HMS_nationalwinter2021_-update1.5.21

2021 Winter/Spring Data Report

ABOUT THE HEALTHY MINDS STUDY (HMS) STUDY TEAM Principal Investigators: Daniel Eisenberg, PhD & Sarah Ketchen Lipson, EdM, PhD & Justin Heinze, PhD Co-investigator: Sasha Zhou, PhD, MPH, MHSA Project Managers: Amber Talaski, MPH & Akilah Patterson, MPH REPORT TEAM Graphic Designer: Sarah Fogel, University of Michigan School of Art and Design, Class of 2014 Report Automation: Paul Schulz & Liz Hanley

STUDY PURPOSE The Healthy Minds Study provides a detailed picture of mental health and related issues in college student populations. Schools typically use their data for some combination of the following purposes: to identify needs and priorities; benchmark against peer institutions; evaluate programs and policies; plan for services and programs; and advocate for resources. STUDY DESIGN The Healthy Minds Study is designed to protect the privacy and confidentiality of participants. HMS is approved by Advarra. To further protect respondent privacy, the study is covered by a Certificate of Confidentiality from the National Institutes of Health. SAMPLING Each participating school provides the HMS team with a sample of currently enrolled students over the age of 18, either randomly selected or their entire student population. Schools with graduate students typically include both undergraduates and graduate students in the sample. DATA COLLECTION HMS is a web-based survey. Students are invited and reminded to participate in the survey via emails, which are timed to avoid, if at all possible, the first two weeks of the term, the last week of the term, and any major holidays. The data collection protocol begins with an email invitation, and non-responders are contacted up to three times by email reminders. Reminders are only sent to those who have not yet completed the survey. Each communication contains a URL that students use to gain access to the survey. NON-RESPONSE ANALYSIS A potential concern in any survey study is that those who respond to the survey will not be fully representative of the population from which they are drawn. In the HMS, we can be confident that those who are invited to fill out the survey are representative of the full student population because these students are randomly selected from the full list of currently enrolled students. However it is still possible that those who actually complete the survey are different in important ways from those who do not complete the survey. The overall participation rate for the Winter 2021 study was 15%. It is important to raise the question of whether the 15% who participated are different in important ways from the 85% who did not participate. We address this issue by constructing non-response weights using administrative data on full student populations. Most of the 102 schools in the Winter 2021 HMS were able to provide administrative data about all randomly selected students. The analysis of these administrative data, separated from any identifying information, was approved in the IRB application at Advarra and at each participating school. We used the following variables, when available, to estimate which types of students were more or less likely to respond: gender, race/ethnicity, academic level, and grade point average. We used these variables to estimate the response propensity of each type of student (based on multivariate logistic regressions), and then assigned response propensity weights to each student who completed the survey. The less likely a type of student was to complete the survey, the larger the weight they received in the analysis, such that the weighted estimates are representative of the full student population in terms of the administrative variables available for each institution. Finally, note that these sample weights give equal aggregate weight to each school in the national estimates. An alternative would have been to assign weights in proportion to school size, but we decided that we did not want our overall national estimates to be dominated by schools in our sample with very large enrollments. 1

