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Prevalence and correlates of depression and anxiety disorders in U.S. graduate students

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Title:
Prevalence and correlates of depression and anxiety disorders in U.S. graduate students
Creator:
Barton, Barbara A
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English
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xv, 219 leaves : ; 28 cm

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Subjects / Keywords:
College students -- Mental health ( lcsh )
Depression, Mental ( lcsh )
Anxiety ( lcsh )
Anxiety ( fast )
College students -- Mental health ( fast )
Depression, Mental ( fast )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

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Bibliography:
Includes bibliographical references (leaves 153-174).
General Note:
Abstract.
General Note:
Also available as microform.
Statement of Responsibility:
by Barbara A. Barton.

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776914246 ( OCLC )
ocn776914246

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PREVALENC E AN D CORRELATE S O F DEPRESSIO N AN D ANXIET Y DISORDER S I N U.S GRADUAT E STUDENT S A DISSERTATIO N SUBMITTE D I N PARTIA L FULFILLMEN T O F TH E REQUIREMENT S FO R TH E DEGRE E O F DOCTO R O F PHILOSOPH Y I N TH E GRADUAT E SCHOO L O F TH E TEXA S WOMAN' S UNIVERSIT Y DEPARTMEN T O F HEALT H STUDIE S COLLEG E O F HEALT H SCIENCE S B Y BARBAR A A BARTON B.S.N. M.P.H DENTON TEXA S AUGUS T 201 1

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UM I Number : 348087 8 Al l right s reserve d INFORMATIO N T O AL L USER S Th e qualit y o f thi s reproductio n i s dependen t upo n th e qualit y o f th e cop y submitted I n th e unlikel y even t tha t th e autho r di d no t sen d a complet e manuscrip t an d ther e ar e missin g pages thes e wil l b e noted Also i f materia l ha d t o b e removed a not e wil l indicate th e deletion UM I Dissertatio n Publishin g UM I 348087 8 Copyrigh t 201 1 b y ProQues t LLC Al l right s reserved Thi s editio n o f th e wor k i s protecte d agains t unauthorize d copyin g unde r Titl e 17 Unite d State s Code ues t ProQues t LL C 78 9 Eas t Eisenhowe r Parkwa y P.O Bo x 134 6 An n Arbor M l 48106-134 6

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TEXA S WOMAN' S UNIVERSIT Y DENTON TEXA S Jul y 15,201 1 T o th e Dea n o f th e Graduat e School : I a m submittin g herewit h a dissertatio n writte n b y Barbar a A Barto n entitle d "Prevalenc e an d Correlate s o f Depressio n an d Anxiet y Disorder s i n U.S Graduat e Students. I hav e examine d thi s dissertatio n fo r for m an d conten t an d recommen d tha t i t b e accepte d i n partia l fulfillmen t o f th e requirement s fo r th e degre e o f Docto r o f Philosoph y wit h a majo r i n Health Studies Kristi n Wiginton Ph.D. Ma£o r Professo r W e hav e rea d thi s dissertatio n an d recommen d it s acceptance : ;^Ur PAJ) Departmen t Chai r Accepted : Dea n o f th e Graduat e Schoo l

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DEDICATIO N Severa l year s ago i n spite o f th e dementi a cloudin g hi s mind m y fathe r encourage d m e t o kee p pushin g along n o matte r what tha t someda y I woul d mak e it I dedicat e thi s dissertatio n t o th e memor y o f Rober t G Barton m y lovin g father wh o alway s believe d i n m e an d kne w I coul d succeed eve n whe n I didn' t believ e i t myself Yo u ar e dearl y love d an d missed i n

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ACKNOWLEDGMENT S N o sou l attemptin g t o ear n a doctora l degre e reache s graduationwithou t som e help I a m greatl y indebte d t o severa l individual s wh o generousl y supporte d an d encourage d m y efforts I n particular m y dea r brother Thoma s T Barton ha s bee n a n unfailin g sourc e o f love suppor t an d humor Hi s unshakabl e belie f tha t I coul d succeed an d hi s abilit y t o alway s mak e m e laugh eve n whe n w e wer e disagreeing bolstere d m y spirit s throug h th e mos t difficul t o f day s her e i n Texas I als o coul d not hav e aske d fo r a bette r mento r an d rol e mode l tha n Dr Sandr a Bulmer wh o ha s bee n a sourc e o f unwaverin g encouragemen t sinc e I firs t sa t i n he r graduat e researc h method s cours e seve n year s ag o a t Souther n Connecticu t Stat e University Dr Bulme r i s a n extraordinar y teacher an d I a m gratefu l t o hav e bee n he r student I hop e tha t someda y I wil l b e abl e t o teac h wit h th e sam e grac e an d intellec t tha t sh e doe s ever y tim e sh e walk s throug h th e classroo m door I a m als o indebte d t o Dr Bulme r fo r facilitatin g m y acces s t o th e datase t use d fo r thi s dissertation an d fo r he r insightfu l participatio n i n m y researc h committee I a m als o indebte d t o th e exceptiona l professor s i n th e Departmen t o f Healt h Studie s a t Texa s Woman' s University Abov e all Dr Ga y Jame s ha s bee n a certai n sourc e o f suppor t an d guidance not onl y i n th e classroom bu t als o a s a membe r o f m y researc h committe e an d a s a mento r i n th e Departmen t wher e I worke d a s a graduat e teachin g assistant Dr Kristi n Wiginto n ha s als o graciously mentored m e alon g i n th e i v

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dissertatio n proces s servin g a s m y researc h chair an d I a m s o thankfu l fo r he r insigh t an d advice Dr Kimberl y Parke r ha s als o bee n outstanding providin g especiall y helpfu l advic e an d critiqu e a s I prepare d m y prospectu s an d defense I appreciat e an d than k al l o f the m fo r th e wonderfu l way s the y mentore d an d encourage d me I n addition I als o wan t t o than k an d acknowledg e Laure n Bifulc o fo r he r hel p accessin g th e datase t an d Chery l Taylo r fo r he r assistanc e wit h th e statistica l analyses Man y othe r people ofte n fro m unexpecte d places hav e als o helpe d m e alon g i n thi s doctora l journey s o man y i n fac t tha t I coul d neve r than k the m al l i n thes e fe w shor t paragraphs especiall y whe n thei r kindnes s an d compassio n touche d m e s o deeply I hav e realized however tha t th e bes t way t o hono r an d than k the m i s t o "pa y i t forward b y doin g m y bes t t o provid e m y futur e student s wit h th e sam e kin d o f support mentorin g an d encouragemen t tha t I wa s s o fortunat e t o hav e receive d durin g m y tim e here Becaus e o f thes e wonderfu l experience s an d th e peopl e a t TWU I kno w tha t n o matte r wher e m y academi c caree r ma y tak e me a piec e o f m y hear t wil l alway s remai n i n Texas v

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ABSTRAC T BARBAR A A BARTO N PREVALENC E AN D CORRELATE S O F DEPRESSIO N AN D ANXIET Y DISORDER S I N U.S GRADUAT E STUDENT S AUGUS T 201 1 Th e purpos e o f thi s stud y wa s t o examin e th e prevalence correlate s an d predictor s o f depressio n an d anxiet y disorder s (generalize d anxiet y disorde r an d pani c disorder ) amon g a nationa l sampl e o f U.S graduat e students I n recen t decades depressio n an d anxiet y disorder s hav e becom e increasingl y prevalen t o n colleg e campuses ; however fe w studie s hav e explore d th e factor s tha t lea d t o thes e illnesse s amon g graduat e students T o addres s thi s knowledg e ga p an d infor m campus menta l healt h programming thi s epidemiologica l stud y was conducte d usin g secondar y dat a collecte d fro m graduat e student s (N=4477 ) i n 201 0 a s par t o f th e nationa l Health y Mind s Study Demographi c an d socia l factor s an d lifestyl e an d health-relate d behavior s wer e use d t o predic t screenin g positiv e fo r depressio n and/o r anxiet y disorders a s measure d b y th e Patien t Healt h Questionnair e (PHQ) a validate d an d reliabl e screenin g instrument.Statistica l analyse s wer e conducted includin g cross tabulatio n an d multipl e regression Prevalenc e testin g result s showe d tha t 14 % screene d positiv e fo r depression whic h include d majo r depressio n an d othe r depressiv e disorder an d 9.5 % screene d v i

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positiv e fo r anxiet y disorders whic h include d generalize d anxiet y disorde r an d pani c disorder Abou t 19 % screene d positiv e fo r eithe r depressio n o r anxiet y disorders an d 4.4 % screene d positiv e fo r bot h menta l illnesses Thes e finding s indicat e thes e menta l illnesse s ma y b e a s prevalen t amon g graduat e student s a s the y ar e amon g undergraduates an d perhap s mor e prevalen t tha n amon g th e U.S genera l population I n logisti c regressio n modeling th e stronges t predictor s o f screenin g positiv e included : a ) havin g a sexua l orientatio n othe r tha n heterosexual ; b ) bein g single divorce d o r widowed ; c ) havin g financia l problem s whe n growin g up ; an d d ) experiencin g discrimination Th e stronges t protecto r wa s exercisin g thre e o r mor e time s pe r week Th e result s o f thi s stud y hav e importan t implication s fo r universit y healt h promotio n programs whic h hav e largel y ignore d graduat e students Universitie s ar e i n a uniqu e positio n t o identif y an d interven e befor e menta l healt h problem s occu r o r becom e serious bu t ar e largel y missin g thi s opportunit y whe n i t come s t o graduat e students v n

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TABL E O F CONTENT S Pag e DEDICATIO N ii i ACKNOWLEDGMENT S i v ABSTRAC T v i LIS T O F TABLE S x Chapte r I INTRODUCTIO N 1 Rational e 1 Statemen t o f th e Purpos e 4 Theoretica l Foundatio n 4 Researc h Question s 6 Hypothese s 6 Delimitation s 6 Limitation s 7 Assumption s 7 Definitio n o f Term s 7 Importanc e o f th e Stud y 8 II REVIEW O F LITERATUR E 1 0 Changin g Characteristic s o f Graduat e Student s 1 0 Impac t o f Graduat e Schoo l o n Menta l Healt h 1 2 Depressio n an d Anxiet y Disorder s 1 6 Prevalenc e o f Depressio n an d Anxiet y Disorder s Amon g Graduat e Student s 2 3 Correlate s o f Depressio n an d Anxiet y Disorder s Amon g Graduat e Student s 2 8 Socio-demographi c Factor s 2 9 Lifestyl e an d Healt h Behavior s 3 3 Progra m Characteristic s an d Relationship s wit h Advisor s 3 4 Summar y an d Conclusio n 3 5 vi n

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III METHODOLOG Y 3 6 Populatio n an d Sampl e 3 6 Protectio n o f Huma n Participant s 3 7 Dat a Collectio n Procedure s 3 8 Instrumentatio n 3 8 Dat a Analysi s 4 0 Summar y 4 1 IV RESULT S 4 3 Sampl e Descriptio n 4 3 Primar y Analyse s 4 3 Prevalenc e Testin g fo r Researc h Questio n 1 4 3 Prevalenc e Testin g fo r Researc h Questio n 2 5 1 Hypothesi s Testin g fo r Hypothesi s 1 5 2 Hypothesi s Testin g fo r Hypothesi s 2 7 8 Summar y o f Result s 11 9 V CONCLUSIO N AN D RECOMMENDATION S 12 3 Summar y 12 3 Conclusio n 12 4 Discussio n 13 2 Prevalenc e o f Depressio n an d Anxiet y Disorder s 13 2 Association s fo r Depressio n an d Anxiet y Disorder s 13 3 Predictio n Model s 14 4 Implication s fo r Healt h Educatio n 14 9 Limitation s 15 0 Recommendation s 15 1 REFERENCE S 15 3 APPENDICE S A Healthy Mind s Questionnair e 17 5 B Institutiona l Revie w Boar d Approva l Lette r 21 8 i x

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LIS T O F TABLE S Tabl e Pag e 1 Frequencie s an d Percentage s o f Graduat e Studen t Statu s 4 4 2 Prevalenc e o f Demographi c Factor s ( n = 4,477 ) 4 6 3 Prevalenc e o f Socia l Factor s ( n = 4,477 ) 4 8 4 Prevalenc e o f Lifestyl e an d Health-Relate d Behaviors ( n = 4,477) 5 0 5 Prevalenc e o f Positiv e Screening s fo r Depression Anxiet y Disorders Eithe r Depressio n o r Anxiet y Disorders an d Bot h Depressio n an d Anxiet y Disorder s ( n = 4,477 ) 5 2 6 Prevalenc e an d Ch i Squar e Analyse s o f Demographi c Factor s b y Positiv e Scree n fo r Depressio n ( n = 4,477) 5 4 7 Prevalenc e an d Ch i Squar e Analyse s o f Socia l Factor s an d Positiv e Scree n fo r Depressio n ( n = 4,477) 5 6 8 Prevalenc e an d Ch i Squar e Analyse s o f Lifestyl e an d Health-Relatio n Behavior s b y Positiv e Scree n fo r Depressio n ( n = 4,477 ) 5 8 9 Prevalenc e an d Ch i Squar e Analyse s o f Demographi c Factor s b y Positiv e Scree n fo r Anxiet y Disorder s ( n = 4,477 ) 6 0 10 Prevalenc e an d Ch i Squar e Analyse s o f Socia l Factor s b y Positiv e Scree n fo r Anxiet y Disorder s ( n = 4,477 ) 6 2 x

