Jena Shields is a busy sophomore biophysics major at UCLA. Last spring, when she needed a distraction from her grinding study schedule, she would log into an online treatment program that helps students cope with depression and anxiety. Tips on mindfulness, reminders to go outside and take a breath of fresh air, advice on getting rid of negative thought patterns. It was all there as part of the 6-week online program that UCLA students are using as part of a study to test the effectiveness of online coaching, paired with peer coaching from fellow students, to deal with mild to moderate depression and anxiety.
“I know a lot of people who grew up in really high-performance, high-stress areas. My high school was more stressful than college,” Shields said, noting that her high school had a high rate of attempted suicide. “I see a lot of people who just don’t understand they could be happier. They get all wrapped up at the cost of their mental health.”
Shields was among the first students to try the internet-based cognitive behavioral treatment (ICBT) program introduced last spring as part of the UCLA Depression Grand Challenge, an ambitious far-reaching $500 million effort that aims to find a cure for depression.
About 40 percent of college students suffer from depression or anxiety and universities are struggling to identify those students who need help and deal with the crush of demand for mental health services on campus. At many campuses, students with mild or moderate depression may wait months for an appointment with a campus therapist.
UCLA’s ICBT study is testing whether online training programs, paired with peer coaching, is an effective way of helping students, especially those who otherwise may not get any treatment at all. The university is identifying students with depression and anxiety with online screenings available to all students. This academic year, nearly 3,500 students took the online screening and 1,200 showed signs of depression or anxiety, said Eliza Congdon, project director of the UCLA Depression Grand Challenge Human Studies. The screening detected 275 students who were severely depressed, 690 who were moderately depressed and 579 who were mildly depressed. The online test is adaptive – offering different follow-up questions depending on the answers given.
Students who show up as suicide risks trigger a high-priority response, getting a phone call from mental health experts within hours and triggering an alert to the UCLA research and clinical teams, who work feverishly to reach the student and get them into treatment and, if necessary, the hospital. Once a suicidal student is identified, back-up alerts remind Congdon and her colleagues to ensure that the student has been reached and is safe.
“Most programs on university campuses don’t ask about suicidality,” Congdon said. “If you ask about it, you’re required to follow up and develop a protocol,” something that most universities aren’t prepared to handle, she said.
Since UCLA’s online surveys began in January 2017, researchers have intervened with more than 100 students at risk of suicide, Congdon said. In some cases, that meant clinicians contacting a student and taking them to the emergency room for urgent treatment. Without the survey, the students’ level of despair may not have been identified unless a roommate or professor reported concerns.
“These are people we would not have known about,” said Elizabeth Gong-Guy, executive director of campus and student resilience at UCLA and an associate clinical professor in the psychology department. Some of the severely depressed and suicidal students were managing to attend classes, but they were suffering and needed help. In addition to urgent treatment for suicidal students, UCLA has a crisis response team to help severely depressed students make it through the academic quarter, ensuring they don’t fail their classes or get kicked out of the dorms.
“It’s hard to characterize how much more quickly we can learn about a student’s symptom level from that single screening. It draws from thousands of questions and they end up answering about 15,” Gong-Guy said. After the survey, “we have a really good picture of the level of care that makes sense.”
Those students with less severe depression and anxiety are encouraged to join the internet training program, which provides immediate, free access to weekly lessons online supported with peer coaching. Currently, 712 students are taking part in the ICBT study and many have already completed the six-week online treatment program and are being followed to gauge the effects of the program. The Depression Grand Challenge ICBT study is the first of many that UCLA is undertaking to unravel the mysteries of depression. UCLA also is mounting the largest-ever study into the causes of depression, amassing data from 100,000 people to identify both genetic and environmental contributions to the disease. The Depression Grand Challenge study is unique in adopting a longitudinal design, following participants over at least 10 years to find out why some people suffer multiple episodes of depression.
The internet training, known as ICBT, helps reduce or even eliminate symptoms of depression and anxiety in students, especially when combined with the peer coaching, Congdon said. Some 200 UCLA graduate and undergraduate students have trained as Certified Resilience Peers, meeting in support groups and one-on-one sessions with students in the ICBT programs.
The peer counselors attend a rigorous training program over three academic quarters, which includes classroom instruction and practice leading group therapy sessions. Once they finish the course, they lead the sessions for fellow students, with a clinician supervising them. Eventually, students in the internet treatment study may be able to connect to their peer counselors via a secure video link.
Devika Chandramohan, a 20 year old Los Angeles psychobiology student and peer counselor in the study, headed to the group counseling sessions after her chemistry lab. She said her work leading fellow students in a discussion about methods for dealing with depression and anxiety was the most life-changing experience she had at UCLA and has helped shape her decision to become a psychiatrist.
“We’re not expected to have answers to everyone’s issues,” she said. In fact, “We’re told not to give advice in the sessions. It’s not for us to be providing solutions to the problems individuals face. It’s to provide support so they can find the resilience within themselves and they can find ways to improve their own situations.”
Chandramohan, who is graduating after three years at UCLA and plans to attend medical school, said having a fellow student to talk to about their symptoms and worries really helps students who are depressed or anxious.
“You’re dealing with people who are oftentimes at the most vulnerable part of their lives and they’re sharing a lot with you and trusting you. I like building that kind of trust with my fellow peers, being able to hear their stories and provide a listening ear,” she said. “I think with college – especially a big one like UCLA – it may seem like there are a lot of people around, but it’s often hard to find a community that you belong in. For individuals suffering from mental illness, that can be even harder.”
For the peer counselors, providing support in active listening, mindfulness and other stress-reducing techniques often improves their own lives, Gong-Guy said.
“Many of the peer counselors have a history of depression and anxiety and some have an extensive history of treatment. In some ways, that makes them experts and better able to serve their fellow peers,” Gong-Guy said, noting that some of the peer counselors who were experiencing depression or anxiety saw their symptoms resolve as they went through the peer counseling training.
UCLA’s internet program is still in the demonstration stages, but researchers hope the program will be ready to share with other universities within the next year.
“It’s an evidence-based scalable intervention that support students with tightly supervised treatment,” Gong-Guy said. “This is a program run on good will, on the hope that a solution (to depression) is around the corner and that we can be a part of it.”
As a busy UCLA student, Shields says the tips and mindfulness techniques she learned as part of the online study continue to help her deal with the stress of college life. The sticky notes she wrote during the program still adorn the wall in her dorm room, reminding her: “Treat yourself. You deserve it.” She even finds herself sharing some of the stress-reducing techniques with her mother.
“The program is good and it’s good if you don’t have other options or don’t want to talk to your parents about it. This is something you can do on your own and it’s free,” Shields said. Plus, she said, it’s easy to sign up, especially for students who may be nervous about talking about their symptoms. “It can be intimidating to call an office and say, ‘I need help,’” she noted. Shields spotted a flyer about the depression screening and study in a bathroom stall at school and within a week, she was enrolled and doing the online lessons.
“It helps you remind yourself that it’s not your fault (that you’re depressed) and gives you the tools to get better,” she said.
– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –
Robina Riccitiello is a journalist and storyteller who lives in the San Francisco Bay Area. She volunteers for and supports the UCLA Depression Grand Challenge.