ABOUT THIS REPORT This data report provides descriptive statistics (percentages, mean values, etc.) from the sample of respondents at your institution for a set of key measures. In addition to the key measures highlighted in this report, an appendix is also included with descriptive statistics for each survey item (see below). APPENDIX The appendix includes values for most measures in the three standard survey modules that are administered on all participating campuses: Demographics, Mental Health Status, and Mental Health Services Utilization/Help-Seeking. For each measure, the data tables display the following information: the value table for your institution, the 95% confidence interval for your institution's value, the value for the national sample, and an indicator if your institution's value is significantly higher or lower than the national value. All values in the appendix have been weighted to be representative of the full student populations to which they refer (see Non-response Analysis). Also note that for some measures, respondents were allowed to check more than one response category (e.g., they might have gone to more than one type of provider for mental health services), so the percentages sometimes add up to more than 100% across response categories. The 95% confidence intervals give a sense of how much uncertainty there is about each estimated value. This uncertainty exists because our estimates are based only on a random sample of students, rather than a complete census of the student population. However, some schools that had less than 4,000 students (the typical requested sample size), provided their entire population. For consistency sake, these schools were not treated any differently than those schools that provided a 4,000 student sample of their full population. Essentially, the confidence interval tells us that there is a 95% probability that the true population value is within this particular range. Because both the school-level and national values are only estimates based on random sampling, we cannot say for certain that your institution's true value is above or below the national value. But in cases where we can say that there is a 95% or higher statistical probability that your institution's value is higher or lower than the national value, we indicate this. EXPLORING YOUR DATA FURTHER There are two options for exploring your data beyond what is in this report. First, you can use statistical software (e.g., SPSS, Stata, etc.) to analyze the full data set for your students, which has been provided to your school. Second, you will be able to log on to a user-friendly website with drop-down menus, at data.healthymindsnetwork.org. 2

4 SAMPLE CHARACTERISTICS (N=103748) 18 19 20 21 22 23-25 26-30 31-35 36-40 41+ 10% 20% 12% 15% 15% 14% 9% 11% 9% 5% 3% 5% Age (years) Other 3% Male 39% Female 58% Gender WHI BLA LAT AMIN ARAB ASIAN PAC OTH 10% 20% 30% 40% 50% 60% 70% 63% 17% 12% 2% 2% 11% 1% 2% Race/ethnicity OTH Other PAC Pacific Islander ASIAN Asian/Asian American ARAB Arab/Middle Eastern or Arab American AMIN American Indian/Alaskan Native LAT Hispanic/Latino BLA African American/Black WHI White or Caucasian Other 4% Parent or guardian's home 30% Off-campus, non-university housing 38% Other university housing 6% Fraternity or sorority house 1% Campus residence hall 21% Living arrangement ASS BA MA JD MD PHD ND OTH 10% 20% 30% 40% 50% 60% 70% 18% 64% 11% 0% 1% 3% 2% 2% Degree program OTH Other ND Non-degree student PHD PhD or equivalent MD MD JD JD MA Master's degree BA Bachelor's degree ASS Associate's degree INP HYB ONL OTH 10% 20% 30% 40% 50% 6% 44% 48% 2% Class Format OTH Other ONL All Online HYB Hybrid INP All In-Person

5 PREVALENCE OF MENTAL HEALTH PROBLEMS DEPRESSION SCREEN Depression is measured using the Patient Health Questionnaire-9 (PHQ-9), a nine-item instrument based on the symptoms provided in the Diagnostic and Statistical Manual for Mental Disorders for a major depressive episode in the past two weeks (Spitzer, Kroenke, & Williams, 1999). Following the standard algorithm for interpreting the PHQ-9, symptom levels are categorized as severe (score of 15+), moderate (score of 10-14), or mild/minimal (score <10). 22% 19% 41% Severe depression Moderate depression Any depression ANXIETY SCREEN Anxiety is measured using the GAD-7, a seven-item screening tool for screening and severity measuring of generalized anxiety disorder in the past two weeks (Spitzer, Kroenke, Williams, & Lowe, 2006). Following the standard algorithm for interpreting the GAD-7, symptom levels are categorized as severe anxiety, moderate anxiety, or neither. 17% 18% 34% Severe anxiety Moderate anxiety Any anxiety EATING DISORDER SCREEN Eating disorders are measured using the written U.S. version of the SCOFF, a five-item screening tool designed to identify subjects likely to have an eating disorder (Morgan, Reid, & Lacey, 1999). Eating disorders 12% LONELINESS How often do you feel... lack companionship 21% 43% 36% left out 23% 45% 32% isolated from others Often 28% Some of the time 40% Hardly ever 32%

