Alexandra C. Kirsch

Negotiating the Transition to College Developmental Trajectories and Gender Differences in Psychological Functioning, Cognitive-Affective Strategies, and Social Well-Being

The transition to college, which for the majority of youth coincides with the transition to emerging adulthood, is stressful and disruptive. Using latent growth curve modeling (LGM), this study examines the longitudinal course of psychosocial adjustment in a sample of 2,095 emerging adults, at three time-points across this transition: In the week prior to college entry and at the end of each semester of the first year. Overall, the immediate transition is characterized by steep declines in psychological well-being, cognitive-affective strengths, and social well-being as well as increases in psychological distress and cognitive-affective vulnerabilities. These setbacks generally plateau, but do not resolve, later in the year. Examining gender differences in developmental trajectories revealed that females experience additional elevations in psychological distress even after the immediate transition, while males evidenced worse baseline levels in cognitive-affective vulnerabilities, cognitive-affective strengths, and social well-being. These findings indicate the need for services that promote well-being across this challenging developmental transition.

A Meta-analysis of Universal Mental Health Prevention Programs for Higher Education Students

This meta-analysis investigated the effectiveness of universal mental health prevention programs for higher education students on a range of adjustment outcomes. A systematic literature search identified 103 controlled published and unpublished interventions involving college, graduate, or professional students. As hypothesized, skill-training programs that included a supervised practice component were significantly more effective overall (mean effect size = 0.45, confidence interval (CI) = 0.39 to 0.52) compared to skill-training programs without supervised practice (0.11, CI = −0.01 to 0.22) and psychoeducational (information-only) programs (0.13, CI = 0.06 to 0.21). When comparisons on specific outcomes were possible, skill-training programs including supervised practice were significantly more effective than the other two groups of programs in reducing symptoms of depression, anxiety, stress, and general psychological distress, and in improving social-emotional skills, self-perceptions, and academic behaviors and performance. The magnitude of effects achieved in several outcome areas is comparable to or higher than that reported in other reviews of universal programs, suggesting that skill-training programs for higher education students that incorporate supervised practice now join the ranks of other effective preventive mental health interventions. This review offers several recommendations to improve the experimental rigor of future research.

A Meta-Analysis of the Impact of Universal and Indicated Preventive Technology-Delivered Interventions for Higher Education Students

The uses of technology-delivered mental health treatment options, such as interventions delivered via computer, smart phone, or other communication or information devices, as opposed to primarily face-to-face interventions, are proliferating. However, the literature is unclear about their effectiveness as preventive interventions for higher education students, a population for whom technology-delivered interventions (TDIs) might be particularly fitting and beneficial. This meta-analytic review examines technological mental health prevention programs targeting higher education students either without any presenting problems (universal prevention) or with mild to moderate subclinical problems (indicated prevention). A systematic literature search identified 22 universal and 26 indicated controlled interventions, both published and unpublished, involving 4763 college, graduate, or professional students. As hypothesized, the overall mean effect sizes (ESs) for both universal (0.19) and indicated interventions (0.37) were statistically significant and differed significantly from each other favoring indicated interventions. Skill-training interventions, both universal (0.21) and indicated (0.31), were significant, whereas non-skill-training interventions were only significant among indicated (0.25) programs. For indicated interventions, better outcomes were obtained in those cases in which participants had access to support during the course of the intervention, either in person or through technology (e.g., email, online contact). The positive findings for both universal and indicated prevention are qualified by limitations of the current literature. To improve experimental rigor, future research should provide detailed information on the level of achieved implementation, describe participant characteristics and intervention content, explore the impact of potential moderators and mechanisms of success, collect post-intervention and follow-up data regardless of intervention completion, and use analysis strategies that allow for inclusion of cases with partially missing data.

A meta-analysis of indicated mental health prevention programs for at-risk higher education students.

This meta-analysis found empirical support for the effectiveness of indicated prevention programs for higher education students at risk for subsequent mental health difficulties based on their current subclinical levels of various presenting problems, such as depression, anxiety, or interpersonal difficulties. A systematic literature search identified 79 controlled published and unpublished interventions involving 4,470 college, graduate, or professional students. Programs were effective at post-intervention overall (ES = 0.49, CI [0.43, 0.55]), and for both targeted outcomes (ES = 0.58, CI [0.51, 0.64]) as well as additional nontargeted outcomes assessed in the studies (ES = 0.32, CI [0.25, 0.39]). Interventions compared with a no-intervention or a wait-list control (ES = 0.64, CI [0.57, 0.71], k = 68) demonstrated significantly larger effects overall than did interventions compared with an attention-placebo control (ES = 0.27, CI [0.11, 0.43], k = 11), although both were significant. Among the former group, modality and presenting problem emerged as significant moderators of intervention effectiveness, and among the 43 of these that assessed effectiveness at an average follow-up period of 35 weeks, the positive effects from intervention remained strong (ES = 0.59, CI [0.50, 0.68]). Overall, programs were fairly brief, attracted and retained students, were positively rated by students, and effective when administered by paraprofessionals as well as professionals. Current findings are promising and stimulate recommendations for improving future research, such as expanding the range of outcomes assessed, and clarifying moderators and mediators of intervention impact.

