HEALTH AND WELLNESS IN THE

COLLEGE POPULATION:

FACTORS AFFECTING

MENTAL HEALTH

Umamah FatimaCarolyn Meyer Lydia Nader Brittany PinkosNicole Potts

Thesis advisor: Bonnie Beezhold, PhD, MHS, CHES

RESEARCH QUESTION

What factors are linked to mood in college students at

Benedictine University?

OVERVIEW About 1/3 of college students report feeling depressed 1

Factors that influence mood in college students: substance abuse, loss of academic productivity, acute infectious illness, antisocial behavior 2

Poor diet associated with depression in college students 3,4

¹American College Health Assoc, 2012; ²Blanco 2014, ³Park, 2010; ⁴Kwasky, 2014

STUDY OBJECTIVES Objective 1: To investigate the link between diet and depression in young adults within the Benedictine University community

Objective 2: To investigate health and lifestyle factors that are also associated with mood

METHODS

METHODS OVERVIEW

Station 1 and 7: Wellness survey (completed in 2 parts)Demographic and lifestyle information Multidimensional Scale of Perceived Social Support Assessment (MSPSSA)

University of Washington Life Substance Use Survey Pittsburg Sleep Quality Index (PSQI)

Depression Anxiety Stress Scale short form (DASS-21)

Station 3: Finger sticks for Cholestech lipid profiles

Alere.com

DASS-21 Self-reported questionnaire measuring emotional states of Depression, Anxiety, and Stress. Developed for research and clinical use Acceptable for use in adolescents as well as the general adult population

https://researchingparents.wordpress.com/2013/02/22/depression-anxiety-stress-scales-dass/

DASS-21 ValidityHigh validity for adolescent and adult non clinical patients when compared to the Quick Inventory of Depressive Symptomatology (QIDS-SR), Center for Epidemiologic Studies Depression Scale (CES-D) 5

Reliability Excellent reliability compared to CES-D and QIDS-SR; internal consistency (α=.87)

5Weiss, 2015

RESULTS

Class12 Senior Students (24%)

10 Fresh-man Stu-dents (20%)

19 Junior Stu-dents (38%)

7 Sopho-more Stu-dents (14%)

2 Grad (4%)

Demographic and Lifestyle Characteristics

VariablesMean ±

SEAge 20.44 ±

0.23Gender (m/f) 17 / 33Non-white/white 23 / 27Live on campus/off campus 18 / 32

Homework hrs/wk 14.90 ± 10.30

Work hrs/wk 12.14 ± 13.45

Sleep hrs/night 7.16 ± 1.15

Body mass index (kg/m2)

25.96 ± 0.86

Health and Wellness Characteristics

Variable n Mean± SE Guideline

s*Systolic BP (mm Hg) 50 108.51 ± 2.03 <120Diastolic BP (mm Hg) 50 68.08 ± 1.49 < 80Triglycerides (mg/dL) 44 80.23 ± 5.54 < 150Total-C (mg/dL) 44 152.52 ± 4.61 < 200HDL-C (mg/dL) 43 53.51 ± 2.22 >60LDL-C (mg/dL) 31 90.68 ± 5.23 <100Total-C/HDL ratio (mg/dL) 42 3.14 ± 0.17 <3.5Glucose – fasting (mg/dL) 44 87.59 ± 1.37 70-100

* National Institutes of Health

DASS-21 Results

Depression* Anxiety*

Stress*

Sample mean 10 11 11

Normal range 0 - 9 0 - 7 0 - 14* Cronbach alpha coefficients for our sample: DASS-D 0.77, DASS-A 0.75, DASS-S 0.74.

FISH AND MOOD

Nicole Potts

BACKGROUND - FISH Fish contain long-chain n3 fats > brain cell membrane structure and function (EPA/DHA).6

Higher intake of fish is associated with lower prevalence of depressive symptoms in women.7

Omega-3 fatty acid supplementation is associated with lower risk of depressive symptoms.8

6Dyall, 2006; 7Smith, 2014 ; 8Ginty et al, 2015 K&B seafood inc.