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11 Prevalenc e an d Ch i Squar e Analyse s o f Lifestyl e an d Health-Relate d Behaviors b y Positiv e Scree n fo r Anxiet y Disorder s ( n = 4,477) 6 3 12 Prevalenc e an d Ch i Squar e Analyse s o f Demographi c Factor s b y Positiv e Scree n fo r Depressio n o r Anxiet y Disorder s ( n = 4,477 ) 6 7 13 Prevalenc e an d Ch i Squar e Analyse s o f Socia l Factor s b y Positiv e Scree n fo r Depressio n o r Anxiet y Disorder s ( n = 4,477) 6 8 14 Prevalenc e an d Ch i Squar e Analyse s o f Lifestyl e an d Health-Relate d Behavior s b y Positiv e Scree n fo r Eithe r Depressio n o r Anxiet y Disorders( n = 4,477) 7 1 15 Prevalenc e an d Ch i Squar e Analyse s o f Demographi c Factor s b y Positiv e Scree n fo r Bot h Depressio n an d Anxiet y Disorder s ( n = 4,477 ) 7 3 16 Prevalenc e an d Ch i Squar e Analyse s o f Socia l Factor s b y Positiv e Scree n fo r Bot h Depressio n an d Anxiet y Disorder s ( n = 4,477 ) 7 4 17 Prevalenc e an d Ch i Squar e Analyse s o f Lifestyl e an d Health-Relate d Behaviors b y Positiv e Scree n fo r Depressio n an d Anxiet y Disorder s ( n = 4,477) 7 7 18 Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n fro m Demographi c Factor s 7 9 19 Cross-Validatio n o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n fro m Demographi c Factor s 8 0 20 Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n fro m Socia l Factor s 8 2 21 Cross-Validation s o f Summar y o f Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n fro m Socia l Factor s 8 2 x i

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22 Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n fro m Lifestyl e an d Health-Relate d Behaviors 8 6 23 Cross-Validatio n o f Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n fro m Lifestyl e an d Health-Relate d Behaviors 8 6 24 Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n fro m Demographi c Factors Socia l Factors an d Lifestyl e an d Health-Relate d Behavior s 8 7 25 Cross-Validatio n o f Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n fro m Demographi c Factors Socia l Factors an d Lifestyl e an d Health-Relate d Behaviors 8 8 26 Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Anxiet y Disorder s fro m Demographi c Factor s 9 0 27 Cross-Validatio n o f Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Anxiet y Disorder s fro m Demographi c Factor s 9 0 28 Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Anxiet y Disorder s fro m Socia l Factor s 9 2 29 Cross-Validatio n o f Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Anxiet y Disorder s fro m Socia l Factor s 9 2 30 Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Anxiet y Disorder s fro m Lifestyl e an d Health-Relate d Behavior s 9 4

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31 Cross-Validatio n o f Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Anxiet y Disorder s fro m Lifestyl e an d Health-Relate d Behavior s 9 4 32 Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Anxiet y Disorder s fro m Demographi c Factors Socia l Factors an d Lifestyl e an d Health-Relate d Behavior s 9 7 33 Cross-Validatio n o f Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Anxiet y Disorder s fro m Demographi c Factors Socia l Factors an d Lifestyl e an d Health-Relate d Behavior s 9 8 34 Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n o r Anxiet y Disorder s fro m Demographi c Factor s 10 0 35 Cross-Validatio n o f Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n o r Anxiet y Disorder s fro m Demographi c Factors.. 10 0 36 Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n o r Anxiet y Disorder s fro m Socia l Factor s 10 2 37 Cross-Validatio n o f Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n o r Anxiet y Disorder s fro m Socia l Factor s 10 3 38 Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n o r Anxiet y Disorder s fro m Lifestyl e an d Health-Relate d Behaviors 10 5 39 Cross-Validatio n o f Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n o r Anxiet y Disorder s fro m Lifestyl e an d Health-Relate d Behavior s 10 5 xii i

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40 Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n o r Anxiet y Disorder s fro m Demographi c an d Socia l Factors Lifestyl e an d Health-Relate d Behaviors 10 7 41 Cross-Validatio n o f Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n o r Anxiet y Disorder s fro m Demographi c Factors Socia l Factors an d Lifestyl e an d Health-Relate d Behaviors 10 9 42 Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n an d Anxiet y Disorder s fro m Demographi c Factor s 11 0 43 Cross-Validatio n o f Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n an d Anxiet y Disorder s fro m Demographi c Factor s Il l 44 Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n an d Anxiet y Disorder s fro m Socia l Factor s 11 2 45 Cross-Validatio n o f Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n an d Anxiet y Disorder s fro m Socia l Factor s 11 3 46 Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n an d Anxiet y Disorder s fro m Lifestyl e an d Health-Relate d Behaviors.. 11 4 47 Cross-Validatio n o f Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n an d Anxiet y Disorder s fro m Lifestyl e an d Health Relate d Behaviors 11 5 xi v

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48 Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n an d Anxiet y Disorder s fro m Demographi c Factors Socia l Factors an d Lifestyl e an d Health-Relate d Behavior s 11 7 49 Cross-Validatio n o f Summar y o f Multipl e Logisti c Regression s Predictin g Positiv e Scree n fo r Depressio n an d Anxiet y Disorder s fro m Demographi c Factors Socia l Factors an d Lifestyl e an d Health-Relate d Behaviors 11 8 50 Conclusio n o f Result s fo r Hypothesi s 1 12 7 51 Conclusio n o f Result s fo r Hypothesi s 2 12 9 x v

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CHAPTE R I INTRODUCTIO N Rational e Depressio n an d anxiet y ar e amon g th e mos t commo n psychiatri c disorder s i n adults Bot h ar e associate d wit h diminishe d qualit y o f life poo r socia l functionin g an d exces s disabilit y (Center s fo r Diseas e Contro l & Preventio n [CDC] 2009) Depressio n alon e affect s ove r 12 1 millio n individual s worldwid e an d i s th e thir d leadin g contributo r t o th e tota l burde n o f diseas e (Worl d Health Organizatio n [WHO] 2008) Amon g middle an d high-incom e countries i t i s th e leadin g caus e o f disability accountin g fo r abou t 12 % o f tota l year s live d wit h disabilit y (WHO 2008) Thi s depressio n disabilit y burde n i s 50 % highe r fo r female s compare d t o male s (WHO 2007) Anxiet y disorder s compris e a wid e rang e o f conditions includin g generalize d anxiet y disorder pani c disorder an d phobia s (WHO 2004) Base d o n dat a collecte d i n 2004 pani c disorde r wa s th e twelft h leadin g caus e o f diseas e burde n fo r wome n age d 15-4 4 year s i n low an d middle-incom e countrie s (WHO 2008) I n th e U.S. depressio n i s estimate d t o affec t abou t 6.7 % o f th e populatio n i n a give n year whic h account s fo r approximatel y 14. 8 millio n America n adult s (Nationa l Institut e o f Menta l Healt h [NIMH] 2011) Simila r t o th e internationa l data depressio n i s th e leadin g caus e o f disabilit y amon g American s age d 15-4 4 year s an d i s mor e prevalen t i n wome n tha n me n (NIMH 2011) Statistic s fo r anxiet y disorder s ar e equall y 1

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concerning bu t no t surprisin g give n tha t anxiet y disorder s ofte n preced e o r occu r i n tande m wit h depression Base d o n dat a fro m th e Behaviora l Risk Surveillanc e Syste m (BRFSS) abou t 19. 1 millio n American s age d 1 8 t o 5 4 year s suffe r fro m a n anxiet y disorde r i n a give n yea r (CDC 2009) Thi s account s fo r abou t 13 % o f individual s i n thi s ag e group I n addition amon g peopl e i n thi s sam e ag e group abou t 2. 4 millio n o r 1.7 % experienc e pani c disorder an d 6. 3 millio n hav e on e o r mor e phobia s (CDC 2009) Clearly depressio n an d anxiet y disorder s ar e significan t problem s i n th e U.S population an d colleg e student s ar e n o exception Whe n compare d t o thei r non-colleg e attendin g counterparts Blanc o e t al (2008 ) reporte d tha t colleg e student s ha d th e sam e overal l prevalenc e o f depression anxiet y an d moo d disorders an d a highe r prevalenc e o f alcoho l us e disorders I n 2007 a nationa l surve y o f ove r 20,00 0 colleg e student s fro m 3 9 institution s foun d tha t ove r 43 % reporte d feelin g s o depresse d tha t i t wa s difficul t t o functio n a t leas t onc e i n th e pas t 1 2 months an d 10.3 % admitte d seriousl y considerin g suicid e withi n th e sam e tim e perio d (America n Colleg e Healt h Associatio n [ACHA] 2008) Moreover approximatel y 2 % reporte d tha t the y ha d actuall y attempte d suicide I n thi s sam e survey abou t 16 % o f student s reporte d bein g diagnose d wit h depression an d o f thos e students 24 % wer e i n therap y fo r depressio n an d 36 % wer e takin g antidepressan t medicatio n (ACHA 2008) Gallaghe r (2008 ) reporte d tha t th e proportio n o f student s takin g psychiatri c medicatio n increase d fro m 9 % i n 199 4 t o 26 % i n 2008 Althoug h alarming thes e finding s ar e no t unexpecte d amon g menta l healt h practitioner s an d administrator s a t U.S universities I n 2010 91 % o f participant s i n th e Nationa l 2

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Surve y o f Counselin g Cente r Director s state d tha t th e numbe r o f student s wit h seriou s psychologica l problem s ha d increase d i n recen t year s (Gallagher 2010) Graduat e student s ar e als o no t immun e t o depressio n an d anxiet y disorders I n a surve y stud y conducte d a t a larg e wester n university Hyun Quinn Mado n an d Lusti g (2006 ) reporte d tha t almos t hal f o f graduat e student s experience d a n emotiona l o r stress relate d proble m tha t significantl y impacte d thei r well-bein g and/o r academi c performanc e durin g th e pas t year Untreate d menta l healt h problem s hav e bee n significantl y associate d wit h graduat e studen t drop-ou t an d poo r emotiona l well-bein g (Turne r & Berry 2000) Mor e tha n eve r before graduat e student s fac e a n arra y o f academic financia l an d persona l stressor s a s the y manag e th e rigor s o f graduat e education Demographi c an d socia l change s durin g th e pas t tw o decade s hav e contribute d t o th e increas e o f thes e stressors a situatio n tha t i s not expecte d t o abat e i n ligh t o f curren t economi c projection s an d steadil y increasin g graduat e studen t enrollmen t (Gallagher 2010) Betwee n 198 3 an d 2008 enrollmen t i n U.S graduat e program s increase d fro m 1. 6 t o 2. 7 millio n students an d thi s numbe r i s projecte d t o jum p t o 3. 4 millio n student s b y th e yea r 201 9 (Au d e t al. 2010) I n spite o f this th e proble m o f depressio n an d anxiet y disorder s amon g graduat e student s i s largel y unexplored Thi s i s particularl y concernin g give n th e prevalenc e o f thes e condition s amon g thi s ag e group an d th e substantia l consequence s o n academi c success substanc e abus e an d futur e socioeconomi c statu s i f lef t untreated 3

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Statemen t o f th e Purpos e Th e overal l purpos e o f thi s epidemiologica l stud y wa s t o examin e th e prevalenc e an d correlate s o f depressio n an d anxiet y disorder s (generalize d anxiet y disorde r an d pani c disorder ) amon g a nationa l sampl e o f U.S graduat e students Thi s stud y investigate d i f significan t association s existe d betwee n screenin g positiv e fo r depression anxiet y disorders o r both an d demographi c variable s (gender age race/ethnicity nationality schoo l location an d sexua l orientation) socia l factor s (livin g situation curren t financia l situation financia l situatio n growin g up an d relationshi p status) an d lifestyl e an d healt h behavior s (smokin g tobacco marijuan a an d othe r illici t dru g use exercise bing e drinking gambling an d experiencin g discriminatio n du e race ethnicit y o r culture) Thi s stud y als o examine d i f demographi c variables socia l factor s and/o r lifestyl e an d healt h behavio r variable s wer e predictiv e o f screenin g positiv e fo r depression anxiet y disorders eithe r menta l illness o r bot h illnesse s amon g U.S graduat e students Theoretica l Foundatio n Increasingly college s an d universitie s ar e endorsin g th e realizatio n tha t campus wide community-leve l preventio n strategie s ar e neede d t o addres s menta l healt h issue s amon g students Thi s realizatio n ha s bee n based upo n a growin g bod y o f evidenc e suggestin g tha t institution s o f highe r learnin g hav e bee n largel y unsuccessfu l i n addressin g thes e problems particularl y regardin g depressio n (Swaner 2007) On e reaso n identifie d fo r thi s failur e i s tha t universit y effort s ten d t o lac k multi-dimensionality i n spit e o f th e recognitio n tha t th e ris k factor s o f depressio n an d anxiet y disorder s involv e 4

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individual socia l an d environmenta l factor s (Swaner 2007 ; Gonzalez 2002) Therefore a theoretica l framewor k tha t allow s fo r th e examinatio n o f th e relationship s betwee n depressio n an d anxiet y disorder s an d factor s a t multipl e level s o f influenc e wa s neede d fo r thi s researc h initiative Fo r thi s reason th e ecologica l mode l wa s chose n t o guid e thi s study Th e ecologica l mode l identifie s thre e mai n level s tha t influenc e healt h an d huma n behavior : a ) th e intrapersona l level whic h include s persona l characteristic s suc h a s attitudes belief s an d knowledge ; b ) th e interpersona l level whic h include s socia l suppor t an d th e qualit y an d natur e o f huma n interactions ; an d c ) th e communit y level whic h encompasse s institutiona l factors communit y factor s an d publi c polic y (Salli s & Owen 2002 ; McKenzie Neige r & Thackeray 2009) A t th e communit y level institutional factor s includ e rule s an d informa l structure s withi n organization s o r institutions suc h a s universities tha t ma y facilitat e o r constrai n healt h behavior ; whil e communit y factor s refe r t o socia l norm s an d network s tha t exis t amon g individuals group s an d organizations Publi c polic y include s local stat e an d federa l law s an d regulation s tha t promot e diseas e contro l an d preventio n (McKenzi e e t al. 2009) Becaus e o f thi s multi leve l approach consideratio n o f menta l healt h problem s usin g a n ecologica l approac h provide s th e multi-dimensionalit y neede d t o explor e th e individual sociocultua l an d environmenta l factor s influencin g depressio n an d anxiet y disorder s amon g graduat e student s (Bronfenbrenner 1994 ; Salli s & Owen 2002) 5