7 HEALTH BEHAVIORS AND LIFESTYLE Drug use Over the past 30 days, have you used any of the following drugs? (Select all that apply) 79% No, none of these 1% Other drugs without a prescription 0% Athletic performance enhancers (anything that violates policies set by school or any athletic governing body) 0% Kratom 1% Psilocybin (also known as magic mushrooms, boomers, shrooms) 1% LSD (also known as acid) 0% Ketamine (also known as K, Special K) 0% MDMA (also known as Ecstasy or Molly) 1% Other stimulants (such as Ritalin, Adderall) without a prescription or more than prescribed 0% Methamphetamines (also known as speed, crystal meth, or ice) 1% Benzodiazepenes 0% Opioid pain relievers (such as Vicodin, OxyContin, Percocet, Demerol, Dilaudid, codeine, hydrocodone, methadone, morphine) without a prescription or more than prescribed 0% Heroin 1% Cocaine (any form, including crack, powder, or freebase) 20% Marijuana Binge drinking The following questions ask about how much you drink. A "drink" means any of the following: A 12-ounce can or bottle of beer A 4-ounce glass of wine A shot of liquor straight or in a mixed drink During the last two weeks, how many times have you had 4 (female), 5 (male), 4 or 5 (other gender) or more drinks in a row? (among those with any alcohol use) 10 or more times 2% 6 to 9 times 3% 3 to 5 times 14% Twice 16% Once 23% None 41% Exercise In the past 30 days, about how many hours per week on average did you spend exercising? (include any exercise of moderate or higher intensity, where "moderate intensity" would be roughly equivalent to brisk walking or bicycling) 5 or more 38% 3-4 13% 1-2 18% Less than 1 32%

8 ATTITUDES AND BELIEFS ABOUT MENTAL HEALTH SERVICES KNOWLEDGE SCHOOL CLIMATE Knowledge of campus mental health resources If I needed to seek professional help for my mental or emotional health, I would know where to go to access resources from my school. Strongly disagree 9% Disagree 13% Somewhat disagree 8% Somewhat agree 20% Agree 27% Strongly agree 23% Perceived need (past year) In the past 12 months, I needed help for emotional or mental health problems such as feeling sad, blue, anxious or nervous. Strongly disagree 18% Disagree 14% Somewhat disagree 6% Somewhat agree 16% Agree 18% Strongly agree 28% Perceived need (current) I currently need help for emotional or mental health problems such as feeling sad, blue, anxious or nervous. Strongly disagree 3% Disagree 9% Somewhat disagree 10% Somewhat agree 28% Agree 23% Strongly agree 27% Agree 81% Anti-racism I believe my school actively works towards combating racism within the campus community.

10 Mental health counseling/therapy, all students (past year) In the past 12 months have you received counseling or therapy for your mental or emotional health from a health professional (such as psychiatrist, psychologist, social worker, or primary care doctor)? 30% Mental health counseling/therapy among students with positive depression or anxiety screens (past year) In the past 12 months have you received counseling or therapy for your mental or emotional health from a health professional (such as psychiatrist, psychologist, social worker, or primary care doctor)? 40% Mental health counseling/therapy, all students (lifetime) Have you ever received counseling or therapy for mental health concerns? 47% Mental health counseling/therapy among students with positive depression or anxiety screens (lifetime) Have you ever received counseling or therapy for mental health concerns? 59% Informal help-seeking In the past 12 months have you received counseling or support for your mental or emotional health from any of the following sources? (Select all that apply) 2% Staff member 4% Faculty member/professor 35% None of the above 1% Other non-clinical source 2% Support group 4% Religious counselor or other religious contact 37% Family member 30% Significant other 41% Friend (who is not a roommate) 15% Roommate Barriers to help-seeking In the past 12 months, which of the following factors have caused you to receive fewer services (counseling, therapy, or medications) for your mental or emotional health than you would have otherwise received? (Select all that apply) 17% No barriers 6% Other 4% People providing services don't understand me 2% Privacy concerns 19% Prefer to deal with issues on my own or with support from family/friends 9% Difficulty finding an available appointment 14% Not sure where to go 19% Not enough time 18% Financial reasons (too expensive, not covered by insurance) 37% No need for services 5% I haven't had the chance to go but I plan to

