Mental health interventions for college and university students during the COVID-19 pandemic: A critical synthesis of the literature.

BACKGROUND: The aim of the study is to compare the emotional effects of COVID-19 among three different groups, namely: health personnel, medical students, and a sample of the general population. METHODS: 375 participants were recruited for this study, of which 125 were medical students (preclinical studies, 59; clinical studies, 66), 125 were health personnel (COVID-19 frontline personnel, 59; personnel not related with COVID-19, 66), and 125 belonged to the general population. The PHQ-9, GAD-7, and CPDI scales were used to assess the emotional impact. A multinomial logistic regression was performed to measure differences between groups, considering potential confounding factors. RESULTS: Regarding CPDI values, all other groups showed reduced values compared to COVID-19 frontline personnel. However, the general population, preclinical and clinical medical students showed increased PHQ-9 values compared to COVID-19 frontline personnel. Finally, confounding factors, gender and age correlated negatively with higher CPDI and PHQ-9 scores. CONCLUSIONS: Being frontline personnel is associated with increased COVID-19-related stress. Depression is associated, however, with other groups not directly involved with the treatment of COVID-19 patients. Female gender and younger age correlated with COVID-19-related depression and stress.

Meeting the Mental Health Needs of College Students with ASD: A Survey of University and College Counseling Center Directors.

An increasing number of individuals with Autism Spectrum Disorder (ASD) are enrolling in post-secondary education. Though many students may use services provided by university and college counseling centers (UCCCs), little is known about the landscape of care for students with ASD in this setting. UCCC directors (n = 79) completed an online survey to assess current utilization, clinician experience with ASD, and campus collaborations. While the majority of directors (69.7%) reported an increase in students with ASD requesting mental health services at their centers, the survey identified a discrepancy between their intention to improve services and current reported levels of expertise, training, and resources. Directors identified barriers to improving UCCC services to students with ASD, providing direction for future improvement.

Intrapersonal and interpersonal emotional networks and their associations with treatment outcome.

In this study, we used multilevel vector autoregressive network analysis to examine clients' intrapersonal and client-therapist interpersonal emotional dynamics from session to session. We expected to find differences in the network structure (i.e., the density) of responders versus nonresponders to treatment. The sample comprised 95 clients treated by 58 therapists in a university clinic. Clients and therapists self-reported their emotions after each session. The functioning level was assessed at the beginning of each session using clients' self-reports. The results indicated that higher intrapersonal density among clients' emotions within the temporal network (associations from session to session) was associated with less improvement in functioning, but higher intrapersonal density among clients' emotions within the contemporaneous network (same-session associations) was not associated with clients' functioning level. Additionally, higher interpersonal density among clients'-therapists' emotions within the contemporaneous network was associated with greater improvement in clients' functioning. These findings highlight the importance of recognizing the dynamic nature of emotions within the client, as well as between the client and the therapist and the contribution of such session-by-session emotional dynamics to the outcome of psychotherapy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Who is more important in stigmatization, family or friends?

INTRODUCTION: Although the knowledge about epilepsy is rapidly increasing, the rate of stigmatization still remains high among patients. Since stigmatization is a condition that reduces the quality of life of patients and adversely affects the treatment response, it is very important to reveal the contributing factors. In this study, it was aimed to investigate which of the current social support resources of the patients are related to stigmatization, whether the support received from family or friends and a special person. MATERIALS AND METHODS: A total of 60 patients with epilepsy (30 males and 30 females) were included in the study. Sociodemographic data form, stigma scale of epilepsy, and multidimensional scale of perceived social support were administered to all participants. RESULTS: Duration of education from sociodemographic variables and duration of epilepsy from clinical variables were associated with stigma scores (for each other, p < 0.01). While a negative correlation was determined between friend support, special person support scores, and total social support score and stigma scores (p < 0.01, p < 0.001, p < 0.01, respectively), no significant relationship was detected between family support score and stigma score. CONCLUSIONS: The findings of the study show that the support of a friend and a special person may be more important than the family support in patients with epilepsy. When evaluating these patients, questioning the type and adequacy of social support that they receive and taking necessary interventions (such as forming peer support groups) may be helpful in reducing the perceived stigmatization.

