The Health and Wellness of Today’s College Students

1. The Health and Wellness of Today’s College Students Jon Brunner, Ph.D. Director, Counseling and Health Services

2. FGCU Health and Wellness Services • Student Health Clinic • Counseling Center (CAPS) • Adaptive Services for Students with Disabilities • Prevention & Wellness Services (health education) • Testing Center

3. Millennial Students: The Good, the Bad, and the Ugly(Born between 1982 through to today) • They tend to: • not to learn from failure. • idealistic—hopeful of the future • have increasing levels of stress and anxiety • be more nurtured than previous generations. • parents tend to be overprotective and highly involved • exposed to more structured upbringing • Greater expectation for personal and immediate resolutions • have been raised by parents believing in the importance of self-esteem  • have been pushed to study hard and succeed • to choose careers that “pay off” nicely • multi-task well • having juggled sports, school, and social interests as children

4. Millennials contd. • be quite interdependent (i.e. on friends, family, teachers/role-models) • be more inclusive and tolerant of religions, ethnicity and sexual orientations • have exposure to vast information but go less in-depth • acknowledge and respect positions, titles, and rules • however, see it as a challenge to find a way around the rules. • value peer bonding (e.g. organized team sports, church groups, clubs) • banding together to date and socialize rather than pairing off • work well in groups, preferring this to individual endeavors • be quite technologically savvy (self-taught from experimenting and exploring) • computers, internet, smart phones, pocket pc

5. American College Health Association (ACHA)National College Health Assessment (NCHA) • The largest known and most comprehensive data set on the health of college students • Initiated in 2000 • Revised in 2008 (NCHA II) • Last given at FGCU, Fall 2009

6. The Top 10 Impediments to Academic Performance According to Students 2000-2007 • Stress- 32% (32.4%) • Cold/Sore Throat- 26% (20.7%) • Sleep Difficulties- 24% (27%) • Concern for Family or Friend- 18% (21.2%) • Depression/Anxiety- 16% (14.3%) • Relationship Difficulty- 15.5% (17.6%) • Internet/ Games- 15% ** (12%) • Sinus Infection- 8.5% (8.5%) • Death of Friend/Family- 8.5% (11%) • Alcohol Use- 7% (4.5%)ADHD 6%

7. The NCHA II Top 10 Impediments to Academic Performance According to Students 2008-Present • Stress- 27.3% (19.5%) • Sleep Difficulties- 19.6% (19.5%) • Anxiety- 18.4% (19.9% #1) • Cold/Sore Throat- 17.3% (16.4%) • Work- 13.3% (16.4%) • Depression- 11.3% (13.9%) • Internet/ Games- 11.1% (10.3%) • Concern for Family or Friend- 11.0% (8.2%) • Extracurricular Activities- 10.6% (6.5%) • Relationship Difficulty- 10.5% (8%) • ADHD- 6.7% #9

8. NCHA II Survey - Mental Health2008-Present, Incidence in Last 12 Months • 46.3% felt hopeless once during the year (50.2%) • 48.4% felt overwhelming anxiety (49.8%) • 38.1% felt overwhelming anger (44.1%) • 30.3% reported being “so depressed that it was difficult to function” (31.0%) • 6.2% seriously considered suicide (6.0%) • 81% felt exhausted (not from physical activity) (84.5%) • 5.3% intentionally injured themselves (3.5%)

9. NCHA II Survey - Mental Health continued • 75.1% of students found some aspect of their life being traumatic or very difficult to handle in the last 12 months (77.3%) • 44.9% reported Academics (47.5%) • 27.3% reported Family problems (30.7%) • 32.3% reported Intimate relationships (36.5%) • 35.4% reported Finances (43.6%) • 24.4% reported Sleep difficulties (31.6%)

10. NCHA II Survey - Sleep • Only 58.6% of students reported getting enough sleep to feel rested in 3 or more mornings of the past 7 days (56.8%) • 60.5% of students reported feeling tired, dragged out or sleepy during the day for 3 or more days of the past 7 days (63.5%) NCHA II Survey - Stress • 50.7% of students rated their level of stress as above average or tremendous within the last 12 months (51.2%)

11. NCHA II Survey – Violence & Abusive Relationships2008-Present, Incidence in Last 12 Months • 21.7% reported receiving a verbal threat (25.6%) • 10.6% reported unwanted sexual activity (8.4%) • 10.0% reported an emotionally abusive intimate relationship (15.1%) NCHA II Survey – Sexual Behavior • 68.0% had a sexual partner in the last 12 months (72.3%)

12. NCHA II Survey – Alcohol & Other Drug Use2008-Present • Number of drinks consumed that last time students “partied” or socialized – Median of 4 (4) • 33.1% of student reported binge drinking (five or more drinks per sitting) within the past 2 weeks (27.9%)

