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.

Health Care Efficiency and Patient's Fiscal Health

The Dartmouth Atlas Project was a research operation that was conducted to compare the costs of health care at first within the immediate area and grew into a nationwide project. The findings were quite different from what researchers expected: rate of illness and healthcare cost had very little correlation in the country. The problem with health care cost was "over-service," health care physicians taking it upon themselves to perform operations and tests that the patient never really asked for basically because the means to do so are present.

Health care, in today's day and age, should be a right given to every citizen. In a country such as this, it's a but striking to think that people would be unable to receive prenatal care because they lack health insurance or people opt for trips to the hospital rather than a doctor's office because they cannot afford the latter. The argument against universal healthcare is short term cost, but when you look at it, the system as it is now is very flawed. People who get sick only receive attention when it's gotten to the point where they need to go to the hospital, and their serious treatment is provided to them free of charge.

Grand Junction, Colorado is the example of how health care ought to operate. One of the prevailing issues with providing health care is the physician refusal to give service to someone who isn't on the correct health care plan for his pocket book. This system mandates that al physicians provide service whether they be on Medicare or Medicaid. Another issue for most personal physicians is just how little time you spend with him or her after spending all that time at the clinic. In Seattle, there is a system in which the physicians work their schedules around the patients, and there is a much more personal doctor - patient relationship. The patients will sit and talk with the doctor for long periods of time to discuss all of their health issues and aren't being rushed out of the office. In Everett, Washington, the problem of "over-service" is directly tackled via a program that essentially surveys a patient's symptoms and conditons to decide whether or not a certain test is recommended or not. If it isn't, physicians usually don't go forward with the test, though they can overrule the decision if they see fit. The decrease in scans an services of the like because the program have decreased the cost of healthcare.

The issue with these styles of healthcare that make me think that it's unlikely for them to catch on is the whole aspect of caring about your patient's pocketbook just as much as your own. It may sound pessimistic, but I really doubt that people will care enough about that to make massive changes to their practices. Sure, your doctor may prescribe the generic over the name brand drug to save you a few dollars, but completely overhauling their style of treatment is a lot to ask for. The whole fact that there are doctors that would refuse to treat patients who do not have proper insurance is a testament to the fact the the empathy found in the physicians in places like Grand Junction is not a universal idea.

Vaccination: Fact vs. Fanaticism

The documentary details the conflict between two sides of a public health argument. One side is comprised of the supporters of vaccination during infancy and childhood because such measures have had a direct hand in the eradication of certain diseases. The other side hold the opponents of vaccination, purporting that the process has a direct hand in the increased incidence of developmental disorders, most notably autism. Physicians and the CDC acknowledge the inherent risk that comes along with the administration of vaccines but conclude that the benefits far outweigh he potential risks. The families that have been supposedly affected negatively by vaccinations of children spread their stories to the public via the internet and news media, fueling "public awareness."

I was very pro-vaccination before this video, and if nothing else, it only made me more so. The points made by the opposing side are not grounded in concrete fact at all, honestly based more on faulty correlation than anything else. The symptoms of autism generally develop around two years of age or so, when certain developmental milestones are missed. Because your child happens to develop these symptoms around the same time that they are administered a vaccine doesn't mean that one caused the other. Correlation does not equal causality. Another extremely flawed idea is the listing of ingredients in vaccines and demanding to know what the purpose behind their inclusion was. Ingredients are not put into medical products just for the sake of putting them in. They certainly have some sort of effect on the vaccine that aids in the delivering process. While the substances themselves may odd things to put into you body, one must account for their reactions with each other.

Vaccines should not be a thing that parents can just opt out of because a youtube video has suddenly enlightened them to the intricate workings of medicine. Getting vaccinated has a direct effect on those around you because you are not only putting yourself at risk for the contraction of a serious disease, but all those you interact with. Parents that have their children opt out of vaccinations rely solely on herd immunity. This is the idea that because a large amount of the surrounding population are immune to a particular disease, it's enough to safeguard yourself from said disease. If everyone has this idea however, the concept of herd immunity falls apart.

While there are a handful of reasons that children do not get vaccinated for things, only a handful are actually legitimate reasons to not do so. Children cannot get certain vaccines until certain ages, so during the time until then, they are relying completely on immunization of those around them to be safe. Some parents simply do not have the financial means to get their children immunized because they lack insurance for a regular health care physician. However the ones that are not acceptable are those that opt out because they find that the fictional link that has been created between autism and vaccinations to be far too great of a risk to give it to their children. One comment was that the mother would prefer measles to autism if she had the choice. Not only is the stance on the issue outrageously ignorant, it's also extremely selfish because it harms the children whose parents actually made the effort to safeguard their children's health from deadly diseases.

If it were in my power to try and increase vaccination rates, I would definitely try and raise credible awareness for vaccines that rebuked the extreme thoughts of a handful. Publication of just hard statistics that go in the face the critics would be an idea. For example, autism is generally on the rise in diagnoses because autism wasn't really a readily diagnosed disorder in the past not because it didn't exist but because it wasn't diagnosed as autism. Therefore to create a causation between the rise in autism cases and the rise in vaccination rates is extremely flawed, because one could essentially make that correlation with anything that had a positive rise along with autism. Another method to increase vaccination rates is to make more vaccinations mandatory for entrance into the public school system. This will essentially force parents to find the means to get their children vaccinated because they need to go to school.

