Depression Among College Students in the US - Implementation and Evaluation

Problem Definition: High prevalence of depression among college students in the US from the years 1985 to 2010

The primary intervention decided upon revision from the last blog entry to the outline of the final paper will be the promotion of student organize clubs and organizations along with the funding of recreational facilities on campus. The crux of this intervention relies on the fact that those who are physically active tend to exhibit better mental health, while the student organizations will be able to provide both support and community for students on campus. The plan itself focuses on stress as its key determinant, and the programs implemented would seek to reduce said stress from the college environment.

The implementation of the plan will require both a substantial amount of funding on behalf of the institutions and the support and involvement of students on campus. Ideally, the student groups would be ethnically or culturally inspired and ran by upperclassman for the incoming freshman of institution. The stakeholders in this case would be students who would join the organizations and upperclassmen needed to get the group off the ground, while the university itself would need to provide initial funding for these clubs before they can fund raise and function on their own.

The recreational center would certainly be a long term project for schools and benefits would far outweigh the initial costs, but these costs would be high. Depending on the institution, the school would need to set aside revenue or look to alumni to aid in funding this venture, and this could only be accomplished if they approved of the reasons behind creating these centers. The additions can range from a modest addition of a volleyball net of basketball hoop on campus to a full on center, however this would take several months if not years to complete.

The evaluation of these programs would most effectively be discovered via an indirect survey of student sentiments as the changes progress. Instead of sending out online surveys asking specifically about depression, these surveys would instead test for levels of stress, comfort, happiness, etc as time wore on and the changes came into effect. As these descriptions generally are not paired with the conditions of depression and students are more likely to state how they are feeling than identify themselves with a certain condition, this will definitely prove the best way to evaluate the efficacy of the intervention.

Depression Among College Students in the US - Interventions

A couple current interventions at work on college campuses are:

1. Credit limits - while these are applied to the student body as a whole, they are greatly beneficial in decreasing the amount of stress on a student by limiting how much work they can take on per semester. Even though these limits can be surpassed, students are generally strongly advised against such action.
2. On campus counseling - student counseling services like JHU's "A Place to Talk" provide an area for students under emotional duress to seek advice on how to deal with their current issues and how to move forward.  
3. Promotion of cultural and ethnic clubs on campus, providing a sense of familiarity and community in a different environment

A few possible interventions to help lower the incidence of depression on college campuses are:

1. Hosting early year and mid-year assemblies, much like the orientation events, that would educate the student body about depression and various campus resources available to deal with the issue
• Secondary intervention
2. Increase the availability of on-campus recreation areas and activities - there is a strong correlation between physical activity and good mental health.
• Secondary intervention
3. Enforce stricter guidelines for underage alcohol consumption and inebriation by students - dependency on alcohol only worsens depression and the measure would benefit not only those who are suffering from depression but the health of the student body as a whole.
• Tertiary intervention
4. Record the students who are currently prescribed antidepressants according to their mandatory student health forms submitted at the beginning of these school year and create an opt-in counseling program for which said students would be contacted.
• Secondary intervention

There are no primary interventions, as there are no actual means to "prevent" depression in people. One can only treat the onset of the condition and help people through it. 

1 = Poor

2 = Fair

3 = Good

Options Decision Criteria	Intervention 1: Early and Midyear Informational Assemblies	Intervention 2: Increase of On-campus Recreational	Intervention 3: Opt-in Counseling Program
Effectiveness	2	2	3
Feasibility	3	2	1
Sustainability	3	2	1
Cost	3	1	1
Cost effectiveness	3	2	3
Political acceptability	3	3	1
Social will	1	2	1
Potential for unintended risks	3	1	1
Potential for unintended benefits	3	3	2
Total/conclusion	24	18	14

The best/ most feasible intervention is the early and midyear assemblies for educating the student body about on campus ready - they are perhaps the most plausible methods to address the problem as they are the least invasive and least costly. 

The creation of on-campus recreational centers, while being a pro not only for the population of depressed students but the community as a whole, will be quite costly to create and will take a significant amount of time and resources to organize.

The opt-in program is premised on the fact that Hopkins officials will use medical records as a basis to contact depressed students and offer help of some sort. While this may be seen as a solid step to some, it will certainly come off as invasive to others. However, it will be the most direct means of reaching the depressed community specifically. 

Depression Among College Students - Stakeholders

The issue of depression among college students has several stakeholders. These include:

• Students
• Higher level institution
• Parents
• Student advisors

Depression itself directly affects the student body's health and well being; both the atmosphere of the school and the success of students rely on the health of the students, whether it be  physical or mental. Institutions that have high rates of depression tend to be looked at with caution during the application process; if the student is looking to spend the next four years of their life at a school, it shouldn't be somewhere that will provide enough stress to push students towards mental instability. Parents definitely beyond anything want good health for their children.

