Eating Disorders Affect More Racially Diverse Population Than Previously Thought

Eating disorders are often thought to primarily affect White people, but a study in the International Journal of Eating Disorders suggests that eating disorders affect college students at largely similar rates across racial and ethnic groups. Furthermore, where differences emerged along racial and ethnic lines, some minoritized groups had a greater probable prevalence and severity of eating disorders than Whites.

Carli P. Howe, a graduate student at the University of Washington in St. Louis, and colleagues analyzed data from 3,929 students from 26 U.S. colleges and universities whose results on a mental health screen suggested the presence of an eating disorder. Participants self-identified as Asian, Black, Hispanic, multiracial, or White. They were also asked about their gender identity and were categorized as men, women, cisgender, or non-cisgender.

The researchers found that:

• Non-cisgender Asian participants had the highest prevalence of probable anorexia nervosa (8.64%), followed by cisgender Asian women (3.61%), non-cisgender multiracial participants (3.28%), and cisgender multiracial women (2.5%).
• Non-cisgender Hispanic participants had the highest prevalence of probable clinical or subclinical bulimia nervosa/binge eating disorder (20.49%), followed by cisgender Hispanic women (18.2%), cisgender multiracial women (17.25%), and cisgender White women (15.54%).
• Non-cisgender Black participants were most likely to be at high risk for eating disorder onset (6.67%), followed by cisgender Hispanic women (5.87%), cisgender White women (4.83%), and cisgender Black women (4.52%).
• Among participants with probable eating disorders, there were no significant differences between racial or ethnic groups across any gender with respect to the frequency of eating disorder behaviors such as binge eating, vomiting, or laxative/diuretic use in the past three months.

“These findings are key for refuting widely held stereotypes that [eating disorders] primarily affect White individuals and also underscore a critical need for solutions aimed to equitably address [eating disorders] in college populations,” the researchers wrote.

They added that universal screening and intervention for eating disorders on college campuses have the potential to significantly reduce the population prevalence of eating disorders in college students: “Such universally delivered programs may include targeted interventions for racially/ethnically minoritized students. These directions represent a critical path to closing the large [eating disorder] treatment gap in this high-risk population.”

For further information, see the Psychiatric Services article “Eating Disorder Treatment Access in the United States: Perceived Inequities Among Treatment Seekers.”

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Half of College Students May Have Mental Illness

More than half of college students meet the criteria for one or more mental health conditions, a study in Psychiatric Services in Advance has found.

Sarah Ketchen Lipson, Ph.D., Ed.M., of the Boston University School of Public Health and colleagues analyzed 2016-2019 data from the Healthy Minds Study, an annual web-based survey. Data were drawn from 10,089 students from 23 community colleges and 95,711 students from 133 four-year institutions. As part of the study, students completed several standard mental health measures, such as the nine-item Patient Health Questionnaire for depression, the seven-item Generalized Anxiety Disorder scale for anxiety, and the SCOFF Questionnaire for eating disorders. They were also asked if they had ever seriously thought about attempting suicide in the previous year.

Relative to students from four-year campuses, community college students were older and a higher portion were Latinx.

More than 50% of the students met the criteria for one or more mental health conditions, including roughly 33% who screened positive for depression and for anxiety and roughly 15% who reported suicidal ideation. Community college students aged 18 to 22 years were more likely to screen positive for these conditions than their peers at four-year institutions.

The study also measured how often students received mental health care through campus resources. Community college students had lower rates of therapy and psychotropic medication use than their peers at four-year institutions: Roughly 25% received therapy compared with nearly 38% at four-year institutions, and approximately 26% used psychotropic medications compared with more than more than 31% at four-year institutions. Financial constraints were the most common barrier to treatment among community college students, but the fourth most common barrier among those at four-year institutions.

“As U.S. higher education is shaped by the COVID-19 pandemic, shifts in enrollment could exacerbate known disparities in mental health, college persistence, and other key social and economic outcomes,” Lipson and colleagues wrote. “Continued research on the unique mental health needs of community college students is imperative in promoting equity across these domains, and funding for mental health services on community college campuses is a high priority.”

For related information, see the Psychiatric News article “College Students Struggle Amid Pandemic.”

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Problematic Internet Use, Gaming May Point to Students Experiencing Mental Health Symptoms

College students whose academic performance has been negatively impacted by internet use or computer gaming are at higher risk of mental health problems than students without problematic internet use/computer gaming behaviors, according to a report in Depression & Anxiety.

