An Assessment of Depression among NAU Students in 2006

General Overview of Depression among the Nation’s College Students

Approximately 12.5 million college and university students attend more than 3,400 schools in the United States (Brindis & Reyes, 1997). In a recent report according to SAMSHA (report SM-06-004), about 85 percent of college counseling centers revealed an increase in the number of students they see with psychological problems. Furthermore, the American College Health Association (ACHA, 2005a), found that 64 percent of college students reported feeling hopeless within the past school year, 46 percent said they felt so depressed they could barely function, and 10 percent felt suicidal at least once in the past school  year.. Forty-four percent of students surveyed at four-year colleges reported drinking heavily during the two weeks prior to the survey (Wechsler et al., 2000). These problems have significant implications for students’ lives, academic performance, and behavior. The ACHA reports high self-reported rates of depression diagnosis and treatment:

• 16% ever diagnosed with depression
• 27% diagnosed with depression within the school year
• 28% in therapy for depression

Of those in therapy for depression, 38 percent of students report taking medications for depression.

General Overview of Depression among NAU Students

Surveys conducted on the NAU campus find similar results to the ACHA national survey.

• 62 percent of NAU students reported experiencing hopelessness at least once in the past school year
• 44 percent said they felt so depressed they could barely function
• 11 percent felt suicidal at least once in the past school year (ACHA, 2005b).

The 2006 Health and Wellness Survey (N= 292 randomly selected students) used the Behavioral Risk Factor Surveillance System module (Green & Kreuter, 2005) used to measure Health-Related Quality of Life (Healthy Days Measure) to assess the relationship of healthy days lost and depression symptoms in students.  Findings from this survey include:

• A median of 4 days a month in which mental health is not good are experienced by NAU students.
• Over 34 percent report 7or more days a month with poor mental health.
• A median of 2 days a month of being unable to function with daily activities from either mental or physical ailments are experienced by NAU students.
• About 13 percent of students report an inability to perform normal daily activities from either mental or physical problems on 7 or more days a month.

Depression Symptoms Impact on Academic Performance

Students who reported experiencing at least 1 period of depression-like symptoms for 2 weeks or longer in the past year were significantly more likely to experience academic problems than those without symptoms.  Of those with symptoms 2 weeks or longer:

• 21 percent received a lower grade in the course

• 11 percent took an incomplete or dropped a course as a result of mental problems.

This compares to 2% who received a lower grade and one-half of one percent who had to drop a course among those not reporting extended depression-like symptoms.  Students with at least 1-2 times experiencing difficulty functioning with normal activities were twice as likely to have academic performance difficulties. As the frequency of functioning difficulties increased for students, they reported a greater impact on their academic performance from depression symptoms.

Depression Symptoms and Students Perceptions of Quality of Life

The Health and Wellness Survey 2006 survey employed the use of the Ferrans and Powers (2006) Generalized Quality of Life Index (QLI) to measure quality of life satisfaction This index measures both satisfaction and importance of life quality in health and functioning, psychological and spiritual domains, socio-economic life and family life as shown in Table 1.

 

	Percent not satisfied
QLI Measures	With symptoms > 2 weeks	Without symptoms > 2 weeks
Not having a job *	47.6	36.5
How you take care of your financial needs *	42.4	20.6
Personal appearance *	34.1	11.6
Peace of mind *	31.0	4.2
Happiness in general *	30.7	2.8
Faith in a higher power or God	30.2	17.8
Your health *	26.4	12.5
Residence	26.4	14.7
Achievement of personal goals *	23.2	7.2
Your life in general *	21.7	4.2
Your health care	21.0	16.3
University environment	20.5	12.4
With your job	19.7	14.6
Emotional support other than family *	19.4	10.3
Your friends	9.3	3.7
Your education *	6.8	4.7

Table 1. Comparison of quality of life measures between students with and without depression symptoms for 2 or more weeks over the past year.

* Pearson Chi-Square p < .05

Students who reported 2 or more weeks of depression-like symptoms had statistically significantly greater dissatisfaction with 10 of the 16 QLI measures

Interaction of Class Standing and Depression Symptoms on Lost Healthy Days

Karp et al (2003) summarize key findings in the literature that supports the hypothesis that sophomore students may be at a much higher risk for developmental confusion than other students related to autonomy, defining purpose, establishing identity, and competency. They point out that the “Sophomore Slump” is characterized with depression symptoms of apathy, sadness, alienation, decision-making problems, dysfunctional behavior and absenteeism from classes.

An examination of the Health and Wellness data show that sophomores and juniors are more likely to experience depression symptoms. Sophomores average a 200 percent increase in days of inability to perform daily functions mentally and physically in a month (Lost Healthy Days) compared to freshman and seniors while juniors have a 250 percent increase in average number of sickness days compared to freshmen and seniors as shown in Table 2.

