Bipolar disorder and the college student: A review and implications for universities

Abstract

Objective: This brief report provides a review of the prevalence and expression of bipolar disorder in the college student population. Implications for college teachers and universities working with students with bipolar disorder are presented. Methods: Responses from the National College Health Assessment (2009–2017) reference groups were collated to estimate whether the prevalence of students with bipolar disorder has been increasing over time. Results: Data indicate that although overall prevalence is low, the presence of students with bipolar disorder has increased over the past decade. Conclusions: To help students with serious mental illness, including bipolar disorder, succeed in higher education, practices consistent with the philosophy of supported education should be adopted. Special attention will need to be paid to students’ financial and academic challenges.     

Pilot study of a personality-based approach to assessing eating disorder and Obsessive Compulsive Disorder symptom risk in college men and women

Abstract

Objective: To conduct a pilot test of the validity of using empirically derived personality types to characterize eating disorder (ED) risk in college students and resolve discrepancies regarding the role of perfectionism and obsessive-compulsive disorder (OCD) symptoms.

Participants: Man and woman undergraduate students (N?=?169) at a small, private university. Data were collected from February to May 2016 and 2018. Methods: Participants completed self-report measures of personality (perfectionism, impulsivity, and effortful control) and psychopathology (EDs, OCD). Results: Our analyses replicated three validated personality types: overcontrolled, undercontrolled, and resilient. Analysis of variances demonstrated perfectionism, ED, and OCD symptoms were significantly elevated in the overcontrolled subtype. There was no interaction by sex. Conclusions: These findings suggest that personality types may be useful for classifying ED risk and OCD symptoms in college students across sexes. Further study and relevance to prevention and intervention efforts to reduce the burden of EDs on college campuses will be discussed.     

Implementing a college mental health program – an overview of the first twelve months

Objective: To evaluate the demographics and clinical utilization patterns among college students during the initial 12 months of a novel, multi-disciplinary, collaborative, college mental health program (CMHP). Participants: Undergraduate and graduate students receiving treatment at the CMHP from Jan-Dec 2015. Methods: De-identified data was obtained via electronic health records for all students receiving care through the CMHP. Results: 1.2 FTE clinical providers treated 278 undergraduate and graduate students during the year (65.1% < age 26, 53.6% female, 49.6% caucasian). There were 1822 CMHP outpatient visits, 318 other medical visits and 103 total emergency room (ER)/inpatient visits. Ten students were identified as high utilizers of ER/inpatient services, while charges to the CMHP totaled $470,157 and total charges to the Health System were $2,378,315. Conclusions: Students with complex psychiatric/medical co-morbidities received cost effective, convenient and integrative treatment. Over time, we hope to intervene earlier and decrease ER/inpatient visits.     

Trends in college students’ mental health diagnoses and utilization of services, 2009–2015

Abstract

Objective: To examine changes in diagnoses/treatment for 12 mental health (MH) conditions, previous use of campus MH services, and willingness to seek MH services in the future. Participants: ACHA–NCHA II participants from 2009 to 2015 (n?=?454,029). Methods: Hierarchical binary logistic regression with step 1 controlling for demographics and step 2 considering time. Results: Time was significant except for bipolar disorder, bulimia, and schizophrenia with increases for all conditions except substance abuse. Anxiety (OR?=?1.68), panic attacks (OR?=?1.61), and ADHD (OR?=?1.40) had the highest odd ratios. Use of MH services at current institution (OR?=?1.30) and willingness to utilize services in the future (OR?=?1.37) also increased over time. Conclusions: Based on a national sample, self-reported diagnoses/treatment of several MH conditions are increasing among college students. This examination of a variety of MH issues can aid college health professionals to engage institutional stakeholders regarding the resources needed to support college students’ MH.     

Borderline Personality Disorder and Hospitalization

SUMMARY

This chapter reviews and discusses the issues and controversies related to the hospitalization of suicidal patients with a diagnosis of borderline personality disorder. It highlights the challenges faced by both the clinical staff and a prototypical patient during a hospitalization. Included are a discussion of the transference and counter-transference that arise during inpatient treatment, the stressors on the staff as well as on the patients themselves. The chapter offers suggestions for enhanced in-hospital treatment, including increased collaborative decision-making, clear and realistic short- and long-term goals for patient and family, and increased supervision and ongoing education of staff.     