METHODSOmega-3 Fatty Acid Questionnaire9; modified with info from a study about categories of fish 10 Inquired about the frequency and quantity of moderate and high n-3 fish, high n-6 fish, and high mercury fish over the past 6 months Index calculated by multiplying frequency X quantity

9Sublette et al, 2011; 10Weaver et al, 2008

Fish intake in the past 6 mos n

Never or

rarely

>2-3 timesper

monthSeafood intake 50 17 33High n-3 fatty acid fish 50 28 22Moderate n-3 fatty acid fish 50 41 9High n-6 fatty acid fish 50 32 18High mercury fish 50 30 20

RESULTS - Population Intake of Fish

RESULTS – Associations with DASS-21 scores*Fish category

 DASS-D (n=50)

 DASS-A (n=50)

 DASS-S(n=50)

 DASS-Tot(n=50)

  rho / p value

rho / p value

rho / p value

rho / p value

TOTAL fish .020 / .893 -.161 / .264 -.025 / .864 -.043 / .769Mod n3 fish .226 / .114 .003 / .983 .049 / .733 .103 / .47

6High n3 fish .142 / .325 .069 / .636 .082 / .573 .129 / .37

2High n6 fish .249 / .820 .193 / .180 .238 / .097 .250 / .08

0Hi mercury fish

.117 / .418 .130 / .368 .283 / .047

.282 / .047

*Spearman’s correlations are significant at the p < 0.05 level.

RESULTS – Comparison of DASS-21 scores by intake level*Scores

No serv of high merc fish (n=31)

≥1 serv of highmerc fish (n=19)

pvalue

  Mean (95% CI) Mean (95% CI)  DASS-D 17.74 (16.10,

19.30)19.05 (16.30,

21.80) .294

DASS-A 17.42 (15.77, 19.07)

18.53 (16.30, 20.75) .284

DASS-S 19.74 (17.59, 21.89)

23.47 (20.51, 26.43) .0291

DASS-Tot

54.90 (50.29, 59.52)

61.05 (55.00, 67.11) .0352

*Mann Whitney U tests; means vs medians to display actual scores. 1U = 186.5, r = .308; 2U = 189.5, r = .298

DISCUSSION

Intake of high mercury fish was associated with higher stress. Higher mercury exposure in children was associated with cognitive developmental delay.11

Higher total mercury was not associated with increased odds of depression.12

11Freire , 2010; 12Ng, 2013

SWEETS AND MOOD Umamah

Fatima

BACKGROUND - SWEETSSweet taste is associated with sensitivity to mood altering effects.13,14

Participants with depressive symptoms had a higher consumption of sweets.15

13Kampov-Polevoy, 2006; 14Nagai, 2015; 15Mooreville, 2014 Wowamazing.com

METHODS How often (servings) did you consume sweets on average, per day?

RESULTS – ASSOCIATIONS*

Scores nCorrelation w/sweets

rho / p value

DASS-D

49 .127 / .384

DASS-A 49 .123 / .402DASS-S

49 .379 / .007

DASS-Tot

49 .297 / .038*Spearman’s correlations are significant at the p < 0.05 level.

RESULTS - INTAKE OF SWEETS Sweets servin

gs

Daily intake (n=49

) %1 9 17.32 25 48.13 11 21.24 3 5.85 1 1.9

Class

Sweet servings

1 or 2 3 to 5

Freshman 5 5Sophomore 5 2

Junior 15 3Senior 8 4Graduate 1 1

RESULTS – COMPARISONS*

Scores

1-2 servings of sweets/day

(n=34)

3-5 servings of sweets/day

(n=15)

pvalue

Mean (95% CI) Mean (95% CI)

DASS-D 17.71 (16.14, 19.27)

19.60 (16.30, 22.90) .378

DASS-A 16.94 (16.03, 17.85)

20.00 (16.14, 23.86) .396

DASS-S 19.41 (17.55, 21.27)

24.80 (21.16, 28.44)

.0091

DASS-Tot

54.06 (50.72, 57.40)

64.40 (55.15, 73.65) .0402

*Mann Whitney U tests; means vs medians to display actual scores.1U = 35.0, r = .38. 2U =160.5, r = .29.

