Healthy Minds Study: Whence, Where, Whither?
Daniel EisenbergDepartment of Health Management and PolicySchool of Public Health, University of Michigan
College Mental Health Research SymposiumAnn Arbor, MI March 9, 2010
Collaborators in Healthy Minds• Center for Student Studies, at the Survey Sciences
Group, LLC (http://www.surveysciences.com/css.html)• Scott Crawford, Sara O’Brien, and colleagues
• Pilot Healthy Minds Study– Co-developers and co-authors: Ezra Golberstein, Sarah Gollust,
Jennifer Hefner– Co-authors: Jim Cranford, Emily Nicklett, Katie Roeder, Alisha Serras
• National Healthy Minds Study– Collaborators/co-authors: Jim Cranford, Marilyn Downs, Ezra
Golberstein, Sarah Gollust, John Greden, Summar Habhab, Justin Hunt, Corey Keyes, Karen Saules, Alisha Serras, Nicole Speer, Daphne Watkins, Kara Zivin
– Study coordinators at 50 colleges and universities
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Funders• Pilot Healthy Minds Study
– University of Michigan• Office of the Vice President of Research• School of Public Health• Dept of Health Management & Policy (McNerney Award)• Rackham Graduate School (two grants)
– Blue Cross Blue Shield of Michigan Foundation• National Healthy Minds Study
– University of Michigan Comprehensive Depression Center– Participating colleges and universities– Virginia Department of Health (VDH)– Penn State Children, Youth, and Families Consortium
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Whence: Broad Motivation
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How can we invest most efficiently in the mental health of college students (What are the
returns from potential interventions)?
Design and evaluate programs and interventions
Collect descriptive data
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Whence: Study Design• Sample
– Random samples from full student populations– Methods to boost response rates and adjust
carefully for differences in non-responders• Topics
– Focus on help-seeking and access to care– Also, broad range of factors related to mental health
(e.g., stigma, social support, academic outcomes, substance use)
• Collaborative networks of schools
Whence: Growth to Date• 2005: 1 school (U-M), ~2,900 respondents, RR=57%• 2007: 13 schools, ~5,500 respondents, RR=44%• 2009: 15 schools, ~8,500 respondents, RR=43%• 2010: 27 schools, ~35,000 (?) respondents, RR=35%(?)
• Total to date: 50 campuses, ~50,000 respondents
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Where: Key Findings
1. High prevalence of MH problems, but also “flourishing”2. <50% of students with MH problems receive treatment3. Substantial variation in MH & treatment use across
demographic groups4. Several apparent risk & protective factors (particularly
related to social support and financial stress)5. Substantial variation in MH and treatment use across
campuses (but not across types of campuses)6. Stigma is important but not the only important barrier to
help-seeking7. Mental health predicts GPA & likelihood of dropping out
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Whither: Emphasize Coalitions• Example from state of Virginia
• Key benefits:– Efficiencies in data collection– Workshops and other forums to discuss data– Strengthening ties across campuses– Potential efficiencies in data analysis
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Whither: Deepen Understanding of Help-seeking Behavior
• Can we classify individuals by their most prominent barriers/facilitators to help-seeking?
• For example, some students have deep-rooted opposition to treatment, whereas others simply have been putting it off
• This would move us towards tailored, person-centered interventions to increase help-seeking
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Discussion Questions• General strategies for growing the study?
– Specific thoughts on coalitions?• New topics and measures to include?• Ideas for deepening understanding of help-
seeking behavior?• Other directions to consider?