Knowledge, Attitudes, and Practice Patterns of Health Professionals Toward Medical and Non-medical Stimulant Use by Young Adults.

BACKGROUND: The role of family physicians (FPs) and college health professionals (CHPs) in stimulant treatment and nonmedical use of stimulants is not clear. OBJECTIVE: To investigate the current practices, concerns, needs, beliefs, barriers, and facilitators to appropriate pharmacological treatment of teens and young adults with attention deficit hyperactivity disorder (ADHD) and prevention of nonmedical use and diversion. METHODS: A cross-sectional survey developed by the project team and experts in the field, delivered to national sample of FPs and CHPs. RESULTS: A total of 794 completed surveys were analyzed. The average age of respondents was 51.6 ± 10.3 years; 50.6% of the respondents were female. The majority of CHPs (80.6%) reported they spend 75% to 100% of their time with patients age 17 to 24 years and 74.0% of FPs reported they spend less than 25% of their time with this age group. The majority (91.7%) of the respondents indicated that untreated ADHD affects quality of life, and 76.4% indicated untreated ADHD is often associated with risky behaviors. More CHPs than FPs always refer out for ADHD diagnosis (70.7% vs 52.1%; P < .001). Most respondents (81.2%) were concerned with ADHD medication diversion, and 84.2% believed that diversion or abuse is a problem overall. Respondents indicated they are unprepared to provide patient education on decisions about pharmacotherapy or behavioral therapy choices for adult ADHD. CONCLUSION: There is an opportunity to enhance safety and effectiveness of ADHD management in young adults. Additional resources and interventions are needed to improve medication management, reduce misuse, and ensure safe and appropriate use of stimulants.

Suicide among college students in psychotherapy: Individual predictors and latent classes.

This study sought to identify predictors of suicidal behavior among college students who are psychotherapy clients, as well as to determine underlying classes of clients with suicidal ideation. Data were gathered from 101,570 clients, 391 of whom engaged in suicide behavior during treatment. Regression analyses revealed that suicide behavior was positively associated with 3 pretreatment variables: depression, prior suicide behavior, and prior nonsuicidal self-injury. Four latent classes of clients with suicidal ideation were identified that were named "prior ideation," "extensive risk," "prior treatment," and "circumscribed depression." The number of clients in each class varied widely, as did the relative risk of suicide behavior. Implications for treatment, suicide assessment, and suicide prevention are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The effect of implementing the partners for change outcome management system in a nationwide student counseling service.

The aims of the present study were to investigate the effect of implementing the Partners for Change Outcome Management System (PCOMS) in the Danish Student Counseling Service and to explore both between-condition moderators and within-condition predictors of outcomes. The study was a nonrandomized controlled study, comparing the outcome of individual and group student counseling for 634 PCOMS clients to that of 740 clients having started treatment as usual (TAU) 2 years before the PCOMS data collection began. The primary outcome measure was the Global Severity Index on the Symptom Checklist 90-Revised. Main analyses were conducted with multilevel models on the intention-to-treat sample. The results demonstrated no effect of the PCOMS compared with the TAU condition, neither for the primary outcome nor for the number of dropouts or clients experiencing deterioration. The PCOMS effect was not predicted by the counselors' adherence to the PCOMS protocol. Because the counselor level explained less than 1% of the variance in outcome, the counselor factors (i.e., attitude to feedback, reactions to negative feedback, and deliberate practice) were not analyzed as predictors. In conclusion, this study does not align with previous studies finding a positive effect of the PCOMS in counseling settings. However, all previous studies relied on the PCOMS Outcome Rating Scale as the only measure of outcome, maybe indicating a measure-specific effect. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Development and Effects of College-Based Lifestyle Modification Program for Menstrual Health of Young Adult Women with Irregular Menses: A Randomized Controlled Trial.

