Major Needs of Students with Depression:

1
Major Needs of Students with Depression
Supporting Their Success

• Deborah Megivern, Ph.D.

2
Acknowledgements

• Faculty committee Dr. Carol Mowbray (chair), Dr.
  Susan Nolen-Hoeksema, Dr. Lorraine Gutierrez, Dr.
  Robert Ortega, and Dr. Enola Proctor
• National Institute of Mental Health (Grant
  RO3-MH61633-01)
• Numerous undergraduate research assistants from U
  of M
• Michigan State-Resource Center for Persons with
  Disabilities
• University of Michigan Psychology Department and
  University of Michigan School of Social Work
• University of Michigan Counseling Center and the
  Services for Students with Disabilities Office
• American Psychological Foundation-Todd Husted
  Award

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• Young adulthood represents a high risk
  developmental stage for the onset of psychiatric
  symptoms
• Approximately 37 of
• 15-24 year olds have a diagnosable MI
• (Kessler et. al, 1994)

Degree Career
4
U.S. Census 2002 The Big Payoff
Average annual earnings in 1999 dollars
Note. represents the full-time employment rate
of this group
5
Tintos Theoretical Model of College Attrition
PRE-ENTRY GOALS/COMMITMENTS
INSTITUTIONAL INTEGRATION
GOALS/COMMITMENTS OUTCOME ATTRIBUTES

EXPERIENCES
ACADEMIC SYSTEM
FORMAL
BACKGROUND AND FAMILY
ACADEMIC PERFORMANCE
INTENTIONS
INTENTIONS
ACADEMIC INTEGRATION
FACULTY / STAFF INTERACTIONS
GOALS AND INSTITUTIONAL COMMITMENTS
GOALS AND INSTITUTIONAL COMMITMENTS
SKILLS AND ABILITIES
INFORMAL
Mental Health
FORMAL
COMPLETION OR DEPARTURE DECISION
EXTRA- CURRICULAR ACTIVITIES
SOCIAL INTEGRATION
PRIOR SCHOOLING
PEER GROUP INTERACTIONS
INFORMAL
EXTERNAL COMMITMENTS
EXTERNAL COMMITMENTS
SOCIAL SYSTEM
EXTERNAL COMMUNITY
TIME (T)
Tinto, 1993
6
Mental Health and College Attrition

• Johnson Buck (1995) found 50 of students
  leaving college in good academic standing cited
  personal problems as the reason
• Estimates of the number of people who prematurely
  discontinue pursuit of educational goals --due to
  psychiatric illness--exceed 7.2 million (Kessler
  et al., 1995), and this is associated with
  unemployment or underemployment (Collins, 2000)
• The utility of mental health services for
  preventing college dropout is debated, but may be
  positive (Wilson et al, 1997)

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Recruitment Methods

• Sites Two large public Midwestern universities
• University Access Offices (Disability)
• Psychology Subject Pool
• Mentality

N27 (7.7)
N312 (88.9)
N12 (3.4)
Students with MI 256 Comparison101
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Study Methods

• Study respondents were interviewed for 1 ½ to 2
  hours

• Semi-structured interview questions focused on
• educational goals
• how mental health affects academic / social life
• life stressors
• experiences with mental illness illness
  management
• mental health services utilization and evaluation
• reactions of social network to mental illness

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Research Measures

• Collegiate Psychological Sense of Community-15
  items (Lounsbury Deneui, 1996).
• Social Support Questionnaire-Short Form-6 items
  (Sarason, Sarason, Shearin, Pierce, 1987).
• Brief Symptom Inventory BSI-52 items (Derogotis
  Melisarotos, 1983).
• Institutional Integration Scale-34 items
  (Pascarella Terenzini, 1980).

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Gender
Significant X2 at plt.01
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Ethnic Composition of the Sample
12
Ethnic Composition of the Sample
13
Class Year
of Students
14
Age
Mean Age
15
Socioeconomic Status (Hollingshead Index)
Significant X2 at plt.05
16
Annual Family Income
Significant T test at plt.05
17
Primary Diagnoses
Major Depression (76.7)
Bipolar Disorder (8.0)
Anxiety Disorder (9.6)
Eating Disorder (1.6)
Schizophrenia (0.4)
PTSD (0.8)
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Secondary Diagnoses N65 (18)
Anxiety Disorder (32.3)
Eating Disorder (30.8)
PTSD (6.2)
Major Depression (24.6)
Substance Abuse (6.2)
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Symptomatology
Brief Symptom Inventory
26
40
70
21
75
Significant T test at plt.001
20
Life Stressors
Significant T tests at plt.001
21
Mental Health Beliefs
Beliefs about etiology treatment
Impact of symptoms
Experience of mental illness
Help-seeking Attitudes
22
Service Utilization
of Sample
23
Disability (Access) Services
X2 5.918 p lt .05
24
Service Satisfaction
Not at all Satisfied
Very Satisfied
25
1. Student A has a history of major depression
2. She approached her academic counselor for
advice. She was referred to a dorm counselor
4. Completed counseling center paperwork and was
given an appt. for 3 weeks later
5. Too depressed to wait, she goes to the health
service, but she needs a referral to see the
psychiatrist
6. She visited the counseling center again, but
is referred to someone in the community
3. She visited a counselor in her dorm who
referred her to the counseling center
7. ONE MONTH after approaching her academic
counselor, she makes a trip out-of-state to her
hometown to get a prescription for Prozac
26
Academic Integration
3.13
3.20
Significant T-tests at plt.01, except grades
which is plt.05
27
Employment Status
Significant X2 at plt.01
28
Social Integration
Annual Hours Spent in Extracurricular Activities
Sense of Belonging/Community
Social Support Satisfaction Ratings
Institutional Integration Scale-Peer Interactions
Significant T-tests at plt.001
29
Disclosure Stigma
Treated Differently after Disclosure
Feels stigma affects their choices
Disclosure to Faculty Staff
Disclosure to Family and Friends
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Mental Health Matters
Students Of Color
Women
Mental Health Services
High Psychiatric Symptom Levels

Positive
Academic Social Integration
?
Indirect
Employed
-
Negative
Nature of Relationship
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Service-Related Needs

• Preference for informal services
• Transition to college
• Awareness of services
• Multiple service entry points

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Service-Related Needs

• Coordination
• Referral Follow-up
• Outreach
• Crisis services

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Informational Needs

• Psychoeducation
• Diagnosis-specific
• Navigating the mental health system
• Coping and healthy behaviors
• Transitioning to campus
• Medication information
• Insurance information

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Cultural Needs

• Mental health worldview
• Processing life experiences including
  discrimination

35
Personal Needs

• Comfort
• Economic
• Transportation

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Important Notes

• This is NOT a representative sample. The results
  cannot be generalized beyond the sample.
• This research was a preliminary work, and all
  conclusions require further research
• Its the system, not the service provider

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Priorities

• Benton et al (2003)
• Since 1989, the rates of depression have doubled
  and the rates of suicide have tripled on one
  large university campus

• Keeling (2002)
• More money is invested in vaccinating against
  meningitis than on mental health despite the fact
  that students are 12 to 15 times more likely to
  commit suicide than die of the bacteria

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Future Directions

• Planned analysis of follow-up data
• Plans for collaborative research that is
  representational, longitudinal, and includes a
  diagnostic protocol to obtain updated
  epidemiological estimates of serious mental
  illness on campus
• Needs assessment with faculty and staff coupled
  with intervention research utilizing models like
  those implemented in California, Louisiana, and
  New York

Thank you!