Transcript Graduation - University of Michigan Depression Center

Major Needs of
Students with
Depression:
Supporting
Their
Success
Deborah Megivern, Ph.D.
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
• 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)
Meets diagnostic
criteria
Does not meet
criteria
% Students
Degree
Career
U.S. Census 2002: The Big Payoff
Master's degree (76.1%)
Bachelor's degree (76.7%)
Associate's degree (75%)
Some college (73.9%)
High School (73.1%)
$25,000
$40,000
$55,000
$70,000
Average annual earnings in 1999 dollars
Note. % represents the full-time employment rate of this group
Tinto’s Theoretical Model of College Attrition
PRE-ENTRY
ATTRIBUTES
BACKGROUND
AND
FAMILY
SKILLS
AND
ABILITIES
GOALS/COMMITMENTS
INSTITUTIONAL
EXPERIENCES
INTEGRATION
GOALS/COMMITMENTS
OUTCOME
ACADEMIC SYSTEM
FORMAL
INTENTIONS
GOALS
AND
INSTITUTIONAL
COMMITMENTS
ACADEMIC
PERFORMANCE
INTENTIONS
ACADEMIC
INTEGRATION
FACULTY /
STAFF
INTERACTIONS
GOALS
AND
INSTITUTIONAL
COMMITMENTS
INFORMAL
Mental Health
FORMAL
EXTRACURRICULAR
ACTIVITIES
PRIOR
SCHOOLING
COMPLETION
OR
DEPARTURE
DECISION
SOCIAL
INTEGRATION
PEER GROUP
INTERACTIONS
INFORMAL
EXTERNAL
COMMITMENTS
TIME (T)
SOCIAL SYSTEM
EXTERNAL
COMMITMENTS
EXTERNAL COMMUNITY
Tinto, 1993
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)
Recruitment Methods
⌘ Sites: Two large public Midwestern universities
• University Access Offices (Disability)
N=27
(7.7%)
• Psychology Subject Pool
N=312
(88.9%)
• Mentality
Students with MI = 256
N=12
(3.4%)
Comparison=101
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
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).
Gender
80
70
Men
60
50
Women
40
30
20
10
0
den
u
t
S
MI
/
ts w
on
s
i
r
pa
**Significant X2 at p<.01
m
o
C
Ethnic Composition
of the Sample
80
Students w.
MI
60
Comparison
40
20
0
n
a
i
s
A
ino
t
a
L
n
al
a
i
c
c
i
a
r
e
ltir
m
u
A
M
na
c
i
Afr
ite
h
W
Class Year
45
Students w.
MI
40
35
30
Comparison
25
20
15
10
5
0
ear
Y
t
Firs
ore
m
ho
Sop
ior
n
u
J
ior
n
e
S
Age
20
18
16
14
12
10
8
6
4
2
0
13.5
15.2
19
Age of
Onset
Age of 1st
Treatment
Age
19
11.8
Age (Com) % Onset
during
college
Socioeconomic
Status (Hollingshead Index)
80
Upper
60
Middle
40
Lower
20
0
Stu
nt
e
d
I
M
/
sw
on
s
i
ar
p
m
Co
*Significant X2 at p<.05
Annual
Family Income
100
Upper
(over
$65,000)
80
60
Middle
40
20
0
Stu
nt
e
d
I
M
/
sw
on
s
i
ar
p
m
Co
Lower
(under
$35,000)
*Significant T test at p<.05
Primary Diagnoses
Major
Depression
(76.7%)
Bipolar
Disorder
(8.0%)
Anxiety
Disorder
(9.6%)
Schizophrenia
(0.4%)
PTSD
(0.8%)
Eating
Disorder
(1.6%)
Secondary Diagnoses
N=65 (18%)
Anxiety
Disorder
(32.3%)
Major
Depression
(24.6%)
Eating
Disorder
(30.8%)
Substance
Abuse
(6.2%)
PTSD
(6.2%)
Symptomatology
Brief Symptom Inventory
80
70
60
50
Students w/ MI
40
Comparison
30
20
10
0
70 21
75 26
40
Men
Women
Cutoff
***Significant T test at p<.001
Life Stressors
Health
Social
Family
Financial
Work
Mental Health
Comparison
Students
with MI
0
5
10
15
***Significant T tests at p<.001
Mental Health Beliefs
80
Student Role
60
Part of Identity
40
20
Work Twice as Hard
0
Blocks Plans
Biological
Takes
Medication
0
Beliefs about etiology & treatment
1
2
3
4
Impact of symptoms
