The Reach, Effectiveness, Adoption, Implementation, and Maintenance of Digital Mental Health Interventions for College Students: A Systematic Review.

PURPOSE OF REVIEW: We evaluated the impact of digital mental health interventions (DMHIs) for college students. We organized findings using the RE-AIM framework to include reach, effectiveness, adoption, implementation, and maintenance. RECENT FINDINGS: We conducted a systematic literature review of recent findings from 2019-2024. Our search identified 2,701 articles, of which 95 met inclusion criteria. In the reach domain, student samples were overwhelmingly female and White. In the effectiveness domain, over 80% of DMHIs were effective or partially effective at reducing their primary outcome. In the adoption domain, studies reported modest uptake for DMHIs. In the implementation and maintenance domains, studies reported high adherence rates to DMHI content. While recruitment methods were commonly reported, adaptations and costs of implementation and maintenance were rarely reported. DMHIs for college students are effective for many psychological outcomes. Future work should address diversifying samples and considering implementation in a variety of college settings.

Intersecting gender identity and racial/ethnic inequities in eating disorder risk factors, symptoms, and diagnosis among U.S. college students: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy.

INTRODUCTION: There are documented inequities in eating disorders (EDs) by gender and race/ethnicity, yet, little is known about population-level prevalence of ED risk factors, symptoms, and diagnosis at the intersection of diverse gender and racial/ethnic identities. METHODS: Data from the Healthy Minds Study 2015-2019 (N = 251,310 U.S. university students) were used in a multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Participants were nested in 35 intersectional strata given by all combinations of 5 gender and 7 racial/ethnic categories. Multilevel logistic models with participants at level 1 and intersectional strata at level 2 were used to estimate stratum-specific predicted prevalence estimates for self-reported thin-ideal internalization, ED symptoms, and ED diagnosis. The variance partition coefficient (VPC) was calculated to quantify the contextual effect of the strata. RESULTS: There was considerable heterogeneity in the predicted prevalence of our ED outcomes across the strata (e.g., .3%-18.3% for ED diagnoses). There were large disparities in all three outcomes, with transgender participants of color having a higher predicted prevalence than expected based on the additive effects of gender and race/ethnicity. Moderation by race/ethnicity was also apparent, such that racial/ethnic disparities were wider within the cisgender groups relative to the transgender groups. VPCs indicated that ~10% of the total variance in ED outcomes was due to intersectionality between gender and race/ethnicity, over and above variance due to individual-level differences. CONCLUSION: Findings suggest that gender and racial/ethnic disparities in EDs are interrelated, underscoring the need to develop preventive interventions centering health equity. PUBLIC SIGNIFICANCE: Despite evidence that sexism, racism, and cissexism (i.e., anti-transgender prejudice) can impact EDs risk, little research examines the social patterning of EDs at the intersection of diverse gender and racial/ethnic identities. Using data from a sample of 250,000 U.S. university students, this study found that gender and racial/ethnic disparities in eating disorder risk are interrelated, highlighting the need to develop health equity centered preventive interventions.

Disparities in eating disorder symptoms and mental healthcare engagement prior to and following the onset of the COVID-19 pandemic: Findings from a national study of US college students.

