NCHA Data: Administrative and Clinical strategies for linking (mental) health and substance abuse disorders to academic

NCHA Data: Administrative and Clinical strategies for linking (mental) health and substance abuse disorders to academic success. Joy Himmel, Psy D. Director, Health and Wellness Center, Penn St. Altoona Keith Anderson, Ph.D. Psychologist, Rensselaer Polytechnic Inst.

Objectives • Issues that influence student learning and academic progress. • Prevalence of disorders and a review of NCHA data and trends. • Identifying strategies to develop best practice guidelines that promote academic success.

Issues that influence student learning and academic progress. • Determining barriers to academic success • Surveys • NCHA • Data collected from 2000 to 2005 • Current analysis uses Spring 2005 data set • N= 54,111 • AUCCCD • Survey of Counseling center directors • Data is from Fall 2005 • N= 366

Impediments to Academic Success • Stress 31.6% • Cold/Flu 26.5% • Sleep Problems 24.8% • Depression 15.3% • Internet Use/ Games 14.2% (3-6% of students addicted to internet pornography; 20% are women)

ACHA-NCHA Spring 2005 American College Health Association. American College Health Association - National College Health Assessment (ACHA-NCHA) Web Summary. Updated April 2006. Available at http://www.acha.org/projects_programs/ncha_sampledata.cfm. 2006

Academic performance impaired by impact of Alcohol use Percentage

Academic performance impaired by Depression, Anxiety, Seasonal Affective Disorder Percentage

Academic performance impaired by Drug Use Percentage

Academic performance impaired by Internet/Computer game use Percentage

Evidence for Rise in Psychological Distress • Big 10 Universities Student Suicide Study (1980-1990) • CDC’s YRBS ( 1999 - 2003) • CDC’s NCHRBS (1995) • ACHA-NCHA - Spring 2000 - 2004 • AUCCCD’s Annual Surveys • Published literature

Rise on college campuses • Earlier identification and referral (high school) • Improved treatment options • Decreased stigma (high school & college) • Increased accessibility/availability • Greater use of structured screening tools, web-based resources • Improved accommodations • Greater parity with physical health • More students working, increased stress

Consequences of increased demands for service • Advocating for more staff • Increased wait times • for intake and between sessions • premature drop out • if we focus on those with more severe disorders, do some students fall between the cracks? • Requires an analysis of our mission • Who should we serve?

Related (but often unapparent) concerns • Do some avoid treatment, problems stigma, center reputation, concerns about confidentiality. • How do we reconcile a high demand for service with concerns that some are still untreated.

Why Some Students Do Not Use University Counseling Facilities • For help with all kinds of problems, friends were the first choice, parents were the second choice, and faculty and psychological services the last choice. • Counseling centers should begin to focus their attention on more preventive-oriented types of services rather than traditional remediation, which may include being available to the student in his own life space rather than in the counseling center. Derksen, Timothy; Hill, Clara; Snyder, John. “Why Some Students Do Not Use University Counseling Facilities.” Journal of Counseling Psychology 19 No.4 (1972): 263-268.

Stigma of Psychological Therapy: Stereotypes, Interpersonal Reactions, and the Self-Fulfilling Prophecy • Negative attitudes were displayed toward people who sought psychological assistance from a clergyman or from a psychiatrist. • A person described as seeking counseling is rated more negatively than is a “typical” person. Dovidio, John; Sibicky, Mark. “Stigma of Psychological Therapy: Stereotypes, Interpersonal Reactions, and the Self-Fulfilling Prophecy.” Journal of Counseling Psychology 33 No.2 (1986): 148-154.

Finding value in our services Retention • 562 students asking for counseling followed over 2 year period • 0 sessions 65% 1-12 79% >13 83% • Several studies followed people over 5 years all showed dramatically higher retention rates, averaging more than 10% for students who used counseling services Steve Wilson, Terry Mason, Evaluating the impact of receiving university based counseling services on student retention Journal of Counseling Psychology 1997 vol 44. no 3 p. 316-320

Retention • Social Isolation single most important determinant of dropout rates Pascarella and Terrazini, 1979 • Emotional- Social Adjustment items predicted attrition better than academic items Gerdes and Mallinckrodt 1994 • 5 year study of Berkeley students and those making use of counseling had higher graduation rates Frank and Kirk 1975

Retention Counseling records of 2365 students and student body records of 67,026 over 6 years(473 /13,400) at Western Land Grant University. • 70% report that personal problems were affecting their academic progress • 70.9% retention of students in counseling, 58.6% retention in control group over 6 years (annual, eventual, graduation and total retention) • Annual rates were 85.2 vs. 73.8% Andrew Turner Journal of College Student Development, Nov. Dec 2000