Risk Factors for Suicide in Taiwanese College Students

Objective: The authors investigated the personality characteristics, psychopathology, parenting style, and family function among Taiwanese college students with high, moderate, and low suicidal risks. Participants: The sample included 2,919 first-year college students (1,414 men, 1,505 women) from a university in Taipei, Taiwan. Methods: A self-administered questionnaire assessed domains covering demographics, personality, psychopathology, frequency of substance use, parenting style, family functioning, and suicidal behaviors. The authors used mixed models for data analysis. Results: The authors observed a positive linear trend between increased suicidal tendency and levels of neuroticism, harm avoidance, novelty seeking, psychopathology, and parenting styles of low affection, overprotection, and authoritarian controlling. Use of tobacco and alcohol and impaired family adaptation and cohesion were associated with high and moderate suicidal risks. Conclusions: Personality, psychopathology, substance use, and familial factors are important correlates of suicidal risks among college students in Taiwan. Optimal suicide prevention strategies in the college setting should incorporate the multiple facets of suicidal risks.     

Socioeconomic Correlates of Current and Regular Smoking Among College Students in Rhode Island

Objective: The objective of this study was to determine how sociodemographic variables, in particular socioeconomic status, correlate with current and regular smoking among college students in Rhode Island. Participants and Methods: Over a 4-year period (academic year 2000-2001 to 2003-2004), the authors examined sociodemographic correlates of cigarette use among 3,984 students aged 17 to 24 years from 10 colleges and universities in Rhode Island. Results: One-third of participants (32.0%) had smoked a cigarette in the 30 days preceding the questionnaire. Findings from a pair of logistic regression models indicated that participants from upper-income families were more likely to be current smokers—although not regular smokers—suggesting that the effect of socioeconomic status on smoking is partly dependent on the level of addiction. In addition, freshmen were more likely to be current and regular smokers than were upperclassmen, and white students were most likely to be regular smokers. Conclusions: The frequency of college students who reported that they first tried smoking and first smoked regularly while in college increased from freshman to senior year, indicating that the college years are a vulnerable period for smoking initiation and habituation.     

Suicide risk among urban children

ObjectiveThis study examines how socio-demographic and clinical characteristics influence suicide risk among a large, urban sample of children (ages 12 and younger) receiving Psychiatric Emergency Services (PES).MethodsBivariate and binomial logistic regression analyses were employed to analyze data for a sample of 951 urban children presenting for pediatric PES.ResultsApproximately 17.2% of patients presented had a history of suicidal thought and behavior. Despite the larger number of black children presenting for PES, we found no significant difference in suicide risk across ethnic group, though the prevalence rates were increasingly higher in Whites, Latinos, and Black respectively. Of those presenting with suicidality: 65.1% were diagnosed with a behavioral disorder, 26.3% were diagnosed with a mood disorder, 3.8% with a psychotic disorder, and 4.8% with another disorder. About one in ten suicidal cases admitted to prior child abuse. Furthermore, patients admitted to the hospital for suicidality were more likely to be female, to have a mood disorder, and to be appropriately discharged to an inpatient setting following initial hospital care.ConclusionsThe study points to the importance of screening publically insured (Medicaid) urban children experiencing psychological distress regardless of ethnicity and age for suicide risk. Clinicians should consider these findings when working with children in psychiatric crisis.     

Are college students health literate?

Abstract

Objective: To examine the health literacy of college students. Participants: A convenience sample of 245 graduate and undergraduate college students. Methods: During February–April of 2018 participants completed the Short Test of Functional Health Literacy which assessed literacy on two passages describing a thyroid scan, and basic healthcare insurance information. Results: Most college students displayed adequate health literacy (99.2%). The ANOVA analyses revealed college classification was the most significant predictor, followed by ethnicity, sex, and primary language. Age was significantly related to health literacy, when holding college classification constant. Interestingly, college major, healthcare work experience, or having health care credentials were not predictors of health literacy. Conclusion: This group of college students had adequate health literacy skills. However, the results of this study revealed demographic disparities that suggest further study.     

