|The WHO World Mental Health Surveys International College Student Project (WMH-ICS)|
The college years are a crucial time period when students make the transition from late-adolescence to adulthood. Importantly, this transition takes place during an extremely sensitive part of the life cycle for the onset of emotional problems and mental disorders. Approximately 75% of all lifetime mental disorders have their onsets prior to the age of 24. These early-onset cases have greater delays in seeking treatment as well as poorer clinical and functional outcomes than later-onset cases. Mental disorders are more prevalent among students than among adults who have completed their educations. In addition, suicide is the second leading cause of death among university students. The college years are also associated with a significant increase in risky health behaviors, such as excessive alcohol and cannabis use. These disorders and behaviors are associated with low academic attainment as well as with a range of adverse outcomes in the domains of health and role functioning subsequent to leaving college.
The WHO World Mental Health Surveys Initiative International College Student Project (WMH-ICS) aims to obtain accurate longitudinal cross-national information about the prevalence and correlates of mental, substance, and behavioral disorders among college students worldwide with the goals of assessing unmet need for treatment, targeting students in need of outreach, and evaluating model preventive and clinical interventions. The initial phase of the initiative will carry surveys with representative samples of college students in order to estimate the prevalence of mental disorders, associated impairments, adverse social and academic consequences, and patterns of help-seeking. Later phases of the initiative will use the protocol developed for implementing these surveys to target students in need of outreach and will evaluate the effects of interventions implemented based on this targeting.
The initial phase of the WMH-ICS, which is the current focus of the project, is designed to create a flexible and cost-effect college student survey data collection instrument and protocol that will enable us to (1) generate reliable screening estimates for a broad range of mental disorders (e.g. Major Depressive Episode, Generalized Anxiety Disorder, Panic Disorder, Bipolar Disorder, adult ADHD, substance abuse and dependence, and suicidal behaviors), (2) test the predictive validity of new methods of screening for risks of suicidal behaviors and other behavioral/mental health and academic problems, (3) examine the use of services, predictors of service use, and barriers to help-seeking among college students, (4) estimate the burden of emotional problems, mental disorders, and suicidal behaviors among college students and their association with academic functioning.
The WMH-ICS Project is being carried out as part of the WHO World Mental Health Survey Initiative (http://www.hcp.med.harvard.edu/wmh). The WMH-ICS is coordinated by an executive committee of WMH researchers including: Randy Auerbach (Harvard University, US), Ronny Bruffaerts (KU Leuven, Belgium), Jennifer Green (Boston University, US), Matthew Nock (Harvard University, US) and Ronald Kessler (Harvard University, US). For more information about the WMH-ICS project, please contact us here: WMHICS@fas.harvard.edu.
Sampling: The first phase of the WMH-ICS consists of web-based self-report surveys administered to representative samples of college freshmen in the Fall of their first year of college along with tracking surveys administered each subsequent year of college. The baseline survey focuses on the assessment of risk factors for negative outcomes as well as strengths that guard against such outcomes. The subsequent tracking surveys include update information on the course of baseline emotional and behavioral problems as well as assessments of the subsequent onset of additional problems along with information on the occurrence of positive and negative life experiences and outcomes of interest (academic achievement as well as functioning in other important role domains).
Mode: All surveys use a web-based data collection method, which enables us to conduct surveys much more cost-effectively than would be possible otherwise. Surveys take an average of 20-30 minutes to complete. The web-based nature of the surveys also allow for the addition of online interventions once high-risk students are identified.
Measures: The WMH-ICS survey instrument consists of a broad range of screening instruments that include the CIDI-Screener, the AUDIT, and the ASRS-6. The instrument also includes items from common clinical measures like the Columbia Suicide Severity Rating Scale, the NIDA-Modified Assist-Prescreen, and specific modules from the CIDI-3.0. The use of these instruments enables us to generate reliable screening estimates for, among others, Major Depressive Episode (MDE), Generalized Anxiety Disorder (GAD), Panic Disorder (PD), Social Phobia (SP), Separation Anxiety Disorder (SAD), Bipolar Disorder (BD), adult ADHD, a range of eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder), substance abuse and dependence, and suicidal behaviors. The instrument also generates reliable estimates of self-reported health, use of services for emotional or mental health problems, college expectations, adaptation to college life, and academic outcomes.
Training and Field Procedures: The WHO translation, back-translation, and harmonization protocol was used to create instruments and training materials in a wide range of languages. Standardized descriptions of the goals and procedures of the study, data uses and protections, and the rights of respondents are provided in written form for review and discussion by all eligible respondents before obtaining informed consent for participation in the survey. Quality control protocols are standardized across settings to guarantee accuracy and to specify data cleaning and coding procedures. The institutional boards of the colleges that carry out the surveys approve the surveys before they are implemented and monitored compliance with procedures for obtaining informed consent and protecting human subjects. All these implementation procedures have been codified in a fashion that makes them easy to export to other settings in order to expand the number of institutions in the initiative.
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