Common Presenting Problems Mood Disorders • In any given year- 9.5% of US population age 18+, or 20.9 million adult Americans, • 16.3% indicate that depression/anxiety/SAD affect academics (NCHA, spring 2005) • Major Depressive Disorder • Dysthymic Disorder • Cyclothymia • Bi Polar Disorder • Depressive Disorder NOS • Twice as many women as men NIMH Facts about Depression

Signs and Symptoms • Prolonged sadness/increased crying • Noticeable changes in appetite and sleep patterns • Worry, anxiety • Irritability, agitation, anger • Pessimism, indifference • Loss of energy, persistent lethargy • Unexplained aches and pains • Excessive feelings of guilt, worthlessness, hopelessness • Difficulty concentrating, indecisiveness • Social Withdrawal, loss of pleasure in things of interest • Excessive consumption of alcohol or other drugs • Recurring thoughts of death or suicide

The Prevalence of Depression as a Function of Gender and Facility Usage in College Students • The rate of depression is 50% higher for college students than for non-student peers. • One-third of college drop-outs suffer depression just before leaving school. • Men are more likely to present psychological problems at a health facility with a nonpsychological image. • Students with somatic symptoms associated with depression are seen quite frequently at infirmaries. Balzer, Diana; Pillsbury, Elecia; Nagelberg, Daniel. “The Prevalence of Depression as a Function of Gender and Facility Usage in College Students.” Journal of College Student Personnel (Nov 1983): 525-529.

Percentage of High School Students Who Felt Sad or Hopeless,* 1999 - 2003 * Felt so sad or hopeless almost every day for > 2 weeks in a row that they stopped doing some usual activities during the 12 months preceding the survey 1 No change over time National Youth Risk Behavior Surveys, 1999 – 2003

2005 Spring Survey Results American College Health Association. American College Health Association - National College Health Assessment (ACHA-NCHA) Web Summary. Updated April 2006. Available at http://www.acha.org/projects_programs/ncha_sampledata.cfm. 2006

Felt things were hopeless Percentage Number of Incidents NCHA 2000/05

Felt so depressed it was difficult to function Percentage NCHA 2000/05

Seriously considered attempting suicide Percentage NCHA 2000/05

Percentage of High School Students Who Seriously Considered Attempting Suicide,* 1991 - 2003 * During the 12 months preceding the survey 1 Significant linear decrease and quadratic effect, p < .05 National Youth Risk Behavior Surveys, 1991 - 2003

Summary of Suicide & Suicide Attempts [Comparing 18-24 year olds to total population 2001] • Female youths attempt at a slightly higher rate, however • Male youths are more likely to have a fatal outcome [Source: CDC WISQARS Fatal & Non-fatal 2001]

Risk Factors for Youth Suicide • Personal Characteristics • Psychopathology (mood disorders, substance abuse) • History of prior attempt • Cognitive and personality factors, including hopelessness and poor interpersonal problem-solving • Biological factors (primarily serotonin function) Gould MS, Greenberg T, Velting DM, Shaffer D. Youth suicide risk and preventive interventions: a review of the past 10 years. Journal of the American Academy of child Adolescent Psychiatry. 2003;42(4):386-405.

Risk Factors for Youth Suicide • Family characteristics • History of suicidal behavior • Parental psychopathology • Adverse life circumstances • Stressful life events, loss, legal/disciplinary problems, bullying • Physical abuse • Sexual abuse • Socio-environmental • Academic problems/failure • Media influence (contagion) Gould MS, Greenberg T, Velting DM, Shaffer D. Youth suicide risk and preventive interventions: a review of the past 10 years. Journal of the American Academy of child Adolescent Psychiatry. 2003;42(4):386-405.

Suicide Among College Undergraduates • Therefore, our best estimate of number of suicides and attempts among all U.S. college undergraduates to date, • approx. 1,305 will die as a result of suicide /year • approx. 31,469 will attempt suicide /year • Note: # suicides using Big Ten suicide rate for 17-24 year olds [6.3/100,000†] * # 18-24 year old undergraduates [9,367,000] + 30%=767 college undergraduate suicides/year; • and using Harvard Pilot suicide rate for 18-24 year olds [3.74/100,000] * # 18-24 year old undergraduates [9,367,000] + 30% = 455college undergraduate suicides/year • In order to know the true number of college undergraduate suicides & attempts, we need to know the rate of suicide & attempts among this population [Source: †rate is weighted average of 17-19 and 20-24 categories; CDC WISQARS Fatal & Non-fatal 2001]

Academic Consequences • Consistently high/significant correlations between GPA and • Hopelessness • Feeling exhausted • Considering/attempting suicide • Feeling so depressed it was difficult to function

Bipolar Disorder In any given year 5.7 million American Adults have Bipolar (2.6%). • Commonly diagnosed in college age • 20-25% increased risk of committing suicide Signs and Symptoms • Irritability, distractibility, increased energy, elation, racing thoughts, decreased need for sleep, reckless behavior, decreased need for sleep, loss or reason