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Bonus Slides
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Finding #1: High Prevalence of Mental Health Problems, But also “Flourishing”
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Major d
epres
sion (P
HQ-9)
"Minor"
depres
sion (P
HQ-9)
Panic
disord
er (PHQ)
Genera
lized
anxie
ty (P
HQ)
Suicidal
ideatio
n (yr)
Non-suici
dal se
lf-injury
(yr)
Any MH pro
blem
Flourishing (K
eyes
' MHC)
0%
10%
20%
30%
40%
50%
60%
Overall Prevalence Estimates (%)
Finding #1: Implications• Affirms importance of more effective prevention
and treatment of mental disorders in this population
• Also points to importance of promoting positive mental health (tapping into protective factors of students and campus settings)
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Finding #2: Fewer than Half of Students with Mental Health Problems Receive Treatment
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Major depression (PHQ-9)
Anxiety (Panic or Generalized) (PHQ)
Suicidal ideation (yr) Non-suicidal self-injury (yr)
0%
10%
20%
30%
40%
50%
60%
Any Treatment Past Yr (%), by Mental Health Problem
Finding #2: Implications• Affirms importance of programs and
interventions to increase detection and linkage to treatment
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Finding #3: Substantial Variation Across Student Characteristics
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Un-der-
grad.
Grad. Student
Asian Black Hispanic Multi Other White0%2%4%6%8%
10%12%14%16%
Major Depression (%) by Demographic Group
Finding #3 (cont’d): Substantial Variation Across Student Characteristics
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Un-der-
grad.
Grad. Student
Asian Black Hispanic Multi Other White0%5%
10%15%20%25%30%35%40%45%
Treatment in Past Yr (%) among those with a Mental Health Problem, by Demographic Group
Finding #3: Implications• Supports the value of targeting and tailoring
programs and interventions
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Finding #4: Several Apparent Risk and Protective Factors
• Risk factors– Financial stress (both past and present)– Experiencing discrimination
• Protective factors– Social support– Living on campus– Religiosity
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Finding #4: Implications• Programs and interventions that address
financial stresses and social context may improve mental health
• Relationship between campus residential setting and mental health warrants further study
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Finding #5: Substantial Variation across Campuses (but not Types of Campuses)
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• On the other hand, little apparent variation across groups of campuses defined by:– Public versus private– Enrollment size– Academic rank
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Finding #5 (cont’d)
Finding #5: Implications• Campus-level factors are probably important, but
more work is needed to understand them
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Finding #6: Stigma Is Important but Not the Only Important Barrier to Help-seeking• If we could reduce the level of stigma by half, we
project treatment use among those with major depression would increase from 44% to 60%
• Other factors that appear to be important:– No need– Prefer to deal with issues on my own– Stress is normal in college/graduate school– Get a lot of support from other sources, such as
friends and family– Don’t have enough time
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Finding #6: Implications• Affirms value of efforts to reduce stigma• Also points to need to understand and address
other factors more effectively– Many students have low stigma but do not seek
treatment—mental health care simply does not make it to the top of their busy priority list
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Finding #7: Mental Health Predicts Academic Outcomes
• Longitudinal analysis of Univ. Michigan students• Depression associated with:
– Drop in GPA distribution by 25 percentile points– Doubling of probability of drop-out
• Rough economic analysis of a hypothetical screening and referral program indicate that productivity benefits from improved academic outcomes would far outweigh costs of program
• Full manuscript at: http://www.bepress.com/bejeap/vol9/iss1/art40/
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Finding #7: Implications• “Business case” for mental health programs on
college campuses looks good, but requires more definitive studies (ideally, a large randomized trial of a prevention and/or treatment program, with follow-up on academic outcomes)
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Current Projects Building on Healthy Minds
• e-Bridge to Mental Health online intervention– PI: Cheryl King (University of Michigan)– Funder: NIMH (2009-2012)
• Peer effects in mental health among college students– PI: Daniel Eisenberg (University of Michigan)– Funder: W.T. Grant Foundation (2009-2011)
• Evaluation of Mental Health First Aid training for resident advisors (RAs)– Co-PIs: Nicole Speer (WICHE) and Daniel Eisenberg– Funder: NIMH (2009-2011) 28
Projects in Development• Multi-campus study of the effects of residential
settings on mental health and other outcomes• Analysis of the role of procrastination in
students’ help-seeking behavior• National survey of law students on mental health
and substance use
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Future Iterations of Healthy Minds• Plan to continue annually (next iteration will be
February-April 2011)• Aim to include more campuses that are typically
underrepresented (e.g., community colleges, HBCUs, Tribal Colleges)
• Most measures will remain consistent over time, but some will change (we welcome ideas)
• More information at www.healthymindsstudy.net
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