With respect to possible interventions that could be made, a major factor for depression is extreme stress and a sense of hopelessness. Certain financial and academic situation may be the major triggers for depression. As such, increasing the availability of on campus resources when under a lot of stress or other issues would be extremely beneficial to the students. However, at the same time there would be the issue of funding said programs and providing staff available to speak and provide help to the students in question. The institution itself must be willing to invest resources, both monetary and human, to curbing the rates of depression. They will not go down without options being there to help the process along. Advisors of students could help students by directing them on the proper schedules to make such that workloads aren't overwhelming and the quality of student life isn't hindered by taking too many credits. Parents can be advised not to place excessive importance on doing well in school verses enjoying the time that is spent in college. The biggest intervention would be the increased amount of on-campus counseling resources to reach out to troubled students. However, this would require the most effort on the side of the school using its budget to fund it. Colleges may be reluctant to allocate many funds to such a cause and may be against the idea in general. 

Problem Definition & Key Determinants

Problem Definition: Studies show an high prevalence of depression among college students.

Depression has several different factors that contribute to its prevalence among college students. As discussed in my previous entry, the most notable factors being social circumstances. The standard loneliness and hopelessness isn't the only issue, however. In fact, there are several issues beyond the economic factors that contribute to the prevalence of depression.

Among the environmental determinants, one factor that appeared in the Furr article was the effect on the actual type of school at which the student attended. According to the data, the social and economic determinants intertwined with the environmental. Those attending large community colleges expressed income as the major cause in their depression. From campus to campus, loneliness is a major issue because of the institution's ability to fund and maintain extracurricular on campus groups to promote a sense on belonging among students on the campus.

Other specifically social and cultural factors would be the race and genders of students at college. The prevalence of self-harm was greater among men than women. Asian Americans expressed a much greater prevalence of depression in their sample population. The differences among other races were not noted as significant. The article put forward "self-silencing" as a major factor for both genders, which is the extreme internalization of emotion and needs before those of others.  The key determinants that can be gathered from this data are the race of the college student and the gender of the student. These however, are the main two key determinants that are gathered from the given data. They can be further expressed by looking at the reasons behind why there is a difference among these sample populations. The kind of parents of these students, their culture of they come, the expectations of the families , and even the expectations of society. All of these factors play a role in depression's prevalence among students.

References:

Furr, Susan R., John S. Westefeld, Gaye N. McConnell, and J. M. Jenkins. "Suicide and Depression among College Students: A Decade Later." Professional Psychology (2000): n. pag. EBSCOhost. Web. 6 Apr. 2013.

Gratch, Linda V., Margaret E. Bassett, and Sharon L. Attra. "The Relationship Of Gender And Ethnicity To Self-Silencing And Depression Among College Students." Psychology of Women Quaterly 19.509 (1995): n. pag. SAGE. Web. 06 Apr. 2013.

Surveillance of Trends in Depression According to Susan R. Furr Article

There have been several active methods of surveillance done by public health officials to describe the trend of depression among college students over the years. Many different aspects are analyzed, beyond the general percentage of students who express symptoms of depression. The following is an exerpt from an article by Susan R. Furr, which details a trend observed in her research:

One of the most extensive analyses of suicide prevalence rates among college students was published by Schwartz and Whitaker (1990), who examined the research on college student suicide rates over a 60-year period (1928–1988) at 12 colleges and universities. From this research, they concluded that the suicide rate among college students was approximately half that of the nonstudent group. However, some professionals working in college counseling center settings have reported an increase in the severity of presenting problems ( Heppner et al., 1994), which suggests that depression and suicide might be becoming increasingly prevalent on college campuses.

- Suicide and Depression Among College Students, A Decade Later, Susan R. Furr

While this data initially seems to support an idea that students exhibit better mental health than non-students because of the apparent greater number of suicides among non-students, it goes on to say that the severity of problems has persisted. While perhaps the rates of suicide have are not as high in this particular case, it appears that it is more prevalent as a whole in the student population and has increased in severity. This information is a direct factor in the prevalence of depression in college students.

An indirect factor that was gathered from that same article was the seriousness of the situation as described by the student population. In a survey that included 1455 students over 4 college campuses, only 37% of the students surveyed reported that depression was a serious problem on campus. Even among the students the students that expressed feelings of depression since coming to college, only about 47% thought it was a serious problem. If even those affected by depression undermine the importance and severity of the situation, it will never reach the proper level of understanding and awareness to the student body as a whole. Measures cannot be taken to combat an issue that is not even presented as one. This could very likely effect the prevalence of depression among students; because so few people express the issue as an actual problem on campuses, it is less likely that the campus will have the means to treat those who express symptoms of depression. As a result, the prevalence will increase without being known to the actual institution, as depression and other mental conditions are not things that can be easily seen like a cold or any other illness.