11 REFERENCES MENTAL HEALTH SCREENS Center for Collegiate Mental Health (2015). CCAPS User Manual. University Park, PA. Diener, E., Wirtz, D., Tov, W., Kim-Prieto, C., Choi, D., Oishi, S., & Biswas-Diener, R. (2009). New measures of well-being: Flourishing and positive and negative feelings. Social Indicators Research, 39, 247-266. Morgan, J. F., Reid, F., & Lacey, J. H. (1999). The SCOFF questionnaire: assessment of a new screening tool for eating disorders BMJ, 319(7223), 1467-1468. Spitzer, R. L., Kroenke, K., Williams, J. B., & Patient Health Questionnaire Primary Care Study Group. (1999). Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA, 282(18), 1737-1744. Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166(10), 1092-1097. SELECTED ARTICLES PUBLISHED WITH HMS DATA Eisenberg, D., Golberstein, E., Hunt, J. (2009). Mental Health and Academic Success in College. B.E. Journal of Economic Analysis & Policy 9(1) (Contributions): Article 40. Eisenberg, D., Hunt, J.B., Speer, N., Zivin, K. (2011). Mental Health Service Utilization among College Students in the United States. Journal of Nervous and Mental Disease 199(5): 301-308. Eisenberg, D., Chung, H. (2012). Adequacy of Depression Treatment in College Student Populations. General Hospital Psychiatry 34(3):213-220. Eisenberg, D., Speer, N., Hunt, J.B. (2012). Attitudes and Beliefs about Treatment among College Students with Untreated Mental Health Problems. Psychiatric Services 63(7): 711-713. Eisenberg, D., Hunt, J.B., Speer, N. (2013). Mental Health in American Colleges and Universities: Variation across Student Subgroups and across Campuses. Journal of Nervous and Mental Disease 201(1): 60-67. Lipson, S., Gaddis, S.M., Heinze, J., Beck, K., Eisenberg, D. (2015). Variations in Student Mental Health and Treatment Utilization Across US Colleges and Universities. Journal of American College Health, 63(6): 388-396. Lipson, S., Zhou, S., Wagner, B., Beck, K., Eisenberg, D. (2016). Major differences: Variations in student mental health and service utilization across academic disciplines. Journal of College Student Psychotherapy, 30(1), 23-41. Email: healthyminds@umich.edu Website: www.healthymindsnetwork.org

13 Respondent Characteristics MEASURE All Students 95% CONFIDENCE INTERVAL Very unimportant Unimportant Neutral Important Very important Religiosity 16% 14% 25% 22% 24% (15%, 16%) (13%, 14%) (25%, 25%) (21%, 22%) (24%, 25%) Never Stressful Rarely Stressful Stressful Often stressful Always stressful Current financial situation 7% 19% 35% 24% 15% (7%, 7%) (19%, 19%) (35%, 35%) (23%, 24%) (15%, 16%) Never Stressful Rarely Stressful Stressful Often stressful Always stressful Financial situation growing up 14% 26% 29% 19% 13% (13%, 14%) (25%, 26%) (28%, 29%) (19%, 19%) (12%, 13%) Divorced Married or domestic partnership In a relationship Single Relationship status 1% 13% 34% 51% (1%, 1%) (13%, 13%) (33%, 34%) (51%, 52%) Other Questioning Queer Gay / lesbian Bisexual Heterosexual Sexual orientation 3% 3% 3% 3% 12% 78% (3%, 3%) (3%, 3%) (3%, 3%) (3%, 3%) (11%, 12%) (78%, 79%) Other chronic disease (please specify) Other autoimmune disorder (please specify) HIV/AIDS High cholesterol Cancers Seizure disorders (e.g., epilepsy) Sickle cell anemia Arthritis Gastrointestinal disease (e.g., Crohn's Disease, Ulcerative Colitis) Thyroid disease (e.g., hypothyroid or hyperthyroid) Asthma High blood pressure Diabetes Chronic disease 5% 2% 0% 3% 1% 1% 0% 2% 2% 3% 15% 4% 2% (4%, 5%) (2%, 2%) (0%, 0%) (3%, 3%) (1%, 1%) (1%, 1%) (0%, 0%) (2%, 2%) (2%, 2%) (3%, 3%) (14%, 15%) (4%, 5%) (2%, 2%) Mental Health Measures Flourishing Scale (8-56) Positive Mental Health 43.1 (43.0, 43.2) Depression overall Other depression (positive screen) Major depression (positive screen) In severe range (20-27) In moderately severe range (15-19) In moderate range (10-14) Overall score (0-27) Depression (PHQ-9) 41% 19% 22% 8% 11% 17% 9.1 (40%, 41%) (19%, 19%) (21%, 22%) (8%, 8%) (11%, 11%) (16%, 17%) (9.0, 9.2)