Anxiety Disorders In any given year, anxiety disorders affect about 40 million Americans (18%), NCHA spring 2005, (13.4%) All symptoms cluster around excessive, irrational fear and dread, subjective tension. • Generalized Anxiety Disorder • Panic Disorder • PTSD • Obsessive-Compulsive Disorder • Social Phobia (NIMH-Facts about anxiety disorders)

Signs and Symptoms • Worrying about things –big and small • Headaches or other aches and pains for no reason • Tense, difficulty relaxing, pressured speech • Trouble concentrating • Irritable • Trouble falling asleep or staying asleep • Sweats, hot flashes • On guard, hyper vigilant

Adjustment Disorders Precipitators of stress • Common stressors include: • Greater academic demands • Being on your own in a new environment • Changes in family relations • Financial responsibilities • Changes in your social life/fitting in • Exposure to new people, ideas, and temptations • Awareness of your sexual identity and orientation • Preparing for life after graduation (NIMH)

National College Health Assessment Data - Alcohol American College Health Association. American College Health Association - National College Health Assessment (ACHA-NCHA) Web Summary. Updated April 2006. Available at http://www.acha.org/projects_programs/ncha_sampledata.cfm. 2006 .

Major characteristics of abuse and dependency • Abstinence • Experimentation-episodic use without pattern or consequences • Social/Recreational- seek it out, no established pattern or negative consequences • Habituation- established pattern • Abuse- use despite consequences • Addiction- Abuse plus compulsion (Inaba, 2003)

Cognitive impact of substance abuse Two to three standard drinks can directly: • interfere with restful sleep • Cause slow thinking processes- Lack of glycogen to the brain • Impairment in sustained concentration • Impairment in reaction time • Ability to use abstract thought processes (Dodes, 2002)

Impact of Alcohol Abuse The positive: • 74.6% use a designated driver, 64.1% keep track, 42% avoid drinking games, 33.9% determine in advance not to exceed a set number, 76.9% eat before they go out

Michigan Alcohol Screening Test Scores and Academic Performance in College Students • Several studies have indicated that problem drinking behaviors among college students can lead to legal, academic, or social difficulties. • Freshman reported a significantly greater weekly drinking frequency, Sophomore weekly alcohol consumption was significantly greater than consumption frequencies reported by junior, senior, or graduate students.

Academic Consequences • A significant inverse correlation was obtained between GPA and weekly alcohol consumption. This was evident for persons with GPAs below 2.5. Students reporting lower GPAs (1.5-1.9) also reported a significantly greater weekly consumption of alcohol. • Data indicated negative correlation between the students’ average weekly alcohol consumption and their GPA. Students in the lowest GPA category (1.5-1.99) had the greatest mean alcohol consumption rate. • Lall, Rakesh; Schandler, Steven. “Michigan Alcohol Screening Test Scores and Academic Performance in College Students.” College Student Journal (1988): 245-251.

Consequences to alcohol use and abuse • 37% did something they later regretted • 15% had unprotected sex • 30% experienced blackouts • 18.5% physically injured • Only 4.1% report experiencing substance abuse problems, 7.6% indicate that use affected academics, (NCHA, spring 2005)

Other common problemsSleep Correlations between sleep patterns and reported GPA • Consequences of sleep loss: poor academic performance, increased medical illness and increased rates of depression and anxiety. (Armitage, R., 2004) • 24.8% report that sleep has affected academics, (NCHA, spring 2005)

Sleep Quality, Sleep Propensity and Academic Performance • 15% of college students experience poor sleep quality. • The median length of sleep reported by college students has decreased by over one hour across the last three decades. (Hicks, Fernandez, Pellegrini) • Higher GPAs were associated with, waking up less often during the night, taking fewer naps, and sleeping somewhat longer on school nights.

Sleep Quality and Academic Performance • For a sample of 148 undergraduates that those who slept on the average less than six hours per night had lower self-reported GPAs than those who slept nine hours or more. (Kelly, Kelly, Clanton) • Lower GPAs were significantly associated with later weekday and weekend bedtimes, later weekday and weekend wake-up times, and longer hours of sleep on weekend nights. (Trockel, Barnes, Egget) Howell, Andrew; Jahrig, Jesse; Powell, Russell. “Sleep Quality, Sleep Propensity and Academic Performance.” Perpetual and Motor Skills 99 (2004): 525-535.

Sleep Problems • 35% of adult population experience insomnia • 11% of college students get a “good night’s sleep” • Loss of cognitive functioning, driving • Increased risk of depression • < 7 hours yields sleep deprivation

NCHA Data: Administrative and Clinical strategies for linking (mental) health and substance abuse disorders to academic