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      Increasing intentions to use mental health services among university students. Results of a pilot randomized controlled trial within the World Health Organization's World Mental Health International College Student Initiative

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          Abstract

          The majority of university students with mental health problems are untreated. Only a small empirical literature exists on strategies to increase mental health service use. To investigate the effects and moderators of a brief acceptance‐facilitating intervention on intention to use mental health services among university students. Within the German site of the World Health Organization's World Mental Health International College Student (WMH‐ICS) initiative, 1,374 university students were randomized to an intervention condition (IC; n  = 664) or a control condition (CC; n  = 710) that was implemented in the survey itself. Both conditions received the questions assessing mental disorders and suicidality that were included in other WMH‐ICS surveys. The IC group then additionally received: Internet‐based personalized feedback based on subject symptom severity in the domains of depression, anxiety, substance use, suicidal thoughts and behaviors, and nonsuicidal self‐injury; psychoeducation tailored to the personal symptom profile; and information about available university and community mental health services. The primary outcome was reported intention to use psychological interventions in the next semester, which was the last question in the survey. A broad range of potential moderating factors was explored. There was a significant main effect of the intervention with students randomized to IC, reporting significantly higher intentions to seek help in the next semester than students in the CC condition ( d  = 0.12, 95% CI: 0.02 to 0.23). Moderator analyses indicated that the intervention was more effective among students that fulfilled the criteria for lifetime ( d  = 0.34; 95% CI: −0.08 to 0.7) and 12‐month panic‐disorder ( d  = 0.32; 95% CI: −0.10 to 0.74) compared with those without lifetime ( d  = 0.11; 95% CI: 0.00 to 0.22) or 12‐month panic disorder ( d  = 0.11; 95% CI: 0.00 to 0.22), students with lower ( d  = 0.37; 95% CI: −0.77 to 1.51) than higher ( d  = −0.01; 95% CI: −0.36 to 0.34) self‐reported physical health, and students with nonheterosexual (d = 0.38; 95% CI: 0.08 to 0.67) compared with heterosexual (d = 0.06; 95% CI: −0.06 to 0.17) sexual orientation. The intervention had no effects among students who reported that they recognized that they had an emotional problem and “are already working actively to change it” (Stage 4 “stages of change”). A simple acceptance‐facilitating intervention can increase intention to use mental health services, although effects, are on average, small. Future studies should investigate more personalized approaches with interventions tailored to barriers and clinical characteristics of students. In order to optimize intervention effects, the development and evaluation should be realized in designs that are powered to allow incremental value of different intervention components and tailoring strategies to be evaluated, such as in multiphase optimization designs.

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          The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI)

          This paper presents an overview of the World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and a discussion of the methodological research on which the development of the instrument was based. The WMH‐CIDI includes a screening module and 40 sections that focus on diagnoses (22 sections), functioning (four sections), treatment (two sections), risk factors (four sections), socio‐demographic correlates (seven sections), and methodological factors (two sections). Innovations compared to earlier versions of the CIDI include expansion of the diagnostic sections, a focus on 12‐month as well as lifetime disorders in the same interview, detailed assessment of clinical severity, and inclusion of information on treatment, risk factors, and consequences. A computer‐assisted version of the interview is available along with a direct data entry software system that can be used to keypunch responses to the paper‐and‐pencil version of the interview. Computer programs that generate diagnoses are also available based on both ICD‐10 and DSM‐IV criteria. Elaborate CD‐ROM‐based training materials are available to teach interviewers how to administer the interview as well as to teach supervisors how to monitor the quality of data collection. Copyright © 2004 Whurr Publishers Ltd.
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            Mental disorders among college students in the World Health Organization World Mental Health Surveys.

            Although mental disorders are significant predictors of educational attainment throughout the entire educational career, most research on mental disorders among students has focused on the primary and secondary school years.
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              Mental health of college students and their non-college-attending peers: results from the National Epidemiologic Study on Alcohol and Related Conditions.

              Although young adulthood is often characterized by rapid intellectual and social development, college-aged individuals are also commonly exposed to circumstances that place them at risk for psychiatric disorders. To assess the 12-month prevalence of psychiatric disorders, sociodemographic correlates, and rates of treatment among individuals attending college and their non-college-attending peers in the United States. Face-to-face interviews were conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Analyses were done for the subsample of college-aged individuals, defined as those aged 19 to 25 years who were both attending (n = 2188) and not attending (n = 2904) college in the previous year. Sociodemographic correlates and prevalence of 12-month DSM-IV psychiatric disorders, substance use, and treatment seeking among college-attending individuals and their non-college-attending peers. Almost half of college-aged individuals had a psychiatric disorder in the past year. The overall rate of psychiatric disorders was not different between college-attending individuals and their non-college-attending peers. The unadjusted risk of alcohol use disorders was significantly greater for college students than for their non-college-attending peers (odds ratio = 1.25; 95% confidence interval, 1.04-1.50), although not after adjusting for background sociodemographic characteristics (adjusted odds ratio = 1.19; 95% confidence interval, 0.98-1.44). College students were significantly less likely (unadjusted and adjusted) to have a diagnosis of drug use disorder or nicotine dependence or to have used tobacco than their non-college-attending peers. Bipolar disorder was less common in individuals attending college. College students were significantly less likely to receive past-year treatment for alcohol or drug use disorders than their non-college-attending peers. Psychiatric disorders, particularly alcohol use disorders, are common in the college-aged population. Although treatment rates varied across disorders, overall fewer than 25% of individuals with a mental disorder sought treatment in the year prior to the survey. These findings underscore the importance of treatment and prevention interventions among college-aged individuals.
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                Author and article information

                Journal
                International Journal of Methods in Psychiatric Research
                Int J Methods Psychiatr Res
                Wiley
                10498931
                June 2019
                June 2019
                November 20 2018
                : 28
                : 2
                : e1754
                Affiliations
                [1 ]Department of Clinical Psychology and Psychotherapy; University of Erlangen-Nuremberg; Erlangen Germany
                [2 ]Department for Clinical Psychology and Psychotherapy; Ulm University; Ulm Germany
                [3 ]Public Health Psychiatry; KU Leuven; Universitair Psychiatrisch Centrum KU Leuven; Leuven Belgium
                [4 ]Research Group Psychiatry, Department of Neurosciences; KU Leuven University; Leuven Belgium
                [5 ]Department of Clinical Psychology; VU Amsterdam and Amsterdam Public Health Institute; Amsterdam The Netherlands
                [6 ]Health Services Research Unit; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP); Madrid Spain
                [7 ]Department of Psychiatry; Columbia University, New York, USA; Division of Clinical Developmental Neuroscience, Sackler Institute; New York New York
                [8 ]Department of Health Care Policy; Harvard Medical School; Boston Massachusetts
                Article
                10.1002/mpr.1754
                6877244
                30456814
                85a8ca16-71ff-4e2d-b6ee-e5d582dd4010
                © 2018

                http://doi.wiley.com/10.1002/tdm_license_1.1

                http://onlinelibrary.wiley.com/termsAndConditions#vor


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