Report 8 of the Council on Science and Public Health (A-06)

Responding to Depression, Suicide, Substance Use, and Addiction on College Campuses

Summary

Objectives. To review available scientific data on the efficacy of prevention programs aimed at reducing the incidence of depression, substance abuse, and suicide on college campuses; to review existing data on access to and utilization of college mental health and substance abuse services; and to advocate for the development of guidelines concerning appropriate access to psychiatric, addiction medicine, and other mental health and substance abuse services on college campuses.
 
Methods. Google Scholar and PubMed were searched for English-language articles published from 1990 to 2006 using the search words suicide, depression, young adults, college, university, and student, and citations were identified via the “related articles and links” option. The SafetyLit Injury Prevention Literature Update Archive 2000-2006 was searched by abstract categories: age: adolescents; age: young adults; alcohol and other drugs; suicide and self-harm, and the key words college, university, young adults, depression, and suicide.  An additional source was the Higher Education Center for Alcohol and Other Drug Prevention: Published Literature Review January 1999-May 2001 (with Supplemental Literature Reviews for January 2000-June 2003, and July-December 2003), conducted for the U.S. Department of Education. It searched ERIC, MedLine, PsycInfo, ARIV, ETOH, Substance Abuse Policy Research Program Monthly News Reports, Robert Wood Johnson Foundation Web page, Health Reference Center Academic, and scanned 32 journals in substance abuse, public and college health, psychology, violence and suicide, using 73 keywords to identify programs and research on college alcohol, other drugs and violence issues. These were categorized into review articles, and two primary topics: alcohol and other drugs and violence, subdivided into evaluation, college (not evaluation), and non-college. Additional literature reviews were found at The Cochrane Collaboration: Reviews. Additional information was derived from manual review of references cited in relevant journal articles, reports, and textbooks, and examination of Web sites of federal agencies and advocacy and information organizations. Information also was received from direct communication with other professional organizations, recognized experts in higher education, federal agencies, medical specialty societies, and mental health and other recognized researchers in this field.

Results. The literature survey indicates that depression and related mental illness are significant and growing problems among college students and contribute to self-harm and suicide. Substance use problems, particularly high-risk drinking, are prevalent. They contribute to numerous academic, social, and health problems, including suicide, and are often co-morbid with mental health problems. Review of prevention strategies demonstrates some effectiveness but indicates that screening and brief intervention and environmental policies to reduce problems are not widely implemented. Counseling and health services on campuses are stretched due to inadequate resources in the face of increasing severity of conditions among students, especially graduate students.

Conclusions. Colleges are becoming overburdened by stress, depression, and alcohol- and other drug-related problems among their students. Best practices of prevention, screening, and follow up interventions are often not implemented and rarely integrated into regular campus policy or campus or community services. Institutions need to give higher priority to a comprehensive strategy to address mental health and substance use issues.

RECOMMENDATIONS

The following statements, recommended by the Council on Science and Public Health, were adopted as by the AMA House of Delegates as AMA directives and policy at the 2006 AMA Annual Meeting:

1. The AMA Council on Medical Service will evaluate health insurance coverage of full-time undergraduate and graduate students. (Directive)
2. The AMA recommends that any such insurance coverage should have full parity for mental health and substance abuse treatment, which is consistent with established AMA Policy (H-185.974, AMA Policy Database). (Directive)
3. The AMA recommends that colleges and universities increase the availability and ensure the quality and quantity of on-site mental health and substance abuse clinical services and/or improve access to appropriate community services. (Directive)
4. The AMA will advocate for the elimination of college and university policies that discriminate against students who disclose or seek treatment for depression, substance use disorders, or other mental health issues, including policies that mandate suspension or withdrawal from school for students who request or receive psychiatric or addiction medicine services. (Directive)
5. The AMA encourages the Association of American Medical Colleges (AAMC) to develop similar programs in medical schools. (Directive)
6. The AMA encourages clinical staff of campus health services and campus counseling services of colleges and universities to improve their skills in screening, brief intervention, and referral for students' problem drinking. (Directive)
7. The AMA will seek funding in cooperation with interested partners to educate physicians and the media to focus attention on the issues and linkages of substance use and addiction, mental disorders, and suicide among college students. (Directive)
8. The AMA reaffirms Policy D-185.993 to work actively to secure repeal of laws and state insurance codes which allow for the denial of insurance payments for the treatment of injuries sustained as a consequence of the insured person being intoxicated due to alcohol or under the influence of narcotics. (Reaffirm Policy)

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