorders in C2-4, 0.2% of students with lifetime disorders but no 12-month disorders (C5), and 0.1% of students with no lifetime disorders (C6). CONCLUSIONS: In line with prior research, comorbid mental disorders were common; however, sociodemographic correlates of LCA profiles were modest. The high level of comorbidity underscores the need to develop and test transdiagnostic approaches for treatment in college students.

A Model CSMH Curriculum for Child and Adolescent Psychiatry Training Programs.

Child and adolescent psychiatrists (CAP) care for high school students preparing to enter college. They also may continue to see students while on school vacations and may care for college students in various settings (emergency room, inpatient hospital unit, private practice, college student health service, or counseling center). As increasing numbers of students with mental health diagnoses pursue secondary education, CAP need to be knowledgeable about campus systems of care, principles of transition, and privacy and educational laws affecting college students. This article describes an informal needs assessment of general CAP members of the American Academy of Child and Adolescent Psychiatry and details the results of a survey of CAP program directors on training opportunities in college student mental health (CSMH). The authors present a sample curriculum for a clinical rotation in CSMH, as well as providing ideas for core didactic lectures, and proposing the development of online resources to reduce the burden of creating new lectures and standardize experiences among training programs.