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Depression on the College Campus: Connections to Stress, Sleep, and Alcohol Thomas R. Insel, M.D.

Depression on the College Campus: Connections to Stress, Sleep, and Alcohol Thomas R. Insel, M.D. Director, National Institute Mental Health Bethesda, MD. Data for United States and Canada all ages. WHO World Health Report 2002. Which medical disorder causes greatest disability?.

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Depression on the College Campus: Connections to Stress, Sleep, and Alcohol Thomas R. Insel, M.D.

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  1. Depression on the College Campus: Connections to Stress, Sleep, and Alcohol Thomas R. Insel, M.D. Director, National Institute Mental Health Bethesda, MD

  2. Data for United States and Canadaall ages WHO World Health Report 2002 Which medical disorder causes greatest disability?

  3. Causes of Disability by Illness CategoryUnited States and Canada15-44 years old WHO World Health Report 2002

  4. Causes of Disability by Specific IllnessUnited States and Canada15-44 years old WHO World Health Report 2002

  5. U.S. Prevalence of Major Depression One year prevalence: 6.6% (13.1 – 14.1 million adults) Lifetime prevalence: 16.2% (32.6 – 35.1 million adults) (Severe or very severe role impairment in 59.3%) 51.6% receive health care treatment, but only 21.7% receive adequate treatment Kessler et al., JAMA 2003

  6. Genetic vulnerability Early loss/trauma/stress Anxiety in childhood/early adolescence STRESS SLEEP DISTURBANCE Mood Disturbance Alcohol/Substance Abuse When does depression start? Co-morbidity with anxiety = 67.8% with Subst. Abuse = 27.1%

  7. How do we treat depression? Awareness - Screening Referral - Access Therapy – Meds/CBT Follow-up

  8. Treating Depression: Different Strokes for Different Folks? Nemeroff et al., PNAS, 2003

  9. Depression Remission: Meds vs Therapy treatment-specific changes Paroxetine F9 th th +4 Cg25 hc P40 - 4 CBT mF9 Cg24 Cg24 mF9 F9 F9 mF10 pCg vF hc hc pCg F11 Goldapple et al Arch Gen Psych 2003

  10. SSRIs in College Students? FDA is currently reviewing the risk of suicide in adolescence on SSRIs: Is suicide an effect of the disease or the treatment?

  11. What is a greater source of mortality: suicide or homicide? Approx 30,000 suicides/year (10.7/100,000) Deaths from homicide: 18,000/year AIDS: 20,000/year Prostate Ca: 28,900/year

  12. Suicide in College Students Suicides for 15-19 year olds nearly doubled between 1970-1990 Age-related Risk Factors: carry a weapon, drive after drinking, impulsive/aggressive personality, rarely use seatbelts, depression Campus Risk Factors: Stress, clusters of suicides, loss of social support NOTE: Some studies in general population have estimated a 10-30 fold increase in risk due to availability of firearms (Kellerman et al., NEJM 1992)

  13. National College Health Risk Behavior Survey (1995) Percentage in past 12 months: Seriously Considered Made Plan Suicide Attempt Required Med. Attn. Total10.3 6.7 1.5 0.4 Male 9.7 7.2 1.7 0.5 Female 10.8 6.3 1.3 0.3 Self –report from 4609 students, ages 18-24, in 2 and 4 year colleges. Higher rate among African American males? • http://www.cdc.gov/mmwr/preview/mmwrhtml/00049859.htm

  14. Suicide on Campus – Big Ten Study Review of 261 suicides on 12 Midwestern campuses from 1980 – 1990 Overall rate = 7.5/100,000 across 10 year period Rates of suicide highest in older students: age <25 age >25 females 3.2 9.4 males 7.9 15.6 Silverman et al., 1997

  15. How do we prevent suicide? Reducing risk Increase protective factors Referral - Screening Rx/Hospitalization Follow-up The National Strategy for Suicide Prevention – U.S. Surgeon General Safeguarding your students against suicide – NMHA and Jed Found.

  16. Air Force Program to Reduce Suicide Community awareness and reduction of stigma (Priority for senior officers, training at all levels, buddy system) Coordination of social services and social support (Distributed support in schools, work sites, community facilities) Focus on high risk situations (Legal investigations, protections of privacy) Knox et al., BMJ, 2003

  17. Air Force Program to Reduce Suicide Knox et al., BMJ, 2003

  18. What can the Air Force Study teach us about reducing suicide on college campuses? Stigma – Top down message that mental health is part of health Beliefs – “Real men do seek help” “It takes courage to change” Norms – Community-wide investment to increase protective factors and increase social support

  19. Summary Mental disorders are the most disabling medical illnesses, beginning early in life and usually following a chronic course. Depression is common among college-aged students, often associated with substance abuse. Depression can be treated successfully. Suicide risk in college students is increased by depression and substance abuse, but can occur in the absence of either. Suicide can be reduced – “it takes a village”.

  20. Thanks to Drs. Bernie Arons and Jane Pearson www.nimh.nih.gov

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