Effects of "Passive Smoking" on Non-Smoking Japanese Women

The study presented the severity of effects of cigarette smoke on non-smoking wives of their smoking husbands. This was discovered in research that analyzed factors including cigarette smoking of husbands, alcohol consumption of husbands, and profession in how they affected the health of women, specifically the spouses of those husbands. There were no real correlations to be made with alcohol and health, but there was a noticeable correlation between smoking in husbands and the prevalence of lung cancer in non-smoker wives. Continued exposure to cigarette smoke from husband increased mortality from lung cancer by almost twofold according to the data. There was also a higher prevalence of lung cancer mortalities in more agricultural families vs. those in which the husband had an urban employment. This was attributed to the amount of time the more agriculturally based couples remained in contact with each other daily vs. the amount of time the more organized families operated.

What was probably the most interesting about this study was just how numerous the deaths due to lung cancer among women were according to figure 2 of the article. Only fifteen percent of Japan's female population smokes, and yet lung cancer is such an issue among this population. This could probably attest to the fact that second hand smoking from spouses is a real and dangerous issue, as it could be the missing link to explain why there were so many cases of women with lung cancer despite so few actual women who smoke.

This type of study design restricts potential bias because the habits of husbands and wives are acquired independently of each other. Also, there isn't solely a check comparison being made between lung cancer deaths and second hand smoking. There are several other health conditions that are recorded into the data as well to compare their specific rates of incidence in regards to a certain negatively stimulating factor. It not only proved that passive smoking was a problem, but a bigger problem compared to other common conditions. The sample size makes it possible to acquire a large amount of data and properly demonstrate the link between smoke and lung cancer that is being pushed forward.

The article, in my opinion, does a good job of creating the relationship of cause and effect between passive smoking and the prevalence of lung cancer among women. The data clearly depicts that prolonged exposure increased the numbers of Japanese women who died of lung cancer. The sample contained several thousands of people so it was a good representative of the Japanese populous. Perhaps the major flaw that does not really demonstrate the cause and effect relationship is the lack of any biological basis to link the cigarette smoke and the onset of lung cancer. The two are linked but it is never really physically described who. Understandably it may as well be common knowledge that cigarette's cause cancer. However, it would have definitely strengthened the report if there was a mention of the direct effects of the smoke on a person's body, even when not actually smoking it themselves.

Prevalence and Effects of Bing Drinking on High School Girls and Adult Women

According to the article published by the CDC, binge drinking is a real public health issue for American women, especially those in high school and early adulthood. Women that binge drank were likely to do so fairly often, generally 3 times a month, and each time would have about 5 drinks. Drunkenness was linked to many issues that made the seriousness of binge drinking among women very clear: a higher risk of unwanted pregnancy, late recognition of said pregnancy, consuming alcohol while pregnant because of late recognition, STIs, and even breast cancer. The data was acquired among high school students via school surveys and among other women via anonymous phone surveys.

I imagine that this is mainly a public health issue because of the prevalence of alcohol consumption among people in high school. Not only are they well below the drinking age, the quantity of alcohol they are consuming will have a long term effect on their bodies, liver damage for example, and may even have immediate effects like unwanted pregnancy. Older women, such as those in college, are almost expected to drink and despite the risk of drinking heavily, no one really bats an eye at the idea of someone drinking in their college years. This problem should also be put forward as an important public health issue simply because not many people really think it as such. When destructive substance use comes to mind, alcohol isn't really up there with cocaine, heroine, etc. Despite the fact that it isn't legal to drink before 21, it is extremely easy to do so and there are very few repercussions even in the event that you are caught. It's as if breaking the law has become normalized, making the severity of the issue difficult to properly capture.

Honestly, the data presented isn't much of a surprise, despite the fact that it isn't even the most reliable. It's not news to anyone that people drink and do so often. What may be slightly disconcerting is how high the numbers were even though they were mostly dishonest. It's very possible that some women lied in their responses to the telephone survey, mainly because of social implications that honesty answers would entail. No person wants to be thought of as a drunk who goes out every weekend, so if the survey is answered, one could assume the responses would be rather tame compared to the actual fact.

For college women, I believe the only way to curb drinking is to properly enforce the drinking age so alcohol is not as easily accessible to them. College students have the risks of alcohol drilled into them was soon as they arrive on campus the same way the dangers of sex are drilled into high schoolers. The risks are simply taken regardless. From personal interactions, people honestly joke about the long term damage to their livers as they drink, it's not anything that's news to them that they need to be enlightened of. Only denying the alcohol acquisition in the first place will be a useful deterrent. As for high school students, restricting how teens get the alcohol is a big part, but a large part also goes to the responsibility of the parents. A fourteen year old generally isn't walking into a liquor store and getting a bottle on their own. Parents need to be more aware of who their children associate with because they definitely have friends that are older than them that allow them to access the alcohol in the first place. The proposed methods of curbing alcohol consumption are no more than inconveniences for people that actually drink responsibly or have nothing to do with the issue, like raising the prices of alcohol and decreasing liquor store density in neighborhoods. These methods just hurt businesses as a whole because of poor decisions made by a few, and seems like a rather unfair method to combat binge drinking among women.