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Researc h Question s Thi s stud y addresse d th e followin g researc h questions : 1 Wha t i s th e prevalenc e o f demographi c factors socia l factors an d lifestyl e an d health-relate d behavior s amon g U.S graduat e students ? 2 Amon g U.S graduat e students wha t i s th e prevalenc e o f screenin g positiv e fo r depression anxiet y disorders eithe r depressio n o r anxiet y disorders o r both ? Hypothese s Th e followin g nul l hypothese s wer e teste d a t the/ ? < .0 1 leve l o f significance : 1 Ther e ar e n o statisticall y significan t relationship s betwee n demographi c factors socia l factors and/o r lifestyl e an d health-relate d behavior s an d a positiv e screenin g fo r depression anxiet y disorders eithe r depressio n o r anxiet y disorders o r both 2 Demographi c variables socia l factors o r lifestyl e an d healt h behavio r variable s ar e neithe r predictiv e no r protectiv e o f a positiv e screenin g fo r depression anxiet y disorders eithe r depressio n o r anxiet y disorders o r both Delimitation s Thi s stud y ha d th e followin g delimitations : 1 Thi s stud y use d secondar y dat a collecte d fro m 2 5 college s an d universitie s tha t participate d i n th e Health y Mind s Stud y (HMS ) dat a collectio n durin g 2010 2 Onl y dat a collecte d fro m th e 201 0 HM S participant s wh o self-identifie d a s graduat e student s wer e included 3 Graduat e student s self-identifyin g a s medica l student s wer e excluded 4 Th e participant s wer e 1 8 year s o f ag e o r older 6

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Limitation s Th e stud y ha d th e followin g limitations : 1 Thi s stud y onl y include d self-reporte d dat a collecte d fro m graduat e student s abou t menta l healt h measure s an d lifestyl e an d healt h behaviors Thi s self-reporte d dat a canno t b e corroborated and therefore introduce s a potentia l fo r inaccuracy 2 Th e Patien t Healt h Questionnair e (PHQ ) instrumen t tha t wa s use d t o scree n fo r anxiet y an d depressio n wa s not diagnostic ; however th e instrument' s validatio n studie s supporte d it s us e i n makin g reasonabl y accurat e prevalenc e estimate s (Klein Ciotoli & Chung 2011 ; Kroenke Spitze r & Williams 2001 ; Martin Rief Klaiber g & Braehler 2006 ; Spritzer Kroenke William s & th e Patient Health Questionnair e Primar y Car e Stud y Group 1999) 3 Missin g dat a canno t b e collected an d coul d potentiall y hav e affecte d th e statistica l analyses Assumption s I n thi s study th e followin g assumption s wer e made : 1 Participatin g graduat e student s wer e hones t i n answerin g th e surve y questions 2 Th e dat a wer e collecte d usin g th e rando m samplin g strategy define d i n th e HM S desig n (HMS 2010) Definitio n o f Term s Anxiety disorders: Pani c disorde r an d generalize d anxiet y disorde r (GAD ) a s define d i n th e Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) 7

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wer e include d i n thi s grou p (America n Psychiatri c Associatio n [APA] 2011 ; HMS 2010) Depression: Majo r depressiv e disorde r (MDD ) an d othe r depressiv e disorde r a s define d i n th e DSM-I V wer e include d i n thi s grou p (APA 2010 ; HMS 2010) Graduate student: A studen t engage d i n post-baccalaureat e stud y a t a colleg e o r universit y participatin g i n th e 201 0 HM S dat a collection Medica l students however wer e exclude d fro m thi s group PHQ: Th e Patien t Healt h Questionnair e (PHQ ) i s a three-page self-administere d questionnair e tha t "assesse s eigh t diagnoses divide d int o threshol d disorder s (disorder s tha t correspon d t o specifi c DMS-I V diagnoses : majo r depressiv e disorder pani c disorder othe r anxiet y disorde r an d bulimi a nervosa) an d subthreshol d disorder s (disorder s whos e criteri a encompas s fewe r symptom s tha n ar e require d fo r an y specifi c DSM-I V diagnoses : othe r depressiv e disorder probabl e alcoho l abuse/dependence somatoform an d bing e eatin g disorder) (Kroenk e e t al. 2001 p 606) PHQ-9: Th e PHQ9 i s th e "nine-ite m depressio n modul e fro m th e ful l PHQ (Kroenk e e t al. 2001 p 607) PHQ-Anxiety Scale: Th e PHQ-Anxiet y scal e consist s o f a serie s o f branchin g question s fro m th e ful l PH Q an d screen s fo r pani c disorde r an d generalize d anxiet y disorde r (GAD ) (Spitze r e t al. 1999) Importanc e o f th e Stud y Althoug h atypical th e homicide s a t Virgini a Tec h an d Norther n Illinoi s Universit y hav e draw n attentio n t o th e growin g publi c healt h proble m o f menta l illnes s 8

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amon g colleg e an d universit y students Indeed menta l illnesses includin g depressio n an d anxiet y disorders ar e a s prevalen t amon g colleg e student s a s thei r same-age d counterpart s i n U.S society Th e availabl e literatur e indicate s tha t depressio n an d anxiet y disorder s ar e als o significan t problem s amon g graduat e students ; however researc h i n thi s are a i s quit e limited T o hel p fil l thi s ga p i n knowledge thi s epidemiologica l stud y contribute d valuabl e informatio n usin g a nationa l sample Ultimately thi s researc h wil l provid e universit y administrator s wit h guidanc e regardin g menta l healt h progra m developmen t targetin g graduat e student s who m t o dat e hav e bee n a n under-serve d populatio n o n U.S campuses 9

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CHAPTE R I I REVIE W O F LITERATUR E Becaus e o f change s i n th e characteristic s o f graduat e student s durin g recen t decades thes e student s hav e bee n identifie d a s a grou p a t ris k fo r menta l illnesses Depressio n an d anxiet y disorder s ar e amon g th e mos t commo n an d treatabl e o f thes e disorders but i f untreated pu t graduat e student s a t increase d ris k o f academi c failure substanc e abuse an d suicide Som e researc h ha s indicate d tha t sociodemographi c factors lifestyl e an d healt h behaviors an d factor s pertainin g t o academi c progra m characteristic s an d relationship s wit h advisor s ar e associate d wit h increase d risk s o f depressio n and/o r anxiet y disorder s amon g students Th e followin g chapte r provide s a revie w o f th e relevan t literatur e pertainin g t o depressio n an d anxiet y disorder s amon g graduat e students Changin g Characteristic s o f Graduat e Student s Th e benefit s o f graduat e educatio n ar e substantia l an d wel l documented Individual s typicall y experienc e intellectua l an d socia l benefits, i n additio n t o significan t economi c return s (Brus 2006 ; Counci l o f Graduat e School s [CGS] 2008a ; Nationa l Cente r fo r Educatio n Statistic s [NCES] 2007) Moreover th e CG S (2008a ) asserte d tha t graduat e educatio n als o benefit s societ y a s i t "play s a centra l rol e i n producin g a n educate d citizenr y tha t ca n promot e an d defen d ou r [nation's ] democrati c ideals (p 1) Durin g th e las t thre e decades enrollmen t i n graduat e program s ha s steadil y increased 1 0

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fro m abou t 1. 6 millio n student s i n 198 3 t o 2. 7 millio n b y 200 8 (Au d e t al. 2010) Give n th e benefit s o f graduat e education thi s 41 % increas e i n enrollmen t i s no t particularl y surprising ; however alon g wit h thi s trend a considerabl e shif t i n th e demographi c characteristic s o f graduat e student s ha s als o occurred Traditionally graduat e student s wer e primaril y Caucasia n males singl e o r marrie d withou t children an d range d i n ag e fro m 2 2 t o 3 0 year s ol d (Brus 2006) The y cam e fro m familie s o f highe r socioeconomi c statu s an d ha d parent s wh o serve d a s thei r mai n sourc e o f financia l an d emotiona l support Th e primar y obligatio n o f thes e traditiona l graduat e student s wa s t o exce l i n thei r studies whic h mean t the y engage d i n fewe r hour s o f pai d wor k an d ha d mor e flexibilit y regardin g thei r tim e an d availabilit y fo r mentorin g an d networking Thes e characteristic s hav e shifte d remarkabl y sinc e 1980 Today graduat e student s ar e older man y com e fro m familie s o f lowe r socioeconomi c status an d wor k mor e hour s outsid e o f schoo l (Brus 2006) Th e averag e ag e o f a master' s studen t i s 32. 4 years whil e th e averag e o f a doctora l studen t i s 32. 9 year s (Cho y & Cataldi 2006) Th e majorit y (58% ) o f graduat e student s i s femal e an d mor e minoritie s ar e represente d (Bell 2010) Fo r example fro m 199 6 t o 2009 graduat e enrollmen t amon g Africa n American s increase d 39% whil e i t increase d onl y abou t 14 % amon g White s (Bell 2010 ; Redd 2008) Also i n 2009 Africa n America n graduat e enrollee s wer e abou t 70 % women compare d wit h onl y 40 % amon g White s (Bell 2010) Curren t graduat e student s ar e mor e ofte n marrie d o r singl e parent s wit h dependen t childre n an d als o hav e financia l and/o r care-givin g responsibilitie s fo r thei r parents 1 1

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Unlik e thei r traditiona l counterparts th e primar y obligatio n o f today' s graduat e student s i s th e welfar e o f thei r families an d a s a result the y hav e les s tim e an d flexibilit y regardin g thei r studie s (Brus 2006) Thi s shif t i n characteristic s mean s tha t th e graduat e studen t populatio n toda y i s older mor e raciall y an d ethnicall y diverse an d shoulderin g considerabl y mor e persona l responsibilitie s compare d t o th e graduat e populatio n twent y year s ago Considerin g th e relativ e inflexibilit y o f th e academi c environment th e burde n o f constantl y weighin g an d prioritizin g competin g demand s ha s importan t implication s fo r menta l healt h amon g today' s graduat e students Thi s i s particularl y concernin g i n ligh t o f th e implication s tha t thes e competin g demands hav e o n academi c achievement career an d famil y relationship s (Brus 2006) Impac t o f Graduat e Schoo l o n Menta l Health Graduat e school b y design present s student s wit h a hos t o f uniqu e challenge s an d stressors Advance d academics o f course ar e mor e demandin g tha n undergraduat e courses an d student s ar e expecte d t o exce l i n a n academi c environmen t tha t i s les s formall y structure d an d supporte d (Howard Schiraldi Pined a & Campanella 2006) Thi s place s greate r responsibilit y o n graduat e student s t o engag e i n independen t learning A s a result graduat e student s ten d t o wor k i n isolation generall y disconnecte d fro m campu s service s an d suppor t staff Thi s wa s apparen t i n a 200 4 surve y conducte d a t th e Universit y o f Californi a Berkele y (UCB ) wher e ove r 25 % o f graduat e student s wer e completel y unawar e o f campu s menta l healt h service s (Berkele y Graduat e Studen t 1 2

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Menta l Healt h Tas k Force 2004) Loude n an d Skee m (2008 ) reporte d simila r finding s a t th e Universit y o f Californi a Irvin e (UCI ) wher e 32 % o f graduat e student s wer e unawar e o f services I n bot h o f thes e surveys th e genera l perceptio n o f graduat e student s wa s tha t campu s service s wer e fo r undergraduates no t themselves whic h provide s a star k testimon y o f th e relativ e isolatio n an d exclusio n fro m mainstream campu s lif e tha t graduat e student s typicall y experience I n additio n t o copin g wit h th e academi c rigo r an d isolatio n o f graduat e school mos t graduat e student s ar e als o face d wit h substantia l economi c difficultie s a s the y struggl e t o balanc e tuition housing livin g expenses and a t times childcare No t surprisingly ove r 56 % o f graduat e student s borro w mone y t o financ e thei r education wit h cumulativ e deb t a t graduatio n averagin g $31,03 1 fo r master' s degrees $57,86 0 fo r doctora l degree s an d $87,30 8 fo r professiona l degree s (We i e t al. 2009) Durin g graduat e school man y ar e unabl e t o maintai n adequat e employmen t and consequently liv e on-the-edg e financiall y fro m paychec k t o paychec k withou t regula r incom e o r acces s t o healt h insuranc e (Howar d e t al. 2006 ; We i e t al. 2009) I n a 201 0 surve y o f 57 8 graduat e student s a t 2 6 universitie s nationwide 60 % indicate d tha t thei r live s woul d improv e a lot i f financia l pressure s wer e reduce d (Sulliva n & Repak 2011) Reducin g financia l pressure s was th e highes t ranke d ite m i n respons e t o thi s question rankin g abov e "havin g a stabl e relationshi p wit h a significan t other an d "havin g bette r self esteem (Sulliva n & Repak 2011 p 5) 1 3

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Difficultie s managin g relationship s wit h significan t other s an d famil y ofte n g o hand-in-han d wit h economi c troubles a s graduat e student s struggl e t o balanc e academic s wit h thei r persona l lives Thi s balancin g ac t produce s rol e conflic t an d stres s a s graduat e student s dea l wit h multipl e demand s o n thei r tim e an d competin g rol e expectation s (Johnson Bati a & Haun 2008 ; Mallinckrod t & Leong 1992) O n average graduat e student s ar e 3 2 year s o r older whic h mean s the y ar e a t th e poin t i n live s whe n the y ar e mor e likel y t o b e involve d i n seriou s relationship s tha t includ e responsibilitie s fo r younge r childre n (Bras 2006 ; Cho y & Cataldi 2006) Women i n particular experienc e rol e conflic t a s the y striv e t o balanc e motherhoo d an d carin g fo r youn g childre n wit h tha t o f bein g successfu l academic s (Bras 2006 ; Johnson Bati a & Haun 2008 ; Mallinckrod t & Leong 1992) Th e ultimat e outcom e fo r man y graduat e student s i s emotional exhaustio n an d graduat e schoo l burnout I n a surve y stud y o f 67 5 graduat e students 60 % indicate d a significan t nee d fo r greate r "balanc e i n life" an d amon g wome n 58 % liste d burnou t a s a "majo r concern (Repak 2010 p 2) No t surprisingly drop-ou t rate s amon g graduat e student s remai n fairl y high Amon g femal e master' s degre e enrollees 27.2 % droppe d ou t an d 25.1 % di d s o amon g male s (Redd 2007) Rate s ar e eve n highe r amon g doctora l students wit h 45 % o f wome n droppin g ou t an d 42 % o f me n (CGS 2008b) Fo r man y students graduat e schoo l i s th e fina l phas e o f thei r formal structure d education an d consequently serve s a s th e transitiona l condui t int o thei r desire d academi c o r professiona l identitie s (Kirby Bieve r & Shell 2006) I t i s th e tim e i n th e students 1 4