OBJECTIVE: Early COVID-19 eating disorders (EDs) research used regionally restricted samples with little sociodemographic diversity. The present study aimed to address these research gaps by examining whether pandemic-related changes in ED symptoms and mental healthcare prevalence differed for historically marginalized groups within a national sample of US college students. METHOD: Participants included 242,906 US college students (Mage  = 23.45, SD = 7.04; MBMI  = 25.28, SD = 5.91) who completed the repeated cross-sectional multi-institute Healthy Minds Study between January 2019 and May 2021. Moderated logistic regressions examined whether pandemic-related changes in individuals' likelihoods of exhibiting current probable ED, reporting lifetime ED diagnoses, and-among individuals with current probable ED-mental healthcare engagement differed for diverse gender, sexual, and racial/ethnic identity groups, and by body mass index (BMI) and financial stress. RESULTS: There were increases of 5% and 12% in individuals' likelihoods of exhibiting current probable ED and symptomatic individuals' mental healthcare engagement, respectively, pre- to post-COVID-19 onset, but no pandemic-related changes in lifetime ED diagnosis prevalence. There were also important variations in these time-trends for different marginalized groups. For example, individuals identifying as genderqueer/gender nonconforming and lesbian exhibited increasing ED symptoms pre- to post-COVID-19 onset, and individuals with current probable ED and higher BMIs were increasingly likely to receive mental healthcare. Associations between financial stress, and the ED and mental healthcare outcomes did not change over time. DISCUSSION: These findings provide insight into groups of US college students that experienced disproportionate ED burden during the pandemic at the population level, and directions for research and interventions that warrant consideration.

Preferred treatment focus among college students with eating disorders and comorbid mental health problems in a digital cognitive-behavioral guided self-help program.

OBJECTIVE: To examine the mental health problems that college students with eating disorders (EDs) and comorbid depression and/or anxiety disorders preferred to target first in a digital treatment program and explore correlates of preferred treatment focus. METHODS: Four hundred and eighty nine college student users of a digital cognitive-behavioral guided self-help program targeting common mental health problems (76.7% female, Mage = 20.4 ± 4.4, 64.8% White) screened positive for an ED and ≥one other clinical mental health problem (i.e., depression, generalized anxiety disorder, social phobia, and/or panic disorder). Students also reported on insomnia, post-traumatic stress, alcohol use, and suicide risk. Before treatment, they indicated the mental health problem that they preferred to target first in treatment. Preferred treatment focus was characterized by diagnostic profile (i.e., ED + Depression, ED + Anxiety, ED + Depression + Anxiety), symptom severity, and demographics. RESULTS: 58% of students with ED + Anxiety, 47% of those with ED + Depression, and 27% of those with ED + Depression + Anxiety chose to target EDs first. Across diagnostic profiles, those who chose to target EDs first had more severe ED symptoms than those who chose to target anxiety or depression (ps < .05). Among students with ED + Depression + Anxiety, those who chose to target EDs first had lower depression symptoms than those who chose to target depression, lower generalized anxiety than those who chose to target anxiety, and lower suicidality than those who chose to target anxiety or depression (ps < .01). CONCLUSIONS: Students with EDs and comorbid depression and/or anxiety disorders showed variable preferred treatment focus across diagnostic profiles. Research should explore specific symptom presentations associated with preferred treatment focus. PUBLIC SIGNIFICANCE: Findings indicate that a sizable percentage of college students with depression/anxiety who also have EDs prefer to target EDs first in treatment, highlighting the importance of increasing availability of ED interventions to college students. Students with EDs and comorbid depression and/or anxiety disorders showed variable preferred treatment focus across diagnostic profiles, and preference to target EDs was associated with greater ED psychopathology across diagnostic profiles.

Changes in the prevalence and sociodemographic correlates of eating disorder symptoms from 2013 to 2020 among a large national sample of U.S. young adults: A repeated cross-sectional study.

