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Increasing Intentions to Use Mental Health Services Among University Students. Results of a Pilot Randomized Controlled Trial Wi VU Research Portal Increasing intentions to use mental health services among university students. Results of a pilot randomized controlled trial within the World Health Organization's World Mental Health International College Student Initiative On behalf of the WHO World Mental Health – International College Student collaborators published in International Journal of Methods in Psychiatric Research 2019 DOI (link to publisher) 10.1002/mpr.1754 document version Publisher's PDF, also known as Version of record document license Article 25fa Dutch Copyright Act Link to publication in VU Research Portal citation for published version (APA) On behalf of the WHO World Mental Health – International College Student collaborators (2019). Increasing intentions to use mental health services among university students. Results of a pilot randomized controlled trial within the World Health Organization's World Mental Health International College Student Initiative. International Journal of Methods in Psychiatric Research, 28(2), 1-12. [e1754]. https://doi.org/10.1002/mpr.1754 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. E-mail address: [email protected] Download date: 25. Sep. 2021 Received: 2 August 2018 Revised: 28 September 2018 Accepted: 12 October 2018 DOI: 10.1002/mpr.1754 SPECIAL ISSUE Increasing intentions to use mental health services among university students. Results of a pilot randomized controlled trial within the World Health Organization's World Mental Health International College Student Initiative David Daniel Ebert1 | Marvin Franke1 | Fanny Kählke1 | Ann‐Marie Küchler2 | Ronny Bruffaerts3 | Philippe Mortier4 | Eirini Karyotaki5 | Jordi Alonso6 | Pim Cuijpers5 | Matthias Berking1 | Randy P. Auerbach7 | Ronald C. Kessler8 | Harald Baumeister2 | On behalf of the WHO World Mental Health – International College Student collaborators 1 Department of Clinical Psychology and Psychotherapy, University of Erlangen‐ Abstract Nuremberg, Erlangen, Germany Background: The majority of university students with mental health problems are 2 Department for Clinical Psychology and untreated. Only a small empirical literature exists on strategies to increase mental Psychotherapy, Ulm University, Ulm, Germany 3 Public Health Psychiatry, KU Leuven; health service use. Universitair Psychiatrisch Centrum KU Aims: To investigate the effects and moderators of a brief acceptance‐facilitating Leuven, Leuven, Belgium intervention on intention to use mental health services among university students. 4 Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Method: Within the German site of the World Health Organization's World Mental Belgium Health International College Student (WMH‐ICS) initiative, 1,374 university students 5 Department of Clinical Psychology, VU Amsterdam and Amsterdam Public Health were randomized to an intervention condition (IC; n = 664) or a control condition Institute, Amsterdam, The Netherlands (CC; n = 710) that was implemented in the survey itself. Both conditions received 6 Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), the questions assessing mental disorders and suicidality that were included in other Barcelona, Spain; Pompeu Fabra University WMH‐ICS surveys. The IC group then additionally received: Internet‐based personal- (UPF), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), ized feedback based on subject symptom severity in the domains of depression, anx- Madrid, Spain iety, substance use, suicidal thoughts and behaviors, and nonsuicidal self‐injury; 7 Department of Psychiatry, Columbia psychoeducation tailored to the personal symptom profile; and information about University, New York, USA; Division of Clinical Developmental Neuroscience, Sackler available university and community mental health services. The primary outcome Institute, New York, New York was reported intention to use psychological interventions in the next semester, which 8 Department of Health Care Policy, Harvard was the last question in the survey. A broad range of potential moderating factors was Medical School, Boston, Massachusetts Correspondence explored. David Daniel Ebert, Clinical Psychology and Results: There was a significant main effect of the intervention with students ran- Psychotherapy, Department of Psychology, Friedrich‐Alexander‐University Erlangen‐ domized to IC, reporting significantly higher intentions to seek help in the next semes- Nürnberg, Nägelsbachstr. 