“These findings suggest that querying students about whether their internet use or computer gaming has negatively affected their academic functioning might be a strategy for identifying students at risk for [mental health] problems,” wrote Courtney Stevens, Ph.D., of Willamette University and colleagues. “This approach may be particularly useful as internet use is likely less stigmatized than other [mental health] symptoms or diagnoses and because students and universities tend to gauge outcomes not by [mental health] status but through students’ ability to function academically.”

Stevens and colleagues analyzed data from 43,003 undergraduates aged 18 and older who participated in the 2017 American College Health Association‐National College Health Assessment—a 30-minute survey on such topics as substance use/abuse, sexual health, physical health, and more. As part of the survey, students were specifically asked about the past-year frequency of 11 mental health symptoms, including hopelessness, loneliness, overwhelming anxiety, sadness, anger, intentional self-harm, and attempted suicide. Students were also asked about problematic internet use, which the authors defined as “internet use and computer gaming negatively impacted academic performance.”

About 10% of students reported problematic internet use/computer gaming over the previous 12 months (with most indicating the most serious consequence of this behavior was receiving a lower grade on an exam or important project).

Overall, 93% of the students surveyed reported at least one of the 11 mental health symptoms during the year. Students reporting problematic internet use/computer gaming exhibited consistently elevated rates of all mental health symptoms relative to students not reporting problematic internet use/computer gaming. For instance, students who reported problematic internet use/computer gaming were more than twice as likely to report feeling “hopeless,” “so depressed it was difficult to function,” “overwhelmed,” “exhausted,” “very lonely,” or “very sad” in the past year. Similarly, students who reported problem internet use/computer gaming were about 1.5 times as likely to report that in the past year they had engaged in intentional self‐harm, had seriously considered suicide, or attempted suicide.

“Whereas screen time monitoring has been discussed extensively for young children, there is little guidance for older adolescents or college students where screen time and internet use are normalized and generally unscrutinized,” the authors continued. “Colleges may wish to consider offering workshops or other educational strategies to help students develop self‐awareness and regulatory strategies for engaging with internet use in a healthy way.”

For related information, see the Psychiatric News article “CBT Intervention May Reduce Addictive Internet Use.”

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Digital CBT May Reduce Eating Disorder Symptoms in College Women

A digital cognitive-behavioral therapy (CBT) intervention that includes personal coaching may help to reduce several symptoms of eating disorders in college women. As reported today in JAMA Network Open, women who received the digital CBT had greater reductions in negative eating-related thoughts or beliefs and the frequency of binge eating compared with women who were referred to usual university care.

“Current treatment delivery efforts for [eating disorders] on college campuses are hindered by factors such as limited counseling center capacity and access to evidence-based treatments. College students report additional barriers, including lack of time and stigma,” wrote Ellen Fitzsimmons-Craft, Ph.D., of Washington University in St. Louis and colleagues. “Digital technologies, highlighted as the future of psychiatry, have the potential to improve mental health care on college campuses by overcoming [these] barriers.”

Fitzsimmons-Craft and colleagues recruited women who had screened positive for a DSM-5 eating disorder excluding anorexia nervosa (which requires more intense medical monitoring) from 27 universities across the country. In total, 690 women were randomly assigned to participate in the online CBT program Student Bodies–Eating Disorders (SB-ED) or receive usual care, which involved a referral and encouragement to attend their university counseling center.

The women in the SB-ED group received access to the self-help CBT program for eight months with a personal coach. SB-ED includes modules that teach such skills as improving body image, regulating emotions, addressing shape-checking behaviors, and challenging negative thoughts. The program also includes meal planning and tracking tools and a personal log. The coaches provided regular feedback and support using an in-program chat function. 

The primary assessment was change in the Eating Disorder Examination-Questionnaire (EDE-Q), which assesses the severity of negative eating-related thoughts or beliefs. The investigators also measured changes in binge eating, compensatory behaviors (vomiting, laxative use, excess exercise), depressive symptoms, and academic problems (such as withdrawing from courses or taking a leave of absence). 

After eight months, EDE-Q scores decreased from 3.62 to 2.70 in the SB-ED group and 3.55 to 3.05 in the usual care group, which was a significant difference. The women in the SB-ED group also reported fewer binge-eating and compensatory behaviors as well as fewer depressive symptoms. There was no difference between SB-ED and usual care in terms of the total number of women who achieved abstinence from all eating disorder behaviors, withdrew from a course, or took a leave of absence.

“Finally, with regard to realized treatment access, the [SB-ED] intervention was far superior,” Fitzsimmons-Craft and colleagues wrote. “83% of students offered the intervention began it, whereas only 28% of students in the control group reported seeking treatment for their ED at any point.”

For related information, see Handbook of Assessment and Treatment of Eating Disorders, by APA Publishing.