OBJECTIVE: The present study aimed to: (1) identify recent temporal changes in the prevalence of different cognitive and behavioral eating disorder (ED) symptoms, current probable EDs, lifetime ED diagnoses, and mental healthcare use among college students across the United States; (2) determine whether established disparities in ED prevalence and receiving mental healthcare have widened or narrowed over time for marginalized groups within this population. METHOD: Participants included a large national sample of U.S. college students (N = 286,720) who completed the repeated cross-sectional Healthy Minds Study from 2013 to 2020. Descriptive statistics and polynomial regressions quantified time-trends in participants' ED symptoms and past 12-month mental healthcare. Moderated regressions examined temporal changes in ED symptoms and mental healthcare based on sociodemographic characteristics. RESULTS: Individuals' engagement in different cognitive and behavioral ED symptoms, and likelihoods of exhibiting current probable EDs, reporting lifetime ED diagnoses, and (for individuals with current probable EDs) receiving therapy or counseling in the past 12-months exhibited nonlinear increases from 2013 to 2020. Further, the prevalence of current and lifetime ED symptoms and (for symptomatic individuals) past 12-month mental healthcare differed over time for individuals with different BMIs and gender, sexual, and racial/ethnic identities (but not ages). In particular, individuals with higher BMIs and those who identified as male, bisexual, and gay, lesbian, or queer exhibited increasing ED pathology over time. DISCUSSION: These findings provide important information on groups of U.S. college students that have experienced increasing burden of ED symptoms and may help guide ED prevention, treatment, and research priorities. PUBLIC SIGNIFICANCE: Recent temporal changes in the prevalence of eating disorder (ED) symptoms and mental healthcare were examined in a national sample of U.S. young adults. Non-linear increases in ED symptoms and mental healthcare were identified among U.S. young adults overall from 2013 to 2020. U.S. young adults with higher BMIs, males, bisexual, and gay, lesbian, or queer individuals exhibited increasing ED burden over time.

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.

Online Methods in Adolescent Self-Injury Research: Challenges and Recommendations.

Online methods hold promise as effective research tools for adolescent psychopathology research. Such methods may be the most effective way to reach large, representative samples of adolescents and harder-to-reach populations. They also may increase adolescent disclosure of risky behaviors, reduce recruitment costs, and increase the cost and time efficiency of recruitment. Despite these advantages, researchers may be concerned about including measures assessing risky behaviors, like suicidal thoughts and behaviors and nonsuicidal self-injury, in online studies of youth. In addition, parental consent in online studies is impractical and difficult to obtain. Concerns also include potential iatrogenic effects, sample bias, and data quality issues. This review discusses the benefits and challenges for online adolescent self-injury research, proposes strategies to overcome barriers, and provides examples and recommendations for future research.

Machine learning enhances prediction of illness course: a longitudinal study in eating disorders.

BACKGROUND: Psychiatric disorders, including eating disorders (EDs), have clinical outcomes that range widely in severity and chronicity. The ability to predict such outcomes is extremely limited. Machine-learning (ML) approaches that model complexity may optimize the prediction of multifaceted psychiatric behaviors. However, the investigations of many psychiatric concerns have not capitalized on ML to improve prognosis. This study conducted the first comparison of an ML approach (elastic net regularized logistic regression) to traditional regression to longitudinally predict ED outcomes. METHODS: Females with heterogeneous ED diagnoses completed demographic and psychiatric assessments at baseline (n = 415) and Year 1 (n = 320) and 2 (n = 277) follow-ups. Elastic net and traditional logistic regression models comprising the same baseline variables were compared in ability to longitudinally predict ED diagnosis, binge eating, compensatory behavior, and underweight BMI at Years 1 and 2. RESULTS: Elastic net models had higher accuracy for all outcomes at Years 1 and 2 [average Area Under the Receiving Operating Characteristics Curve (AUC) = 0.78] compared to logistic regression (average AUC = 0.67). Model performance did not deteriorate when the most important predictor was removed or an alternative ML algorithm (random forests) was applied. Baseline ED (e.g. diagnosis), psychiatric (e.g. hospitalization), and demographic (e.g. ethnicity) characteristics emerged as important predictors in exploratory predictor importance analyses. CONCLUSIONS: ML algorithms can enhance the prediction of ED symptoms for 2 years and may identify important risk markers. The superior accuracy of ML for predicting complex outcomes suggests that these approaches may ultimately aid in advancing precision medicine for serious psychiatric disorders.

Relationships between patterns of weight-related self-monitoring and eating disorder symptomology among undergraduate and graduate students.

