Transcript Young Adult Mental Health Issues: With a Little Help from

Depression on the College Campus:
Connections to Stress, Sleep, and Alcohol
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Thomas R. Insel, M.D.
Director, National Institute Mental Health
Bethesda, MD
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Which medical disorder
causes greatest disability?
Percent of total YLDs
Mental Illness*
26.1
Alcohol and drug use
11.5
Respiratory disease
7.6
Musculoskeletal disease
6.8
Sense organ disease
6.4
Cardiovascular disease
5.0
Alzheimer’s and other dementia
4.8
Injuries, including self-inflicted
4.7
Digestive diseases
3.4
Data for United States and Canada
all ages
WHO World Health Report 2002
Causes of Disability by Illness Category
United States and Canada
15-44 years old
Mental Illness*
Alcohol and drug use
Injuries, including self-inflicted
Respiratory disease
Musculoskeletal disease
Sense organ disease
Cardiovascular disease
Migraine
Infectious disease, excluding HIV
0
5
10
15
20
25
30
35
WHO World Health Report 2002
40
Causes of Disability by Specific Illness
United States and Canada
15-44 years old
Unipolar depression
Alcohol use
Drug use
Bipolar disorder
Schizophrenia
Hearing loss
Migraine
Iron deficient anemia
Diabetes mellitus
0
5
10
15
20
25
30
WHO World Health Report 2002
U.S. Prevalence of Major Depression
One year prevalence: 6.6% (13.1 – 14.1 million adults)
Lifetime prevalence: 16.2% (32.6 – 35.1 million adults)
(Severe or very severe role impairment in 59.3%)
51.6% receive health care treatment, but
only 21.7% receive adequate treatment
Kessler et al., JAMA 2003
When does depression start?
Genetic vulnerability
Early loss/trauma/stress
Anxiety in childhood/early adolescence
STRESS
SLEEP DISTURBANCE
Mood Disturbance
Alcohol/Substance Abuse
Co-morbidity with anxiety = 67.8% with Subst. Abuse = 27.1%
How do we treat depression?
Awareness - Screening
Referral - Access
Therapy – Meds/CBT
Follow-up
Treating Depression: Different
Strokes for Different Folks?
Nemeroff et al., PNAS, 2003
Depression Remission: Meds vs Therapy
treatment-specific changes
Paroxetine
F9
th
th
hc
P40
Cg25
+4
-4
CBT
mF9
F9
Cg24
F9
pCg
mF9
mF10
vF hc
hc
Cg24
pCg
F11
Goldapple et al Arch Gen Psych 2003
SSRIs in College Students?
FDA is currently reviewing the risk of suicide
in adolescence on SSRIs:
Is suicide an effect of the disease or the treatment?
What is a greater source of
mortality: suicide or homicide?
Approx 30,000 suicides/year (10.7/100,000)
Deaths from homicide:
AIDS:
Prostate Ca:
18,000/year
20,000/year
28,900/year
Suicide in College Students
Suicides for 15-19 year olds nearly doubled between 1970-1990
Age-related Risk Factors: carry a weapon, drive after drinking,
impulsive/aggressive personality, rarely use seatbelts, depression
Campus Risk Factors: Stress, clusters of suicides, loss of social
support
NOTE: Some studies in general population have estimated a 10-30
fold increase in risk due to availability of firearms (Kellerman et
al., NEJM 1992)
National College Health Risk Behavior Survey (1995)
Percentage in past 12 months:
Seriously
Considered
Made
Plan
Suicide
Attempt
Required
Med. Attn.
Total
10.3
6.7
1.5
0.4
Male
9.7
7.2
1.7
0.5
10.8
6.3
1.3
0.3
Female
Self –report from 4609 students, ages 18-24, in 2 and 4 year colleges.
Higher rate among African American males?
http://www.cdc.gov/mmwr/preview/mmwrhtml/00049859.htm
Suicide on Campus – Big Ten Study
Review of 261 suicides on 12 Midwestern campuses from 1980 – 1990
Overall rate = 7.5/100,000 across 10 year period
Rates of suicide highest in older students:
age <25 age >25
females
3.2
9.4
males
7.9
15.6
Silverman et al., 1997
How do we prevent suicide?
Reducing risk
Increase protective factors
Referral - Screening
Rx/Hospitalization
Follow-up
The National Strategy for Suicide Prevention – U.S. Surgeon General
Safeguarding your students against suicide – NMHA and Jed Found.
Air Force Program to Reduce Suicide
Community awareness and reduction of stigma
(Priority for senior officers, training at all levels, buddy system)
Coordination of social services and social support
(Distributed support in schools, work sites, community facilities)
Focus on high risk situations
(Legal investigations, protections of privacy)
Knox et al., BMJ, 2003
Air Force Program to Reduce Suicide
Knox et al., BMJ, 2003
What can the Air Force Study
teach us about reducing suicide
on college campuses?
Stigma – Top down message that mental
health is part of health
Beliefs – “Real men do seek help” “It
takes courage to change”
Norms – Community-wide investment to
increase protective factors and increase social
support
Summary
Mental disorders are the most disabling medical
illnesses, beginning early in life and usually following
a chronic course.
Depression is common among college-aged
students, often associated with substance abuse.
Depression can be treated successfully.
Suicide risk in college students is increased by
depression and substance abuse, but can occur in the
absence of either.
Suicide can be reduced – “it takes a village”.
Thanks to Drs. Bernie Arons and Jane Pearson
www.nimh.nih.gov