Email Feasible, Inexpensive Way to Screen for Depression in College Students

Caroline Cassels

May 26, 2010

May 26, 2010 (New Orleans, Louisiana) — Using email to screen college students for major depressive disorder (MDD) appears to be a feasible and inexpensive way to detect MDD in this high-risk group, new research suggests.

Presented here at the American Psychiatric Association 2010 Annual Meeting by first author Irene Shyu, BA, the investigators also found that providing students who screen positive for MDD with information about depression and potential treatment resources does not appear to increase help-seeking behavior.

Irene Shyu

"Our team does a lot of studies and clinical work in people with depression, and we have noticed in the past 10 years or so that college students are an underserved population," principal investigator Albert Yeung, ScD, MD, director of primary care research at the Depression Clinical and Research Program at Massachusetts General Hospital in Boston, told Medscape Psychiatry.

Dr. Yeung added that the prevalence of depression among college students runs between 10% and 17%. In contrast, he said, the prevalence of clinical depression in the community is about 7%.

Traditional depression screening in this population, which typically involves holding outreach clinics at local colleges and universities, is cumbersome and may be significantly hampered by selection bias.

"Typically, we set up booths and give out questionnaires at colleges over 2 or 3 depression screening days and students come in and fill them out, but this process is cumbersome and I always suspected that the healthier students would be more likely to participate in screening because they are more extroverted and more likely to engage, whereas depressed individuals may be less likely to engage," said Dr. Yeung.

The widespread use of the Internet, particularly among young people, prompted the investigators to look into whether email and an online survey might be a feasible and effective way of screening for depression in this population.

Undergraduate and graduate students at 4 colleges were invited through email to complete a depression screening survey. Participating students were linked to an online questionnaire to answer demographic and treatment history questions and complete the Patient Health Questionnaire 9 (PHQ-9).

Those who scored 10 or above on the PHQ-9 were considered positive for MDD and were provided with links to online psychoeducation on depression and information on campus peer-to-peer treatment resources.

In addition, they received a follow-up survey 8 weeks later to assess their treatment use.

A total of 631 students consented to take the survey. Of these, 126 (21.7%) reported a history of depression and 9.4% were receiving treatment for depression that included therapy (40%), medication (30%), and both (30%). A total of 73 individuals (12.9%) had suicidal symptoms.

A total of 82 students (14.5%) screened positive for MDD, and of these 38 (46.3%) completed the follow-up survey.

Overall, only 8 subjects (21.1%) with MDD used the online resources — 7 used online psychoeducation resources and 1 used peer counseling groups.

"On the one hand this is disappointing but not surprising to us. We have worked with a lot of students, primary care patients, and physicians, and we know that simply offering education is not enough, but that was not the main goal of the study," said Dr. Yeung.

"We demonstrated that much of the paper and pencil, physical clinical interactions used to conduct clinical studies can gradually be replaced by Internet-based methods and that many colleges could easily do this in order to help detect mental health problems — including depression as well as drug and alcohol use — among students," he added.

Although this could potentially improve recognition of mental health disorders in this population, said Dr. Yeung. There is still a significant issue around treatment resources, which, he said, are lacking in US college campuses.

Dr. Victor Schwartz

Commenting on the findings, Victor Schwartz, MD, university dean of students at Yeshiva University and associate professor of clinical psychiatry at Yeshiva University's Albert Einstein College of Medicine in New York City, said the study highlights the need for mental health screening in students.

"Perhaps the main value of this study is to emphasize the problem of depression in this population and provide the impetus to do something about it," Dr. Schwartz told Medscape Psychiatry.

He pointed out that there are currently 16 million college students in the United States and, as Dr. Yeung commented, that mental health resources for this population are scarce.

"The college mental health system doesn't have the capacity to take care of 1.6 million depressed people — it is a major public health challenge, which is part of what the folks who are working in this area are trying to figure out," said Dr. Schwartz.

"There is a need for people who are really trained in this area of college mental health. We need to create this group of subspecialists, and schools need to recognize that they need to provide the resources for this kind of care," he added.

Dr. Yeung has disclosed no relevant financial relationships.

American Psychiatric Association (APA) 2010 Annual Meeting: Abstract NR1-42. Presented May 24, 2010.

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