 

Class standing by depression symptoms	Average number of lost healthy days In the past 30 days
Freshmen:          with depression symptoms	4.5
without depression symptoms	1.8
Sophomores:      with depression symptoms	9.2
without depression symptoms	3.0
Juniors:              with depression symptoms	11.3
without depression symptoms	1.8
Seniors:              with depression symptoms	4.8
without depression symptoms	2.6

Table 2. Average number of lost healthy days in the past 30 days across by class standing and among students with and without depression symptoms.

Interaction of Alcohol Use and Depression Symptoms on Lost Healthy Days

Alcohol appears to play a role in the co-morbidity of students who drink excessively. Students with depression symptoms regardless of drinking status have double or triple the number of lost non-functioning healthy days compared to students without symptoms. However, students who drink heaviest (greater than 4 drinks the last time drinking) and who are depressed have almost a 250 percent greater number of lost healthy days compared to students who drink don’t drink or drink lightly. The analysis tends to support the view that alcohol is not a significant cause of depression symptoms but rather is a contributor to loss of functionality among those who drink heavily as shown in Figure 1.

Figure 1. The relationship of average healthy days lots and alcohol consumption status to reported loss of healthy days.

Diagnosis and Treatment of Students with Depression

Moreover, large numbers of students self-report (ACHA, 2005b) having been diagnosed for depression, have been in therapy or are currently under treatment as follows:

• 18% ever diagnosed with depression
• 29% diagnosed with depression within the school year
• 21% in therapy for depression

Of those in therapy for depression, 38 percent of NAU students report taking medication for depression.

From these studies, NAU students’ self-reported rates of depression and depression-related problems are on par with the ACHA findings. However, NAU students may be less often diagnosed with depression or in therapy for depression compared to students at other schools nationally. NAU students receive medications for depression on par with the national average for treating students with depression.

Student reporting depression like symptoms for two weeks or more in the past year were significantly more likely to report less satisfaction of quality of life and more academic problems than students not reporting these symptoms.

Conclusions

1. Depression and depression symptoms affect large numbers of NAU students.
2.  Poor classroom performance is proportional to the daily frequency of students’ depression symptoms.
3. Students with depression symptoms have significantly greater loss of healthy days compared to students without depression symptoms. Not only is poor performance in the classroom is related to depression symptoms frequency but it is also related to the strength of the symptoms (lost healthy days).
4. Alcohol amplifies the effect of depression symptoms for students who binge drink and increases the loss of healthy days.  Alcohol does not have a significant effect contributing to co-morbidity of abstaining or light drinkers who have depression symptoms.
5. Satisfaction with quality of life is significantly reduced for students with depression symptoms compared to students without symptoms. Larger numbers of students with depression symptoms are dissatisfied with their financial management, lack of meaning jobs, and personal appearance.
6. Sophomores and juniors with depression symptoms have perceived lower quality of life and a larger number of lost healthy days than freshmen, seniors and graduate students that is related to developmental issues in their college life cycle.

 Recommendations

Depression is a complex illness with numerous social, environmental, interpersonal and intrapersonal determinants. A multiple-intervention approach has the best likelihood to help reduce the impact of depression on individual students and the collective effect of students’ depression on the institution. Therefore, the following are recommendations to guide the development of a comprehensive plan:

• Conduct a coordinated campus-wide, interdepartmental strategic plan for improved depression prevention, referral, and treatment.
• Improve networking to improve education, screening, referral, and treatment service utilization
• Alcohol use screening of all students identified as potentially clinically depressed
• Depression screening for all students identified as binge drinkers

References  

1. American College Health Association. (2005). Reference group data report. American College Health Association National College Health Assessment. Spring 2005. Baltimore, MD.

2. American College Health Association. (2005). Northern Arizona University Executive Summary. American College Health Association National College Health Assessment. Spring 2005. Baltimore, MD.

3. Brindis, C., Reyes. P. At the crossroads: Options for financing college health. Journal of American College Health, 45(6), p279.

4. Ferrans, C.E., & Powers, M.J. (2006). Ferrans and Powers Quality of Life Index. Retrieved from http://www.uic.edu/orgs/qli/index.htm.

5. Green, L., & Kreuter M. (2005). Health Program Planning: An Educational and Ecological Approach. Boston: McGraw-Hill.

6. Karp, R. et al. (2003) The sophomore year: A literature search prepared for the Clarion University Focus Rountables and StudentSpeak. Retrieved from: http://www.clarion.edu/admin/academicaffairs/ue/Literature_on_sophomore_year.shtml.

7. Wechlar, H. et al. (2000). College binge drinking in the 1990s: A continuing problem.  Journal of American College Health, 48(5), p199