Sarah E. Gollust

Prevalence and Correlates of Depression, Anxiety, and Suicidality Among University Students

Mental health among university students represents an important and growing public health concern for which epidemiological data are needed. A Web-based survey was administered to a random sample at a large public university with a demographic profile similar to the national student population. Depressive and anxiety disorders were assessed with the Patient Health Questionnaire (R. L. Spitzer, K. Kroenke, J. B. W. Williams, & the Patient Health Questionnaire Primary Care Study Group, 1999). Nonresponse weights were constructed with administrative data and a brief non-respondent survey. The response rate was 56.6% (N = 2,843). The estimated prevalence of any depressive or anxiety disorder was 15.6% for undergraduates and 13.0% for graduate students. Suicidal ideation in the past 4 weeks was reported by 2% of students. Students reporting financial struggles were at higher risk for mental health problems (odds ratios = 1.6-9.0). These findings highlight the need to address mental health in young adult populations, particularly among those of lower socioeconomic status. Campus communities reach over half of young adults and thus represent unique opportunities to address mental health issues in this important age group.

Persistence of mental health problems and needs in a college student population

BACKGROUND Cross-sectional studies indicate a high prevalence of mental health problems among college students, but there are fewer longitudinal data on these problems and related help-seeking behavior. METHODS We conducted a baseline web-based survey of students attending a large public university in fall 2005 and a two-year follow-up survey in fall 2007. We used brief screening instruments to measure symptoms of mental disorders (anxiety, depression, eating disorders), as well as self-injury and suicidal ideation. We estimated the persistence of these mental health problems between the two time points, and determined to what extent students with mental health problems perceived a need for or used mental health services (medication or therapy). We conducted logistic regression analyses examining how baseline predictors were associated with mental health and help-seeking two years later. RESULTS Over half of students suffered from at least one mental health problem at baseline or follow-up. Among students with at least one mental health problem at baseline, 60% had at least one mental health problem two years later. Among students with a mental health problem at both time points, fewer than half received treatment between those time points. LIMITATIONS Mental health problems are based on self-report to brief screens, and the sample is from a single university. CONCLUSIONS These findings indicate that mental disorders are prevalent and persistent in a student population. While the majority of students with probable disorders are aware of the need for treatment, most of these students do not receive treatment, even over a two-year period.

Direct-to-consumer sales of genetic services on the Internet

Purpose: The increasing use of the Internet to obtain genetics information and to order medical services without a prescription, combined with a rise in direct-to-consumer marketing for genetic testing, suggests the potential for the Internet to be used to sell genetic services. Methods: A systematic World Wide Web search was conducted in May 2002 to assess the availability of genetic services sold directly to consumers on the Internet. Results: Out of 105 sites that offered genetic services directly, most offered non–health-related services, including parentage confirmation testing (83%), identity testing (56%), and DNA banking (24%); however, health-related genetic tests were offered through 14 sites (13%). The health-related genetic tests available ranged from standard tests, such as hemochromatosis and cystic fibrosis, to more unconventional tests related to nutrition, behavior, and aging. Of these 14 sites, 5 described risks associated with the genetic services and 6 described the availability of counseling. Conclusions: The availability of direct sales of health-related genetic tests creates the potential for inadequate pretest decision making, misunderstanding test results, and access to tests of questionable clinical value.

Motivations and perceptions of early adopters of personalized genomics: perspectives from research participants.

Background/Aims: To predict the potential public health impact of personal genomics, empirical research on public perceptions of these services is needed. In this study, ‘early adopters’ of personal genomics were surveyed to assess their motivations, perceptions and intentions. Methods: Participants were recruited from everyone who registered to attend an enrollment event for the Coriell Personalized Medicine Collaborative, a United States-based (Camden, N.J.) research study of the utility of personalized medicine, between March 31, 2009 and April 1, 2010 (n = 369). Participants completed an Internet-based survey about their motivations, awareness of personalized medicine, perceptions of study risks and benefits, and intentions to share results with health care providers. Results: Respondents were motivated to participate for their own curiosity and to find out their disease risk to improve their health. Fewer than 10% expressed deterministic perspectives about genetic risk, but 32% had misperceptions about the research study or personal genomic testing. Most respondents perceived the study to have health-related benefits. Nearly all (92%) intended to share their results with physicians, primarily to request specific medical recommendations. Conclusion: Early adopters of personal genomics are prospectively enthusiastic about using genomic profiling information to improve their health, in close consultation with their physicians. This suggests that early users (i.e. through direct-to-consumer companies or research) may follow up with the health care system. Further research should address whether intentions to seek care match actual behaviors.

Communicating population health: print news media coverage of type 2 diabetes.

The public learns much about health and health policy from the news media. The news media can shape the publics opinions about issues by emphasizing certain features in their coverage, such as the causes of a problem, who is responsible for addressing it, and what groups are affected. This study examines media framing of the problem of type 2 diabetes, focusing on the extent to which the news media discuss diabetes using features that characterize a population health orientation (mentioning social determinants, upstream interventions, or disparities). We collected data from 698 print news articles appearing in 19 U.S. newspapers between 2005 and 2006. Results demonstrate that the predominant explanation for type 2 diabetes was behavioral factors and obesity. The predominant strategy to address diabetes was individualized behavior changes and medical care. A minority of articles described the social determinants of diabetes, upstream policy solutions, and disparities in diabetes; such articles appeared in a select subset of news outlets. These findings suggest the potential for great variability in public awareness of disparities in diabetes or its social determinants, with implications for the publics likelihood of supporting policies that may improve population health.