13. CORE Survey • Developed by the Department of Education • Published by the CORE Institute • University Southern Illinois • Measures alcohol and drug usage attitudes, related events and perceptions of students • Completed online

14. CORE Survey Forms • CORE Alcohol and Drug Survey-Long Form (Core Survey) • Survey of Students’ Perceptions of Campus Alcohol and other Drug Norms (Norms Survey)

15. 2004 Both Surveys Special Question n=640 “ I feel comfortable in situations where alcohol is consumed.” Always – 20.9% Often- 37.4% Sometimes- 24.8% Rarely- 11.3% Never- 5.8 %

16. Norm Survey: Alcohol Use General Student Perceived Norm Binge Drinking 54% Average Drinks 5.8 Consumed Abstinence from 17.8% alcohol Actual Norm 38% 3.2 17.3%

17. Norm Survey:Attitude Toward Alcohol Response Options: • Drinking is never a good thing to do • Drinking is all right but a person should not get drunk • Occasionally getting drunk is OK as long as it does not interfere with academics or other responsibilities • Occasionally getting drunk is OK even if it does interfere with academics or responsibilities • Frequently getting drunk is OK if that’s what the individual wants to do.

18. Norm Survey:Attitude Toward Alcohol Response Options: • Drinking is never a good thing to do (.3%) • Drinking is all right but a person should not get drunk (5.0%) • Occasionally getting drunk is OK as long as it does not interfere with academics or other responsibilities (52.1% - median) • Occasionally getting drunk is OK even if it does interfere with academics or responsibilities (20.5%) • Frequently getting drunk is OK if that’s what the individual wants to do (22.1%)

19. Student Perceptions of Alcohol Use • 77.2% breaks the Ice • 75.6 % enhances social activity • 74.4% gives people something to do • 68.7% gives people something to talk about • 62.3% allows people to have more fun • 61.8% facilitates a connection with peers • 59.1% facilitates male bonding • 53.9% facilitates sexual opportunities • 48.4 % facilitates female bonding • 27.7% makes women sexier • 17.8% makes men sexier • 17.5% makes me sexier

20. FGCU CORE Survey Comparison

21. 2008 CORE SurveyIllegal Drug Use (2004 Comparisons) • Marijuana • 28.7 % used in past year (30.6%) • 14.8% used this past 30 days (17.5 %) • 11.4% used illegal drug other than marijuana in past year (16.0%) • 4.2% used illegal drug other than marijuana in past 30 days (5.3%)

22. Student Health Services (SHS) Location: Wellness Center Hours: **8:30am – 5:30pm Mon.-Thurs **9:00am-4:30pm Fri **Hours subject to change per semester Phone: 590-7966 Appointments are strongly recommended walk-ins accepted

23. Health Center Services • All Services are Free and Confidential • SHS uses EMR • Provide Routine Medical Care • General Physicals • Health Education • Women’s Health • Vaccinations • Birth Control/Medications • HIV Orasure Testing • After Hours Service through NURSE RESPONSE • Supplies e.g. band-aids, crutches, condoms)

24. Student Health Services Rendered (last year/outside of routine care) • Nearly 50% of FGCU students use SHS • Flu Shots-2602 • Women’s Exams- 214 • STD Tests-529

25. TOP Five Diagnostic Reasons Students Seek Health Services • Upper Respiratory Infection • Contraceptive Management • Reproductive Health Issues • Dermatological Issues • Genital/Urinary Issues • 12,449 student visits in 2009

26. Student Health Services Staff and Insurance • Staffed by: • Medical Doctors • Nurse Practitioners • Registered Nurses • Voluntary Student Health Insurance through Academic Health Plans (not needed to receive health center services and available for year or semester) • Under age students need parent approval (forms available)

27. Parent Tips • If your student is sick, tell them to go to the health center first (its free, accessible and good first response) • If they are told to take pain relievers, drink fluids, and get plenty of rest, tell them that is a good thing • Remind them about Nurse Response for non-service hours • Remind them there are cost recovery charges for tests and medications • Remind daughters to keep up with female health exams • Ask them if they are keeping up with sleep and dietary needs (remind them there are free nutritionist services)

28. 2009-10 Student Survey of Health Services * 77% agreed the Student Health Center is their usual source of care and/ or primary care provider while enrolled at FGCU * 85% was satisfied with the ease of scheduling an appointment that meets their needs * 89% was satisfied with the efficiency of the check-in and check-out process * 91% was satisfied that the provider listened carefully to their concerns * 94% was satisfied that their confidentiality and privacy were carefully protected * 83% was satisfied with their overall visit at Student Health Services * 84% agreed they are very likely to recommend the health service to another student

