In what amounts to a research moonshot, the University of California at Los Angeles aims to “cut the burden of depression in half” by 2050 and to eliminate it by the end of the century.
But before the university starts treating the world, it’s begun treating its own students.
In a study conducted since last year as part of the Depression Grand Challenge — an interdisciplinary research project that adopts the popular “grand challenge” format to solve major social or scientific problems — UCLA researchers have used an online program to measure the anxiety and depression levels of nearly 4,000 students.
In about 12 to 15 minutes, students who volunteer to take the screening tests are categorized on the basis of mild to severe depression, anxiety, or suicidal thoughts. The university then uses those classifications to route students to appropriate mental-health treatments.
Roughly 45 percent of the students whom UCLA has screened since January 2017 have been identified with at least mild levels of depression or anxiety, says Michelle G. Craske, director of the university’s Anxiety and Depression Research Center and a member of the study’s executive committee. About 23 percent of those student have used the campus counseling service. Like many college mental-health services, Craske says, UCLA’s are “overwhelmed with demand.”
“The students are needing more than they can get from the services provided — and we have excellent services,” she says.
College counseling centers often come up in discussions of the scarcity of mental-health resources, says Victor I. Schwartz, chief medical officer at the Jed Foundation, which promotes mental health and suicide prevention among teenagers and young adults. More often than not, though, students receive better care than the rest of the population suffering from depression or anxiety, he says.
“On many campuses, you can actually get to see a clinician or therapist a fair bit quicker than you might if you were just anywhere else in the country,” Schwartz says. “So while there is attention to the challenges in providing enough care for college students, our mental-health system is stressed nationwide, and in many cases colleges are doing a great job in getting people the attention and clinical care they need.”
Overall, Craske says, treatment options for anxiety and depression are “just OK, but not fantastic.” Only 50 percent of people getting treatment respond favorably to it, according to reports cited by the UCLA project.
The percentage of UCLA students suffering from anxiety or depression is consistent with what other studies are finding. What surprised UCLA researchers was the number of suicide alerts. Within the first few thousand screenings of students, more than 100 were flagged as having severe depression with suicidal tendencies. (In many of those cases, she says, the students who had been flagged turned out not to be at immediate risk.) When a student is flagged as a suicide risk, researchers are alerted; within three hours, a study staffer reaches out to the student to discuss intervention.
“It just makes you realize how many students are walking around, going to classes, and feeling really that bad that they are having thoughts coming into their mind about the possibility of killing themselves,” Craske says.
Computerized Screening
Students take part in the online screening with a computerized testing tool that tailors its approach to their responses. With 1,000 to 1,500 questions for the program’s algorithm to pull from, Craske says, the screening is designed to produce measurements in a short time with a high level of specificity.
Researchers then use the feedback to place students in one of three tiers: those with no more than mild symptoms, those with mild to moderate symptoms, and those with severe indicators. Students within each tier are offered appropriate treatment for eight weeks.
Students in all tiers are assigned a generic, internet-based therapy program. They receive six lessons along with monitoring of their symptoms using adaptive-testing tools. They also download an app to their phones that they use to keep track of their activity levels, sleep, and social interactions.
Behaviors that are healthful in general, Schwartz says, are also helpful in managing anxiety and depression. The main goal of computer-based therapy, he says, is to teach new ways of thinking through challenges and difficulties.
“We know that people who have a good handle on their life skills, who have positive connections and friendships to other people, actually feel better overall,” he says.
Leaders of the challenge hope the work at UCLA will lead to an integrated technology platform of online testing, therapy, and app-based monitoring of symptoms that can effectively treat a large scale of people. “There are never ever going to be enough clinicians to treat everybody who is depressed or anxious,” Craske says.
Efforts to use technology for mental-health treatment are growing because of the shortage of resources available, Schwartz says. But online-only treatments, like online courses, have a fairly high burnout rate.
Computerized treatment is clearly better than not receiving care at all, Schwartz says, but he doesn’t “think we are at a point where we can say they are a replacement for human interaction.”
Student Support
The UCLA project aims to provide plenty of human interaction, too. Students who are classified in the mild-to-moderate depression level are also routed to the UCLA Resilience Peer Network, a collective of undergraduate and graduate students who have received training in mental-health support, or graduate students in clinical psychology. The support is used to reinforce the content of the cognitive behavioral therapy of the online program.
If a student presents as being severely depressed or suicidal, or having signs of manic behavior, he or she is triaged into UCLA’s research clinic for treatment by psychology and psychiatry fellows under the supervision of licensed professionals.
Any indication that a student’s depression may be worsening or showing suicidal inclinations alerts the team and sends an automated response to the participant. Someone on the study staff then engages with the student and determines whether a clinical response is necessary.
There are never ever going to be enough clinicians to treat everybody who is depressed or anxious.
“It becomes a very personalized treatment based on their needs and how they are responding in the moment,” Craske says. “And we are keeping track of that data not only to guide in-the-moment treatment decisions, but also to become a guide for selecting which individual is going to respond to a certain treatment.”
Last September more than 2,000 students enrolled in the screening in one week. The surge reflects the need on campus and the seriousness with which students are looking for ways to manage high levels of anxiety and depression, Craske says.
It is not clear why students are experiencing mental-health issues in such numbers. In coming years, researchers hope to answer why and find the best way to treat depression by continuously enrolling participants to attain a sample of 100,000 people.
That’s a noble goal, and it is possible to make a lot of headway, Schwartz says. But the challenge of eradicating depression and anxiety is based in part on social factors — the economy, or immigrants’ fears about their legal status — which cannot be controlled clinically.
“It’s great that they’re doing this work and that they’re trying to get this all sorted out,” Schwartz says. “But obviously there is still more that we don’t know than we do.”
Correction (3/9/2018, 12:00 p.m.): Because of inaccurate information supplied by a source, this article originally understated the proportion of students identified with anxiety or depression in a UCLA screening. it was 45 percent of students, not 25 percent, who were so identified.