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academi c career s whe n the y ar e give n th e mos t responsibilit y fo r self-correctio n an d self definitio n a s the y striv e t o establis h themselve s a s reputabl e expert s i n thei r chose n fields Students therefore ofte n fee l a desperat e sens e o f "do-or-die a s the y perceive ofte n accurately tha t thei r futur e career s an d reputation s ar e a t stake I n som e students thi s "do-or-die mentality combine d wit h th e isolatio n typica l o f graduat e schoo l academics create s a psychologica l tippin g poin t tha t Brande s (2008 ) calle d "gra d studen t perfectionism" a mindse t wher e th e nee d t o d o "perfect wor k become s overl y importan t (p 4) Thi s perfectionis m shoul d not b e confuse d wit h a health y desir e t o achiev e an d excel especiall y considerin g th e inheren t competitio n o f graduat e schoo l an d tha t mos t graduat e student s ar e classi c example s o f over-achievers Instead thi s perfectionis m i s a n engulfin g "one-side d vie w o f sel f a s perfec t o r nothing tha t lead s t o a dangerou s situatio n wher e student s rel y o n academi c achievemen t a s thei r sol e sourc e o f self-estee m an d persona l worthines s (Brandes 2008 p.4) Fo r man y graduat e students thi s tendenc y towar d a perfectionis m mindset th e academi c pressur e an d isolatio n o f graduat e school an d th e economi c an d family relationshi p stressor s al l combin e i n a perfec t stor m o f disordere d thinkin g tha t place s graduat e student s a t significan t ris k fo r menta l illness Th e Studen t Menta l Health Committe e o f th e Universit y o f Californi a (2006 ) recognize d thi s situatio n i n thei r fina l repor t t o th e universit y administration whic h stated : Graduat e student s a s a grou p hav e bee n identifie d a s a populatio n a t highe r ris k fo r menta l healt h concerns Th e leve l o f stres s fo r graduat e student s i s magnifie d 1 5

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b y thei r relativ e isolatio n fro m th e broade r component s o f academi c life th e intens e academi c pressure s o f thei r advance d studies an d th e increase d presenc e o f famil y an d financia l obligations (p 4 ) Mos t graduat e students however d o no t recogniz e thes e problems I n a surve y o f 1,02 5 graduat e student s a t U C Irvine ove r 60 % reporte d tha t thes e stressor s wer e considere d norma l an d a n expecte d par t o f th e graduat e schoo l experienc e (Loude n & Skeem 2008) Th e reality however i s tha t graduat e student s experienc e a wid e spectru m o f menta l condition s an d disorders Th e tw o mos t commo n o f thes e ar e depressio n an d anxiet y disorder s (Anxiet y Disorder s Associatio n o f Americ a [ADAA] 2007 ; Brandes 2008) Bot h o f thes e ar e highl y treatable but becaus e graduat e student s generall y d o no t recogniz e thei r symptom s o r see k assistance the y g o undiagnose d an d untreated placin g the m a t greate r ris k fo r academi c failure substanc e abus e an d othe r risk y healt h behaviors relationshi p failur e an d eve n suicid e (NIMH 2009) Depressio n an d Anxiet y Disorder s I n th e Unite d States clinician s an d researcher s currentl y us e th e Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV ) a s th e standar d classificatio n syste m fo r definin g an d diagnosin g menta l disorders includin g depressio n an d anxiet y (America n Psychiatri c Associatio n [APA] 2011) Th e DMS-I V organize s menta l disorder s int o fiv e axe s o r dimensions Th e axe s wer e designe d t o provid e clinician s wit h a diagnosti c syste m tha t allow s consideratio n o f multipl e factor s i n determinin g th e prope r diagnosi s an d treatmen t pla n (APA 2000) I n thi s system 1 6

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depressio n an d anxiet y disorder s ar e bot h categorize d unde r Axi s I whic h include s clinica l disorder s an d developmenta l an d learnin g disorder s (APA 2000) A s wit h mos t othe r disease s an d disorders depressio n an d anxiet y disorder s manifes t themselve s i n differen t forms Th e tw o mos t commo n form s o f depressio n see n i n primar y car e setting s ar e majo r depressiv e disorde r (MDD ) an d dysthmyia whic h i s als o calle d chroni c mino r depressio n (NIMH 2008) I n th e DSM-I V Axi s I nin e criteri a ar e use d t o diagnos e MDD whic h i s characterize d a s a seriou s moo d disorde r wher e individual s repor t feeling s o f sadness worthlessnes s and/o r excessiv e guil t nearl y ever y day an d experienc e markedl y diminishe d interes t o r pleasur e i n activitie s tha t the y woul d otherwis e enjo y (APA 2000) Individual s wit h MD D suffe r poo r concentration lo w energ y level s an d slee p disturbances Disordere d eating eithe r excessiv e dietin g o r over eating i s als o common Thes e symptom s profoundl y impai r th e abilit y t o complet e self car e activitie s an d fulfil l th e responsibilitie s o f academi a an d famil y life A t it s worst MD D result s i n suicide a traged y tha t i n 200 7 cause d ove r 32,40 0 death s i n th e U.S (Mark Shern Bagalma n & Cao 2007) Dysthymi a i s les s sever e tha n MD D an d not a s disabling but place s affecte d individual s a t increase d ris k o f majo r depressiv e episode s (NIMH 2008) Th e hallmar k symptom s o f dysthymi a ar e experiencin g depresse d moo d almos t constantl y fo r a t leas t tw o years accompanie d b y a t leas t tw o o f th e following : feeling s o f hopelessness lo w self-esteem fatigue difficult y concentratin g o r makin g decisions slee p disturbances an d change s i n eatin g pattern s (NIMH 2008) 1 7

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Althoug h th e exac t caus e o f depressio n remain s unknown ris k factor s i n th e genera l adul t populatio n hav e bee n identified Thes e ris k factor s include : a ) a famil y histor y o f MD D o r suicide ; b ) bein g female ; c ) traumati c childhoo d experiences ; d ) substanc e abuse includin g nicotin e o r alcohol ; e ) a lac k o f socia l support ; f ) lo w socio economi c status ; an d g ) experiencin g stressfu l lif e event s (Center s fo r Diseas e Contro l & Preventio n [CDC] 2010 ; Hirschfel d & Weissman 2002) Althoug h depressio n i s a profoundl y disablin g condition i t ca n b e effectivel y diagnose d an d treate d i n th e primar y car e settin g (CDC 2010 ; Worl d Healt h Organizatio n [WHO] 2011) Severa l screenin g tool s hav e bee n develope d t o identif y individual s suspecte d o f havin g depressio n an d i n nee d o f furthe r evaluatio n an d possibl e treatment Th e depressio n modul e o f th e Patien t Healt h Questionnair e (PHQ-9 ) i s on e suc h screenin g tool whic h ha s bee n documente d a s reliabl e an d vali d i n primar y car e an d obstetrica l settings a s wel l a s th e genera l populatio n (Kronke Spitze r & Williams 2001 ; Martin Rief Klaiberg & Braehler 2006 ; Spitzer Kroenke William s & PH Q Primar y Car e Stud y Group 1999) I t consist s o f nin e question s correspondin g t o th e nin e DSM I V depressio n criteri a an d categorize s individual s b y severit y o f symptom s base d upo n th e instrument' s scorin g rubric Individual s screenin g positiv e fo r depressio n i n th e primar y car e settin g ar e furthe r evaluate d t o asses s suicid e risk and whe n indicated referre d t o a behaviora l healt h specialist I n 4 5 80 % o f affecte d individuals depressio n ca n b e effectivel y treate d wit h antidepressan t medication s an d structure d psychotherap y (Meyer s e t al. 2002 ; NIMH 1 8

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2008) On e widel y supporte d theor y abou t th e caus e o f depressio n i s tha t abnorma l level s o f brai n neurotransmitter s responsibl e fo r moo d regulatio n pla y a critica l rol e i n th e developmen t o f thi s disorde r (NIMH 2008) Antidepressan t medication s wor k b y correctin g thes e abnorma l levels and therefore treatin g depressio n withou t usin g thes e medication s i s contraindicate d (APA 2000) Th e mos t commo n categorie s o f antidepressan t medication s ar e selectiv e serotoni n reuptak e inhibitor s (SSRIs) serotoni n an d norepinephrin e reuptak e inhibitor s (SNRIs) an d norepinephrin e an d dopamin e reuptak e inhibitor s (NDRIs ) (NIMH 2008) I n som e cases tw o o r mor e antidepressan t medication s ar e use d fo r optima l effec t i n a strateg y calle d augmentatio n therapy Th e treatmen t o f depressio n i s ofte n complicate d b y th e presenc e o f othe r menta l healt h problems Althoug h th e causa l relationshi p i s not clearl y understood anxiet y disorders i n particular ar e commonl y co-morbi d wit h depressio n (Schneider 2007) Moreover recen t researc h finding s hav e identifie d havin g a n anxiet y disorde r a s a significan t ris k facto r fo r MD D (Schneider 2007) Simila r t o depression anxiet y disorder s occu r i n differen t forms ; however al l hav e excessive relentles s anxiet y a s a cor e symptom Th e DSM-I V define s twelv e differen t categorie s o f anxiet y disorder s i n adult s (APA 2000) O f these th e majo r categorie s include : a ) generalize d anxiet y disorde r (GAD) ; b ) pani c disorder ; c ) socia l anxiet y disorde r (SAD) ; d ) obsessive-compulsiv e disorde r (OCD) ; e ) post-traumati c stres s disorde r (PTSD) ; an d f ) phobia s (NIMH 2009) Amon g colleg e student s an d younge r adults GA D an d pani c disorde r ar e prevalen t (ADAA 2007) Individual s wit h 1 9

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GA D suffe r fro m excessiv e worr y an d tensio n lastin g si x month s o r longe r an d als o experienc e physica l symptoms includin g insomnia headaches involuntar y muscl e contractions frequen t urination hot flashes sweating nause a an d abdomina l discomfor t (ADAA 2007 ; NIM H 2009) Thi s excessiv e worr y an d tensio n ar e presen t eve n whe n ther e i s littl e o r nothin g t o provok e suc h a n extrem e response Affecte d individual s anticipat e disaste r a t ever y turn becomin g overl y concerne d abou t school financia l issues health persona l safety an d famil y problem s (NIMH 2009) Th e outcom e i s tha t individual s wit h GA D liv e i n a constan t stat e o f fea r an d dread suc h tha t everyday activitie s becom e a struggl e an d thei r abilit y t o functio n productivel y a t schoo l an d wor k i s severel y impaired Famil y an d socia l relationship s ar e als o negativel y affected Aki n t o thos e wit h GAD individual s sufferin g fro m pani c disorde r als o experienc e significan t impairment Without warning thes e individual s hav e sudde n attack s o f pani c an d terror typicall y accompanie d b y ches t pain hear t palpitations sweating chokin g sensations dizzines s an d faintin g (ADA A 2007 ; NIMH 2009) Thes e pani c attack s provok e intens e fear s o f dyin g o r losin g control an d fo r som e produc e out of-bod y feeling s o r a sens e o f not bein g connecte d t o reality No t surprisingly man y individual s experiencin g pani c attack s thin k the y ar e havin g a cardia c even t o r menta l break-down Becaus e the y canno t predic t whe n a pani c attac k wil l occur affecte d individual s liv e i n drea d an d fea r o f th e nex t attack whic h furthe r exacerbate s thei r condition Pani c disorde r ofte n occur s i n tande m wit h agoraphobia whic h i s a fea r o f ope n spaces bein g i n crowds o r o f bein g unabl e t o escap e fro m a plac e i f a pani c attac k 2 0

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shoul d occu r (NIMH 2009) A s a result thes e individual s hav e difficult y feelin g saf e i n publi c place s and therefore avoi d them ofte n becomin g essentiall y homebound Becaus e o f th e debilitatin g consequence s o f anxiet y disorders accurat e screenin g i s essentia l t o facilitat e timel y diagnosi s an d treatment Th e PHQ i n additio n t o screenin g fo r depression als o include s question s t o scree n individual s fo r anxiet y disorders Th e PHQ-Anxiet y consist s o f a branchin g serie s o f u p t o 2 2 question s tha t screen s individual s specificall y fo r GA D an d pani c disorde r (Spitze r e t al. 1999) Simila r t o th e PHQ-9 thi s too l ca n b e self-administere d i n a relativel y shor t perio d o f tim e t o identif y individual s i n nee d o f furthe r evaluatio n t o rul e ou t othe r medica l cause s o f thei r symptoms Th e exac t caus e o f anxiet y disorders a s wit h depression i s no t full y understood Severa l factors includin g genetics brai n chemistr y an d traumati c experiences al l contribute althoug h th e specifi c mechanism s involve d remai n unclea r (APA 2010) Bot h GA D an d pani c disorde r hav e a familia l tendency Twi n studie s suggeste d tha t i f on e identica l twi n ha s pani c disorde r tha t i n abou t 40 % o f case s th e othe r twi n woul d als o (Berger 2010 ; Nugent Weissman Fye r & Koenen 2010) However othe r factor s i n additio n t o genetic s ar e involved a s pani c disorde r frequentl y occur s i n individual s withou t an y famil y history A s wit h depression abnorma l brai n chemistr y play s a critica l rol e i n th e developmen t o f GA D an d pani c disorder Specifically th e neurotransmitter s serotoni n an d gamma-aminobutyri c aci d (GABA ) ar e involved a s wel l a s th e stres s hormone s norepinephrin e an d corticotropin-releasin g hormon e (CRH ) (Weistaub 2 1