Purpose: This study was conducted to develop the 'College-based Lifestyle Modification Program' (College-based LMP) for young adult women with irregular menstruation and examine its effects after intervention. Methods: The College-based LMP consisted of small group education, individual physical exercise counseling/training, individual diet counseling, and feedback and support. Participants were comprised of 38 females who reported less than 10 irregular menstruations in a year and were randomly assigned to the experimental and control groups. The primary outcome variables consisted of menstrual cycle index (MCI), sex hormone binding globulin (SHBG), and androgenic profile (testosterone-T, free androgen index-FAI), while the outcome variables included premenstrual symptoms (PMS), menstrual volume, body composition parameters, glycemic parameters (fasting blood sugar-FBS, insulin, HOMA-IR), sleep duration, perceived stress, and nutrient intake.. Results: There were no significant differences in primary outcome variables (MCI, SHBG, T, and FAI). In the variables, there were no significant differences except for the partial domain of PMS (symptoms of depression and anxiety) and sleep duration. Conclusions: The study was significant in that it demonstrated the importance of lifestyle, which could provide ordinary young adult women with healthy menstruation. The College-based LMP needs to be elaborated with further studies.

Efectividad de intervención basada en modelo de Nola Pender en promoción de estilos de vida saludables de universitarios peruanos / Effectiveness of an Intervention Based on the Nola Pender Model in Promoting Healthy Lifestyles in Peruvian Universities

Introducción: Los estilos de vida saludables previenen enfermedades y optimizan la salud del ser humano, mejor aún en los estudiantes universitarios quienes están vulnerables a cambiar actitudes, rutinas, hábitos y su estilo de vida. Objetivo: Determinar la efectividad de programa basado en modelo de Nola Pender para promover estilos de vida saludables en universitarios peruanos. Métodos: Estudio preexperimental con pretest y postest, en una universidad privada de Tarapoto, Perú, durante 2017. Participaron 869 estudiantes de siete carreras. Para conocer el estilo de vida de los universitarios, se utilizó el PESPS-I de Pender. La intervención tuvo una duración de ocho meses, se consideraron aspectos nutricionales, salud emocional y actividad física. En el análisis estadístico se realizó la prueba no paramétrica Wilcoxon, con nivel de significación de p = 0,05, además de la distribución de frecuencias absolutas, porcentajes, medias, rango promedio y desviación estándar. Resultados: Las medidas del postest fueron superiores a las del pretest demostrando la efectividad del programa para promover los estilos de vida saludables en el ejercicio, la responsabilidad en salud y el manejo del estrés (p < 0,05). Sin embargo, en las dimensiones: nutrición, soporte interpersonal y auto-actualización no se encontraron diferencias significativas (p > 0,05). Conclusiones: El programa para promover los estilos de vida saludables en universitarios peruanos de 16 a 22 años demostró ser efectivo para mejorar el ejercicio, la responsabilidad en salud y el manejo del estrés(AU)

ABSTRACT Introduction: Healthy lifestyles prevent diseases and optimize the health of the human being, even better among university students, who are vulnerable to changing attitudes, routines, habits, and their lifestyle. Objective: To determine the effectiveness of a program based on the Nola Pender model to promote healthy lifestyles in Peruvian university students. Methods: Pre-experimental study with pre-test and post-test, in a private university in Tarapoto, Peru, during 2017. 869 students from seven majors participated. To know the lifestyle of university students, the Pender PESPS-I was used. The intervention lasted eight months. Nutritional aspects, emotional health and physical activity were considered. In the statistical analysis, the non-parametric Wilcoxon test was performed, with a significance level of p=0.05, in addition to the distribution of absolute frequencies, percentages, means, average range and standard deviation. Results: The post-test measures were higher than to those of the pre-test, which demonstrated the effectiveness of the program to promote healthy lifestyles through exercising, health responsibility and stress management (p < 0.05). However, in the dimensions nutrition, interpersonal support and self-update, no significant differences were found (p >0.05). Conclusions: The program to promote healthy lifestyles in Peruvian university students aged 16 to 22 years proved to be effective in improving exercise, health responsibility and stress management(AU)

Hashtag Health: College Health on Social Media and Students' Motivations to Follow, Interact, and Share Their Social Media Content.