14 Mental Health Measures MEASURE All Students 95% CONFIDENCE INTERVAL Extremely difficult Very difficult Somewhat difficult Not difficult at all Impairment from depression (1) 9% 17% 51% 23% (8%, 9%) (17%, 18%) (51%, 52%) (22%, 23%) Probable anxiety disorder (positive screen) In severe range (15-21) In moderate range (10-14) Overall score (0-21) Generalized anxiety (GAD-7) 34% 17% 18% 7.8 (34%, 35%) (16%, 17%) (17%, 18%) (7.7, 7.8) Depression or anxiety disorder Depression/Anxiety 48% (48%, 49%) Think you are very underweight Need to be very thin to feel good about self Probable eating disorder (3+ on SCOFF) Disordered eating and body image 1% 27% 12% (1%, 2%) (26%, 27%) (12%, 12%) 6 or more days 3-5 days 1-2 days None Academic impairment from mental health, past 4 weeks (2) 27% 26% 28% 18% (27%, 28%) (26%, 27%) (27%, 28%) (18%, 19%) Self-Injury and Suicide Other Punching or banging wall or object Rubbing sharp objects on skin Carving words or symbols in skin Interfering with wound healing Biting self Pulling one's hair Scratching self Punching or banging self Burning self Cutting self Any Non-suicidal self-injury, past year 2% 7% 3% 1% 8% 5% 9% 9% 9% 1% 5% 23% (1%, 2%) (7%, 7%) (3%, 3%) (1%, 1%) (8%, 8%) (4%, 5%) (8%, 9%) (9%, 9%) (9%, 9%) (1%, 2%) (5%, 5%) (23%, 24%) Nearly everyday, or everyday 3 to 5 days a week Once or twice a week 2 or 3 times a month Once a month or less Once or twice Frequency of self-injury, past year (among those with any) 2% 3% 6% 14% 25% 51% (2%, 2%) (2%, 3%) (5%, 6%) (13%, 14%) (24%, 26%) (50%, 52%) Attempted suicide, past year Made a plan for attempting suicide, past year Seriously thought about attempting suicide, past year Suicidality 1% 5% 13% (1%, 1%) (5%, 6%) (13%, 14%) (1) How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? (2) How many days have you felt that emotional or mental difficulties have hurt your academic performance?