DISCUSSION Students who ate a higher number of sweets servings per day reported more stress. Higher consumption of sweets has been associated with stress.16

Higher consumption of sweets, cookies, snacks and fast food was associated with depressive symptoms.17

16Mikolajczyk, 2009; 17El Ansari, 2014

BLOOD LIPIDS

AND MOOD Brittany Pinkos

BACKGROUND Depressed patients had lower total serum cholesterol levels, lower LDL-C levels and high HDL-C levels.18

Lower HDL-C was associated with long-term depressive symptoms.19

18Olusi, 1996; 19Lehto, 2008whattoexpect.com

METHODS Fasted finger sticks Cholestech LDX Analyzer Yielded lipid profiles - Total-C, LDL-C, HDL-C, TGL, Tot-C/HDL

alere.com

RESULTS*Lipid n

Lower classmen

mean

Upper classmen

meanNational CE

Total-C 44 148.56 ± 6.97

157.93 ± 6.04 < 200

LDL-C 31 86.83 ± 9.58

93.11 ± 6.16 < 100

HDL- C 43 46.671± 3.99

57.181 ± 2.43

>40 M, >50 F

TGL 44 78.88 ± 8.85

81.04 ± 7.21 < 150

TC/HDL 42 3.35 ± 0.36 3.04 ± 0.18 < 5.0 (optimal=3.5)

* Mann-Whitney U-tests; means vs medians shown to display actual values.1 M-W U Test; p=.029

RESULTS- ASSOCIATIONS* Lipids n DASS-D DASS-A DASS-S DASS-Tot

rho / p value

rho / p value

rho / p value

rho / p value

Total-C 44

.315 / .037

.399 / .007 .177 / .215 .365 / .015

LDL-C 31 .314 / .085 .343 / .059 .309 / .091 .452 / .01

1

HDL-C 43 .027 / .863 -.500 / .74

9-.079 / .61

4 -.051 / .746Triglycerides

44 .106 / .492 .290 / .056 -.004 / .98

0 .139 / .367

TC/HDL 42 .214 / .173 .328 / .03

4 .155 / .326 .278 / .074

*Spearman’s correlations are significant at the p < 0.05 level.

RESULTS - COMPARISON OF GROUPS*

Lower Total-C

<149 (n=23)

Higher Total-C>150

(n=27)

pvalue

Lower TC/HDL< 3.5

(n=30)

Higher TC/HDL> 3.5 (n=12)

pvalue

Mean (95% CI)

Mean (95% CI)

Mean (95% CI)

Mean (95% CI)

DASS-D17.13

(14.97,19.29)

19.10

(17.28,21.09)

.05517.40

(15.55,19.25)

18.33 (16.05,20.62

).232

DASS-A16.00

(14.78,17.22

)

19.41

(17.37,21.44)

.0011

16.93

(15.43,18.44)

20.00

(16.17,22.78)

.0283

DASS-S20.2

(17.76,22.77)

21.93 (19.35,24.5

0).398

20.33 (17.89,22.78

)

22.50 (18.94,26.06

).181

DASS-T53.39

(48.31,58.48)

60.52

(55.39,65.64)

.0272

54.67

(49.91,59.42)

60.83 (52.59,69.08

).078

*Mann Whitney U tests; means vs medians to display actual scores.1U = 146.5, r = .466; 2U = 197.5, r = .312; 3U = 104.5, r = .301

DISCUSSION Anxiety scores were associated with total cholesterol values, and students with higher Tot-C and TC/HDL ratios reported higher anxiety. Patient’s meeting DSM-4 criterial had significantly higher cholesterol, LDL and cholesterol/HDL levels than controls.20

Participants with both MDD and GAD had higher mean total cholesterol, triglycerides and LDL- C and lower mean HDL-C.21

20Peter, 1999; 21Sevincok, 2011

EXERCISE AND MOOD

Carolyn Meyer

BACKGROUND Regular physical activity intervention in depressed patients reduced depressive symptoms by at least 50% vs controls 22

Sedentary depressed females in high intensity weekly exercise intervention reduce depressive symptoms vs those in low intensity or stretching 23

22Kerling, 2015; 23Chu, 2009http://crossfitimpulse.com/what-is-fitness/

METHODS-FREQUENCY OF WEEKLY EXERCISE

30. Again, think about only those physical activities that you did for at least 10 minutes at a time. During the last 7 days, on how many days did you do moderate physical activities like bicycling at a regular pace, swimming at a regular pace, and doubles tennis in your leisure time? _____ days per week No moderate activity in leisure time

