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A Successful Community-Based Intervention for Addressing College Student Depression

Posted on: Tuesday, 14 February 2006, 03:03 CST

By Field, Lynda D; Elliott, Melissa S; Korn, Paul R

Campus personnel are concerned with the results of several studies showing high rates of depression on college campuses. A 2001 study of 1,455 college students from four universities (Furr, Westefeld, McConnell, & Jenkins, 2001) found that 53% of the respondents experienced some form of depression while at college. Additionally, 9% reported that they had thought of committing suicide, with 1% reporting a suicide attempt. The American College Health Association's (2001) National College Health Assessment found that 76% of students reported feeling "overwhelmed" during the previous year and 22% were sometimes so depressed that they could not function. In studying college impact, Astin (1993) found that after entering college, students show a number of positive and negative changes in personality and self-concept. The most notable declines during college years are in the student's sense of psychological well-being.

The stresses and costs that untreated depression places on institutions of higher education are very significant (Levine & Cureton, 1998). There is little argument that colleges and universities would benefit from programs that creatively engage their members in positive options for prevention and early detection of depression (National Mental Health Association, 2002). College counseling centers must move away from the traditional focus on reactive and remedial treatment of depression and instead build community investment in reducing stress, providing social support, and encouraging and sustaining self-care (Stone & Archer, 1990). Counseling center professionals on one urban campus used this approach to develop a community-based program, Action for Depression Awareness, Prevention, and Treatment (ADAPT).

The ADAPT program incorporates a community psychology perspective- that mental health problems are best understood and addressed within the context of an individual's environment (Miller, 1969; Sarason, 1974). Community psychology conceptualizes human behavioral problems and solutions as part of a social context (Zax & Spector, 1974). This perception has led to the view that student depression can best be understood as resulting from the stressful educational environment. In addition, the university is viewed as a system that can provide positive resources while serving to alleviate some problems that result from depression. The community psychology approach places an emphasis on collaboration across disciplines to respond to community needs and utilizes the knowledge and skills of the targeted treatment population (Dalton, Elias, & Wandersman, 2001). In the last three decades, professionals in both the field of student development (Astin & Sax, 1998) and community psychology (Bloom, 1975) increasingly have documented the important positive academic, emotional, and social benefits that students derive when they are actively involved in their college community. For counseling services taxed by high demand for individual services, the community psychology approach increases available resources for students at risk. With expertise in direct psychological treatment, the staff of the Counseling Center has initiated, coordinated, and evaluated the efficacy of this community intervention.

ADAPT: ACTION FOR DEPRESSION AWARENESS, PREVENTION, AND TREATMENT

The ADAPT program was implemented in four incremental stages, each of which will be described in the following segments.

The Planning Stage

Successful community-based interventions require extensive input and involvement from all members of the university. Accordingly, the Counseling Center professionals developed programs based upon information and perspectives gained from focus groups, individual interviews, and written feedback from students, faculty, staff, and administrators. Psychologists from the Counseling Center received initial support for this project from the university president and the dean of the College of Arts and Sciences. University officials are particularly invested in addressing the problem of student depression because of media focus on suicides committed at a high profde campus (Farrell, 2002). With this support, Counseling Center staff members sent letters announcing the creation of a new depression prevention program, which solicited ideas about how to best meet the needs of the college community. The letter was designed to enlist participation from a broad spectrum of university members in order to identify the impact of student depression on the community, ways to reduce the risk of depression and decrease stigma that might prevent students from seeking help, and ways to provide support to those suffering from depression. These letters were followed by phone calls to arrange individual meetings with all academic deans, the dean of students, the campus minister, and staff members from academic support services. Group meetings were held with representatives from the Student Government Association, Resident Advisors, the directors of all student service departments, chairpersons and faculty members from all academic departments, and a variety of student groups.

The needs assessment asked participants to think about their experiences with students who were stressed and/or depressed and to share their thoughts about the types of programs that would meet ADAPT goals of prevention, stigma reduction, and early detection. In addition, participants were asked about the types of resources needed to address the problem of student depression. These qualitative data were then transcribed, summarized, and submitted to the community for additional feedback. This year-long assessment process helped to publicize the project and build strong working alliances.

