Year of Award

2017

Document Type

Thesis

Degree Type

Master of Arts (MA)

Degree Name

Clinical Psychology

Department or School/College

Department of Psychology

Committee Chair

Duncan Campbell, PhD

Commitee Members

Bryan Cochran, PhD; John Sommers-Flanagan, PhD; Mike Frost, LCPC, LAC

Keywords

universal depression screening, student health, college health, depression

Publisher

University of Montana

Subject Categories

Clinical Psychology

Abstract

Universal depression screening at university student health centers can increase identification and treatment of depression among college students, but the rates of screening in these settings were, until now, unknown (Shepardson & Funderburk, 2014). The U.S. Preventive Services Taskforce (USPSTF), American College Health Association, and other organizations have recommended that all primary care settings universally screen for depression, provided that necessary supports are in place (USPSTF, 2016; ACHA, 2010). Notably, others disagree (Joffres et al., 2013; Mitchell et al., 2009; Gilbody et al., 2005). An online survey was electronically mailed to 493 college health center directors and/or medical directors of public 4-year universities in the U.S. Survey respondents represented 40 states and included 131 respondents (N = 131). The prevalence of universal depression screening among college health centers of public 4-year universities in the U.S. was 64.2% (54-74%; 95%). Characteristics associated with universal depression screening use clustered around greater resources, such as larger student populations and healthcare staff, greater perceived financial resources, and lower estimations of time it takes to screen. Additional factors associated with universal screening use included: respondents’ awareness of the USPSTF recommendation, agreement with the evidence base supporting universal depression screening, and a belief that codified standards of care aid in effectively serving patients. Leading reasons for not universally screening for depression were: lack of mental health support available, lack of providers and support staff available to assist, reluctance from providers and staff due to process change, concerns about liability, and concerns about the time and space screening takes in the clinic. Perceived barriers to—and reasons for not—screening were endorsed at significantly different rates among screeners and non-screeners in the following domains: estimation of time required to screen, lack of providers and support staff, and lack of financial resources. Ninety percent of respondents estimated that less than half of students seen in student health centers experience mental health concerns. Discussions around universal depression screening adoption in student health centers should address resource concerns, awareness regarding the evidence base and USPSTF recommendation for universal depression screening, as well as information about the average time it takes to screen and prevalence estimates of mental health concerns in primary care. Future directions for research are addressed.

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