Undergraduate students survey their peers on mental health: Perspectives and strategies for improving college counseling center outreach

Abstract

Objective: The purpose of the study was to examine student perspectives about college mental health including the primary mental health issues affecting students, common college student stressors, student awareness of campus mental health resources, and mental health topics students want more information about. Participants: Participants were 822 undergraduate and graduate students enrolled in a private university. The study was conducted during September 2016. Methods: As part of a public health course in program planning, undergraduate students surveyed their peers about their experience with mental health and mental health resources. Results: Stress was perceived as the largest mental health issue. Students most wanted more information about school/work/life balance followed by stress management. Electronic newsletters, social media, and on-campus seminars were the top strategies that students suggested as ways to reach them. Conclusions: The results provide student perspectives on mental health that may be useful in developing effective outreach efforts.     

Professor Perceptions of College Students With Attention Deficit Hyperactivity Disorder

Objective: From April to June 2005, the authors investigated professor perceptions of college students with attention deficit hyperactivity disorder (ADHD). Participants: 253 participants completed the ADHD Beliefs Survey-Revised, a 40-question survey measuring professor perceptions of ADHD. Methods: Analysis of variance measured false and reasonable beliefs related to ADHD. Results: Results indicated that professors with differing levels of education, years of teaching experience, colleges in the university or community college, previous experiences with a student with ADHD, and ADHD training did not differ significantly in perceptions regarding general ADHD knowledge or college students with ADHD.     

Coping and Regulating Emotions: A Pilot Study of a Modified Dialectical Behavior Therapy Group Delivered in a College Counseling Service

Abstract

Objective: To analyze the efficacy of a pilot program, aimed at treating college students with borderline personality disorder (BPD) using short-term, modified group dialectical behavior therapy at an Australian college counseling service (CCS). Participants: Seventeen enrolled college students aged between 18 and 28 (76.5% female), with a diagnosis of BPD completed the program between November 2009 and November 2010. Methods: Participants attended 8 2-hour group therapy sessions, held at the CCS during semester. Participants were assessed for levels of depression, anxiety, BPD traits, and coping strategies, at commencement and completion of the program. Results: There was a reduction in symptoms of depression and BPD traits, and an increase in adaptive coping skills, including problem solving, and constructive self-talk. There was no reduction in anxiety. Conclusions: The findings indicate promise for short-term treatment of college students with BPD. Implications and limitations are discussed, with emphasis on replication with a control group.     

Cultural Factors in Collegiate Eating Disorder Pathology: When Family Culture Clashes With Individual Culture

Objective: The authors evaluated the validity of familial enmeshment (extreme proximity in family relationships) as a risk factor for eating disorders across cultural value orientations. They tested the hypothesis that although familial enmeshment may be a risk factor for eating disorder pathology for (1) participants of non-Asian descent or (2) culturally independent participants, enmeshment will not be a risk factor for (1) participants of Asian descent or (2) culturally interdependent participants. Participants: 255 undergraduate women participated. Methods: Participants completed questionnaires on cultural value orientations, enmeshment, and eating disorder pathology. Results: As hypothesized, enmeshment was related to eating disorder pathology in non-Asian American and culturally independent participants, but not in Asian American and culturally interdependent participants. Conclusions: Depending on cultural values, enmeshment may or may not be a risk factor for eating disorders. This study highlights the importance of examining risk factors in the appropriate cultural framework when considering college student mental health.     

Positive Changes in Perceptions and Selections of Healthful Foods by College Students After a Short-Term Point-of-Selection Intervention at a Dining Hall

Abstract

Objective: Determine the effects of a short-term, multi-faceted, point-of-selection intervention on college students’ perceptions and selection of 10 targeted healthful foods in a university dining hall and changes in their self-reported overall eating behaviors. Participants: 104 college students, (age 18–23) completed pre-I and post-I surveys. Methods: Pre-survey collected at dining hall in April 2007, followed by 3-week intervention then post-survey collected via email. Healthy choice indicators, large signs, table tents, flyers and colorful photographs with “benefit-based messages” promoted targeted foods. Response rate to both surveys was 38%. Results: Significantly more participants reported that healthful choices were clearly identified in the dining hall after the intervention. Over 20% of participants reported becoming more aware of healthful food choices in the dining hall after the intervention. Significant increases in self-reported intake were reported for cottage cheese and low-fat salad dressing, with a trend toward increased consumption of fresh fruit. Seven of the 14 assessed eating behaviors had significant changes in the desired direction. Increased awareness of healthful foods was the top reason for self-reported changes in overall eating behaviors. Conclusion: Short-term, multi-faceted, point-of-selection marketing of healthful foods in university dining halls may be beneficial for improving college students’ perceptions and selections of targeted healthful foods in the dining hall and may improve overall eating behaviors of college students.     

