Rationale, Methods, Feasibility, and Preliminary Outcomes of a Transdiagnostic Prevention Program for At-Risk College Students

Abstract

Purpose: Early adulthood represents one period of increased risk for the emergence of a serious mental illness. The college campus provides a unique opportunity to assess and monitor individuals in this at-risk age group. However, there are no validated early detection programs that are widely implemented on college campuses. In an effort to address this gap, we designed and tested an early detection and prevention program tailored to college students. A transdiagnostic approach was employed because of evidence for shared risk factors across major mental illnesses.

Design: Single arm, prospective study evaluating outcomes following a 4-week intervention.

Method: Three in-person mental health screenings were conducted on the campus of one university. Undergraduate students with at least mildly elevated, self-reported levels of depressive or subclinical psychotic symptoms, who were not receiving treatment for these symptoms, were invited to participate in a 4-session workshop focused on increasing self- and other- awareness and emotion regulation using established mindfulness, self-compassion, and mentalization principles and experiential exercises. Symptoms, resilience-promoting capacities, and aspects of social functioning were assessed pre- and post- intervention.

Results: 416 students were screened and a total of 63 students participated in the workshop. 91% attended at least 3 of the 4 sessions. The majority of participants found the workshop interesting and useful and would recommend it to a friend. Significant pre-to-post reductions in symptoms (depression, anxiety, and subclinical psychotic symptoms, ps < 0.004) and improvements in resilience-promoting capacities (self-compassion and self-efficacy, ps < 0.006) and indices of social functioning (social motivation, activity, and a measure of comfort with the physical presence of others, ps < 0.04) were observed. Moreover, the significant increases in resilience-promoting capacities correlated with the reductions in affective symptoms (ps < 0.03).

Conclusions: These findings suggest that an on-campus mental health screening and early intervention program is feasible, acceptable, and may be associated with improvements in resilience-related capacities and symptom reductions in young adults with non-impairing, subclinical symptoms of psychopathology. Follow-up work will determine whether this program can improve both shorter and longer-term mental health and functional outcomes in this at-risk population.

Keywords: college students; depression; prevention; psychosis; resilience; self-compassion; transdiagnostic; transition-aged youth.

Figure 1

A flowchart of participant recruitment and enrollment.

Figure 2

These bar plots display the reductions in symptoms of depression, anxiety and psychotic experiences, as well as in the distress associated with psychotic experiences, that followed the 4-session intervention (A); these symptoms were measured using the Beck Depression Inventory, Speilberger State and Trait Anxiety Inventory (trait subscale), and the Peters et al. Delusions Inventory (Total score and Distress subscale), respectively. The intervention was also followed by significant increases in measures of resilience-related capacities, such as self-efficacy and self-compassion (measured using the Self Efficacy Scale and the Self-Compassion Scale, respectively) (B) and significant improvements in aspects of social functioning, including social motivation (measured using the Time Alone Questionnaire), social activity (measured with the embedded networks subscale of the Social Network Index), and personal space (measured using the Stop Distance Procedure) (C). * p < 0.05; ** p < 0.01; *** p < 0.001.

Figure 3

Correlations between the pre-to-post intervention improvements in self-compassion (A) and self-efficacy (B) and the pre-to-post intervention reductions in symptoms of depression, anxiety, and distress associated with psychotic experiences (PE) are displayed in these scatter plots. Increases in self-compassion and self-efficacy were correlated with reductions in symptoms (all p < 0.05). Depressive symptoms were measured using the Beck Depression Inventory, anxiety symptoms were measured using the Speilberger State and Trait Anxiety Inventory (trait subscale), and distress associated with psychotic experiences was measured using the distress subscale of the Peters et al. Delusions Inventory.