Technology and College Student Mental Health: Challenges and Opportunities

In recent years, there has been an increase in symptoms of depression, anxiety, eating disorders, and other mental illnesses in college student populations. Simultaneously, there has been a steady rise in the demand for counseling services. These trends have been viewed by some as a mental health crisis requiring prompt investigation and the generation of potential solutions to serve the needs of students. Subsequently, several studies linked the observed rise in symptoms with the ubiquitous rise in use of personal computing technologies, including social media, and have suggested that time spent on these types of technologies is directly correlated with poor mental health. While use of personal computing technologies has dramatically shifted the landscape in which college students connect with one another and appears to have some detriments to mental health, the same technologies also offer a number of opportunities for the enhancement of mental health and the treatment of mental illness. Here, we describe the challenges and opportunities for college student mental health afforded by personal computing technologies. We highlight opportunities for new research in this area and possibilities for individuals and organizations to engage with these technologies in a more helpful and wellness-promoting manner

Neuroimmune Function, Life Distress, Stress Management Skills and Physical Symptoms in Chronic Fatigue Syndrome

Chronic Fatigue Syndrome (CFS) is a debilitating disorder with no clear etiology. Many, but not all, patients with CFS evidence signs of neuroimmune dysfunction prompting the suggestion that there exist subgroups of CFS patients with significant neuroimmune dysfunction while other subgroups of diagnosed patients may suffer from CFS-like symptoms due to other causes. Research has demonstrated that emotional distress responses impact CFS symptoms and that having adequate coping skills may predict less illness severity among individuals with CFS. However, no study to date has examined the influence of a comprehensive set of stress management skills on CFS symptoms nor has prior work evaluated if a relationship between stress management skills and CFS symptoms is mediated by lowered levels of emotional distress. Given the breadth of research literature linking neuroimmune dysfunction to emotional distress symptoms such as depression, and to physical symptoms such as fatigue, this study sought to examine a mediation model in which perceived stress management skills predict physical symptoms via lowered emotional distress. Moreover this study also sought to examine whether this model is most salient in individuals with a higher degree of neuroimmune dysfunction. In total, 117 individuals with CFS provided blood and saliva samples, as well as self-report measures of emotional distress, perceived stress management skills (PSMS), and CFS symptoms including fatigue. Plasma interleukin-2 (IL-2), IL-5, IL-6, IL-12, and tumor necrosis factor-alpha (TNF-a) and diurnal salivary cortisol were analyzed. This study examined relations among perceived stress management skills, emotional distress, and physical symptoms in CFS patients who did and did not evidence neuroimmune abnormalities. Results indicated that higher levels of perceived stress management skills were related to lower levels of emotional distress, which related to lower levels of fatigue and a lower total symptom severity score. Greater levels of PSMS were also associated with lower circulating levels of IL-2 and a more negative diurnal cortisol slope. The indirect relationship between perceived stress management skills and fatigue via emotional distress was moderated by level of plasma IL-6, such that it was significant in participants with elevated levels of IL-6, but not significant in those participants with lower levels of IL-6. No other neuroendocrine or cytokine indicator functioned as a moderator of this relationship. In conclusion, the relationship between perceived stress management skills and fatigue via emotional distress was more pronounced in individuals with greater levels of the circulating pro-inflammatory cytokine IL-6. These findings support the need for research examining the impact of stress management interventions in subgroups of CFS patients showing neuroimmune dysfunction

Creation and validation of the Cognitive and Behavioral Response to Stress Scale in a depression trial

The Cognitive and Behavioral Response to Stress Scale (CB-RSS) is a self-report measure of the use and helpfulness of several cognitive and behavioral skills. Unlike other measures that focus on language specific to terms used in therapy, the CB-RSS was intended to tap the strategies in ways that might be understandable to those who had not undergone therapy. The measure was included in a clinical trial of cognitive-behavioral therapy for depression and completed by 325 participants at baseline and end of treatment (18 weeks). Psychometric properties of the scale were assessed through iterative exploratory and confirmatory factor analyses. These analyses identified two subscales, cognitive and behavioral skills, each with high reliability. Validity was addressed by investigating relationships with depression symptoms, positive affect, perceived stress, and coping self-efficacy. End of treatment scores predicted changes in all outcomes, with the largest relationships between baseline CB-RSS scales and coping self-efficacy. These findings suggest that the CB-RSS is a useful tool to measure cognitive and behavioral skills both at baseline (prior to treatment) as well as during the course of treatment

The relationship between mobile phone location sensor data and depressive symptom severity.