29. Prevention and Wellness Services (PWS) • Health Education Programming • MYSTUDENTBODY (online for all students and parents) • Alcohol and Drug Education • Peers Care (Student group) • Health Fair and Guest Speaker Services • Prevention Extension (Gazebo) • Graduate Student Assistantships • Nutritionist Care • Massage Therapy

30. Prevention and Wellness Programs • Men’s mental health (emotional issues) • Cookies, cokes and conversation series (housing 6 weeks series) • Weight loss myths (healthy weight loss) • Walking Wednesday (noon time walk for all) • Social hosting (for Greeks) • Health Fair (all campus event) • 3Cs of Stress (stress management) • Sexual Jeopardy (sexual health) •  What’s in your lunch? (nutrition) •  McDreamy or McNightmare? (relationships) •  Party Smart (alcohol) •  Fitness-tips-to-go (physical health) •  Free 10 minute massages (stress relief) • Total number of programs=322 Participants=6940

31. Counseling and Psychological Services (CAPS) Located: Second Floor Howard HallHours 8:00 – 6:00 Mon.-Thurs.8:00 - 5:00 FridayPhone: 590-7950Provides 24 hour Emergency Services

32. CAPS Services • Personal Counseling & Therapy • Career Counseling • Psychiatric Services • Consultation • Referral • Case Management • Emergency On-call (24/7 availability) • Outreach Programs • Assessment Services (neuropsych testing for LD/ADHD) • Website http://studentservices.fgcu.edu/Counseling/ (mental health screening and other electronic resources)

33. Top 8 Reasons Students Come to CAPS (2008-2010) • Anxiety • Stress • Depression • Self Esteem • Relationship • Academic • Dating/Marriage • Family 5,626 Sessions in 2009

34. The National Survey of Counseling Center Directors (NSCCD) of 2009 • Conducted since 1981 • Data provided by administrative heads of college and university counseling centers in the United States & Canada • Designed to stay abreast of current trends in counseling centers

35. NSCCD 2009 Survey Highlights • The 302 centers surveyed represent 2.6 million students who are eligible for counseling services at their institutions. • 6.1% of centers charge for personal counseling, down from a peak of 17.2% in 1996. Only 1.7% of centers collect third party payments. • 10.4% of enrolled students sought counseling in the past year. This represents approximately 270,000 students from the surveyed schools. • The ratio of counselors to students in 1 to 1,527. • The average number of counseling sessions for all students is 6.2 sessions per client. • 61% of the surveyed directors have access to on-campus psychiatric consultation.

36. 2009 NSCCD Findings • 93.4% of directors report that the recent trend toward greater number of students with severe psychological problems continues to be true on their campuses. • Directors report that 48.4% of their clients have severe psychological problems. 7.4% of these have impairment, so serious, that they cannot remain in school or can only do so with extensive psychological/psychiatric help • 40.9% experience severe problems but can be treated successfully with available treatment modalities. • 60.6% increased the amount of time training faculty and others to respond in a helpful way to students in trouble and to make appropriate referrals. • 53% expanded external referral networks.

37. 2009 NSCCD Findings continued • 48.7 % provide psycho-educational assistance on center websites. • 47.4% increased training for staff in working with difficult cases. • 28.5% increased counseling center staff. • 260 centers hospitalized an average of 8.5 students per school (2,200 students in all) for psychological reasons. The average number of hospitalizations per 1,000 students was 1.5. • 73% of directors describe their centers as primarily a mental health/psychological services center.

38. 2009 NSCCD Findings continued • Directors reported 103 suicides in the past year.95.5% of centers maintain the right to refuse treatment to a student whose problems appear to be beyond the capability of the center to handle. However, 46% of responding directors report that they would not deny service in such cases if the student refused an outside referral and demands to be seen at the center. • 87% contribute to freshman orientation programs

39. Article Review: Birth Cohort Increases in Psychopathology Among Young Americans, 1938-2007: A Cross-temporal Meta-analysis of the MMPI An article written by Twenge, J. M., Gentile, B., DeWall, C. N., Ma, D., Lacefield, K., & Schurtz, D. R. and published in Clinical Psychology Review, 30, 145-154 (2010).

40. Purpose of the study: Use quantitative research with a large sample size to explore 2 important questions: • Is mental illness on the rise in emerging adults? • What model might best explain such a rise in mental illness?

41. Meta-Analysis • What is a meta-analysis? • A research method that combines the results of several studies to address related research hypotheses. • This meta-analysis used mean scores that are reported as T-scores on the MMPI measures. • This meta-analysis looked at data from the MMPI, MMPI-2, and MMPI-A for the years 1938 through 2007 (1951-2002 for the MMPI-A). • In total, this study included 117 samples of 63, 706 college students and 14 samples of 13,870 high school students. • High school students were included to confirm data found in college populations and attempt to rule out population changes in college samples. • While the study may have included students who were seen at counseling centers, to be included in the meta-analysis, a study had to report means for all students, not those chosen for high/low scores, being current clients, or otherwise indicating maladjustment.

