Prevention of Depression in the College Student Population a Review of the Literature
Co-ordinate to the fall 2007 American College Health Clan-National College Health Assessment ( 1 ), a national survey of approximately 20,500 college students on 39 campuses, 43.2% of the students reported "feeling so depressed it was hard to office" at least once in the past 12 months. More than 3,200 academy students reported being diagnosed as having depression, with 39.2% of those students diagnosed in the past 12 months, 24.2% currently in therapy for depression, and 35.8% taking antidepressant medication. Among the students surveyed, 10.3% admitted "seriously because attempting suicide" inside the past 12 months and one.ix% actually attempted suicide during that period.
Although the in a higher place data may seem surprising to some, information technology is not to most mental health clinicians and administrators at U.S. colleges. According to the 2008 National Survey of Counseling Center Directors, 95% of respondents believe that there has been a trend in recent years of an increase in the number of students with serious psychological issues. In 2008 an estimated 26% of counseling eye clients were taking psychiatric medication, up from 20% in 2003, 17% in 2000, and 9% in 1994 ( ii ). And although the rate of suicide among college students may have decreased in contempo decades ( 3 ), suicide remains the tertiary leading cause of decease among adolescents and immature adults ( 4 ).
Many college administrators have begun to appreciate the effect that a educatee'south depression tin have on overall functioning in the higher community. Depression has been linked to bookish difficulties besides as interpersonal problems at school, with more severe depression correlated with higher levels of harm ( 5 ). The treatment of depression among college students has been associated with a protective effect on these students' course point averages ( 6 ). In an effort to diagnose and treat early and effectively, and thus decrease the excess morbidity and run a risk of suicide associated with depression, some U.Due south. colleges have even begun to screen students for low in the main intendance setting ( 7 ).
In that location are unique challenges of providing treatment to college students. These challenges include significant academic pressure in semester-based cycles, all-encompassing semester breaks that result in discontinuities of care, and heavy reliance on community supports that tin can be inconsistent. Given the prevalence and impact of depression on college campuses and the varying services offered by university mental health centers throughout the United States, at that place is a meaning need to evaluate successful models of treatment and their related outcomes.
Methods
The databases PsycINFO, MEDLINE, and CINAHL were searched for studies related to depression amongst U.S. higher students and treatment outcome past using the following terms: "depression," "college or university or graduate or junior higher or community college students," "colleges," "customs colleges," "treatment and prevention," "empirical study," and "peer reviewed journal." Initially, no limitation was placed on years included in the search. Eighteen relevant publications were read and analyzed closely for method and content, with detail focus on location and inclusion criteria of study participants. Studies were eliminated if participants were students at colleges outside of the Usa, if the studies did not have specific depression criteria for inclusion, or if the students included were at take a chance of depression simply did not meet criteria for having depression. Nine remaining manufactures were reviewed further, and information technology was decided that the 5 studies published before 1990 had decreased relevance and would be excluded from this review in light of the growing availability of selective serotonin reuptake inhibitor medications since 1990, which substantially changed the treatment of depression amid college students. In addition, the demographic characteristics of U.S. higher students may take changed since the early 1990s, with many college counseling center directors noting a tendency in recent years of an increase in students with serious psychological bug ( two ). Just four articles ( viii , 9 , ten , 11 ) remained for this review of depression and handling outcomes of U.S. college students.
Results
Table 1 summarizes the four studies on depression and treatment outcomes that were reviewed in this study.
Enlarge table
In 2007 Kelly and colleagues ( 8 ) conducted a nonexperimental study that recruited from introductory psychology classes academy students with depression who were not currently in treatment, offering both fiscal bounty and class credit for research involvement. Sixty higher students (66% Caucasian, 57% female) with major depression were followed for nine weeks without any handling to appraise for sudden gains (that is, sharp improvements in depressive symptomatology), remission of depressive symptoms, and reversal of improvements. The authors plant that 60% of the college students with major depression experienced sudden gains over the nine weeks of non receiving treatment. All the same, before the terminate of the nine-calendar week observation period, more than half of these sudden gains reversed. At the terminate of the period of not receiving treatment, depression was in remission for 20% of the students. The authors ended that sudden gains may be part of the natural course of depression for some college students, irrespective of treatment, and that self-evaluation processes may play an important role in recovery.
In 2000 Lara and colleagues ( 9 ) conducted a nonexperimental study in which undergraduate students taking psychology classes who had a recent-onset major depressive episode were paid or received course credit for their inquiry participation. Eighty-four students (51% Caucasian, 86% female) were followed for 26 weeks to assess whether various psychosocial factors predicted the short-term course of major low. The authors institute that inside the 26-week period of no handling, 68% of the college students who were initially depressed recovered. Amidst those who recovered, 21% relapsed by the cease of the 26-week period into another major depressive episode. Lara and colleagues concluded that college students with depression may sometimes spontaneously recover and relapse and that harsh discipline in childhood was significantly associated with higher mean levels of depression at follow-up and relapse but not with recovery.