OBJECTIVE: To characterize patterns of weight-related self-monitoring (WRSM) among US undergraduate and graduate students and examine associations between identified patterns of WRSM and eating disorder symptomology. METHOD: Undergraduate and graduate students from 12 US colleges and universities (N = 10,010) reported the frequency with which they use WRSM, including self-weighing and dietary self-monitoring. Eating disorder symptomology was assessed using the Eating Disorder Examination Questionnaire. Gender-specific patterns of WRSM were identified using latent class analysis, and logistic regressions were used to identify differences in the odds of eating disorder symptomology across patterns of WRSM. RESULTS: Among this sample, 32.7% weighed themselves regularly; 44.1% reported knowing the nutrition facts of the foods they ate; 33.6% reported knowing the caloric content of the foods they ate; and 12.8% counted the calories they ate. Among women, four patterns of WRSM were identified: "no WRSM," "all forms of WRSM," "knowing nutrition/calorie facts," and "self-weigh only." Compared with the "no WRSM" pattern, women in all other patterns experienced increased eating disorder symptomology. Among men, three patterns were identified: "no WRSM," "all forms of WRSM," and "knowing nutrition/calorie facts." Only men in the "all forms WRSM" pattern had increased eating disorder symptomatology compared with those in the "no WRSM" pattern. DISCUSSION: In a large sample of undergraduate and graduate students, engaging in any WRSM was associated with increased eating disorder symptomology among women, particularly for those who engaged in all forms. Among men, engaging in all forms of WRSM was the only pattern associated with higher eating disorder symptomology.

Dietary restraint patterns and eating disorder help-seeking.

OBJECTIVE: Determine whether gender differences exist in associations among central barriers to and facilitators of eating disorder (ED) help-seeking-ED stigma, negative affect, perceived ED treatment need-as a function of individuals' probability of classification within empirically derived groups characterized by different dietary restraint patterns. METHOD: As part of the cross-sectional, multi-institute Healthy Bodies Study, women (n = 2215) and men (n = 986) attending three colleges and universities in 2015 completed measures of ED symptoms, affect, and ED help-seeking in an online survey. Structural equation mixture modeling was used to (1) classify women and men, separately, into distinct classes characterized by unique dietary restraint patterns and (2) test associations among the three ED help-seeking barriers and facilitators within each class. RESULTS: Five dietary restraint symptoms (food amount limiting attempts, fasting, food avoidance, following food/diet rules, desiring an empty stomach) clustered within four classes among women and three classes among men, which were characterized by qualitative and quantitative similarities and differences. Further, opposite patterns were generally found in associations among the ED help-seeking barriers and facilitators for women versus men as a function of the way dietary restraint symptoms clustered within each class. For example, bivariate associations between worse ED stigma and negative affect relative to greater perceived ED treatment need were both significant only among women in their lowest restraint severity class, whereas these associations were both significant among men in their highest severity class. DISCUSSION: These findings can help to increase the reach of ED intervention efforts, including increasing ED help-seeking rates. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Objective Sensory Testing Methods Reveal a Higher Prevalence of Olfactory Loss in COVID-19-Positive Patients Compared to Subjective Methods: A Systematic Review and Meta-Analysis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has currently infected over 6.5 million people worldwide. In response to the pandemic, numerous studies have tried to identify the causes and symptoms of the disease. Emerging evidence supports recently acquired anosmia (complete loss of smell) and hyposmia (partial loss of smell) as symptoms of COVID-19, but studies of olfactory dysfunction show a wide range of prevalence from 5% to 98%. We undertook a search of Pubmed/Medline and Google Scholar with the keywords "COVID-19," "smell," and/or "olfaction." We included any study that quantified smell loss (anosmia and hyposmia) as a symptom of COVID-19. Studies were grouped and compared based on the type of method used to measure smell loss-subjective measures, such as self-reported smell loss, versus objective measures using rated stimuli-to determine if prevalence differed by method type. For each study, 95% confidence intervals (CIs) were calculated from point estimates of olfactory disturbances. We identified 34 articles quantifying anosmia as a symptom of COVID-19 (6 objective and 28 subjective), collected from cases identified from January 16 to April 30, 2020. The pooled prevalence estimate of smell loss was 77% when assessed through objective measurements (95% CI of 61.4-89.2%) and 44% with subjective measurements (95% CI of 32.2-57.0%). Objective measures are a more sensitive method to identify smell loss as a result of infection with SARS-CoV-2; the use of subjective measures, while expedient during the early stages of the pandemic, underestimates the true prevalence of smell loss.