Social media are advocated as a prime channel through which to reach college students with health-related information. However, how well are colleges and universities utilizing social media as it was intended-a means to be truly social and not just promotional? Social media can only be effective if students actually follow, interact, and share the content being produced. The following study completed a census of student health center Facebook accounts in the United States as well as investigated students' motivations to follow, interact with, and share health-related content. Facebook pages were found for about 20% of student health centers, and about two thirds posted content within the past 14 days. However, their median number of "likes" was between 191 and 496 despite being in existence for an average of 6 years. Additionally, the majority of these centers' most recent posts were promotional, instead of trying to socially engage with their followers. Students indicated that they would be likely to follow, interact, or share social media content from college health accounts if they were incentivized to do so, if they thought the content could be relevant to them, or if they simply knew that the account existed. Unless more attention is given to growing their followings, resources used by student health organizations to consistently post content might be better placed elsewhere. Recommendations for increasing engagement with students are discussed.

Evaluation and Management of Mental Health Disability in Post-secondary Students.

PURPOSE OF REVIEW: Due to the interdisciplinary nature of mental health disability in post-secondary educational settings, there is limited information available in the general psychiatric literature. This paper aims to familiarize psychiatrists with issues surrounding mental health disability in post-secondary educational settings. In this manuscript, we review critical aspects of the evaluation and management of post-secondary students who may be entitled to academic accommodations as a result of impairment from psychiatric diagnoses. We discuss common misconceptions about mental health impairment and best practices to mitigate its burden. We review relevant legislation and literature from psychiatric, psychological, and higher education journals and include multidisciplinary expert opinions. RECENT FINDINGS: Mental illness is increasingly common in the post-secondary student population. When symptoms are severe, they can lead to academic impairment or disability. Nationwide data suggests an increase in post-secondary students requesting accommodations for mental health-related impairments. Recent guidelines from the American Psychiatric Association and The Jed Foundation aim to familiarize mental health providers, evaluators, administrators, students, and their families with best practices related to evaluating and managing mental health disability in post-secondary educational settings. Evaluating, accommodating, and managing mental health disability during the post-secondary years are complicated processes. Legislation and nuanced evaluations can guide evaluating psychiatrists and administrators in recommending appropriate accommodations. By being knowledgeable about relevant legislation, best practices for evaluations, and available student resources, psychiatrists will be able to collaborate effectively with all stakeholders.

Prevalence and characteristics of universal depression screening in U.S. college health centers.

INTRODUCTION: Whereas universal depression screening has potential to increase identification of mental health concerns among college students, the prevalence of universal screening in college health centers is unknown. This study provides an estimate of the prevalence of universal depression screening at public, 4-year universities in the United States. It also documents systems-level facilitators and correlates of universal screening, as well as reasons for not screening. METHOD: Online cross-sectional survey of college health center directors and student health personnel of public 4-year universities. RESULTS: There were 131 participants who responded to the survey (25% response): 64.2% (54-74%; 95% confidence interval [CI]) of respondents reported that their clinics use universal depression screening. Characteristics associated with universal depression screening use clustered around systems-level resources, including larger student populations and health care staff, greater perceived financial resources, and shorter estimates of time required for screening. Universal screening use was also associated with respondents' awareness of the U.S. Preventive Services Task Force (USPSTF) recommendation, agreement with the evidence base supporting universal depression screening, and beliefs that codified standards support effective care. Leading reasons for not screening included: lack of mental health professionals, provider reluctance, liability concerns, and lack of clinic space. DISCUSSION: Universal depression screening is reasonably common among college health centers. Care planner discussions regarding depression screening initiatives should address resource concerns, awareness of the USPSTF recommendation and evidence base, and information about the average time it takes to screen. Future research should examine functional outcomes and implementation experiences of college health centers that have adopted universal depression screening. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Implementation of the new ILAE classification of epilepsies into clinical practice - A cohort study.