Turner Syndrome: Four Challenges Across the Lifespan

Turner syndrome (TS) is a sex chromosome condition that occurs in approximately 1/2,500 live female births. Despite the prevalence of this chromosomal condition, the challenges these women face throughout their lives are not fully understood. This qualitative research study aimed to characterize the subjective experiences of individuals with TS throughout their lifespan, to investigate their concerns and obstacles, and to offer insight into the strengths and weaknesses of health care delivery, as they perceived them. Ninety‐seven girls and women with TS and 21 parents consented to participate in this interview study. Interviews were semi‐structured and open‐ended in design. Questions sought to elicit responses relating to existing concerns associated with their condition and positive and negative health care experiences. Participants were divided into four age categories (childhood, adolescence, adulthood, and mature adulthood) to facilitate a comparative analysis across the age spectrum. Regardless of age, infertility was the most frequently cited concern followed closely by short stature. Sexual development and function and general health were also viewed as challenges by a number of participants in each age group. Although the relative weight of these four concerns tended to shift based upon the individuals age and life experiences, all four issues remained significant throughout the lifespan. Enhanced awareness of the evolving physical and psychological challenges faced by girls and women with TS may help health care providers (HCPs) improve the quality of life for these individuals. Published 2005 Wiley‐Liss, Inc.

Living with achondroplasia in an average‐sized world: An assessment of quality of life

Mutations in the gene encoding fibroblast growth factor receptor 3 cause achondroplasia, the most common form of inherited skeletal dysplasia. Although there are more than 10,000 individuals with achondroplasia living in the United States, there has been little study of their quality of life (QOL). For this study, surveys were collected from 189 individuals affected with achondroplasia (ACH) and 136 unaffected first‐degree relatives (FDRs) of affected individuals. Individuals affected with achondroplasia had lower annual income, less education, and were less likely to be married than FDRs. They also differed significantly in their perceptions of achondroplasia, with FDRs believing that achondroplasia is a more serious condition. Total QOL indices and indices in each of four QOL subdomains were significantly lower in affected individuals than in relatives. When controlling for demographic characteristics and affected status, having lower self‐esteem scores and perceiving achondroplasia as more serious were the independent factors most highly associated with lower QOL. A qualitative analysis of open responses to questions about the advantages and disadvantages of achondroplasia revealed that individuals were as likely to cite disadvantages relating to social barriers as they were to cite those relating to health and functioning. We interpret the low QOL scores to reflect the social challenges that individuals with achondroplasia regularly experience in the average‐sized world. Genetics professionals should consider sources of lower QOL for affected individuals in their counseling sessions to acknowledge the relative importance of non‐medical contributions. Published 2003 Wiley‐Liss, Inc.

“It’s Not Like Judgment Day”: Public Understanding of and Reactions to Personalized Genomic Risk Information

The value of genomic risk assessment depends upon patients making appropriate behavioral changes in response to increased risk leading to disease prevention and early detection. To date, few studies have investigated consumers’ response to personalized genomic disease risk information. To address this gap, we conducted semi-structured interviews with 60 adults participating in the Coriell Personalized Medicine Collaborative. The interviews took place after receiving results providing genomic and other risk information for up to eight common complex diseases. We found that participants were most likely to recall results which conferred an increased risk or those of particular personal interest. Participants understood the multi-factorial nature of common complex disease, and generally did not have negative emotional responses or overly deterministic perceptions of their results. Although most participants expressed a desire to use results to improve their health, a minority had actually taken action (behavior change or shared results with their doctor) at the time of the interview. These results suggest that participants have a reasonable understanding of genomic risk information and that provision of genomic risk information may motivate behavior change in some individuals; however additional work is needed to better understand the lack of change seen in the majority of participants.

Controversy Undermines Support For State Mandates On The Human Papillomavirus Vaccine

State actions requiring adolescent girls to receive the human papillomavirus (HPV) vaccine created controversy following the vaccines approval in 2006. Some health professionals worried that the controversy might dampen public support for those state policies and for other school immunizations in general. We fielded an experimental Internet survey to determine how controversy affects attitudes about vaccines. We discovered that public support for the HPV vaccine mandates wanes when the public is informed that the policies are controversial. However, the experimental survey also revealed that exposure to this policy controversy did not spill over and reduce public support for immunizations in general.

Carrier screening panels for Ashkenazi Jews: is more better?

Purpose: To describe the characteristics of Ashkenazi Jewish carrier testing panels offered by US Laboratories, including what diseases are included, the labels used to describe the panels, and the prices of individual tests compared to the prices of panels for each laboratory.Methods: GeneTests (http://www.genetests.org) was searched for laboratories that offered Tay-Sachs disease testing. Information was obtained from laboratory web sites, printed brochures, and telephone calls about tests/panels.Results: Twenty-seven laboratories offered up to 10 tests. The tests included two diseases associated with death in childhood (Niemann-Pick type A and Tay-Sachs disease), five with moderate disability and a variably shortened life span (Bloom syndrome, Canavan disease, cystic fibrosis, familial dysautonomia, Fanconi anemia, and mucolipidosis type IV), and two diseases that are not necessarily disabling or routinely shorten the lifespan (Gaucher disease type I and DFNB1 sensorineural hearing loss). Twenty laboratories offered a total of 27 panels of tests for three to nine diseases, ranging in price from