16 Health Behaviors and Lifestyle MEASURE All Students 95% CONFIDENCE INTERVAL Other drugs without a prescription Athletic performance enhancers (anything that violates policies set by school or any athletic governing body) Kratom Psilocybin (also known as magic mushrooms, boomers, shrooms) LSD (also known as acid) Ketamine (also known as K, Special K) MDMA (also known as Ecstasy or Molly) Other stimulants without a prescription or more than prescribed Methamphetamines Benzodiazepenes Opioid pain relievers without a prescription or more than prescribed Heroin Cocaine Marijuana Vape pen or E-Cigarette Cigarettes Substance use, past 30 days 1% 0% 0% 1% 1% 0% 0% 1% 0% 1% 0% 0% 1% 20% 15% 7% (0%, 1%) (0%, 0%) (0%, 0%) (1%, 1%) (0%, 1%) (0%, 0%) (0%, 0%) (1%, 1%) (0%, 0%) (1%, 1%) (0%, 0%) (0%, 0%) (1%, 1%) (19%, 20%) (14%, 15%) (7%, 7%) More than 3 times More than one time In the past 2 weeks, about how many times did you have 4 [female]/5 [male]/4 or 5 [not female or male] or more alcoholic drinks in a row? (1 drink is a can of beer, a glass of wine, a wine cooler, a shot of liquor, or a mixed drink.) 9% 28% (9%, 10%) (28%, 28%) More than 20 hours/week 16-20 hours/week 11-15 hours/week 6-10 hours/week 3-5 hours/week 1-2 hours/week Less than 1 hour/week Time studying/doing homework 13% 12% 17% 28% 21% 6% 2% (13%, 14%) (12%, 12%) (17%, 18%) (28%, 29%) (21%, 22%) (6%, 6%) (2%, 2%) Did anyone strike or physically injure you? Violence (past 12 months) 6% (6%, 6%) Attitudes and Beliefs about Services Most people... I... ...think less of someone who has received mental health treatment. 45% 6% (45%, 46%) (5%, 6%) Agree or strongly agree know where to go to access resources 70% (70%, 71%) Believes therapy is helpful or very helpful for depression Believes medication is helpful or very helpful for depression Beliefs about effectiveness of treatment for depression 83% 61% (83%, 84%) (60%, 61%)

17 Help-Seeking MEASURE All Students 95% CONFIDENCE INTERVAL Strongly disagree Disagree Somewhat disagree Somewhat agree Agree Strongly agree Think you needed help for emotional or mental health problems, past year 18% 14% 6% 16% 18% 28% (17%, 18%) (14%, 14%) (5%, 6%) (16%, 17%) (18%, 19%) (28%, 29%) Other Mood stabilizers Anti-anxiety Anti-psychotics Anti-depressants Psychostimulants Any, current Psychotropic medication 2% 2% 8% 1% 17% 6% 20% (2%, 2%) (2%, 2%) (7%, 8%) (1%, 1%) (17%, 18%) (5%, 6%) (19%, 20%) Don't know No prescription Other type of health provider Psychiatrist General practitioner/nurse practitioner/primary care physician Prescriber (among those with any past-year medication use) 1% 5% 4% 37% 60% (1%, 2%) (4%, 5%) (3%, 4%) (36%, 38%) (59%, 61%) More than 5 times 3-5 times 1-2 times Not at all Discussed medication with provider, past year (among those with medication use) 22% 28% 39% 10% (22%, 23%) (27%, 29%) (38%, 40%) (9%, 10%) No one Other non-clinical source Support group Religious counselor / other religious contact Family member Significant other Friend (who is not a roommate) Roommate Professional clinician Whom you would talk to, if you were experiencing serious emotional distress 10% 1% 3% 6% 41% 33% 41% 14% 33% (10%, 10%) (1%, 1%) (3%, 3%) (6%, 7%) (41%, 42%) (32%, 33%) (41%, 42%) (14%, 15%) (32%, 33%) Current Past year Therapy or counseling for mental health 16% 30% (16%, 16%) (29%, 30%) More than 10 7-9 4-6 1-3 Visits in past year, among those with any 7% 13% 19% 37% (7%, 8%) (13%, 14%) (18%, 19%) (36%, 38%) Other Provider in another location (such as hometown) Provider in the local community (not on campus) Partial hospitalization program Inpatient psychiatric hospital Psychiatric emergency services Campus Provider C Campus Provider B Campus Provider A Use of specific providers for therapy or counseling for mental health 2% 12% 8% 1% 1% 1% 2% 1% 11% (2%, 2%) (11%, 12%) (8%, 9%) (1%, 1%) (1%, 1%) (1%, 1%) (2%, 2%) (1%, 1%) (11%, 12%)