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McOrnish Hank s & Gingrich 2010) Basically serotoni n an d GA B A hel p t o regulat e th e stres s respons e an d wor k t o produc e a calmin g effec t o n brai n activity Bot h ar e deficien t i n peopl e wit h anxiet y disorders Conversely norepinephrin e an d CR H ar e i n abundance bot h o f whic h ar e responsibl e fo r excitator y response s an d triggerin g th e fight-or-fligh t respons e (Weistrau b e t al. 2010) Thi s imbalanc e i n brai n chemistr y increase s th e ris k o f developin g GA D o r pani c disorder I n addition traumati c lif e experiences suc h a s sexua l abus e o r long-ter m exposur e t o poverty als o increas e th e risk particularl y i f th e exposur e i s durin g childhoo d (Zlotnic k e t al. 2008) I n man y cases a stressfu l even t durin g adulthood suc h a s graduat e school provide s th e impetu s tha t inevitabl y lead s t o th e developmen t o f GA D o r pani c disorder Muc h th e sam e ca n b e sai d o f depression Whe n genetics abnorma l brai n chemistr y an d traumati c lif e experience s converge i t takes relativel y littl e adde d stres s t o ti p th e scale s int o depressio n o r GA D an d pani c disorder Treatmen t fo r GA D an d pani c disorde r involve s medication s an d specifi c type s o f psychotherap y (NIMH 2009 ; Okunda Khan D e l a Cruz & Blanco 2010) Medication s ar e use d t o re-se t th e brai n chemistry makin g i t mor e difficul t t o trigge r a stres s respons e o r pani c attack Th e primar y type s o f medication s ar e antidepressant s an d high-potenc y benzodiazepines suc h a s alprazola m (Xanax ) an d lorazepa m (Ativa n ) (Okund a e t al. 2010) Som e individual s experienc e dependenc e an d withdrawa l symptom s i f thes e medication s ar e stoppe d abruptly makin g medica l supervisio n especiall y important Cognitive-behaviora l therap y (CBT ) i s a typ e o f psychotherap y tha t ha s bee n particularl y 2 2

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effectiv e i n treatin g GA D an d pani c disorder s (Okund a e t al. 2010) Workin g wit h psychiatrists socia l worker s o r othe r qualifie d menta l healt h providers individual s engage d i n CB T explor e wha t drive s thei r anxiet y disorde r an d ho w t o cop e wit h thei r symptoms Usin g a combinatio n o f medicatio n an d CBT th e majorit y o f patient s experienc e significan t improvemen t i n symptoms althoug h rate s o f complet e recover y ar e muc h lowe r a t abou t 40% an d re-occurrenc e onc e medication s ar e remove d ha s bee n reporte d a s hig h a s 85 % (Franci s e t al. 2007 ; Okund a e t al. 2010 ; Rodrigue z e t al. 2006) Althoug h highl y treatable depressio n an d anxiet y disorder s ar e ofte n undiagnose d and therefore g o untreated placin g affecte d individual s a t substantia l ris k fo r a plethor a o f negativ e healt h outcome s an d eve n death Th e consequence s o f no t receivin g treatmen t ca n b e especiall y dangerou s fo r graduat e student s wh o ar e typicall y isolate d fro m mainstrea m campus service s whil e a t th e sam e tim e experiencin g profoundl y stressfu l academi c an d persona l situations Prevalenc e o f Depressio n an d Anxiet y Disorder s Amon g Graduat e Student s I n recen t years prevalenc e studie s hav e clearl y documente d th e growin g proble m o f menta l healt h illnesse s amon g U S colleg e an d universit y student s (ADAA 2007 ; America n Colleg e Health Associatio n [ACHA] 2010 ; ACHA 2009 ; Blanc o e t al 2008 ; Gallagher 2008 ; Gallagher 2010 ; Hun t & Eisenberg 2010 ; Leino & Kisch 2005 ; Silverman Meyer Sloane Raffe l & Pratt 1997 ; Zivin Eisenberg Gollust & Golberstein 2009) Mos t o f thes e epidemiologica l studie s an d reports however hav e 2 3

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focuse d solel y o n undergraduates no t distinguishe d betwee n undergraduate s an d graduat e student s i n th e analyses o r onl y include d a smal l subse t o f graduat e students Thi s i s particularl y problemati c becaus e i n thos e fe w tha t reporte d finding s fo r graduat e students th e prevalenc e o f menta l healt h illnesses includin g depressio n an d anxiet y disorders wa s quit e hig h o r statisticall y th e sam e a s thei r undergraduat e counterparts Thi s wa s apparen t i n tw o studie s conducte d a t th e Universit y o f Californi a (UC) A t U C Berkeley a n online cross-sectiona l surve y stud y o f 3,12 1 graduat e student s wa s conducte d i n April 200 4 t o determin e students perceive d menta l healt h need s (Berkele y Graduat e Studen t Menta l Healt h Tas k Force 2004 ; Hyun Quinn Mado n & Lustig 2006) Althoug h depressio n an d anxiet y screenin g tools suc h a s th e PH Q instruments wer e not used student s wer e aske d a serie s o f question s abou t th e frequenc y o f feeling s o f exhaustion hopelessness sadness depressio n an d bein g overwhelmed Response s wer e totale d t o creat e a n inde x o f depressio n o r emotional distres s wit h highe r score s indicatin g a greate r frequenc y o f experiencin g negativ e emotion s (Hyu n e t al. 2006) Th e finding s showe d tha t a greate r proportio n o f graduat e student s tha n undergraduate s reporte d feelin g overwhelme d (67 % versu s 61%) feelin g s o depresse d i t wa s difficul t t o functio n (54 % versu s 45%) an d ha d considere d suicid e (9.9 % versu s 9.4% ) (Berkele y Graduat e Studen t Menta l Healt h Tas k Force 2004) Ove r 57 % o f graduat e student s reporte d havin g a pee r wit h a n emotiona l o r stress-relate d proble m durin g th e pas t 1 2 months I n addition 1 8 Berkele y graduat e student s reporte d a t leas t on e suicid e attemp t i n th e previou s 1 2 months Usin g dat a fro m th e NIM H tha t estimate d 2 4

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8 t o 2 5 attempt s pe r suicid e death a projecte d suicid e rat e o f 2. 3 7. 2 pe r 10,00 0 surve y participant s wa s calculate d (Berkele y Graduat e Studen t Menta l Health Tas k Force 2004) Thi s projecte d rat e place d thi s populatio n a t remarkabl y highe r ris k fo r suicid e compare d wit h th e genera l populatio n (1.4 8 pe r 10,000 ) an d undergraduate s (0.7 5 pe r 10,000 ) (Berkele y Graduat e Studen t Menta l Healt h Tas k Force 2004) Simila r finding s wer e reporte d a t U C Irvin e i n a n onlin e surve y stud y o f 1,02 5 graduat e student s conducte d durin g winte r semester 200 8 (Loude n & Skeem 2008) Usin g th e K6 menta l healt h screenin g tool th e prevalenc e o f screenin g positiv e fo r a current seriou s DSM-IV Axi s I menta l disorde r wa s 17% whic h wa s ove r thre e time s highe r tha n publishe d result s fo r th e genera l populatio n (Loude n & Skeem 2008) I n addition ove r 29 % ha d a menta l healt h concern tha t affecte d well-bein g o r academi c performanc e i n th e pas t year an d ove r 40 % reporte d knowin g o f anothe r graduat e studen t whos e academi c performanc e wa s compromise d du e t o menta l healt h problems Abou t 30 % ha d considere d suicid e an d 8 % ha d attempte d i t a t som e poin t i n thei r lives Loude n an d Skee m (2008 ) commente d tha t thes e percentage s ma y b e somewha t inflate d a s student s wit h menta l healt h concern s coul d b e mor e likel y t o respon d t o th e onlin e surve y tha n thos e withou t concerns Also i n bot h o f th e U C survey s respons e rate s wer e relativel y lo w (34.5 % an d 20 % respectively ) an d reflecte d th e experience s o f graduat e student s i n onl y one albei t large universit y syste m (Berkele y Graduat e Studen t Menta l Healt h Tas k Force 2004 ; Loude n & Skeem 2008) I n spit e o f thes e issues thes e 2 5

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finding s sugges t tha t th e prevalenc e o f depressio n an d anxiet y disorder s amon g graduat e student s i s considerabl y hig h an d i n nee d o f furthe r study I n tw o othe r studie s tha t include d analyse s o f dat a fro m graduat e students th e prevalenc e o f depressio n an d anxiet y disorder s wa s substantial but no t a s hig h a s tha t indicate d i n th e U C studies I n a cross-sectiona l surve y conducte d a t a singl e mid wester n university Eisenberg Gollust Golberstei n an d Hefne r (2007 ) use d th e PHQ9 an d th e PH Q Anxiet y scale s t o scree n 1,18 1 undergraduate s an d 1,66 2 graduat e student s fo r menta l healt h problems Wit h a 56 % respons e rat e i n thi s study ove r 11 % o f graduat e student s screene d positiv e fo r MD D o r othe r depressiv e disorde r an d almos t 4 % wer e positiv e fo r anxiet y disorders Althoug h th e PH Q instrument s ar e not equivalen t t o clinica l diagnoses th e fac t tha t thes e finding s wer e not significantl y differen t fro m thos e o f th e undergraduate s (13.8 % an d 4.2 % respectively ) indicate d tha t depressio n an d anxiet y disorder s wer e a s prevalen t amon g graduat e student s a s the y wer e amon g thei r younger undergraduat e counterparts I n a smalle r surve y stud y o f 13 2 graduat e student s an d 31 6 undergraduate s a t a publi c northeaster n university Bulmer Syed Barton Vancou r an d Bren y (2010 ) foun d tha t difference s i n self-reporte d rate s o f havin g a depressio n diagnosi s wer e no t statisticall y significan t betwee n graduat e student s an d undergraduate s (17.6 % an d 21.5 % respectively) I n thi s study 38 % o f graduat e student s an d abou t 45 % o f undergraduate s reporte d tha t o n on e o r mor e occasio n durin g th e pas t yea r the y fel t s o depresse d tha t i t wa s difficul t t o function Again ther e wa s no t a statisticall y significan t differenc e betwee n thes e tw o groups Th e finding however tha t 2 6

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ove r one-thir d o f graduat e student s an d almos t one-hal f o f undergraduate s reporte d experiencin g sever e depressiv e symptom s withi n th e pas t yea r wa s remarkable an d provide s evidenc e o f th e substantia l prevalenc e o f menta l healt h problem s amon g student s regardles s o f academi c leve l (Bulme r e t al. 2010) Eisenberg Gollus t e t al (2007 ) als o reporte d tha t 41.2 % o f graduat e student s indicate d tha t menta l healt h problem s ha d affecte d thei r academi c performanc e durin g th e pas t fou r weeks an d ove r 14 % ha d misse d academi c obligation s du e t o menta l healt h problem s durin g th e sam e tim e period Thes e ar e generall y trendin g alon g wit h th e U C surveys bu t Eisenberg Gollus t e t al (2007 ) foun d muc h lowe r rate s o f suicida l ideatio n (1.6% ) withi n th e pas t fou r week s tha n th e alarmingl y hig h rate s reporte d i n th e U C surveys This again ma y b e du e t o som e respons e bia s i n th e U C surveys especiall y give n th e relativel y hig h respons e rat e (56% ) fo r a n onlin e surve y tha t Eisenberg Gollus t e t al (2007 ) achieved Th e prevalenc e o f menta l healt h need s amon g internationa l graduat e student s studyin g i n th e U S ha s rarel y bee n explored Hyun Quinn Mado n an d Lusti g (2007 ) conducte d on e o f th e fe w studie s focusin g o n internationa l graduat e student s an d foun d tha t th e prevalenc e o f menta l healt h problem s amon g the m wa s not significantl y differen t fro m domesti c graduat e student s (44 % an d 46 % respectively) althoug h significantl y fewe r internationa l student s (33% ) indicate d tha t the y ha d considere d usin g campu s menta l healt h service s compare d t o thei r domesti c counterpart s (56%) Amon g thos e wh o woul d see k help internationa l graduat e student s wer e significantl y mor e likel y t o 2 7

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repor t an d see k counselin g fo r financia l problem s tha n domesti c graduat e student s (18 % an d 14 % respectively) whil e domesti c graduat e student s (54.8% ) wer e significantl y mor e likel y t o repor t an d see k counselin g fo r emotiona l o r relationshi p problem s compare d t o internationa l student s (41.2% ) (Hyu n e t al. 2007) Thi s stud y suggeste d tha t internationa l graduat e student s hav e simila r menta l healt h need s a s domesti c graduat e students bu t ar e les s likel y t o see k help unles s th e proble m i s perceive d a s primaril y financia l i n nature Th e fe w prevalenc e studie s tha t hav e focuse d o n graduat e student s indicate d tha t menta l healt h problems includin g depressio n an d anxiet y disorders ar e a t leas t a s prevalen t a s observe d i n undergraduate s an d possibl y greate r tha n tha t see n i n th e genera l population Thi s hold s concernin g implication s fo r universit y menta l healt h services whic h typicall y operat e unde r th e assumptio n tha t graduat e student s suffe r fewe r menta l healt h problem s tha n undergraduates an d therefore d o no t focu s programmin g effort s upo n them Furthe r researc h i s neede d t o full y understan d an d quantif y th e prevalenc e o f depressio n an d anxiet y disorder s i n graduat e students s o tha t thi s informatio n coul d b e use d t o mor e accuratel y infor m decision-makin g an d resourc e allocatio n fo r universit y menta l healt h programs Correlate s o f Depressio n an d Anxiet y Disorder s Amon g Graduat e Student s I n additio n t o furthe r researc h investigatin g th e prevalenc e o f depressio n an d anxiet y disorder s amon g graduat e students identificatio n o f th e potential ris k factor s tha t ma y predispos e student s t o thes e illnesse s mus t als o b e undertaken T o date studie s 2 8