Needs assessment information that guided the implementation stage included: (a) strong consensus about the stigma of mental health problems, especially depression and suicide; (b) students' beliefs that faculty mistook depression for laziness or ineptitude; (c) faculty, staff, and administrators' discomfort and confusion when dealing with depressed students; (d) students' uncertainty about how to help depressed friends; and (e) general confusion about differentiating "normal" stress levels from mental health impairment. Students, faculty, staff, and administrators offered thoughtful and creative suggestions that were immediately implemented. The guiding philosophy was that interventions would need to utilize multiple approaches and incorporate the needs and perspectives of as many members of the community as possible in order to be successful.

Implementation Stage

The results of the needs assessment led to an initial focus on disseminating information about topics such as symptoms of depression and suicidality, prevention and treatment, and helpful ways to talk with someone suffering from depression. These objectives were met partially by enhancing the Counseling Center website, developing and distributing an informative brochure to all segments of campus including parents, and providing educational seminars to faculty and staff with a PowerPoint presentation. The seminar provided referral information, suggested ways to identify depressed students, and gave tips on how to talk with at-risk students. The Counseling Center sought community input and evaluation each time a new resource was developed. For example, the Counseling Center asked needs assessment participants to review the website and drafts of the depression brochure. In addition, seminar participants were asked to complete an evaluation of the effectiveness of the presenter and to share what new information they had learned about depression, prevention, or treatment. Faculty and staff members generally provided positive feedback about the new resources and important interventions and also stressed the need to focus on a large group of students who do not respond to these traditional outreach efforts.

In order to reach this broader group of students Counseling Center staff members developed a collaborative partnership with the Student Performing Arts program to develop an original play depicting one student's experience of depression and the responses of those around her. The 25-minute play, piloted to focus groups to ensure that students could relate to the presentation, was followed by small discussion groups facilitated by Counseling Center staff. These groups were designed to increase understanding of the relationship between stress and depression, decrease stigma, and motivate students to use prevention strategies. Participants were also taught several ??-minute relaxation techniques intended to increase prevention behaviors, which included diaphragmatic breathing, visualization, and/ or progressive muscle relaxation. Additional information and resources about depression awareness were distributed to participants to take home. A videotape of the play was created that continues to be utilized as an educational tool in classroom presentations and workshops.

Program Evaluation

In each of the faculty and student workshops participants were asked to complete a post-workshop questionnaire containing six questions. Response rates ranged from 90% to 50% per workshop \due to the fact that workshops ran until the end of the time limits, sometimes leaving inadequate time for the completions of the evaluation forms given that students rushed off to their next class. A total of 116 forms were completed. To collect an overall rating, one question asked participants to rate their workshops on a four- point scale ranging from "excellent" to "poor." Forty-five percent rated their workshops as "excellent," and 53% rated their workshops as "good." The remaining five qualitative questions addressed aspects of the sessions that were most and least helpful and inquired about the specific skills and information gained. General content analysis showed that 82% of the responses were positive about the manner of presentation and the information provided. The small percentage of negative comments generally indicated that the workshops were too short and asked for increased time to practice the relaxation techniques.

Most importantly, the evaluations indicated that the program had a clear impact upon the community's ability to better respond to depressed students. On the evaluation forms, student Resident Advisors noted an increase in confidence in working with depressed students. Faculty and staff identified new strategies for dealing with suicidal students and an increased understanding of university resources. Students reported a new understanding of their own levels of stress and depression. Overall, the responses clearly indicated the success of the ADAPT program in fostering learning and growth in students who participated in the various workshops.

The Expansion Stage: The Samaritan Award Program

Years I and II of the ADAPT program focused on providing public health information about depression and on building interest in changing the way the university community understood and responded to student depression. In addition, formal and informal data were collected about the program's impact and areas for improvement. In Year III, the centerpiece of the ADAPT program, The Samaritan Awards, was implemented. The Samaritan Awards were developed as a means to further enlist the talents and resources of the university community in addressing the issue of depression among college students. The Samaritan Awards is a mini-grant program that offers three grants of up to $1,000 each year to creative projects that raise awareness on campus about the signs and symptoms of depression, prevention strategies, treatment options, and/or ways to support those who suffer from the disorder.

Consistent with a community psychology perspective, the Counseling Center staff worked with a cross section of interested students, staff, and faculty to establish application criteria that would insure relevance and creativity of selected projects that could make a difference on campus. This collaborative approach was also used to develop the program name and marketing strategies.