Anxiety and depression among college students with attention-deficit/hyperactivity disorder (ADHD): Cross-informant,sex, and subtype differences

Objective: This study examined symptoms of anxiety and depression among college students with attention-deficit/hyperactivity disorder (ADHD). Participants: Data were collected between March 2011 and March 2016 from 150 college students with ADHD and 150 college students without ADHD. Method: Participants with ADHD were compared to a sex- and ethnicity-matched control group. For the ADHD group, parent and self-report of anxiety and depression were also compared. Results: College students with ADHD self-reported significantly higher anxiety and depressive symptoms than did students without ADHD. Scores on parent-report measures of anxiety and depressive symptoms were significantly higher than scores on self-report measures. Significant sex differences were found for participants with ADHD, with females showing higher depressive and anxiety symptoms than males. Parent-reported anxiety symptoms were higher for those with inattentive type ADHD compared to combined type ADHD. Conclusion: The current study highlights the importance of multi-informant assessment in ADHD evaluations for college-aged adults.     

Social Networks,Substance Use,and Mental Health in College Students

Abstract

Objectives: The relationship between social network risk (alcohol-using close friends), perceived peer closeness, substance use, and psychiatric symptoms was examined to identify risk and protective features of college students’ social context. Participants: Six hundred and seventy undergraduate students enrolled in a large southeastern university. Methods: An online survey was administered to consenting students. Results: Students with risky networks were at a 10-fold increase of hazardous drinking, 6-fold increase for weekly marijuana use, and 3-fold increase for weekly tobacco use. College students’ who feel very close to their peers were protected against psychiatric symptoms yet were at increased risk for marijuana use. Perceived closeness of peers was highly protective against psychiatric symptoms, adding a natural preventive effect for a population at great risk for mental illness. Conclusions: Results support targeting college students through network-oriented preventive interventions to address substance use as well as mental health.     

Partying Before the Party: Examining Prepartying Behavior Among College Students

Objective: The authors examined the phenomenon known to college students as prepartying, which is the consumption of alcohol prior to attending an event or activity (eg, party, bar, concert) at which more alcohol may be consumed. Participants: To explore the extent of this behavior, the authors surveyed 227 college students about each drinking event over a 1-month period. Results: Principal results revealed that 64% of participants engaged in prepartying (75% of drinkers) and that prepartying is involved in approximately 45% of all drinking events. Prepartying was predictive of more drinking throughout the day of the drinking event and alcohol-related negative consequences. Men and women engaged in this behavior at similar rates, and prepartying was most related to social reasons for drinking. Conclusion: Because prepartying is well-known among students, the authors suggest that clinicians and researchers target it to better understand college drinking and to help students understand the associated dangers.     

Diagnostic sequence of cocaine use disorder in relation to other mental health conditions among college students

Abstract

Objective: Cocaine use is increasing. Comorbidities and diagnostic sequencing are needed among college students to inform treatment of cocaine use disorder (CUD). Method: Using electronic medical records from the psychiatric clinic at the student health care center of a large, public university from 2005 to 2015, patients diagnosed with CUD were identified. Their top mental health conditions were identified and assessed to see whether the first diagnosis of these conditions was made (1) before, (2) at the same time as, or (3) after the first diagnosis of CUD. Results: Among the 50 CUD patients, their most common mental health comorbidities were alcohol use disorder, anxiety, depression, and cannabis use disorder. Anxiety and depression were likely to be diagnosed before CUD; alcohol and cannabis use disorders were likely to be diagnosed concurrently with CUD. Conclusion: Diagnostic sequencing can be used to inform screening, workup, and treatment for patients with CUD.