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explorin g thes e factor s hav e largel y focuse d o n undergraduate s exclusively o r onl y include d a smal l subse t o f graduat e students Recognizin g tha t graduat e student s ar e a uniqu e populatio n wit h distinc t stressor s an d needs cautio n mus t b e use d whe n applyin g th e finding s fro m undergraduat e o r mixe d populatio n studie s t o th e graduat e studen t population Keepin g thi s i n mind a n ecologica l approac h wil l provid e th e mos t comprehensiv e framewor k fo r considerin g potentia l ris k factor s fo r depressio n an d anxiet y disorder s becaus e thi s approac h wil l facilitat e discussio n o f relationship s acros s multipl e level s o f influenc e (Salli s & Owen 2002) Usin g thi s approach sociodemographi c factors lifestyl e an d healt h behavio r factors an d factor s relate d t o academi c progra m characteristic s an d relationship s wit h advisor s wil l b e discussed Socio-demographi c Factor s Fo r th e purpos e o f thi s review socio-demographi c factor s included : a ) gender b ) race/ethnicity c ) sexua l orientation ; d ) relationshi p status ; an d e ) socioeconomi c status Gender Severa l studie s hav e correlate d bein g femal e wit h a n increase d ris k o f developin g depressio n o r anxiet y disorders Thi s appear s t o b e th e cas e fo r student s a s wel l a s th e genera l population I n a cross-sectiona l stud y o f ove r 9,00 0 participant s fro m th e genera l U S population Kressler Chiu Demle r an d Walter s (2005 ) reporte d tha t femal e gende r wa s significantl y correlate d wit h majo r depressio n an d generalize d anxiet y disorder eve n i n adolescence. Othe r studie s hav e consistentl y reporte d simila r finding s fo r th e genera l U.S populatio n (Bebbingto n e t al. 2003 ; Calvet e & Cardenoso 2005 ; Cyranowski Frank Young & Shear 2000) Wit h suc h stron g association s occurrin g i n 2 9

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th e genera l population i t i s not surprisin g t o fin d simila r result s amon g colleg e students Usin g dat a collecte d fro m ove r 20,00 0 student s tha t participate d i n th e Sprin g 200 0 Nationa l Colleg e Healt h Assessment Leino an d Kisc h (2005 ) foun d tha t femal e se x wa s predictiv e o f havin g eve r bee n diagnose d wit h depression Graduat e student s comprise d onl y abou t 10 % o f thi s sample an d analyse s wer e not reporte d b y academi c level I n th e stud y conducte d b y Eisenberg Gollus t e t al (2007 ) a t a single Midwester n publi c university abou t 58 % o f th e sampl e wa s graduat e students an d i n multivariat e regressio n analyse s femal e gende r wa s on e o f th e sociodemographi c characteristic s tha t wa s predictiv e o f screenin g positiv e fo r GA D o r pani c disorder bu t femal e gende r wa s not predictiv e o f screenin g positiv e fo r majo r depression Simila r t o th e previou s study analyse s b y academi c leve l wer e not conducted i n spit e o f th e relativel y larg e percentag e o f graduat e students Race/Ethnicity Ther e wer e n o studie s foun d linkin g rac e o r ethnicit y t o depressio n o r anxiet y disorder s amon g graduat e students Thi s are a appear s t o hav e largel y no t bee n explored perhap s becaus e o f th e curren t preponderanc e o f non-Hispani c white s amon g U.S graduat e students However a s th e characteristic s o f graduat e student s continu e t o shift i t wil l becom e mor e importan t t o explor e race/ethnicit y a s a facto r i n menta l healt h amon g graduat e students Studie s o f undergraduate s o r mixe d sample s o f undergraduate s an d graduat e student s hav e reporte d n o associatio n (Lein o & Kisch 2005 ) o r a n associatio n onl y betwee n majo r depressio n an d student s self identifyin g a s belongin g t o mor e tha n on e rac e categor y (Eisenberg Gollus t e t al. 2007) 3 0

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I n th e genera l population age d 1 8 t o 2 4 years bein g Black Asia n o r Hispani c wa s associate d wit h decrease d odd s o f havin g a psychiatri c disorde r (Blanco e t al. 2008 ; Kessle r e t al. 2005) Sexua l orientation Typically sexua l orientatio n ha s bee n characterize d i n th e literatur e usin g fou r categories : a ) heterosexual b ) bisexual c ) trans-sexual an d d ) gay/lesbian A s wit h race/ethnicity correlation s betwee n sexua l orientatio n an d depressio n o r anxiet y disorder s amon g graduat e student s hav e no t bee n explored I n studie s usin g mixe d sample s o f undergraduate s an d graduates however sexua l orientatio n ha s bee n foun d t o b e associate d wit h depression I n thei r primaril y undergraduat e sample Lein o an d Kisc h (2005 ) reporte d tha t self-identifyin g a s gay/lesbian bisexua l o r trans-sexua l wa s significantl y associate d (OR=1.778 ; p < .01 ) wit h "eve r havin g bee n diagnose d wit h depression an d "diagnose d wit h depressio n durin g th e las t schoo l year compare d wit h thos e self-identifyin g a s heterosexua l (p 73) Similarly Eisenberg Gollus t e t al (2007 ) foun d tha t student s wh o self-identifie d a s bisexua l wer e significantl y mor e likel y t o scree n positiv e fo r depressio n (OR=3.91 ; p<.05) bu t no t fo r anxiet y disorder s o r suicida l thoughts Thes e finding s ar e consisten t wit h thos e o f th e genera l populatio n linkin g sexua l orientatio n wit h menta l healt h problem s (Ferguson Horwood Ridder & Beautrais 2005 ; Garofalo Wolf Wissow Woods & Goodman 1999 ; Russel l & Joyner 2001 ) Relationshi p status Th e answe r rang e fo r dat a regardin g relationshi p statu s usuall y include s single marrie d o r i n a domesti c partnership divorced an d widowed 3 1

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Amon g colleg e students a fourt h categor y i s ofte n added bein g i n a relationship I n th e genera l population no t bein g marrie d ha s bee n correlate d wit h majo r depressio n (Kressle r e t al. 2005) Result s amon g undergraduate s an d graduat e student s hav e bee n mixed wit h som e reportin g bein g marrie d o r i n a relationshi p a s a protectiv e facto r fo r depressio n (Eisenberg Gollus t e t al. 2007 ; Eisenberg Golberstei n & Gollust 2007 ) an d other s reporte d n o significan t correlation s (Lein o & Kisch 2005) Socioeconomi c status Consistently financia l concern s an d socioeconomi c statu s ha s bee n linke d wit h menta l healt h amon g colleg e students I n a stud y includin g onl y graduat e students Hyu n e t al (2006 ) foun d tha t bein g confiden t tha t on e ha d th e financia l resource s t o finis h graduat e schoo l wa s a significan t contributo r t o positiv e menta l health Usin g a mixe d sampl e o f students Eisenberg Golberstei n e t al (2007 ) foun d tha t student s reportin g thei r financia l situatio n a s "tight wer e mor e likel y t o perceiv e havin g a menta l healt h proble m tha n thos e wh o reporte d thei r financia l situatio n wa s "no t a problem (OR=1.34 p<.02) I n anothe r study Eisenberg Gollus t e t al (2007 ) foun d tha t thos e wh o reporte d growin g u p i n poo r familie s wer e abou t thre e time s mor e likel y t o scree n positiv e fo r depressio n (OR=2.88 p<.05 ) o r anxiet y disorder s (OR=3.02 p<.05 ) tha n thos e reportin g tha t the y gre w u p i n a comfortabl e financia l situation. Thes e finding s suppor t th e assertio n tha t financia l stres s contribute s significantl y t o emotional stres s an d menta l healt h problem s amon g undergraduat e an d graduat e students 3 2

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Lifestyl e an d Healt h Behavior s Som e studie s hav e provide d evidenc e tha t menta l healt h problem s i n graduat e student s ar e associate d wit h increase d risk y healt h behaviors Cranford Eisenberg an d Serra s (2009 ) foun d tha t depressio n an d anxiet y disorder s wer e associate d wit h bing e drinking wit h ove r 34 % o f graduat e student s reportin g thi s behavior Ove r 13 % reporte d smokin g cigarette s i n th e pas t 3 0 day s an d abou t 6 % ha d use d marijuana Rate s fo r smokin g (15.2 % versu s 11.4% ) an d bing e drinkin g (36.2 % versu s 32.8% ) wer e highe r amon g male s tha n females whil e marijuan a us e wa s slightl y highe r amon g female s (5.2 % versu s 6.4%) I n hierarchica l multipl e regressio n analyse s tha t include d ove r 55 % graduat e students majo r depressio n was significantl y associate d wit h cigarett e smokin g (OR=1.6 p<0.05 ) an d bing e drinkin g (OR=0.7 p<0.05) Generalize d anxiet y disorde r wa s als o significantl y associate d wit h thes e tw o behavior s (cigarett e smokin g OR=1.9 p<0.05 ; bing e drinkin g OR=2.0 p<0.05) Pani c disorder however was onl y significantl y associate d wit h cigarett e smokin g (OR=2.0 p<0.05 ) (Cranfor d e t al. 2009) I n a compariso n stud y wit h femal e undergraduates Bulme r e t al (2010 ) foun d n o significan t differenc e betwee n femal e undergraduate s an d femal e graduat e student s i n risk y healt h behaviors includin g smoking physica l inactivity an d frequen t alcoho l use I n thi s relativel y smal l study femal e graduat e student s wer e surprisingl y mor e likel y t o driv e afte r drinkin g tha n thei r undergraduat e counterparts Althoug h bot h o f thes e cross sectiona l studie s involve d singl e universitie s an d include d relativel y subscribe d samples 3 3

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th e finding s sugges t that simila r t o thei r undergraduat e counterparts risk y healt h behavior s ar e associate d wit h menta l healt h problem s amon g graduat e students Progra m Characteristic s an d Relationship s wit h Advisor s Som e studie s hav e explore d th e influenc e tha t academi c progra m characteristic s an d graduat e students relationship s wit h advisor s hav e o n menta l health Hyu n e t al (2006 ) foun d tha t graduat e student s wit h significan t menta l healt h problem s wer e mor e likel y t o see k an d us e service s i f the y ha d a functiona l relationshi p wit h thei r academi c advisor Moreover i n thi s stud y perceive d institutional biase s an d stigm a agains t seekin g hel p contribute d t o lowe r utilizatio n o f menta l healt h services Hyu n e t al (2006 ) suggeste d tha t thes e finding s suppor t investmen t i n strengthenin g facult y graduat e studen t relationship s a s par t o f a campus-wid e menta l healt h promotio n policy Th e Berkele y Graduat e Studen t Menta l Healt h Tas k Forc e (2004 ) als o foun d tha t satisfactio n wit h adviso r an d facult y relationship s playe d a rol e i n th e menta l healt h o f graduat e students I n thi s study graduat e student s reporte d relativel y lo w satisfactio n wit h thei r primar y advisors whic h ma y reflec t a mor e negativ e academi c environmen t tha t i s no t conduciv e t o promotin g menta l health I n addition satisfactio n varie d considerabl y b y academi c progra m wit h professiona l programs suc h a s busines s an d law havin g th e lowes t marks Th e Berkele y Graduat e Studen t Menta l Healt h Tas k Forc e (2004 ) suggeste d tha t facult y coul d b e instrumenta l i n removin g stigm a attache d t o menta l healt h problem s an d contribut e t o greate r progra m satisfaction 3 4

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Summar y an d Conclusio n Whil e th e finding s fro m th e studie s an d report s reviewe d her e provid e interestin g insight s int o th e stat e o f menta l healt h amon g students ver y fe w focuse d exclusivel y o n graduat e students an d som e reporte d conflictin g results Consequently th e prevalenc e an d correlate s o f depressio n an d anxiet y disorder s amon g graduat e student s hav e no t bee n full y explored i n spit e o f thi s populatio n bein g a t significan t ris k fo r thes e menta l illnesse s an d th e negativ e healt h outcome s relate d t o them Furthe r researc h int o thi s are a i s neede d t o garne r a n improve d understandin g o f th e prevalenc e o f depressio n an d anxiet y disorder s amon g graduat e students an d th e factor s tha t predispos e the m t o thei r development Thi s understandin g coul d b e use d t o infor m menta l healt h promotio n fo r graduat e students a grou p tha t historicall y ha s bee n lef t ou t o f menta l healt h program s o n universit y campuses 3 5

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CHAPTE R II I METHODOLOG Y Thi s stud y use d secondar y dat a fro m th e Healthy Mind s Stud y (HMS) a web base d surve y o f undergraduat e an d graduat e student s conducte d annuall y a t college s an d universitie s acros s th e nation Th e propose d stud y include d secondar y dat a collecte d fro m graduat e student s exclusively Th e followin g chapte r describe s th e populatio n an d sampl e unde r study th e IR B revie w process th e validit y an d reliabilit y o f th e instrumentation an d th e statistica l analyse s completed Populatio n an d Sampl e Th e populatio n fo r thi s stud y include d individual s wh o identifie d themselve s a s graduat e student s an d wer e enrolle d i n a graduat e progra m a t on e o f th e 2 5 participatin g institution s durin g th e 201 0 HM S dat a collectio n period College s an d universitie s voluntaril y participate d i n th e 201 0 HM S an d wer e require d t o pa y a $2,25 0 fe e t o cove r th e cos t o f samplin g an d reporting Althoug h participant s wer e not recruite d a s par t o f th e curren t analyse s o f secondar y data a clearl y define d samplin g procedur e wa s use d durin g th e 201 0 dat a collection T o obtai n th e sample currentl y enrolle d student s wer e randoml y selecte d fro m th e registrar' s databas e a t eac h participatin g institutio n (HMS 2010) Usin g maile d an d electroni c invitations student s i n th e sampl e wer e aske d t o complet e a n online confidentia l surve y abou t menta l healt h amon g colleg e students A n incentiv e i n th e for m o f a $2.0 0 toke n o f appreciation wa s include d i n th e maile d 3 6

