Emory Report
December 6, 2004
Volume 57, Number 14


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December 6 , 2004
Project helps channel students toward depression help

BY Kathi Baker

Suicide is the second leading cause of death among college students and the third leading cause of death in persons ages 15–24. According to the National Institute of Mental Health, more than 90 percent of people who kill themselves had been suffering from illnesses such as depression or substance abuse, and could have been treated and possibly saved had they been diagnosed. These statistics have challenged mental health professionals to find a way to get help to adolescents and young adults before it’s too late.

Charles Nemeroff, Reunette W. Harris Professor and chair, Assistant Professor David Moore and Senior Research Associate Jill Rosenberg, all in psychiatry and behavioral sciences, are working on a pilot study that should help develop a plan to identify and treat students at high risk for depression and suicide. The study, called the College Screening Project, began in 2002 and is funded by the American Foundation for Suicide Prevention.

“We know that the majority of students who are in need of counseling services don’t seek help through the traditional route,” Nemeroff said. “We want to be proactive in finding out how to reach these students in a way that makes sense to them.”

In the study, students receive an e-mail in staggered groups (beginning with seniors during fall semester and ending with freshmen at the beginning of their second semester) inviting them to complete a depression screening questionnaire on a secure website. Over about 10 minutes, the students are asked to answer questions touching on suicidal thoughts and attempts and problems often related to depression such as anxiety, alcohol and drug abuse, and eating disorders.

To ensure anonymity, students then choose a user ID and password—the only identifier on the questionnaire—and are asked to supply an e-mail address to receive notification that a counselor’s response is ready. The e-mail address is encrypted and cannot be linked to a student’s identity.

Based on their responses, the computer program classifies students into three tiers. Those who score high on the depression scale, indicating they have thought about suicide within the past four weeks or other serious problems, are placed in Tier 1. Tier 2 includes students who have mid-range depression scores or who indicate problems related to anxiety, alcohol or drug abuse, or eating disorders. All other students fall into Tier 3. Tier 1 students are told to return to the site for their counselor’s assessment in 24 hours; Tier 2, in three to four days; and Tier 3 in five days to a week.

The clinical social worker (Rosenberg, in this case) is notified via e-mail of the student’s tier and is provided a link to that student’s questionnaire, which she reads and evaluates. She then prepares an individualized assessment that is sent back to the student’s user ID. Students can choose to communicate with the counselor by e-mail or come in to see the project psychiatrist. The computer system also sends e-mail reminders to students in tiers 1 and 2.

“The key to making this work for the students is that they can remain anonymous,” Rosenberg said. “Even if students are aware of counseling services, they may not come forward out of fear of the embarrassment that other students will find out. If we reach out to them proactively and give them an opportunity to dialogue online, chances are good that they will come in for counseling.

“We know some students shy away from treatment,” she continued. “This project provides a way to identify students who might benefit from mental health services and help them access these services. We believe that what works best in reaching the greatest number of students is communicating on their level by using the appropriate language.”

Mark McLeod, director of the Counseling Center, is coordinating care for the students who come forward. They are treated while maintaining confidentiality.

“I really feel we are seeing students who would not have been picked up without this project,” McLeod said. “Although we have always been proactive, we have never had access to this type of technology. I believe that once the project is completed, the data will show that this is an effective way to increase the numbers of students who get help.”