PURPOSE: Appropriate management of patients with epilepsy requires precise classification of their disease. Implementation of the recent International League Against Epilepsy (ILAE) classification of seizures and epilepsies may affect data on the relative proportions of specific types of seizures or epilepsies and should be tested in everyday practice. The aim of the study was to determine the prevalence of specific epilepsy types, syndromes, and etiologies, as defined by the new ILAE classification, in a large cohort of adult patients with epilepsy. MATERIAL AND METHODS: The single-center cohort study involved consecutive adult patients with epilepsy seen at the university epilepsy clinic. Information about medical history, neurological examination, neuroimaging, electroencephalography (EEG), genetic tests, epilepsy treatment, and other investigations was collected from medical records and prospectively updated if necessary. Epilepsy types and etiology, as well as epileptic syndromes, were classified according to the new ILAE classifications. RESULTS: We studied 653 patients (mean age: 37.2 years, 59.9% were women). Epilepsy was classified as focal in 458 cases (70.2%), generalized in 155 subjects (23.7%), or as combined focal and generalized in 11 patients (1.7%). The epilepsy type was labeled as unknown in 29 (4.4%) patients. A definite cause of epilepsy was identified in 59.4% of the cases, with a structural etiology (n = 179, 27.4%) and genetic or presumed genetic etiology (n = 169, 25.9%) being the most common. In 167 (25.5%) patients, specific epilepsy syndromes, mostly genetic generalized epilepsy syndromes, were diagnosed. CONCLUSION: The use of the recent ILAE classification of seizures and epilepsies in the cohort of patients with epilepsy seen in single epilepsy center enabled unequivocal characterization of epilepsy type in >95% of patients. A definite etiology of epilepsy could be established in about 60% of patients.

HIV/AIDS information promotion at the library: creative campaigns for young adults.

BACKGROUND: While rates of new HIV diagnoses have gone down nationally, Florida's HIV-positive population is growing and remains one of the largest in the country. Given this landscape, it is clear that diverse, creative, and collaborative efforts are needed to better inform the public about HIV risks, prevention, and treatment and to encourage healthy behaviors. CASE PRESENTATION: Building on previous work, librarians at the University of Florida engaged in a yearlong project to raise awareness about HIV/AIDS risks, prevention, and treatment among university students and to improve their information-seeking behaviors related to this disease. The "Creative Campaigns" project included 3 distinct elements of activity and engagement, designed to complement one another: a graphic novel contest, a social media campaign, and training for campus health care providers. The contest yielded 4 high-quality submissions, and the month long social media campaign garnered over 50,000 views and utilized Facebook ads to extend beyond the library's typical audience. The instruction proved useful to campus counseling and wellness staff. CONCLUSIONS: Overall, the team considered the project a success in terms of reaching new audiences in new ways, and several of its components have been integrated into subsequent projects and regular operations. Exploring new methods of outreach through social media and creative formats required careful planning and the development of new skill sets amongst project team members but proved to be a rewarding way to generate engagement in the local community.

Introduction to the special issue: The WHO World Mental Health International College Student (WMH-ICS) initiative.

Most mental disorders have their first onset in early adulthood. Epidemiological research, as well as research on preventive and early interventions, is therefore very important. This thematic issue focuses on one of the first systematic attempts to develop such services for college students. The WHO World Mental Health International College Student (WMH-ICS) initiative is based on the largest and continuously growing epidemiological dataset ever collected in college students. Based on these results, the initiative has now started to implement internet-based interventions for common mental disorders and emotional problems. In this special issue, a general paper about the initiative is presented, as well as a paper on the implementation of the WMH-ICS initiative in low and middle income countries. It also includes several papers with core epidemiological results of the initiative, a meta-analysis of internet-based interventions for mental health problems in college students and the first results of trials conducted as part of the initiative. Taken together, the papers in this special issue show that WMH-ICS is on its way to becoming a major initiative in addressing the problem of unmet need for treatment of mental health problems among college students.

Measurement invariance and latent profiles of perfectionism in clients and nonclients.

The current study evaluated measurement invariance of the short Almost Perfect Scale-Revised (SAPS; Rice, Richardson, & Tueller, 2014) between large samples of 1,802 university counseling center clients and 1,040 university students. The clinical sample also completed the Counseling Center Assessment of Psychological Symptoms-62 (CCAPS-62; Locke et al., 2011), permitting tests to evaluate support for latent classes of adaptive, maladaptive, and nonperfectionists observed in other studies. Of particular interest was whether an "adaptive" group of perfectionists can be identified within a psychologically distressed sample of counseling center clients. Measurement invariance tests supported the 2-factor SAPS structure (Standards and Discrepancy) although scalar (intercept) noninvariance was observed. Within- and between-sample replication (similarity) analyses supported a 4-class model of perfectionists and nonperfectionists. Classes were distinguished by differing elevations of the 2 perfectionism factors that showed divergent patterns of psychological problems in the clinical sample. In the 4 classes that emerged in both samples, 1 class was consistent with a higher distress, maladaptive perfectionist group, whereas another class represented a less distressed adaptive perfectionist group. Two nonperfectionistic classes were consistent with groups of clients for whom perfectionistic strivings were not rated as important. As might be expected, there was a substantial difference in the frequencies of membership in the classes within- and between-samples, with proportionally fewer adaptive and more maladaptive perfectionists in the clinical sample than in this and other nonclinical university samples. Results have implications for the use of the SAPS as a screening and treatment planning instrument for use in university counseling centers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Clients' emotional instability and therapists' inferential flexibility predict therapists' session-by-session empathic accuracy.