Understanding suicide risk and eating disorders in college student populations: Results from a National Study.

OBJECTIVE: To examine suicide risk by eating disorder severity and symptom presentation in a nationwide sample of college students. METHOD: The Healthy Minds Study is the largest mental health survey of college populations in the United States. We analyzed the most recent available data (2015-2017) with 71,712 randomly selected students from 77 campuses. We estimated associations between two measures of suicidality (ideation and attempts) and three validated measures of eating disorder symptoms (the SCOFF, weight concerns scale, and the eating disorder examination questionnaire binge and purge items). Importantly, we also controlled for co-occurring symptoms of depression and anxiety, based on validated screening tools. The large, diverse sample provided a unique opportunity to assess whether certain individual characteristics were associated with increased risk. RESULTS: Eating disorder symptoms, even at subthreshold levels, were highly predictive of suicidality. Relative to students with no apparent eating disorder symptoms, students with the highest symptom levels (a SCOFF score of 5) had 11 times higher odds of attempting suicide, while those with subthreshold symptoms had two times higher odds. We also observed a strong association between suicide attempts and eating disorder presentations that included purging. Students from marginalized backgrounds, particularly gender and sexual minorities, were at increased risk for suicide and eating disorders. DISCUSSION: In the largest known study to date, findings suggest that eating disorders should be a priority within broader campus suicide prevention efforts, should be assessed along a continuum of severity and symptom presentation, and should focus on reaching vulnerable students.

Why I recovered: A qualitative investigation of factors promoting motivation for eating disorder recovery.

OBJECTIVE: It is difficult for individuals with eating disorders (EDs) to build and maintain motivation to recover. This challenge contributes to high rates of treatment dropout and relapse. To date, motivational interventions have been largely ineffective, and there is little research on factors that affect recovery motivation. To better understand recovery motivation and identify potential intervention targets, this study examines factors that affect recovery motivation in individuals with EDs. METHOD: N = 13 participants completed qualitative interviews. All had been recovered from their diagnosed and treated ED for at least 1 year. We applied thematic analysis to interview transcripts in order to identify factors that had influenced recovery motivation and to classify their effects as helpful, harmful, or mixed. RESULTS: Six main themes were identified, with subthemes detailed under each: (a) important people and groups (e.g., social circle, mentor), (b) actions and attitudes of others (e.g., judgmental responses, failure to intervene), (c) treatment-related factors (e.g., therapeutic skills, therapeutic alliance), (d) influential circumstances (e.g., removing triggers, pregnancy/children), (e) personal feelings and beliefs (e.g., obligation to others, hope for the future), and (f) the role of epiphanies (i.e., sudden insights or moments of change). DISCUSSION: In this study, we identified potentially malleable factors that may affect ED recovery motivation (e.g., removing triggers, focusing on obligation to others, getting involved in meaningful causes, securing non-judgmental support, building hope for the future). These factors may be investigated as potential targets or strategies in motivational interventions for EDs.

Disparities in eating disorder risk and diagnosis among sexual minority college students: Findings from the national Healthy Minds Study.