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invitatio n an d entr y int o a cas h sweepstake s wa s als o offered U p t o fou r emai l reminder s wer e sen t t o non-responder s (HMS 2010) Th e HM S stud y administrato r a t th e Universit y o f Michiga n Schoo l o f Publi c Healt h oversa w th e samplin g procedure s t o ensur e consistenc y (D Eisenberg persona l communication Jul y 2010) Th e sampl e consiste d o f self-identifie d graduat e student s pursin g master's Juri s docto r (J D.) o r Docto r o f Philosoph y (Ph.D. ) degrees Medica l student s wer e exclude d fro m th e sample Thi s wa s don e i n recognitio n o f th e uniqu e educationa l experience s o f medica l student s an d becaus e the y hav e bee n recognize d an d studie d a s a distinc t grou p i n th e curren t literatur e pertainin g t o depressio n an d anxiet y disorder s (Dahlin Jonebor g & Runeson 2005 ; Dyrbye Thoma s & Shanafelt 2006 ; Tija Given s & Shea 2005 : Toew s e t al. 1997) I n addition 28 6 participant s wer e exclude d becaus e the y identifie d themselve s a s graduat e students but als o indicate d tha t thei r curren t ag e wa s 18 1 9 o r 2 0 years Sinc e i t wa s unlikel y tha t participant s thi s youn g woul d b e i n graduat e school th e assumptio n wa s mad e tha t whe n completin g th e HM S surve y thes e student s eithe r incorrectl y identifie d themselve s a s graduat e student s o r selecte d th e incorrec t ag e category Becaus e i t wa s no t possibl e t o validat e whic h answe r wa s correct thes e student s wer e remove d fro m al l analyses Also student s wit h missin g dat a wer e excluded Th e fina l sampl e consiste d o f 4,47 7 graduat e students Protectio n o f Huma n Participant s A n applicatio n fo r exemp t revie w statu s wa s submitte d t o an d approve d b y th e Texa s Woman' s Universit y Institutiona l Revie w Board Thi s stud y me t th e requirement s 3 7

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fo r exemp t revie w becaus e al l persona l identifier s wer e remove d fro m th e dat a se t befor e i t wa s release d t o th e principa l investigator Thes e persona l identifier s include d an y informatio n tha t coul d potentiall y identif y a stud y participant suc h a s socia l securit y number studen t identificatio n number name address and/o r birt h date Th e universit y o r colleg e tha t th e participan t attende d wa s include d i n th e dat a set ; however withou t individual-leve l identifiers surve y response s coul d no t b e trace d bac k t o individuals A s a result ther e wer e minima l potentia l risk s t o huma n participant s involve d i n thi s study Permissio n t o acces s th e HM S dat a wa s grante d b y Dr Danie l Eisenberg HM S principa l investigator a t th e Universit y o f Michiga n Schoo l o f Publi c Health whic h i s th e institutio n tha t administer s th e HM S (D Eisenberg persona l communication Jul y 2010) Dat a Collectio n Procedure s Thi s stud y wa s a secondar y analysi s o f existin g dat a collecte d i n 201 0 a s par t o f th e HMS Dat a wa s collecte d usin g a n online confidentia l survey Instrumentatio n Th e HM S onlin e questionnair e (se e Appendi x A ) wa s use d t o collec t dat a fo r al l th e variable s i n thi s study Th e HM S questionnair e include d component s o f th e Patien t Healt h Questionnair e (PHQ) whic h wa s use d t o scree n graduat e student s fo r depressio n an d anxiet y disorders A positiv e PH Q screenin g resul t wa s use d a s a prox y measur e fo r determinin g prevalenc e i n thi s study Althoug h a positiv e PH Q resul t i s not equivalen t t o a clinica l diagnosis i t ha s bee n highl y correlate d i n validatio n studie s comparin g th e PH Q wit h diagnosi s fro m a menta l healt h professional a s wel l a s wit h othe r screenin g 3 8

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instrument s (Kroenke Spitze r & Williams 2001 ; Martin Rief Klaiberg Braehler 2006 ; Spitzer Kroenke Williams & PH Q Healt h Questionnair e Primar y Car e Stud y Group 1999) I n thi s study depressio n wa s measure d usin g th e PHQ-9 whic h i s th e depressio n modul e fro m th e PHQ Th e PHQ9 i s a clinicall y validate d instrumen t develope d usin g th e nin e diagnosti c criteri a fo r majo r depressio n establishe d i n th e Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) (Klein Ciotol i & Chung 2011 ; Kroenk e e t al. 2001) Dependin g o n th e PHQ9 score whic h range s fro m 1 t o 27 participant s ar e categorize d b y leve l o f depressio n severity Thes e level s ar e minima l (1-4) mil d (5-9) moderat e (10-14) moderatel y sever e (15-19 ) an d sever e (20 27) I n a validatio n stud y includin g ove r 6,00 0 subjects Kroenk e e t al (2001 ) reporte d tha t th e interna l reliabilit y o f th e PHQ9 wa s excellen t i n bot h primar y car e an d obstetrical-gynecologica l setting s wit h a Cronbach' s a o f 0.8 9 an d 0.8 6 respectively Test-retes t reliabilit y wa s als o highl y correlate d (0.84 ) whe n self-administratio n wa s compare d wit h clinician-administration an d th e mea n score s wer e ver y simila r (5.0 8 versu s 5.03 ) (Kroenk e e t al. 2001) T o determin e criterio n validity sensitivit y an d specificit y wer e determine d fo r eac h PHQ9 cu t score Fo r example fo r a PHQ9 scor e o f 1 0 o r higher sensitivit y wa s 88 % an d specificit y wa s 88% Kroenk e e t al (2001 ) als o foun d a stron g associatio n betwee n worsenin g PHQ9 score s an d worsenin g functio n o n th e si x SF-2 0 scales whic h serve d t o establis h construc t validity Klei n e t al (2011 ) use d th e PHQ9 i n a primar y car e depressio n screenin g initiativ e a t a larg e urba n universit y 3 9

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healt h cente r an d foun d i t t o b e effectiv e an d well-accepte d amon g student s an d clinica l staff T o measur e anxiet y disorder s (GA D an d pani c disorder) th e PHQ9 Anxiet y scal e wa s used Spitze r e t al (1999 ) conducte d a validatio n stud y o f th e PHQ includin g th e PH Q Anxiet y scale The y reporte d tha t th e sensitivit y an d specificit y fo r GA D wer e 63 % an d 97 % respectively an d th e overal l accurac y wa s 91 % (Spitze r e t al. 1999) Fo r pani c disorder th e sensitivit y (81% ) an d specificit y (99% ) wer e als o excellent an d th e overal l accurac y wa s 98 % (Spitze r e t al. 1999) Dat a Analysi s Th e Statistica l Packag e fo r Socia l Science s (SPSS) versio n 19 was use d t o perfor m descriptiv e an d inferentia l analyse s fo r thi s study Al l variable s wer e categorical Descriptiv e analyse s wer e use d t o describ e th e sampl e i n term s o f th e prevalenc e o f demographi c variables socia l factors an d lifestyl e an d healt h behavio r variables an d t o determin e th e prevalenc e o f depression anxiet y disorders eithe r menta l illness o r bot h illnesses Bivariat e correlatio n analyse s wer e conducte d t o determin e i f significan t association s existe d betwee n demographi c variables socia l factor s and/o r lifestyl e an d healt h behavio r variable s an d th e outcom e o f screenin g positiv e fo r depression anxiet y disorders eithe r menta l illness o r bot h illnesses Becaus e o f th e relativel y larg e sampl e siz e ( N = 4,477) onl y cross-tabulatio n result s tha t wer e significan t alp < .0 1 wer e reporte d a s significant Result s wit h ap valu e o f .0 1 t o .0 5 o r tha t ha d percentag e difference s o f 5 % o r greate r wer e considere d statisticall y significant 4 0

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bu t clinicall y non-meaningfu l relationships Multivariat e logisti c regression s wer e conducte d t o determin e i f demographi c factors socia l factors and/o r lifestyl e an d health relate d behavior s wer e predictiv e o r protectiv e o f th e outcome s o f screenin g positiv e fo r depression anxiet y disorders eithe r menta l illness o r bot h illnesses Finding s wer e considere d significan t i f th e odd s ratio s wer e les s tha n 0.8 5 o r greate r tha n 1.30 A s note d previously thes e criteri a wer e use d becaus e o f th e sampl e size I f a findin g wa s significant but th e odd s rati o wa s betwee n .8 5 an d 1.30 th e findin g wa s considere d a statisticall y significant but clinicall y non-meaningfu l result I n addition becaus e o f th e relativel y larg e sampl e size thre e rando m sub-sample s wer e create d an d cross-validation s wer e conducte d t o eithe r validat e o r fai l t o validat e th e mai n logisti c regression s complete d usin g th e ful l dat a set Thi s cross-validatio n procedur e assiste d i n determinin g i f a variabl e tha t wa s a significan t predicto r i n th e mai n logisti c regressio n wa s stron g enoug h t o remai n statisticall y significan t wit h a smalle r sample o r i f th e larg e sampl e siz e wa s contributin g t o th e predictor' s significance Fo r th e significan t predicto r i n th e mai n logisti c regressio n t o b e considere d verified i t ha d t o b e a significan t predicto r i n a t leas t tw o ou t o f th e thre e rando m sub-samples Summar y Thi s stud y use d secondar y dat a fro m a nationa l web-base d survey th e HMS t o explor e th e prevalenc e an d predictor s o f depressio n an d anxiet y disorder s amon g a rando m sampl e o f graduat e students Dat a wa s collecte d durin g 201 0 fro m 2 5 differen t college s an d universities Validate d an d reliabl e instrument s wer e use d t o estimat e th e 4 1

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prevalenc e o f depressio n an d anxiet y disorders whic h serve d a s th e outcom e variables Th e independen t variable s include d demographic social an d lifestyl e an d healt h behavio r factors SPS S wa s use d t o complet e descriptiv e an d multivariat e analyse s o f th e dat a i n orde r t o answe r th e researc h question s an d tes t th e hypotheses 4 2

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CHAPTE R I V RESULT S Sampl e Descriptio n Th e initia l sampl e containe d 5,22 0 participant s wh o complete d th e Healthy Mind s Stud y (HMS ) nationa l surve y i n 201 0 an d identifie d themselve s a s graduat e students O f these 28 6 participant s indicate d tha t thei r ag e wa s betwee n 1 8 an d 2 0 year s ol d an d wer e remove d fro m th e sampl e becaus e the y wer e considere d to o youn g t o b e i n graduat e school an d th e accurac y o f thei r ag e response s coul d no t b e determined Also an y participan t wh o ha d missin g dat a fo r an y o f th e variable s wa s removed resultin g i n a fina l sampl e siz e o f 4,47 7 participants A s show n i n Tabl e 1 th e majorit y o f graduat e student s wer e workin g towar d thei r Master' s degre e (63.7%) wit h ove r one-quarte r o f participant s workin g o n thei r Docto r o f Philosoph y (Ph.D. ) o r equivalen t degre e (28.0%) an d th e remainin g participant s wer e workin g o n thei r Juri s Doctorat e (J.D. ) degre e (8.4%) Primar y Analyse s Prevalenc e Testin g fo r Researc h Questio n 1 Th e firs t researc h questio n aske d abou t th e prevalenc e o f th e demographi c factors socia l factors an d lifestyle/health-relate d behavior s amon g thi s sampl e o f U.S graduat e students Demographi c factor s included : a ) age b ) gender c ) race/ethnicity d ) nationality e ) sexua l orientation an d f ) schoo l region 4 3

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Tabl e 1 Frequencies and Percentages of Graduate Student Status (n = 4,477) n % Graduat e Studen t Yes Graduat e Studen t 447 7 100. 0 Master' s Degre e N o 162 6 Master' s Degre e 285 1 Juri s Doctorat e N o 410 3 J.D Degre e 37 4 Ph.D Degre e N o 322 5 Ph D o r Equivalen t Degre e 125 2 Note. Frequencie s no t equalin g 100 % reflec t missin g data A s show n i n Tabl e 2 participant s wer e initiall y categorize d int o thre e distinc t ag e groups : 2 1 t o 2 5 year s ol d (43.1%) 2 6 t o 3 0 year s ol d (36.8%) an d ove r 3 0 year s o f ag e (20.1%) Participant s wer e the n re-categorize d int o tw o ag e group s fo r analysi s purposes : 2 1 t o 2 5 year s (43.1% ) an d 2 6 year s an d olde r (56.9%) A majorit y o f participant s wer e femal e (59.4%) Regardin g race/ethnicity a majorit y o f participant s wer e Caucasia n (66.0%) followe d b y Asian/Asian-America n (17.0%) wit h smalle r racial/ethni c group s o f Africa n America n (3.9%) Hispani c (4.0%) Othe r racial/ethni c grou p (4.2%) an d participant s wh o identifie d themselve s a s Multi-racial/ethni c (4.8%) Th e Othe r 36. 3 63. 7 91. 6 8. 4 72. 0 28. 0 4 4

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racial/ethni c grou p included : America n Indian Alaska n Native Arab/Middl e Easter n o r Ara b American an d Pacifi c Islander Fo r analysi s purposes participant s wer e categorize d int o tw o ethni c groups : Caucasia n (66.0% ) an d Othe r Races/Ethnicitie s (34.0%) A majorit y o f participant s wer e U.S citizens (81.8%) Mos t als o identifie d themselve s a s heterosexua l (92.6%) wit h th e remainin g participant s indicatin g tha t thei r sexua l orientatio n wa s bisexua l (3.0%) ga y o r lesbia n (3.2%) questionin g (0.5% ) o r othe r (0.7%) Fo r analysi s purposes participant s wer e categorize d a s eithe r heterosexua l (92.6% ) o r not heterosexua l (7.4%) Participant s wer e attendin g graduat e schoo l a t on e o f 2 5 differen t universitie s participatin g i n th e 201 0 HM S surve y acros s th e Unite d States O f thes e 2 5 universities th e larges t numbe r o f participant s cam e fro m Stanfor d University followe d b y Universit y o f Denver Tuft s University Loyol a University an d Bosto n University Usin g U.S Censu s Burea u regions graduat e school s wer e categorize d int o fou r geographica l regions : Midwest South Northeas t an d West Nearl y one-hal f (47.2% ) o f participant s wer e i n th e Wes t region followe d b y th e Northeas t regio n (31.2%) Midwes t regio n (16.6% ) an d Sout h regio n (4.9%) 4 5