Comparing Psychosocial Adjustment Across the College Transition in a Matched Heterosexual and Lesbian, Gay, and Bisexual Sample

We compared a matched sample of heterosexual and lesbian, gay, and bisexual (LGB) students on 5 psychosocial adjustment composites, longitudinally across the transitional first year of college. Both LGB and heterosexual students experienced a significant increase in psychological distress over the first semester, along with significant decreases in psychological well-being and cognitive-affective strengths. Across the entire first year, LGB students demonstrated consistently greater psychological distress, greater cognitive-affective vulnerabilities, and less social well-being compared to heterosexual peers. This research indicates specific challenges that LGB students experience during the first year of university, suggesting opportunities for promoting successful transitions through this developmental milestone.

Explaining the pathway from familial and peer social support to disordered eating: Is body dissatisfaction the link for male and female adolescents?

OBJECTIVE This study examined if familial and peer social support longitudinally predicted disordered eating for late adolescents in the transitional first year of college, and if body dissatisfaction mediated this relation. Gender differences between support types and disordered eating, and body dissatisfaction as a mediator, were also examined. PARTICIPANTS/METHODS 651 late adolescent males and females (Mage=18.47) completed measures of social support at the end of the first semester of college and of disordered eating and body image approximately five months later, at the end of the first year. RESULTS Lower levels of familial social support prospectively predicted greater disordered eating, but not greater body dissatisfaction, and lower levels of peer social support prospectively predicted greater body dissatisfaction but not greater disordered eating, above and beyond the other type of social support type, prior levels of body dissatisfaction, disordered eating, and BMI. Body dissatisfaction did not mediate the relation between familial social support and disordered eating; however, it did significantly mediate the non-significant relation between peer social support and disordered eating, which was further moderated by gender. CONCLUSION These findings suggest that parental social support remains a significant predictor of disordered eating for late adolescents even after they transition to college, and has a stronger relation to disordered eating than peer support. In contrast, peer social support seems to be especially linked to feelings of body dissatisfaction and may be an avenue for intervention of this type of negative self-perception that is a risk factor for later disordered eating.

Developmental Course and Determinants of Sleep Disturbances in Adolescents With Spina Bifida

OBJECTIVES To examine (1) trajectories of sleep disturbances in adolescents with spina bifida (SB) compared with a typically developing (TD) group over a 10-year period and (2) individual, family, and socioeconomic determinants of changes in sleep disturbances. METHODS Participants were 68 families of youth with SB and 68 families of TD youth. Parent-report of adolescent sleep was collected every 2 years at 6 time points (T1: ages 8-9; T6: ages 18-19). Multiple informants and measures were used to examine internalizing, externalizing, and inattention symptoms, dyadic/family conflict, socioeconomic status (SES), and family income. RESULTS Sleep disturbances increased over the 10-year period. Youth with SB had greater sleep disturbances during early adolescence. Greater preadolescent externalizing symptoms, greater parent-child and marital conflict, and lower SES predicted increased sleep disturbances. CONCLUSIONS Sleep disturbances are common and persistent in adolescents with SB. Sleep assessment and management are important clinical and research priorities in this population.

Looking Good and Making It Seem Easy: A Prospective Study of Effortless Perfectionism, Body Image, and BMI in Unhealthy Weight Control Behaviors Among Female Adolescents and Young Adults

Unhealthy weight control behaviors are a significant health concern among adolescents and emerging adults, and perfectionism plays a role in the development/maintenance of these behaviors. Effortless perfectionism, or pressure to be perfect with apparent ease, is linked to maladjustment, but its role in weight control behaviors is unexplored. Longitudinal data on effortless perfectionism, body image, body mass index (BMI), and weight control behaviors were collected in college-aged females (N = 376, mean age = 18.48, 66% Caucasian). After controlling for BMI and trait-based perfectionism, effortless perfectionism uniquely predicted weight control behaviors. Higher levels of effortless perfectionism also predicted more weight control behaviors, but only for individuals with poor body image and specifically for those who also reported lower BMI. Pressure to be perfect with apparent ease confers unique risk for unhealthy weight control behaviors among adolescents and emerging adults with low body image and BMI. Findings highlight the importance of developing interventions that target effortless perfectionism to improve health and functioning during the transition to adulthood.