OBJECTIVE: To examine differences in eating disorder (ED) risk and diagnosis by sexual orientation in a national sample of college students. METHOD: Data from 178 U.S. colleges and universities participating in the Healthy Minds Study between 2016 and 2019 were analyzed (36,691 cisgender men, 81,730 cisgender women; 15.7% self-identifying as sexual minorities). Outcomes were ED risk (≥2 on the SCOFF) and self-reported lifetime ED diagnosis. Prevalence estimates adjusted for demographics and weight status were computed via logistic regression. RESULTS: Higher proportions of questioning (29.1%), bisexual (26.3%), and gay men (30.9%) exhibited elevated risk than heterosexual men (14.3%), and a higher proportion of gay men exhibited elevated risk than bisexual men. Higher proportions of questioning (34.5%) and bisexual women (34.6%) exhibited elevated risk than heterosexual women (27.6%); proportions of lesbian (28.1%) and heterosexual women were similar. Among those with elevated risk, higher proportions of bisexual (5.0%) and gay men (7.1%) and of questioning (14.7%), bisexual (18.1%), and lesbian women (19.6%) had been diagnosed relative to heterosexual men (2.0%) and heterosexual women (10.3%), respectively. DISCUSSION: Questioning and bisexual individuals appear to be particularly vulnerable; they may experience elevated ED risk relative to their heterosexual peers yet underdiagnosis relative to their gay or lesbian peers.

Examining vegetarianism, weight motivations, and eating disorder psychopathology among college students.

OBJECTIVE: Previous research has suggested a link between vegetarianism, broadly defined, and symptoms of eating disorders (ED). However, the literature supporting this link is mixed and limited by possible measurement artifacts. Using data from a national sample of college students, the present study examines ED symptomatology among three groups: (a) vegetarians whose meat avoidance is motivated by weight concerns; (b) non-weight motivated vegetarians; and (c) nonvegetarians. METHOD: Participants include 9,910 students from 12 colleges and universities across the United States who participated in the web-based Healthy Bodies Study. ED symptomatology was measured using the Short-Eating Disorder Examination-Questionnaire (S-EDE-Q). First, multi-group confirmatory factor analysis was conducted to test measurement invariance (MI) of the S-EDE-Q across weight-motivated vegetarians, non-weight-motivated vegetarians, and nonvegetarians. Gender- and BMI-adjusted ANCOVA was used to compare S-EDE-Q scores across groups. RESULTS: 9.3% of participants were vegetarian. Cis-women and gender minority students were more likely to be vegetarian; those who became vegetarians after entering college were more likely to report weight-related motivations. Strict MI was supported for the S-EDE-Q global and subscale scores. Weight-motivated vegetarians reported higher levels of restraint, shape/weight overvaluation, body dissatisfaction, and global ED psychopathology relative to other participants. DISCUSSION: To our knowledge, this is the first to explicitly link weight motivations for vegetarianism to ED psychopathology in a large, representative sample of young adults. Results suggest that students presenting with ED symptoms should be assessed for their motivations for adopting a vegetarian diet, and this information should be considered in treatment decisions.

Development and Validation of the Eating Disorders Screen for Athletes (EDSA): A Brief Screening Tool for Male and Female Athletes.

OBJECTIVES: To develop and validate the Eating Disorders Screen for Athletes (EDSA), a brief eating disorders screening tool for use in both male and female athletes. METHODS: Data from Division I athletes at a Midwestern university (N=434) were used to conduct exploratory factor analysis (EFA) by gender. Data from athletes competing at various levels at universities across the United States (N=862) were then used to conduct confirmatory factor analysis (CFA) and receiver operator characteristic (ROC) curve analysis by gender. Athletes from a range of lean and non-lean sports were included. Gender-specific empirically derived cut-offs on the Eating Disorder Examination-Questionnaire were used to classify high eating disorder risk for ROC curve analysis. Measurement invariance by gender, level of competition, and sport type was also examined. RESULTS: A six-item, one-factor structure for the EDSA was supported by EFA and CFA in both genders, and internal consistency was good for both male (α=. 80) and female athletes (α=.86). ROC curve analyses indicated that the EDSA was highly accurate in predicting eating disorder risk status and identified a score of 3.33 as the optimal cut-off for both male (sensitivity=.96, specificity=.80) and female athletes (sensitivity=.96, specificity=.64). Results also supported strong measurement invariance for the EDSA by gender, level of competition (Division I versus club), and sport type (lean versus non-lean). CONCLUSIONS: The EDSA shows promise as a brief screening tool to identify male and female athletes at risk for eating disorders.