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Number of College Students Seeking MH Care Nearly Doubles Over Decade

Over the past decade, the percentage of students at U.S. college campuses seeking mental health care has increased significantly—from 19% in 2007 to 34% in 2017, according to a study published Monday in Psychiatric Services. The most common location for the college students to receive these services was on campus, the study found.

“This study provides the most comprehensive evidence to date regarding upward trends in mental health service utilization on U.S. campuses over the past 10 years,” wrote Sarah Ketchen Lipson, Ph.D., Ed.M., of Boston University School of Public Health and colleagues. “To better meet the mental health care demand from students and reduce strain on existing services, campuses may wish not only to expand capacity but also to increase the use of preventive and digital mental health services, such as those delivered via mobile apps.”

For the study, Lipson and colleagues analyzed 10 years of data collected for the Healthy Minds Study—an annual web-based survey examining mental health, use of mental health services, and related issues among undergraduate and graduate students. Students at participating institutions were randomly recruited to participate in the survey by email and were required to be at least 18 to participate.

Of the 155,026 students (56.5% female; 74.0% white) from 196 campuses included in the sample, 26.9% screened positive for depression, and 8.2% reported suicidal ideation within the past year. Students most commonly reported receiving services for mental health care on campus, with rates increasing from 6.6% in 2007 to 11.8% in the 2016-2017 academic year. The rate of students reporting past-year treatment increased from 18.7% in 2007 to 33.8% in 2016-2017, with similar patterns for both therapy/counseling and medication use. The proportion of students with a diagnosed mental health condition also increased over this period, from 21.9% in 2007 to 35.5% in 2016-2017.

Between 2007 and 2017, students reported less stigma regarding mental illness: the percentage of students who agreed with such statements as “most people think less of a person who has received mental health treatment” (perceived stigma) or “I would think less of a person who has received mental health treatment” (personal stigma) dropped from 64.2% to 46.0% and from 11.4% to 5.7%, respectively.

“The trends revealed in this study have strained counseling centers across the country, given that many are underresourced and operate at full capacity with waitlists for much of the year,” the researchers wrote. “There are a multitude of approaches to consider for alleviating this strain, including universal prevention programs and rapid referral to community treatment.”

For more on what colleges can do to help students seeking mental health care, see the Psychiatric News article “Duck Syndrome, Social Media, and Struggling Together” by Matthew C. Fadus, M.D.

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Clinical/Research News From APA’s 2017 Annual Meeting Day One

Welcome to San Diego!

APA’s 2017 Annual Meeting began in San Diego today. From now through May 24, Psychiatric News will deliver an evening digest of some of the day’s highlights—from the lecture halls to the exhibit floor. Whether you are here in San Diego or at home, these reports will convey the excitement and outstanding scientific program being presented at this year’s meeting.

Strengthening Sense of Identity Can Promote Mental Health of Students of Color

Identity can be a source of both emotional adversity and strength for ethnic minority college students, said speakers at a panel today at APA’s Annual Meeting.
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When Should Psychiatrists Disclose Mental Health Problems?

Psychiatrists have been at the forefront of encouraging patients to adopt ideas like recovery, resilience, and engagement, yet when confronting their own mental health issues, psychiatrists lean toward privacy. Read More >

Experts Describe Recent Advances in Psychodynamic Psychotherapy

Interpretation of transference, treatment of narcissistic personality disorder, and the evolution of psychodynamic treatments for borderline personality disorder and posttraumatic stress disorder were among topics discussed. Read More >

Volkow Honored for Addiction Research

Nora Volkow, M.D., director of the National Institute on Drug Abuse, was presented the Presidential Award for 2017 today by the American Association of Chairs of Departments of Psychiatry. The organization presents the award each year to a psychiatrist for distinguished scientific achievement and leadership in the field of psychiatry. Volkow was honored for her groundbreaking psychiatric research demonstrating drug addiction is a brain disease. She is flanked by Ondria Gleason, M.D., chair of the Department of Psychiatry at the University of Oklahoma School of Community Medicine, and Britta Ostermeyer, M.D., chair of the Department of Psychiatry and Behavioral Sciences at the University of Oklahoma Health Sciences Center.

Panel Discusses the Role of Mobile Technology in Mental Health Care

As interest in digital technologies like smartphones and telemedicine continues to expand in psychiatry, psychiatrists should be aware of the promise and the pitfalls of this digital evolution. Read More >

Scopolamine May Offer Clues About Fast-Acting Antidepressants

Ketamine’s ability to relieve symptoms of treatment-resistant depression in a matter of hours has captured the attention of clinicians and patients alike. However, it’s not the only medication on the market capable of exerting rapid antidepressant effects. Read More >