One other point that this article addressed was the kind of institution from which the different students in the serveys were from. Of the four institutions from wich the pool of students was gathered, two were larger institutions and one was a smaller religious one. The information was analyzed and reported as such:

Students from the community college were less likely to cite loneliness as a factor in depression. When the institution had a large commuter population (comprehensive university and community college), money was more frequently cited as a contributing factor to depression. Students at the community college were more likely to have a local support network because the vast majority of these students lived in the local community and did not have to relocate to attend college. Being a part of the community may be a mitigating factor against depression. The small college in the sample is a religiously affiliated institution. Students may be attracted to this institution because of the opportunities for fellowship, service, and spiritual growth. Research ( Stack, 1998) has found a relationship between low religiosity and increased suicide acceptability. Consequently, students who choose a college with a religious atmosphere may be more inclined to view suicide as less acceptable.

- Suicide and Depression Among College Students, A Decade Later, Susan R. Furr

There are several apparently minor factors that contribute to a person's overall mental health. One would no think that being a commuter vs. non-commuter would have a negative effect on a person's health, but the correlation is present. This is another indirect factor in the surveillence of mental health issues in college students. They are powerful contributing factors when working together but are not exclusively linked to the onset and progression of depression. 

Problem Definition and Term Paper Idea

A prevalent issue that should be looked at more closely in regards to public health is the issue of mental health. This especially applies to youth who suffer from depression, specifically high school and college students. While depression itself isn't something that organizations like the CDC can tackle directly, there can be methods by organizations to better deal with its physical. Meaning, while depression itself is a very difficult condition to treatment, resources should be available in institutions to better prevent situations of self harm and destructiveness. Depression has long term debilitating effects on a person's ability to properly interact with those around them, and it severely limits the academic potential of students. The National Institute of Mental Health reported a 30% rate of depression among 2 and 4 year college students. In an abstract from PubMed, a survey of 14,175 college students nationwide reported 17.3% for depression, 4.1% for panic disorder, 7.0% for generalized anxiety, 6.3% for suicidal ideation, and 15.3% for nonsuicidal self-injury. These surveys were administered in the years 2007 and 2009. 

A possible problem definition using this information could go as follows:

Studies show an increased reportage of mental health issues among college students and adolescents. 

The purpose of the paper would be to explain the "why" of this issue, and put forward ideas on how to tackle the public health. There are several factors that could contribute to the prevalence of poor mental health among college students. Certain aspects of social norms, race, and economic standing weigh heavily on college students, in an environment that demands success as a prerequisite. There is inherently a lot of stress, and this definitely takes its toll. It is in the best interests of universities to try and curb the rates of depression and other mental health issues that are becoming prevalent in schools. Depending on the rates of things like depression among students, prospective students could very likely try and find environments that they would find far more hospitable. If not for the welfare of the students, the loss of potential students would prompt universities to take action. 

"Contagion" - A Modern Pandemic

Contagion presented a hypothetical situation in which a modern epidemic occurred. The movie tracks the spread and attempts to curb the spread of an extremely infectious virus that plagues North America and Asia. The CDC's main concern is to try and educate the populous to try and slow down the rate of incidence. Scientists desperately try and create a vaccine to combat the virus but nearly all subjects die upon its injection, to the point where they are ordered to destroy all the stored viruses and subjects. Only after ignoring the order to destroy samples and continuing to work do scientists come up with a vaccine, but without any proper means to test its efficacy on humans, Dr. Hextall injects it into herself. The vaccine is a success, but the distribution process is long and painstaking, based on a lottery of birth dates. The virus itself originated from a bat whose food was eaten by a pig, which was then slaughtered by a butcher who did not wash his hands before shaking the hands of the protagonist's wife, thus beginning the epidemic.

Outbreak is the occurrence of a disease in much greater numbers and far shorter time period than would be considered normal. This is caused in the movie by the rapid development and reportage of cases of the illness after the virus' exposure to the population. Several steps that are involved in outbreak investigation are shown in the film, such as defining the disease as an actual threat, tracing it fact to its first victim, and acquiring virus samples to study the disease's progression and how to create a vaccine. Isolation is shown in the sports stadium, which all ill persons are kept. Quarantine is shown when officials lock away the first victim's husband, as he was exposed to the virus but did not show any signs of illness.

There were several things that could have been done to properly tackle the spread of the pathogen before it got out of hand. The communication of the shear scope of the outbreak was really kept from the public, which realistically would have stopped a panic, but also didn't allow people to take the virus as seriously as the should have. Another problem was cooperation across agencies. Funding was a constant roadblock for CDC operations, such as creating an isolation unit within the sporting center. A major issue with the movie was the degeneration of civilization as time wore on. People looted and murdered without any consequence and there was really no authority present to keep order. This only exasperated the social issues going on.