E-mail can screen college students for depression

by Kristina Fiore

E-mail may be a simple and cheap way to screen college students for depression, but it’s not likely to motivate them to seek treatment, researchers said.

A commonly-used depression screening tool sent in e-mail blasts to students at four colleges put the prevalence of major depressive disorder at 14.5%, Irene Shyu, MD, of Massachusetts General Hospital in Boston, and colleagues reported at a poster session at the American Psychiatric Association meeting.

But few students who screened positive for depression with the Patient Health Questionnaire 9-Item (PHQ-9) actually used the online educational resources or on-campus peer health support groups provided in the e-mail.

“It did not increase their help-seeking,” Shyu said. “Perhaps we’ll have to tailor [those resources] more specifically toward each college.”

Because of its ease of administration and low costs, the researchers decided to investigate how useful e-mail would be in screening college students for depression. They also wanted to assess whether providing online educational resources could push students to seek help.

Shyu and colleagues reached out to campus organizations at four colleges, and were given access to the e-mail lists of graduate and undergraduate students at each school. They then sent out a demographic survey and the PHQ-9 screening tool to students on the listservs.

Students were given a chance to win a $200 gift card to encourage participation; a total of 631 took the survey.

As soon as students completed the questionnaires, they were given their real-time results. Scores equal to or greater than 10 on the PHQ-9 were indicative of major depressive disorder.

The researchers found that the overall prevalence of depression was 14.5% — significantly greater than the 10.3% reported in national population surveys, they said (P=0.002).

In the overall patient population, 21.7% reported a history of depression, and 9.4% were currently receiving treatment — 40% had therapy, 30% were on medication, and 30% had a combination of both treatment modalities.

About 13% endorsed suicidal symptoms, Shyu said.

The 82 students determined to have major depressive disorder based on the results of the PHQ-9 were sent links to online information on depression and local treatment resources at their school, including peer health support groups.

Almost half — 46.3% — of these students completed a follow-up questionnaire eight weeks later about whether they used the resources provided.

Shyu said that only seven of them used the online health information resource links, and just one attended on-campus counseling groups.

Don Hilty, MD, of the University of California Davis, cautioned that the PHQ-9 can overestimate the prevalence of depression, but still said that the finding about lack of student use of these resources is “concerning.”

“This generation is very apt at using technology, so it’s easy for them to respond to e-mail,” Hilty told MedPage Today. “But seeking treatment is complicated. Do they feel a stigma? Do they know where to go? And of course, payment is another issue.”

Aside from tailoring those resources to college demographics, Shyu told MedPage Today that another option would be to offer 24-hour online resources such as chat rooms that could potentially encourage increased use because of instant availability.

The caveat is that such interventions are more expensive than online links and peer support groups, Shyu added.

Still, using e-mail as an initial screen is inexpensive and simple, she said, and may be a means of identifying depression and increasing its treatment in college students.

Kristina Fiore is a MedPage Today staff writer.

Originally published in MedPage Today. Visit MedPageToday.com for more psychiatry news.