In 2006 Geisner and colleagues ( 10 ) conducted a four-week randomized controlled trial of low treatment and recruited undergraduates with depression who were enrolled in psychology courses to participate for form credit. The study enrolled 177 students with depression (49% Caucasian and 48% Asian, 70% female) who were randomly assigned either to an intervention grouping that received personalized mailed feedback or to a control group. The authors found that depressive symptoms improved for both the intervention and control groups, simply in the intervention condition there was a significantly greater improvement of depressive symptoms, as measured past the DSM-4-Based Depression Scale. There was no meaning deviation between the intervention and control groups on symptoms measured by the Beck Low Inventory (BDI). Geisner and colleagues concluded that an intervention using personalized mailed feedback may be useful for reducing depressive symptoms amid college students.
In 1993 Stride and Dixon ( xi ) conducted a four- to seven-week randomized controlled trial to assess the treatment effectiveness of individual cerebral therapy for higher students with depressive symptoms. Participating undergraduate students earned course credit for their research involvement. Seventy-four students (100% Caucasian, 81% female) who met strict criteria for report inclusion were randomly assigned to either a group that received individual cognitive therapy or a control condition where participants did not receive treatment and were put on a waiting list for cognitive therapy. Stride and Dixon institute that 74% of participants in the cognitive therapy group (versus 33% in command group) were classified as nondepressed with BDI scores of less than ten subsequently four to seven weeks of handling. At the one-month follow-up, 81% of participants in the cognitive therapy group (versus 64% of command grouping) were classified as nondepressed. Outcomes at both time points were statistically significant in favor of cerebral therapy. The authors ended that brief individual cognitive therapy may finer reduce mild to moderate depressive symptoms as well as depressive cocky-schemata among college students.
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The current body of literature on depression and treatment outcomes among U.S. higher students is sparse, and for the four studies we institute, varying inclusion and exclusion criteria, cess methods, and lengths of treatment make the interpretation of results difficult. Whereas Kelly and colleagues ( 8 ) and Lara and colleagues ( 9 ) used the Structured Clinical Interview for DSM-Four to diagnose participants with major depressive disorder, Geisner and colleagues ( ten ) and Pace and Dixon ( eleven ) used self-report scales to measure depressive symptoms for written report inclusion and Step and Dixon excluded students with severe levels of depressive symptoms. All four studies recruited students who were non seeking treatment and who were offered class credit for participating, a reward that might have influenced the caste of improvement in outcomes. There was no consistent standard used across studies to define a student with depression, even when using the same cess tool. In terms of length of treatment, just two of the 4 reviewed studies followed students for more than 9 weeks. The length of time over which students are assessed is especially critical for the college population, where time is defined by a semester agenda, moods are often influenced by examination schedules, and treatments are adjusted to adapt upcoming vacations ( 12 ). Today's college mental wellness services tend to employ curt-term models of care (eight to sixteen sessions), with referral to exterior clinicians if longer-term treatment is necessary ( 13 ). Given these dynamics, hereafter research in higher mental health volition demand to constitute quality standards for ongoing monitoring and follow-up of students' treatment outcomes.
Unfortunately, the results from these four studies may not be fully applicable to college students today or in the future, particularly in low-cal of the irresolute demographic characteristics of those attending universities as well as the quickly evolving function of pharmacology in the treatment of low. Only 2 of the four studies reviewed offered any agile treatment for low, and none of the studies included any form of pharmacological handling. Consequent with electric current medical literature and best practices, many treatment-seeking college students diagnosed equally having depression currently receive psychotherapy and psychopharmacological treatment ( 1 ). Because major low can be a chronic recurring status, future research needs to evaluate the effectiveness of the various treatment modalities used to treat college students with depression. This is particularly important in low-cal of the recent addition of a black-box warning for the apply of antidepressant medications among young adults aged 18 to 24 years, which recommends the shut monitoring of patients taking antidepressant medication for clinical worsening, suicidality, or unusual changes in beliefs.
Conclusions
In light of the loftier prevalence of depression among college students today and the risks and sequelae this illness poses if not diagnosed and treated early and effectively, it is imperative that research funding be increased for both naturalistic and intervention studies of depression and handling outcomes in the higher health setting. First, research documenting low and treatment outcomes in this cohort should be identified in order to evaluate the adequacy of electric current intendance. Second, research should exist directed to assessing specific brusk-term or semester-based interventions for students with depression. Models that explore the effectiveness of integration with primary care, care management, medication, and brusk-term psychotherapy are all important targets for futurity study. By conducting such enquiry, effective treatment models and benchmarks of treatment outcome in the higher population can be adult and integrated into higher mental health practice.
Acknowledgments and disclosures
The authors thank Michael Klein, Ph.D., for his assist in the evolution of this brief report.
Dr. Chung has served on informational boards for Takeda Pharmaceuticals and Lundbeck Pharmaceuticals and has served as a speaker for Pfizer and Jazz Pharmaceuticals. Dr. Miller reports no competing interests.
References
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Source: https://ps.psychiatryonline.org/doi/10.1176/ps.2009.60.9.1257
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