Clients' emotions often serve as a major focus for therapists' attention. Interestingly, little is known about the factors that facilitate or hinder therapists' accurate assessment of these emotions. We hypothesized that therapists' accuracy would be negatively tied to their clients' emotional fluctuation (i.e., instability) and positively tied to the therapists' own inferential fluctuation (i.e., flexibility) as well as to the clients' emotional intensity. Clients (N = 98/N = 76) received weekly psychodynamic psychotherapy at a university-based clinic. Following each session, clients reported their within-session emotions, and therapists provided their own assessment of their clients' emotions. As expected, when clients' emotions were more unstable, therapists were less accurate in tracking these emotions. Additionally, when therapists' assessments of their clients' emotions were more flexible, they were more accurate in tracking them. Our results help identify factors that predict accurate emotion perception within psychotherapy and may translate into actionable ideas for enhancing this accuracy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Increasing intentions to use mental health services among university students. Results of a pilot randomized controlled trial within the World Health Organization's World Mental Health International College Student Initiative.

BACKGROUND: The majority of university students with mental health problems are untreated. Only a small empirical literature exists on strategies to increase mental health service use. AIMS: To investigate the effects and moderators of a brief acceptance-facilitating intervention on intention to use mental health services among university students. METHOD: Within the German site of the World Health Organization's World Mental Health International College Student (WMH-ICS) initiative, 1,374 university students were randomized to an intervention condition (IC; n = 664) or a control condition (CC; n = 710) that was implemented in the survey itself. Both conditions received the questions assessing mental disorders and suicidality that were included in other WMH-ICS surveys. The IC group then additionally received: Internet-based personalized feedback based on subject symptom severity in the domains of depression, anxiety, substance use, suicidal thoughts and behaviors, and nonsuicidal self-injury; psychoeducation tailored to the personal symptom profile; and information about available university and community mental health services. The primary outcome was reported intention to use psychological interventions in the next semester, which was the last question in the survey. A broad range of potential moderating factors was explored. RESULTS: There was a significant main effect of the intervention with students randomized to IC, reporting significantly higher intentions to seek help in the next semester than students in the CC condition (d = 0.12, 95% CI: 0.02 to 0.23). Moderator analyses indicated that the intervention was more effective among students that fulfilled the criteria for lifetime (d = 0.34; 95% CI: -0.08 to 0.7) and 12-month panic-disorder (d = 0.32; 95% CI: -0.10 to 0.74) compared with those without lifetime (d = 0.11; 95% CI: 0.00 to 0.22) or 12-month panic disorder (d = 0.11; 95% CI: 0.00 to 0.22), students with lower (d = 0.37; 95% CI: -0.77 to 1.51) than higher (d = -0.01; 95% CI: -0.36 to 0.34) self-reported physical health, and students with nonheterosexual (d = 0.38; 95% CI: 0.08 to 0.67) compared with heterosexual (d = 0.06; 95% CI: -0.06 to 0.17) sexual orientation. The intervention had no effects among students who reported that they recognized that they had an emotional problem and "are already working actively to change it" (Stage 4 "stages of change"). CONCLUSIONS: A simple acceptance-facilitating intervention can increase intention to use mental health services, although effects, are on average, small. Future studies should investigate more personalized approaches with interventions tailored to barriers and clinical characteristics of students. In order to optimize intervention effects, the development and evaluation should be realized in designs that are powered to allow incremental value of different intervention components and tailoring strategies to be evaluated, such as in multiphase optimization designs.