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DEPARTMEN
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Depression on the College Campus:Connections to Stress, Sleep, and Alcohol
Thomas R. Insel, M.D.Director, National Institute Mental Health
Bethesda, MD
Depression on the College Campus:Connections to Stress, Sleep, and Alcohol
Thomas R. Insel, M.D.Director, National Institute Mental Health
Bethesda, MD
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Which medical disorder causes greatest disability?
Percent of total YLDs
Mental Illness* 26.1
Alcohol and drug use 11.5
Respiratory disease 7.6
Musculoskeletal disease 6.8
Sense organ disease 6.4
Cardiovascular disease 5.0
Alzheimer’s and other dementia 4.8
Injuries, including self-inflicted 4.7
Digestive diseases 3.4
WHO World Health Report 2002Data for United States and Canada
all ages
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Causes of Disability by Illness CategoryUnited States and Canada
15-44 years old
0 5 10 15 20 25 30 35 40
Mental Illness*
Alcohol and drug use
Injuries, including self-inflicted
Respiratory disease
Musculoskeletal disease
Sense organ disease
Cardiovascular disease
Migraine
Infectious disease, excluding HIV
WHO World Health Report 2002
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Causes of Disability by Specific IllnessUnited States and Canada
15-44 years old
0 5 10 15 20 25 30
Unipolar depression
Alcohol use
Drug use
Bipolar disorder
Schizophrenia
Hearing loss
Migraine
Iron deficient anemia
Diabetes mellitus
WHO World Health Report 2002
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U.S. Prevalence of Major Depression
One year prevalence: 6.6% (13.1 – 14.1 million adults)
Lifetime prevalence: 16.2% (32.6 – 35.1 million adults)
(Severe or very severe role impairment in 59.3%)
51.6% receive health care treatment, but only 21.7% receive adequate treatment
Kessler et al., JAMA 2003
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When does depression start?
Co-morbidity with anxiety = 67.8% with Subst. Abuse = 27.1%
Mood Disturbance Alcohol/Substance Abuse
STRESSSLEEP DISTURBANCE
Anxiety in childhood/early adolescence
Early loss/trauma/stress Genetic vulnerability
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How do we treat depression?
Awareness - ScreeningReferral - Access
Therapy – Meds/CBT
Follow-up
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Treating Depression: Different Strokes for Different Folks?
Nemeroff et al., PNAS, 2003
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pCg
Depression Remission: Meds vs Therapytreatment-specific changes
pCg
mF10
CBT
vF
F9
mF9
Paroxetine
Cg25th
F9
P40hc
th
F11
Cg24
hc
Goldapple et al Arch Gen Psych 2003
hc
+4
- 4
mF9F9
Cg24
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SSRIs in College Students?
FDA is currently reviewing the risk of suicide in adolescence on SSRIs:
Is suicide an effect of the disease or the treatment?
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What is a greater source of mortality: suicide or homicide?
Approx 30,000 suicides/year (10.7/100,000)
Deaths from homicide: 18,000/year AIDS: 20,000/year Prostate Ca: 28,900/year
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Suicide in College Students
Suicides for 15-19 year olds nearly doubled between 1970-1990
Age-related Risk Factors: carry a weapon, drive after drinking, impulsive/aggressive personality, rarely use seatbelts, depression
Campus Risk Factors: Stress, clusters of suicides, loss of social support
NOTE: Some studies in general population have estimated a 10-30 fold increase in risk due to availability of firearms (Kellerman et al., NEJM 1992)
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National College Health Risk Behavior Survey (1995)
SeriouslyConsidered
MadePlan
SuicideAttempt
RequiredMed. Attn.
Total 10.3 6.7 1.5 0.4
Male 9.7 7.2 1.7 0.5
Female 10.8 6.3 1.3 0.3
Self –report from 4609 students, ages 18-24, in 2 and 4 year colleges.Higher rate among African American males?
http://www.cdc.gov/mmwr/preview/mmwrhtml/00049859.htm
Percentage in past 12 months:
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Suicide on Campus – Big Ten Study
Review of 261 suicides on 12 Midwestern campuses from 1980 – 1990
Rates of suicide highest in older students:age <25 age >25
females 3.2 9.4males 7.9 15.6
Overall rate = 7.5/100,000 across 10 year period
Silverman et al., 1997
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How do we prevent suicide?
Reducing risk
Referral - Screening
Rx/Hospitalization
Follow-up
Increase protective factors
Safeguarding your students against suicide – NMHA and Jed Found.
The National Strategy for Suicide Prevention – U.S. Surgeon General
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Air Force Program to Reduce Suicide
Knox et al., BMJ, 2003
Community awareness and reduction of stigma(Priority for senior officers, training at all levels, buddy system)
Coordination of social services and social support(Distributed support in schools, work sites, community facilities)
Focus on high risk situations(Legal investigations, protections of privacy)
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Air Force Program to Reduce Suicide
Knox et al., BMJ, 2003
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What can the Air Force Study teach us about reducing suicide
on college campuses?
Stigma – Top down message that mental health is part of health
Norms – Community-wide investment to increase protective factors and increase social support
Beliefs – “Real men do seek help” “It takes courage to change”
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Summary
Mental disorders are the most disabling medical illnesses, beginning early in life and usually following a chronic course.
Depression is common among college-aged students, often associated with substance abuse. Depression can be treated successfully.
Suicide risk in college students is increased by depression and substance abuse, but can occur in the absence of either.
Suicide can be reduced – “it takes a village”.
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www.nimh.nih.govwww.nimh.nih.gov
Thanks to Drs. Bernie Arons and Jane Pearson