A selection committee consisting of students, faculty, and staff members (excluding Counseling Center staff) reviewed applications submitted by teams of students, faculty, and staff. The president of the university presided over The Samaritan Awards ceremony, a major campus event that honored participants and increased campus awareness about the program's ongoing efforts.

The four projects funded reached out to different sectors of the campus. Counseling Center staff functioned as technical consultants for the teams throughout the development and implementation process. One award went to a group of art students who created original artwork that communicated different aspects of depression. A formal gallery opening was held, at which students shared personal and familial struggles with depression. The artwork and accompanying student comments were then displayed in the Student Center in a month-long exhibit. A second award was given to faculty members in the Modern Languages department who developed weekly dialogue groups intended to decrease isolation by helping international and domestic students connect to the community. A third award was granted to a group of ethnic minority students, staff, and faculty members who examined the relationship between culture and depression in a series of campus-wide focus groups that resulted in the creation of eight posters that provided information about depression to different cultural groups. The final award was given to a theatre department faculty member who produced a one-man play about depression and suicide, which, as mentioned above, was followed by a panel discussion led by campus and community counselors.

The Samaritan Award program resulted in the active engagement of over 300 students. Based on Astin's (1984) postulates of involvement, ADAPT provided the opportunity for students to experience growth and development by investing psychological and physical energy in the process of connecting to their college community and helping others.

CONCLUSION

Formal and informal evaluations indicated that the ADAPT program succeeded in increasing awareness of the relationship between stress and depression among college students Perhaps of even greater importance, the program succeeded in creating a university community in which students, faculty, and staff collaborated to encourage prevention of mental health problems and to help students who suffered from depression. The ADAPT program serves as a positive model for other colleges and universities that want to address the growing concern about student depression. The success of the ADAPT program was based on a strong institutional commitment that supported the collaboration of Counseling Center professionals with students, staff, faculty members, and administrators in every aspect of the program.

REFERENCES

American College Health Association. (2001). National College Health Assessment: Reference group report, Spring 2000. Baltimore: Author.

Astin, A. W. (1984). Student Involvement: A developmental theory for higher education. Journal of College Student Personnel, 25, 297- 308.

Astin, A. W. (1993). What matters in college? Four critical years revisited. San Francisco: Jossey-Bass.

Astin, A. W., & Sax, L. J. (1998). How undergraduates are affected by service participation. Journal of College Student Development, 39, 251-263.

Bloom, B. L. (Ed.). (1975). Psychological stress in the campus community: Theory, research, and action. New York: Behavioral Publications.

Dalton, J., Elias, M., & Wandersman, A. (2001). Community psychology: Linking individuals and communities. Stamford, CT: Wadsworth.

Farrell, E. (2002) A suicide and its aftermath. Chronicle of Higher Education, 48(7), 37-40.

Furr, S. R., Westefeld, J. S., McConnell, G. N., & Jenkins, J. M. (2001). Suicide and depression among college students: A decade later. Professional Psychology; Research and Practice, 32, 97-100.

Levine, A., & Cureton, J. S. (1998). When hope and fear collide: A portrait of today's college student. San Francisco: Jossey-Bass.

Miller, G. A. (1969). Psychology as a means of promoting human welfare. American Psychologist, 24, 1063-1075.

National Mental Health Association. (2002). Safeguarding your students against suicide: Expanding the safety net. Proceedings from an expert panel on vulnerability, depressive symptoms, and suicidal behavior on college campuses. Alexandria,VA: Author.

Sarason, S. B. (1974). The psychological sense of community: Prospects for a community psychology. San Francisco: Jossey-Bass.

Stone, G. L., & Archer, J., Jr. (1990). Gollege and university counseling centers in the 1990s: Challenges and limits. Counseling Psychologist, 18(4), 539-607.

Zax, M., & Spector, G. A. (1974). An introduction to community psychology. New York: Wiley.

Lynda D. Field is Associate Professor of Psychological Services; Melissa S. Elliott is a recent graduate of the Education and Human Services Master's degree program in Mental Health Counseling; Paul R. Korn is Professor of Psychological Services; each at Suffolk University.

Correspondence concerning this article should be addressed to Lynda D. Field, 41 Temple Street, Boston, MA 02114; lfield@sujfolk.edu.

Copyright American College Personnel Association Jan/Feb 2006

Source: Journal of College Student Development

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