Be True to Our Schools-Models of Care in College Mental Health.

PURPOSE OF REVIEW: To review and synthesize the previous, current, and proposed models of care in college mental health in order to identify best practices that will address the mental health needs of today's students. To highlight data that supports existing or proposed models and describe areas where more data is needed. RECENT FINDINGS: Despite the potentially appealing attributes of integrated care, empirical evidence supporting these systems and structures in campus settings is mixed. Recent surveys show less than half of campuses have an integrated mental health care model. Overall, there is only partial consensus on optimal models of campus mental health care. Mental health needs in college student populations are greater and more complex than ever. While the resources available are vast and varied, there is limited evidence to support which models and programs can best meet students' needs.

Mental health and academic attitudes and expectations in university populations: results from the healthy minds study.

BACKGROUND: Mental health problems are highly prevalent in university populations and have been shown to impair academic performance. Yet little is known about the ways in which mental health influences academic outcomes in higher education. AIMS: This study seeks to offer new insight into the relationship between mental health and academic performance, focusing on students' academic experience and expectations as interrelated mechanisms. METHOD: Data come from 3556 students at four campuses that participated in the Healthy Minds Study. We explore unadjusted and multivariable relationships between mental health and academic experiences, expectations and impairment. RESULTS: We find significant differences by mental health status, including that one-in-four students with symptoms are dissatisfied with their academic experience, relative to one-in-ten without (p < 0.001). Approximately 30% with symptoms doubt whether higher education is worth their time, money and effort, compared to 15% without (p < 0.001). In multivariable models, mental health problems were a significant predictor of academic dissatisfaction and drop out intentions, while positive mental health was a significant predictor of satisfaction and persistence. CONCLUSIONS: This descriptive study offers further evidence of the importance of mental health for university success, identifying pathways related to students' experiences and expectations that may help to explain this relationship.

A comprehensive review of mental health gatekeeper-trainings for adolescents and young adults.

Mental disorders account for a larger burden of disease among adolescents and young adults than any other class of health conditions, and most of these disorders are untreated. Gatekeeper-trainings represent a potentially powerful mechanism for increasing access to treatment. This article is a comprehensive review of 21 gatekeeper-training studies conducted in schools and other youth settings around the world. Despite the widespread use of these programs, little is known about how they actually affect the abilities and actions of trained gatekeepers and the subsequent help-seeking behaviors of adolescents and young adults. Certain outcomes (knowledge, attitudes, and self-efficacy) have been commonly measured whereas others (behaviors, skills, and population-level outcomes) have rarely been assessed. The studies reviewed here also suggest that positive training effects often diminish over time. The article identifies opportunities for advancing gatekeeper-training research and practice.

Interventions to increase naloxone access for undergraduate students: A systematic review of the literature.

OBJECTIVE: To identify and describe interventions that increase access to naloxone for undergraduate students. METHODS: A systematic review across 4 databases identified interventions that expand access to naloxone at colleges in the United States from 2015-2023. Three reviewers extracted the following data to create a narrative synthesis and summary of program elements: setting, rationale for intervention, timeline, intervention components, study size, collaboration, sustainability, outcomes and results. RESULTS: Seven articles met inclusion criteria. Institutions' implemented naloxone interventions due to concerns for student safety and/or student overdose fatalities. Three universities collaborated with their School of Pharmacy for program design and/or dissemination, while two partnered with state-based naloxone distribution programs. Most programs combined opioid-overdose/naloxone training; four distributed naloxone kits. Three studies included pre/post-outcomes, and all reported increases in participant knowledge, attitudes, and/or ability to respond to an overdose. CONCLUSIONS: Our results indicates an opportunity for wide-scale implementation of undergraduate naloxone programs within US colleges. However, more rigorous implementation research is needed to identify barriers and facilitators to program feasibility, acceptability, and participation.