31. How many hours in total did you usually spend on one of those doing moderate physical activity?

32. During the last 7 days, if you engaged in moderate exercise, were the modes of exercise limited to only swimming or cycling?_____Swimming_____ Cycling______ Other (Please Specify)

24Craig, 2003https://livinghealthylifeplans.wordpress.com/

RESULTS- ASSOCIATIONS*

Days of Exercise in Last 7 Days n

DASS-Dscores

DASS-Ascores

DASS-Sscores DASS-Tot

rho/p value rho/ p value

rho/p value

rho/p value

Vigorous Exercise/day 41 -.213/.138

-.321/.023

-.323/.022

-.332/.019

Moderate Exercise/day 33 .098/.497

-.140/.331

-.068/.638

-.071/.623

Walking days 46 .028/.846 .055/.703

-.032/.825 .024/.866

*Spearman’s correlations are significant at the p < 0.05 level.

RESULTS - WEEKLY PHYSICAL ACTIVITY*

*Mean and range given in days

Days of Vigorous

Exercise in a Week n %

0 9 17.31 3 5.82 6 11.53 8 15.44 6 11.55 8 15.46 4 7.77 6 11.5

RESULTS- COMPARISONS*

ScoresLower Vigorous Exercise (n=26)

Higher Vigorous Exercise (n=24)

p value

Mean (95% CI) Mean (95% CI)DASS-D 18.85 (16.91,

20.79)17.58 (15.41,

19.75) .114

DASS-A 19.15 (16.96, 21.35)

16.42 (15.25, 17.58) .0351

DASS-S 22.92 (20.28, 25.57)

19.25 (17.04, 21.46) .0472

DASS-Tot 60.92 (55.34, 66.50)

53.25 (48.82, 57.68) .0253

*Mann Whitney U tests; mean vs medians shown to display actual scores. 1U = 207.0, r = .005; 2U = 210.0, r = .007; 3U =197.0, r = .004

DISCUSSION Vigorous exercise was associated with less anxiety and stress in students, and those who exercised more than 3 day/wk had lower symptoms that those who exercised fewer days.

Adolescents who exercised at high vs moderate intensity reported less stress over 10 wks 25

Students who met vigorous activity recommendations were less likely to report poor mental health 26

25Norris, 1992; 26VanKim, 2013

LIFESTYLE FACTORS

AND MOODLydia Nader

BACKGROUND Sleep quality and lack of social support are associated with increased depression in students 27

Students with high social anxiety symptoms had poor social support 28

Females within a committed relationship were less likely to report depressive symptoms 29

27Wilson, 2014; 28Cheng, 2015; 29Whitton, 2013

METHODS Survey questions: living situation, community feeling, relationship status, religious status, sleep, and social support network to see the relationship with DASS scores Multidimensional Social Support Questionnaire - MSSQ

METHODS University of Washington’s University Life Substance Use Survey - ULSUS

Pittsburgh Sleep Quality Index - PSQI

RESULTS – ASSOCIATIONS*Lifestyle factors n

DASS-D scores

DASS-A scores

DASS-S scores

DASS-Tot scores

rho / p value

rho / p value

rho / p value

rho / p value

Social support 50 -.380 / .0

06-.186 / .19

8-.286 / .0

05

-.390 / .005

Religious/ Spiritual activity

50 .057 / .695 .147 / .310 .247 / .084 .181 / .20

9

Living situation 50 .135 / .34

9 .061 / .673 .057 / .694 .100 / .488

Relationship status 50 .077 / .59

6 .136 / .348 .177 / .219 .151 / .294

Community feeling** 50 .276 / .05

2 .148 / .304 .263 / .065 .333 / .018

*Spearman’s correlations are significant at the p < 0.05 level. **Scale was negative.

