1. Treatment for Depression as a Gateway for Assessment and Treatment of Other Co-Morbidities Jose M. Pena, MD Randal M. Graf, PhD M. Scott Tims, MS

2. “I have no actual or potential conflict of interest in relation to this educational activity or presentation”

3. Surveys American College Health Association - National College Health Assessment (ACHA) National Survey of Counseling Center Directors (Gallagher, RP) Mental Health Care in the College Community, (ed. Kay J and Schwartz V) College Student Mental Health : Effective Services and Strategies Across Campus (ed. Benton A and Benton L)

4. Increase in Number and Severity of Mental Health Problems Anxiety 13% Anorexia 2% Bulimia 2% Depression 18% – Considered Suicide (1yr.) 9 % – Attempted Suicide (Life) 1% – On Psych Medication 36% ACHA, 2008; Kay 2010

5. Increased Need for Services Directors of Health Services – 93% report increase in # of students on meds. – 95% report greater acuity Staff burnout Service shortages during peak times – 67% report increase in crisis counseling – 60% increased demand w/o increased resources Gallagher 2008

6. On-Line Mental Health Self- Assessment Survey Demographic Information Six Domains – Depression (DEP, n=230) – Bipolar (BP, n=88) – Alcohol Use (AU, n=32) – Eating Dis. (ED, n=58) – Generalized Anxiety (GAD, n=102) – Posttraumatic Stress (PTSD, n=26) Likelihood of problem Received Treatment

7. Demographic Information Across All Groups Caucasian (62-77%) Female (74-91%) Undergraduates (59-75%)

8. Within Group: Very likely to have the identified problem Depression (89%) Bipolar Dis. (34%) Alcohol Use (91%) Eating Dis. (66%) Generalized Anxiety Dis. ( 96%) PTSD (100%)

9. Within Group Treatment Seeking (vs. Likelihood) Depression 27% (vs. 89%) Bipolar Disorder 2% (vs. 34%) Alcohol Use 3% (vs. 91%) Eating Dis. 19% (vs. 66%) Generalized Anxiety 19% (vs. 96%) PTSD 12% (vs. 100%) Low utilization Across Groups

10. Within Group Treatment Seeking for Depression > Other Bipolar Dis. P<.0001 Alcohol Use P<.0027 Eating Dis. P<.0086 PTSD P<.0522 Generalized Anxiety P<.2407 Treatment seeking for depression much more likely than for other problems, with trends in same direction

11. Limitations Demographic : predominantly Caucasian, Female, undergrad. Self-selection Small sample size

12. Discussion All groups: Low treatment utilization Treated Depression highest at only 27% Increased Demand vs. Resources – ?? Tip of the Iceberg

13. Treatment Seeking for Depression Co-Morbidity – Bipolar Dis. – Alcohol Use – PTSD – ED – GAD

14. Treatment Seeking Recall: PTSD Disclosure : PTSD, ED, Alcohol (SA) Denial: Alcohol (SA), ED, Bipolar Distress – Bipolar I : 32% Dep : 15% Mania/Cycling – Bipolar II : 50% Dep; 4% Hypo/Cycling Age/Onset: DSM/Bipolar? Stigma: GAD weakest trend Judd LL et al ArchGenPsych 2002

15. Importance of Effective Screening and Diagnosis Subjective Chief complaint vs. Co-Morbidity Mental health and Non-mental health settings Anti-depressant Rx PHQ

16. Recommendations Prevention/Screening M. Scott Tims, MS Clinical Care/Programs Randall M. Graf, PhD