1. Prevalence of Mental Health Problems in a University Student Population Sarah E. Gollust, Daniel Eisenberg, PhD, Ezra Golberstein, Jennifer L. Hefner, MPH Department of Health Management & Policy, University of Michigan School of Public Health Contact: sgollust@umich.edu, http//:www.healthymindsstudy.netsgollust@umich.edu Research Objective Reports by campus counseling centers and other sources suggest growing mental health problems among university students in the United States, but there are few representative and rigorous studies quantifying the prevalence of mental disorders. In this study we assess the prevalence of several mental health problems (depression, anxiety, suicidality, and self-injury) among a random sample of undergraduate and graduate students at a large mid- western public university. Study Design Conclusions Key Measures Results Main Study: The Healthy Minds study was a web-based survey administered in fall 2005 to a random sample of 5,021 students attending a large, public university with a demographic profile similar to the national student population. 2,843 students responded to the main survey (RR=56.8%). Assessing Non-Response Bias: To address the possibility that responders to the surveys were different from non-responders on measures important to mental health, we created response weights based on: 1) Administrative data from the full student population and 2) A brief non-respondent survey directed toward 500 randomly selected non-responders (RR=54.2%) in Jan/Feb 2006 that included measures of depression and service use. Women, graduate students, and people with higher rates of depression and mental health service utilization in the past year were more likely to respond to the main survey, and African Americans were less likely to respond. Response weights were used to adjust for non-response bias. Post-stratification weights were used to adjust our estimates to reflect a student population composed of 3:1 undergraduates to graduate students. Description of the Sample Prevalence of Mental Health Problems Depression: Patient Health Questionnaire (PHQ-9), 9-item screening instrument for major depression (and “other depression”) (past 2 weeks) Anxiety: PHQ screening instrument for generalized anxiety disorder and panic disorder (past 4 weeks) Suicidality: Three dichotomous questions asking about suicidal thoughts, plans, and attempts (past 4 weeks) Self-injury: One item asking about self-injury behaviors (“ways you may have hurt yourself on purpose, without intending to kill yourself”) (past 4 weeks) Other measures: gender, age, race/ethnicity, nationality, sexual orientation, living situation, degree program, year in program, current financial situation, past financial situation when growing up, relationship status, alcohol use, marijuana use, smoking, affected by Hurricane Katrina, eating disorders (SCOFF screening instrument) Undergraduates, % (n=1181) Graduate students, % (n=1662) Female50.144.4 Age 18-22 Age 23-25 Age 26-30 Age 31+ 94.0 4.5 0.8 0.7 8.4 31.7 38.7 21.2 White (non-Hispanic) African American/Black Hispanic/Latino Asian or Pacific Islander Arab/Middle Eastern Multiple Other 68.4 7.0 3.4 15.5 1.1 4.5 0.2 55.1 6.1 4.2 27.9 1.7 4.5 0.7 International student5.622.4 Heterosexual Gay/lesbian/queer Bisexual 96.6 1.3 2.0 93.1 3.9 2.2 Current financial situation "Financial struggle" "Tight but doing fine" "Finances aren't a problem" 14.2 49.2 36.6 13.9 61.3 24.8 Past financial situation "Poor, not enough to get by" "Enough, not many extras" "Comfortable" "Well to do" 1.3 22.3 57.4 19.0 3.3 33.7 52.3 10.8 Affected by Hurricane Katrina7.85.8 Prevalence of Self-Injury (Full sample, n=2,788) Any 7.23% Cutting 0.80% Burning 0.27% Banging head/ body part 2.59% Scratched oneself 1.33% Punched oneself 1.50% Bit oneself 1.27% Interfered with wound healing 2.65% Other 0.35% Predictors of Mental Health Problems Note: Results above are for undergraduates only; results for graduate students reflect a similar pattern but the prevalence estimates are lower in every case. This study provides prevalence estimates for several common mental health problems among university students, with rigorous adjustments for the possibility of response bias. Nearly 14% of undergraduates screened positive for major or other depression. About 7% of students indicated that they had hurt themselves on purpose, without intending suicide, in the past four weeks, while very few students reported any suicidal ideation. The most consistent predictor of mental health problems was reporting a financial status of “poor” while growing up; this was associated with elevated risk for all 4 mental health problems measured. This finding suggests socioeconomic disparities in mental health, even within a setting often thought of as a privileged segment of society. The study has the following limitations: 1) It focused only on a few key mental health issues, not the full range of problems that may be prevalent among students; 2) The screening instrument used (PHQ) has high sensitivity and specificity but does not indicate a clinical diagnosis; 3) The findings represent only a single university, albeit one with a demographic profile similar to the national population of college students. Behavioral correlates of self-injury: Compared to students who did not report any self-injury, students who reported self-injury were significantly more likely to report smoking cigarettes in the past month (18.4% compared to 4.9%, p-value for difference <0.01), and were no more likely to report binge drinking (p=0.79) and marginally more likely to report marijuana use (p=0.06).