RESULTS – ASSOCIATIONS*Lifestyle factors n DASS-D DASS-A DASS-S DASS-Tot

rho / p value

rho / p value

rho / p value

rho / p value

Sleep hrs/night

50 -.071 / .625 -.120 / .406 -.308 / .030 -.215 /.134

Sleep aid required

50 .230 / .109 .286 / .044 .307 / .030 .288 / .043

Sleep quality 50 .094 / .525 -.029 / .847 .289 / .046 .142 / .336

Listening to music 50 -.101 / .485 -.143 / .322 -.126 / .383 -.151 / .297

Reading 50 -.027 / .853 -.004 / .976 -.076 / .601 -.049 / .738Playing with pets 50 -.007 / .963 -.116 / .421 -.048 / .740 -.067 / .644*Spearman’s correlations are significant at the p < 0.05 level.

Scores

Feels Very much a Part of

Community(n=27)

Feels Not Very much a Part of

Community(n=23)

p valu

eMean (95% CI) Mean (95% CI)

DASS-D 16.96 (15.22, 18.71)

19.74 (17.48, 22.00) .0451

DASS-A 16.74 (15.66, 17.82)

23.30 (16.62, 21.64) .182

DASS-S 19.33 (17.23, 21.44)

23.30 (20.48, 26.13) .0302

DASS-Tot

53.04 (49.03, 57.04)

62.17 (56.10, 68.24) .0093

Results-Comparison of GroupsCommunity Feeling

*Mann Whitney U tests; means vs medians to display actual scores. 1U = 210.5, r = .28; 2U = 200.0, r = .31; 3U = 176.5, r = .37

Scores

Low Social Support(n=17)

High Social Support(n=33)

p valu

eMean (95% CI) Mean (95% CI)

DASS-D 21.41 (18.33, 24.49)

16.61 (15.40, 17.81) .003¹

DASS-A 18.82 (16.41, 21.24)

17.33 (15.76, 18.91) .182

DASS-S 23.41 (20.31, 26.51)

20.00 (17.87, 22.13) .060

DASS-Tot

63.65 (57.21, 70.08)

53.94 (49.75, 58.13) .004²

Results-Comparison of GroupsSocial Support

*Mann Whitney U tests; means vs medians to display actual scores ¹ U = 141.5, r = .41; ² U = 141.5, r = .40

Scores

4-7 hours of Sleep

(n=30)

8-9 hours of Sleep

(n=20)

p valu

eMean (95% CI) Mean (95% CI)

DASS-D

18.73 (16.79, 20.68)

17.50 (15.36, 19.64) .304

DASS-A 18.67 (16.66, 20.67)

16.60 (15.42, 17.78) .312

DASS-S 22.60 (20.37, 24.83)

19.00 (16.19, 21.81) .022¹

DASS-Tot

60.00 (54.88, 65.12)

53.10 (48.28, 57.92) .061

Results- Comparison of GroupsSleep Hrs/Night

*Mann Whitney U tests; means vs medians to display actual scores ¹U = 185.0, r = .33

DISCUSSION Students who felt greater social connection reported lower depressive symptoms; those who slept 8-9 hours vs 4-7 hours reported lower stress.

Students who felt they belonged and highly supported were less stressed 30,31

Studies show students who sleep less are depressed and reported higher stress 32,33

30Osterman, 2000; 31Wang, 2014; 32Orzech, 2011; 33Vail-Smith, 2009

KEY FINDINGS

Total mood

disturbance

Anxiety

Stress

Depression

• Total cholesterol (+)• Social support (-)

• Total Cholesterol (+)

• TC/ HDL (+)• Vigorous

exercise (-)• Sweets intake (+)• High mercury fish

intake (+)• Social support (-)• Sleep hours per

night (-)• Vigorous exercise (-)

Key Findings

*Factors that lower mood disturbance in red.

• LDL Cholesterol (+)

• Community feeling (-)

STRENGTHS LIMITATIONS

Pilot study Participants benefited Study can be replicated

Tested a wide range of variables

Equal mix of males and females

Researchers assigned to stations

Validated questionnaires Heel ultra sound

Small sample size More upper than lower classman

Self-reported data Generalizable to other college populations

Correlational study

CONCLUSIONS Important to mental health in college students?Avoiding ‘unhealthy’ dietary practicesBlood lipid screeningSocial networks on/off campus and enough exercise and sleep

FUTURE RESEARCH Online diet/mood surveys for more participants from other colleges Experimental study on total cholesterol and mood

Questions

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