BackgroundSmartphones offer the hope that depression can be detected using passively collected data from the phone sensors. The aim of this study was to replicate and extend previous work using geographic location (GPS) sensors to identify depressive symptom severity.MethodsWe used a dataset collected from 48 college students over a 10-week period, which included GPS phone sensor data and the Patient Health Questionnaire 9-item (PHQ-9) to evaluate depressive symptom severity at baseline and end-of-study. GPS features were calculated over the entire study, for weekdays and weekends, and in 2-week blocks.ResultsThe results of this study replicated our previous findings that a number of GPS features, including location variance, entropy, and circadian movement, were significantly correlated with PHQ-9 scores (r's ranging from -0.43 to -0.46, p-values <  .05). We also found that these relationships were stronger when GPS features were calculated from weekend, compared to weekday, data. Although the correlation between baseline PHQ-9 scores with 2-week GPS features diminished as we moved further from baseline, correlations with the end-of-study scores remained significant regardless of the time point used to calculate the features.DiscussionOur findings were consistent with past research demonstrating that GPS features may be an important and reliable predictor of depressive symptom severity. The varying strength of these relationships on weekends and weekdays suggests the role of weekend/weekday as a moderating variable. The finding that GPS features predict depressive symptom severity up to 10 weeks prior to assessment suggests that GPS features may have the potential as early warning signals of depression

Millon Behavioral Medicine Diagnostic (MBMD) Predicts Health-Related Quality of Life (HrQoL) over time among men treated for localized prostate cancer

Prostate cancer treatment presents multiple challenges that can negatively affect health-related quality of life (HrQoL), and that can be further compromised by maladaptive personality styles and psychological adjustment difficulties. This study examined the utility of a comprehensive psychosocial screening tool to identify psychosocial traits that prospectively predict HrQoL status among men treated for localized prostate cancer. The Millon Behavioral Medicine Diagnostic (MBMD) was administered to 66 men (M age = 68 years, 59% White) treated by either radical prostatectomy or radiotherapy along with standard measures of general and prostate-cancer-specific quality of life assessed at a 12-month follow-up. Higher scores on both summary MBMD Management Guides (Adjustment Difficulties and Psych Referral) and higher scores on personality styles characterized by avoidance, dependency, depression, passive aggressiveness, and self-denigration predicted lower HrQoL (β range = -.21 to -.50). Additionally, higher scores on the MBMD Depression, Tension-Anxiety, and Future Pessimism scales predicted lower HrQoL. Finally, higher scores on the MBMD Intervention Fragility and Utilization Excess scale also consistently predicted poorer mental and physical health functioning over time. These results point to the utility of the MBMD to help screen for potential impairments in mental and physical health functioning in men undergoing treatment for prostate cancer

Targeting subjective engagement in experimental therapeutics for digital mental health interventions

Engagement is a multifaceted construct and a likely mechanism by which digital interventions achieve clinical improvements. To date, clinical research on digital mental health interventions (DMHIs) has overwhelmingly defined engagement and assessed its association with clinical outcomes through the objective/behavioral metrics of use of or interactions with a DMHI, such as number of log-ins or time spent using the technology. However, engagement also entails users' subjective experience. Research is largely lacking that tests the relationship between subjective metrics of engagement and clinical outcomes. The purpose of this study is to present a proof-of-concept exploratory evaluation of the association between subjective engagement measures of a mobile DMHI with changes in depression and anxiety. Adult primary care patients (N = 146) who screened positive for depression or anxiety were randomized to receive a DMHI, IntelliCare, immediately or following an 8-week waitlist. Subjective engagement was measured via the Usefulness, Satisfaction, and Ease of Use (USE) Questionnaire. Across both conditions, results showed that individuals who perceived a mobile intervention as more useful, easy to use and learn, and satisfying had greater improvements in depression and anxiety over eight weeks. Findings support our proposed experimental therapeutics framework that hypothesizes objective/behavioral and subjective engagement metrics as mechanisms that lead to changes in clinical outcomes, as well as support directing intervention design efforts for DMHIs to target the user experience