25a, 91052 ter than students in the CC condition (d = 0.12, 95% CI: 0.02 to 0.23). Moderator Erlangen, Germany. Email: [email protected] analyses indicated that the intervention was more effective among students that Funding information fulfilled the criteria for lifetime (d = 0.34; 95% CI: −0.08 to 0.7) and 12‐month National Institute of Mental Health (NIMH), panic‐disorder (d = 0.32; 95% CI: −0.10 to 0.74) compared with those without lifetime Grant/Award Numbers: R01MH070884 and R56MH109566; Belgian Fund for Scientific (d = 0.11; 95% CI: 0.00 to 0.22) or 12‐month panic disorder (d = 0.11; 95% CI: 0.00 to Research, Grant/Award Numbers: 1114717N, 0.22), students with lower (d = 0.37; 95% CI: −0.77 to 1.51) than higher (d = −0.01; 11N0516N and 11N0514N; King Baudouin Int J Methods Psychiatr Res. 2019;28:e1754. wileyonlinelibrary.com/journal/mpr © 2018 John Wiley & Sons, Ltd. 1of12 https://doi.org/10.1002/mpr.1754 2of12 EBERT ET AL. Foundation, Grant/Award Number: 2014‐ J2140150‐102905; Eli Lilly, Grant/Award 95% CI: −0.36 to 0.34) self‐reported physical health, and students with nonheterosex- ‐ ‐ ‐ Number: IIT H6U BX I002; BARMER; ual (d = 0.38; 95% CI: 0.08 to 0.67) compared with heterosexual (d = 0.06; 95% CI: Netherlands Organisation for Health Research and Development (ZonMw), Grant/Award −0.06 to 0.17) sexual orientation. The intervention had no effects among students Number: 636110005; Protestants Fonds voor who reported that they recognized that they had an emotional problem and “are de Geestelijke Volksgezondheid (PFGV); South African Medical Research Council; Ithemba already working actively to change it” (Stage 4 “stages of change”). ‐ Foundation; Instituto de Salud Carlos III ‐ FEDER, Grant/Award Numbers: 00506 and Conclusions: A simple acceptance facilitating intervention can increase intention to PI13; DIUE Generalitat de Catalunya; use mental health services, although effects, are on average, small. Future studies Northern Ireland Public Health Agency and Ulster University; Consejo Nacional de Ciencia should investigate more personalized approaches with interventions tailored to bar- y Tecnología (CONACyT), Grant/Award riers and clinical characteristics of students. In order to optimize intervention effects, Number: CB‐2016‐01‐285548; John D. and Catherine T. MacArthur Foundation; Pfizer the development and evaluation should be realized in designs that are powered to Foundation; United States Public Health Ser- allow incremental value of different intervention components and tailoring strategies vice, Grant/Award Numbers: R01‐DA016558, R01‐MH069864 and R13‐MH066849; to be evaluated, such as in multiphase optimization designs. Fogarty International Center (FIRCA), Grant/ Award Number: FIRCA R03‐TW006481; Pan KEYWORDS American Health Organization; Ortho‐McNeil Pharmaceutical; GlaxoSmithKline; Bristol‐ health behavior, psychoeducation, public mental health, risk factors Myers Squibb 1 | INTRODUCTION One of the most commonly used strategies in AFIs for mental dis- orders is giving information about relevant symptom clusters in the Mental disorders are highly prevalent among university students, form of personalized risk feedback (Donker, Griffiths, Cuijpers, & with 12‐month prevalence rates ranging from 20% to 45% (Auerbach Christensen, 2009; Lewis & Neighbors, 2006; Riper et al., 2009). This et al., 2016; Blanco et al., 2008; Bruffaerts et al., 2018). Anxiety, approach has shown promising effects in increasing intention to par- mood, and substance use disorders are the most widespread mental ticipate in preventive medical procedures (Albada, Ausems, Bensing, disorders among these students (Auerbach et al., 2016). Despite the & van Dulmen, 2009; Brouwers et al., 2011; Curry, Taplin, Anderman, wide availability and well‐known efficacy of interventions (Cuijpers Barlow, & McBride, 1993; Hovick, Wilkinson, Ashida, de Heer, & et al., 2013), the majority of university students with mental disor- Koehly, 2014; Sheridan et al., 2011) and in reducing the alcohol con- ders remain untreated (Auerbach et al., 2016; Blanco et al., 2008; sumption of problem drinkers (Riper et al., 2009). However, other Demyttenaere et al., 2004; Eisenberg, Golberstein, & Hunt, 2009; experimental evaluations of the effects of personalized risk feedback Larisch
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