42. What is the MMPI (MMPI-2, MMPI-A)? • The MMPI is a widely used personality inventory that is designed to assess individual personality structure and psychopathology. • It was first published in 1943 and was originally developed to aid psychologists and psychiatrists assign appropriate diagnostic labels. • One of the most commonly used personality tests in the United States. • Items were chosen because they differentiated “normals” from clinical groups. • The MMPI was revised and updated norms were calculated for the MMPI-2, published in 1989. • The current meta-analysis looked at data in reference to 8 clinical scales, 2 non-clinical scales, and 3 validity scales:

43. Scale 9(Ma): overly elevated mood, accelerated speech, irritability, etc. Scale 5(Mf): sexual identity development. Scale 0(Si): tendency to withdraw from social contacts and responsibilities. L Scale(Lie Scale): used to detect attempt to present oneself in unfavorable light, malingering. F Scale(Infrequency): used to detect deviant or atypical ways of responding, such as not reading items or random responding. K Scale(Correction Scale): measures tendency to obscure symptoms, faking good or faking bad. Scale 1(Hs): persistent preoccupation with the body and fears of illness and disease. Scale 2(D): poor morale, lack of hope for the future, general dissatisfaction with one’s life situation. Scale 3(Hy): disruption in mental, or other, functionality Scale 4(Pd): delinquent behavior, sexual promiscuity, excessive drinking, etc. Scale 6(Pa): feeling of persecution, suspiciousness, grandiose self-concepts, etc. Scale 7(Pt): excessive doubts, compulsions, obsessions, unreasonable fears. Scale 8(Sc): bizarre thoughts or experiences, misinterpretations of reality.

44. Hypotheses and Models • The authors believed they might find increases in psychopathology based on findings of previous research. • If those increases were indeed found, the authors wanted to test three potential explanatory models: • The extrinsic versus intrinsic goals model • The economic cycles model • The response bias model (psychopathology is more socially acceptable)

45. Results • *Keep in mind a mean of 50 and a SD of 10 for the MMPI; 2 or more SD above the mean is considered clinically significant.* • MMPI clinical scale scores rose steadily between 1938 and 2007 – US college students scored more than a SD higher on the F scale, Pd, Pa, Sc, and Ma scales. • US college students score more than ¾ of a SD higher on Hy, D, and Pt scales. • US college students scores .45 of a SD higher on Hs. • In 1938, 1 – 5% of students scored above a 70 on the clinical scales (this represents a significantly elevated score, 2 SD above the mean)…by 2007, 40% scored above 70 on Ma, 33% on Sc, 28% on Pd, 19% on Pt, 19% on F, 18% on Pa, 10% on Hy, 8% on D, & 6% on Hs. • These results were confirmed in the high school sample.

46. In plain language: • (Ma) – more students are characterized by unrealistically positive self-appraisal, overactivity, and low self-control. • (Sc) – more students feel isolated and misunderstood. • (Pa) – more students may be described as sensitive and sentimental. • (Pd) – more students are narcissistic, self-centered, and antisocial or do not follow the rules and standards of society. • General symptoms of anxiety are on the rise. • (D, Hs, Hy, & Pt) – more students report worry, sadness, and dissatisfaction, and may express these through physical symptoms. • (F) – more students are predicted to experience moodiness, restlessness, dissatisfaction, and instability.

47. Which model best fits the data? • The extrinsic versus intrinsic model -- linear increase in MMPI scores…each successive generation showed an increase. This suggests that a shift in American culture toward materialism, individualism, unrealistic expectations, and unstable relationships may account for the increase in psychopathology in young people. -Young American’s focus on extrinsic goals is increasing. -Developing a meaningful philosophy of life is less important. -Divorce is indirectly impacting our young people. “At the very least, college campuses now have a larger percentage of students with more serious mental health problems”

48. Suicide Facts in the General Population • In America 30,000 die from suicide • Every day 80 Americans take their own lives • Every day 1,500 Americans attempt suicide • 11th Leading cause of death • 3rd Leading cause of death among 15 – 24 year old group

49. Center for Disease Control and Prevention (CDC) • Developed National Violent Death Reporting System (NVDRS) • Over 50,000 violent deaths in the US annually • Started out with 7 states (up to 18 this year) • First data from 2003 • Majority (56.6%) of deaths were suicide (latest data from 2007 and 16 states) • Followed by homicides at 28% • Most frequent method was firearms • Occurred at higher rate among males, native Americans, non-Hispanic whites and persons ages 45-54

50. College Student Suicide Facts • Suicide is the 2nd Leading Cause of Death for College Students • According to JED Foundation and NMHA over 1,000 College Students Die Each Year from Suicide • Rate of Suicide is 7.5/100,000 Students