Value of
Rx
Negative
life impact
Value of
therapy
Severity
Lead to
Growth
Seek MH
services
2
0
1
2
3
Help-seeking Attitudes
3
4
5
4
Experience of mental illness
Service Utilization
70
60
50
40
30
20
10
0
Counseling Health
Center
Center
Inpatient Psych ER
Working Knowledge
Private Disability Self-help
therapy
Has Utilized
Disability (Access) Services
56%
45%
34%
Willingness to Use
Disability Services
22%
11%
0%
Weak
Identification
Strong
Identification
X2 = 5.918
p < .05
Service Satisfaction
2.96
Counseling Center
Health Center
3.67
Inpatient
3.67
Psych ER
2.42
4.18
Private therapy
4.00
Disability
3.33
Self-help
1
Not at all
Satisfied
2
3
4
5
Very
Satisfied
2. She
approached
her
academic
counselor
for advice.
She was
referred to
a dorm
counselor
1. Student A has
a history of
major depression
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
7. ONE MONTH after
approaching her academic
counselor, she makes a trip
out-of-state to her
hometown to get a
prescription for Prozac
3. She visited
a counselor in
her dorm who
referred her to
the counseling
center
6. She visited
the counseling
center again,
but is referred t
“someone” in
the community
Academic Integration
3.13
Grades
3.20
Academic
Integration
Faculty
Interactions
Total
Integration
0
1
2
3
4
5
Students w MI
Comparison
**Significant T-tests at p<.01,
except grades which is p<.05
Employment Status
70
60
50
40
30
20
10
0
Not working
Working
Stu
nt
e
d
it
w
s
I
M
h
on
s
i
ar
p
m
Co
**Significant X2 at p<.01
Social Integration
300
56
200
52
100
48
0
Students w/ MI
Comparison
Annual Hours Spent in
Extracurricular Activities
5.4
44
Students w/ MI
Comparison
Sense of Belonging/Community
4
5.1
2.5
4.8
4.5
1
Students w/ MI
Comparison
Social Support
Satisfaction Ratings
Students w/ MI
Comparison
Institutional Integration ScalePeer Interactions
***Significant T-tests at p<.001
Disclosure & Stigma
60
52
40
50
20
0
48
Faculty
Peers
Treated Differently after Disclosure
46
45
91.5
30
90
15
Family
Friends
Disclosure to Family and Friends
No
Feels stigma affects their choices
93
88.5
Yes
0
Faculty
Staff
Disclosure to Faculty & Staff
Mental Health Matters
Women
+ Positive

-
Mental Health
Services
High
Psychiatric
Symptom Levels
Indirect
Negative
Nature of
Relationship
Employed
Students
Of
Color
Academic
&
Social
Integration
Service-Related Needs
Preference for informal services
Transition to college
Awareness of services
Multiple service entry points
Service-Related Needs
Coordination
Referral & Follow-up
Outreach
Crisis services
Informational Needs
Psychoeducation
Diagnosis-specific
Navigating the mental health system
Coping and healthy behaviors
Transitioning to campus
Medication information
Insurance information
Cultural Needs
Mental health worldview
Processing life experiences
including discrimination
Personal Needs
Comfort
Economic
Transportation
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
It’s the system, not the service provider
Priorities
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
Benton et al (2003)
Since 1989, the rates of
depression have
doubled and the rates
of suicide have tripled
on one large university
campus
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