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Tabl e 2 Prevalence of Demographic Factors (n = 4,477) % Ag e 2 1 t o 2 5 year s ol d 2 6 t o 3 0 year s ol d Ove r 3 0 year s ol d Gende r Femal e Mal e Race/Ethnicit y Caucasia n Africa n America n Hispani c Asian/Asian-America n Othe r Multi-Racial/Ethni c Nationalit y Yes U S Citize n No Internationa l Studen t Sexua l Orientatio n Heterosexua l Bisexual Gay o r Lesbia n Questionin g Othe r Schoo l Regio n Midwes t Northeas t Sout h Wes t 193 1 164 6 90 0 265 8 181 9 295 6 17 5 18 0 76 3 18 6 21 7 366 0 81 7 414 6 13 3 14 3 2 2 3 3 74 5 139 9 21 9 211 4 43. 1 36. 8 20. 1 59. 4 40. 6 66. 0 3. 9 4. 0 17. 0 4. 2 4. 8 81. 8 18. 2 92. 6 3. 0 3. 2 0. 5 0. 7 16. 6 31. 2 4. 9 47. 2 Note. Frequencie s no t equalin g 100 % reflec t missin g data 4 6

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Socia l factor s included : a ) livin g situation b ) relationshi p status c ) curren t financia l situation an d d ) financia l situatio n growin g up A s show n i n Tabl e 3 th e livin g situatio n fo r th e majorit y o f participant s wa s off-campus non-universit y housin g (75.5%) whil e 10.1 % o f participant s live d i n othe r universit y housing 8.1 % o f participant s live d i n campu s residenc e halls 6.3 % o f participant s live d i n thei r parent s o r guardians homes an d 0.2 % live d i n eithe r a fraternit y o r sorority Thes e group s wer e consolidate d int o tw o groups : livin g o n campu s (18.3% ) versu s livin g of f campu s (81.7%) Regardin g participants relationshi p status 33.9 % o f participant s wer e single 38.0 % o f participant s reporte d tha t the y wer e "i n a relationship" an d 26.5 % o f participant s wer e eithe r marrie d o r i n a domesti c partnership Onl y 1.5 % o f participant s wer e divorce d an d 0.1 % o f participant s wer e widowed Fo r analysi s purposes th e relationshi p categorie s wer e consolidate d int o thre e groups : a ) single divorce d o r widowe d (35.5%) ; b ) i n a relationshi p (38.0%) ; an d c ) marrie d o r i n a domesti c relationshi p (26.5%) A s als o show n i n Tabl e 3 whe n aske d abou t thei r curren t financia l status a majorit y o f participant s reporte d tha t thei r finance s wer e "tight but I' m doin g fine (61.5%) One-fift h o f participant s reporte d tha t thei r finance s wer e "no t reall y a problem (20.9%) an d th e remainin g participant s state d tha t finance s wer e a "struggle (17.6%) Thes e participant s wer e categorize d int o tw o groups : curren t financia l problem s (79.1%) whic h include d "tight an d "struggling" o r n o financia l problem s (20.9%) Whe n aske d abou t thei r financia l situatio n growin g up jus t ove r one-hal f o f participant s 4 7

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(51.2% ) reporte d tha t thei r financia l situatio n wa s "comfortable. Ove r one-thir d o f participant s state d tha t growin g u p the y ha d "enoug h t o ge t by but di d no t hav e man y extras (34.1%) Th e remainin g participant s reporte d tha t thei r financia l situatio n growin g u p wa s "well-to-do (11.4%) o r tha t the y wer e "very poo r an d di d no t hav e enoug h t o ge t by (3.3%) Participant s wer e the n regroupe d int o on e o f tw o categorie s fo r analysi s purposes : n o pas t financia l difficultie s (62.6%) whic h include d "comfortable an d "well-to-do o r pas t financia l difficultie s (37.4%) whic h include d "jus t gettin g by an d "ver y poor" Tabl e 3 Prevalence of Social Factors (n = 4,477) Livin g Situatio n Campu s Residenc e Hal l Fraternit y o r Sororit y Othe r Universit y Housin g Off-Campus Non-Universit y Housin g Parent s o r Guardian' s Hom e Relationshi p Statu s Singl e I n a relationshi p Marrie d o r domesti c partnershi p Divorce d Widowe d n 36 1 7 45 1 337 8 28 0 151 9 170 2 118 7 6 5 4 % 8. 1 2 10. 1 75. 5 6. 3 33. 9 38. 0 26. 5 1. 5 1 (continued ) 4 8

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Tabl e 3 cont n % Curren t Financia l Situatio n It' s a financia l struggl e 78 7 17. 6 It' s tigh t bu t I' m doin g fin e 275 4 61. 5 Finance s ar e no t reall y a proble m 93 6 20. 9 Financia l Situatio n Growin g U p Ver y poor no t enoug h t o ge t b y 14 8 3. 3 Ha d enoug h t o ge t b y bu t not man y "extras 152 7 34. 1 Comfortabl e 229 1 51. 2 Wel l t o d o 51 1 11. 4 Note. Frequencie s no t equalin g 100 % reflec t missin g data Participant s wer e als o aske d abou t thei r lifestyl e an d health-relate d behaviors whic h included : a ) experience d discriminatio n withi n th e pas t yea r du e t o race ethnicit y o r cultura l background ; b ) smokin g tobacco ; c ) bing e drinking ; d ) gambling ; e ) usin g illici t drug s o f an y kind ; an d f ) frequenc y o f exercise A s show n i n Tabl e 4 a majorit y o f participant s (71.0% ) state d tha t the y ha d neve r experience d discrimination ; whereas th e remainin g participant s ha d experience d on e o r mor e instance s o f discriminatio n withi n th e pas t yea r (29.0%) A majorit y o f participant s state d tha t the y di d no t smok e (88.1%) compare d t o smoker s (11.9%) ; di d not engag e i n bing e drinkin g (59.6%) compare d t o engagin g i n bing e drinkin g (40.4%) ; di d not gambl e (78.8%) compare d t o gamblin g a t leas t onc e i n th e pas t yea r (21.2%) ; an d di d no t us e illici t drug s o f an y typ e (87.5% ) compare d t o usin g som e typ e o f illici t dru g (12.5%) Regardin g frequenc y o f exercise a 4 9

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majorit y o f participant s (53.9% ) exercise d thre e o r mor e time s pe r week compare d t o thos e wh o exercise d les s tha n thre e time s pe r wee k (46.1%) Tabl e 4 Prevalence of Lifestyle and Health-Related Behaviors (n = 4,477) % Experience d Discriminatio n Neve r Onc e i n a whil e Sometime s A Lo t Mos t o f th e Tim e Almos t Al l o f th e Tim e Frequenc y o f Smokin g Non e Les s Tha n On e Cigarett e Pe r Da y On e t o Fiv e Cigarette s a Da y Abou t One-Hal f Pac k Pe r Da y Abou t On e Pac k Pe r Da y Abou t onl y On e an d a Hal f Pack s Pe r Da y Abou t Tw o o r Mor e Pack s Pe r Da y Frequenc y o f Bing e Drinkin g Non e Onc e Twic e Thre e t o Fiv e Time s Si x t o Nin e Time s Te n o r Mor e Time s 317 7 94 3 28 2 5 4 8 1 3 394 3 27 7 13 6 7 8 3 9 3 1 267 0 76 3 50 4 45 8 6 8 1 4 71. 0 21. 1 6. 3 1. 2 2 3 88. 1 6. 2 3. 0 1. 7 9 1 0 59. 6 17. 0 11. 3 10. 2 1. 5 3 5 0 (continued )

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Tabl e 4 con't Frequenc y o f Gamblin g Behavio r Neve r Gambl e Gambl e a t Leas t On e Tim e Illici t Dru g Usag e o f An y Typ e N o Illici t Dru g Us e Use d An y Typ e o f Illici t Drug s Amoun t o f Exercis e Les s tha n 3 Time s pe r Wee k Thre e o r Mor e Time s pe r Wee k 353 0 94 7 391 6 56 1 206 3 241 4 78. 8 21. 2 87. 5 12. 5 46. 1 53. 9 Note. Frequencie s no t equalin g 100 % reflec t missin g data Prevalenc e Testin g fo r Researc h Questio n 2 Th e secon d researc h questio n aske d abou t th e prevalenc e o f having : a ) a positiv e scree n fo r depressio n (majo r depressiv e disorde r o r othe r depressiv e disorder) ; b ) a positiv e scree n fo r anxiet y disorder s (generalize d anxiet y disorde r [GAD ] o r pani c disorde r [PD]) ; c ) a positiv e scree n fo r eithe r depressio n o r anxiet y disorders ; an d d ) a positiv e scree n fo r bot h depressio n an d anxiet y disorders Tabl e 5 display s th e percentage s o f participant s wh o ha d a positiv e scree n fo r depressio n and/o r anxiet y disorders I n thi s sampl e o f U.S graduat e students 14.0 % ha d a positiv e scree n fo r depression 9.5 % ha d a positiv e scree n fo r anxiet y disorders 19.1 % ha d a positiv e scree n fo r eithe r depressio n o r anxiet y disorders an d onl y 4.4 % ha d a positiv e scree n fo r bot h depressio n an d anxiet y disorders 5 1

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Tabl e 5 Prevalence of Positive Screenings for Depression, Anxiety Disorders, Either Depression or Anxiety Disorders, and Both Depression and Anxiety Disorders (n = 4,477) n % Depressio n O R Anxiet y Disorder s Doe s No t Hav e Depressio n o r Anxiet y 362 3 Doe s Hav e Depressio n o r Anxiet y 85 4 Depressio n (Majo r o r Othe r Depressiv e Disorders ) Doe s No t Hav e Depressio n 385 2 Doe s Hav e Depressio n 62 5 Anxiet y Disorder s (P D o r GAD ) Doe s No t Hav e Anxiet y 405 3 Doe s Hav e Anxiet y 42 4 Depressio n AN D Anxiet y Disorder s Doe s No t Hav e Bot h Depressio n an d Anxiet y 428 2 Doe s Hav e Bot h Depressio n an d Anxiet y 19 5 Note. Frequencie s no t equalin g 100 % reflec t missin g data Hypothesi s Testin g fo r Hypothesi s 1 I n additio n t o th e prevalenc e testin g conducte d t o addres s th e researc h questions th e curren t stud y als o teste d tw o hypotheses Th e firs t hypothesi s examine d th e relationship s betwee n demographi c factors socia l factors an d lifestyl e an d health-relate d behavior s an d a positiv e scree n fo r depression anxiet y disorders eithe r depressio n o r anxiet y disorders an d bot h depressio n an d anxiet y disorders A s previousl y discussed becaus e o f th e larg e sampl e siz e i n th e curren t study a relationshi p wit h a p valu e o f .0 1 t o .0 5 o r tha t ha d percentag e difference s o f 5 % o r greate r wer e considere d t o b e statisticall y significant bu t non-meaningfu l relationships 5 2 80. 9 19. 1 86. 0 14. 0 90. 5 9. 5 95. 6 4. 4

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Positiv e scree n fo r depression A serie s o f cross-tabulation s wit h Pearso n ch i squar e analyse s wer e conducte d t o examin e th e relationshi p betwee n demographic social lifestyl e an d health-relate d factor s an d havin g a positiv e scree n fo r depression whic h include d majo r depressio n o r othe r depressiv e disorders A s show n i n Tabl e 6 havin g a positiv e scree n fo r depressio n ha d a significan t relationshi p wit h race/ethnicity X 2 (1 ) = 37.96,/ ? < .001 Cramer's V = .092 O f thos e wh o wer e Caucasian a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r depressio n (67.8% ) tha n thos e wh o ha d a positiv e scree n (55.2%) O f thos e wh o wer e fro m a differen t racial/ethni c grou p tha n Caucasian a greate r proportio n o f participant s ha d a positiv e scree n fo r depressio n (44.8% ) tha n thos e wh o di d no t hav e a positiv e scree n (32.2%) Havin g a positiv e scree n fo r depressio n als o ha d a significan t relationshi p wit h nationalit y X 2 (1 ) = 22.99,/ ? < .001 Cramer's V= .07 2 (se e Tabl e 6) O f thos e wh o wer e U.S citizens a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r depressio n (82.9%) compare d t o thos e wh o di d hav e a positiv e scree n (74.9%) O f thos e wh o wer e internationa l students a greate r proportio n o f participant s ha d a positiv e scree n fo r depressio n (25.1%) compare d t o thos e wh o di d no t hav e a positiv e scree n (17.1%) I n additio n t o th e significan t findings havin g a positiv e scree n fo r depressio n ha d a non meaningfu l significan t relationshi p wit h sexua l orientation X (1 ) = 10.64 p = .001 Cramer's V= .049 Finally havin g a positiv e scree n fo r depressio n di d not hav e a significan t relationshi p wit h age gender o r schoo l region 5 3

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Tabl e 6 Prevalence and Chi Square Analyses of Demographic Factors by Positive Screen for Depression (n = 4,477) Ag e 21-2 5 year s ol d 2 6 year s o r olde r Gende r Femal e Mal e Race/Ethnicit y Caucasia n Othe r Ethni c Grou p Schoo l Regio n Midwes t Northeas t Sout h Wes t Sexua l Orientatio n Heterosexua l Othe r Sexua l Orientatio n Nationalit y Yes U S Citize n No Internationa l Studen t Doe s No t Hav e Depressio n n 166 8 218 4 230 6 154 6 261 1 124 1 64 3 122 5 18 4 180 0 358 7 26 5 319 2 66 0 % 43. 3 56. 7 59. 9 40. 1 67. 8 32. 2 16. 7 31. 8 4. 8 46. 7 93. 1 6. 9 82. 9 17. 1 Doe s Hav e Depressio n n 26 3 36 2 35 2 27 3 34 5 28 0 10 2 17 4 3 5 31 4 55 9 6 6 46 8 15 7 % 42. 1 57. 9 56. 3 43. 7 55. 2 44. 8 16. 3 27. 8 5. 6 50. 2 89. 4 10. 6 74. 9 25. 1 x 2 .3 3 2.8 0 37.9 6 4.9 0 10.6 4 22.9 9 P .56 7 .09 4 .00 0 .18 0 .00 1 .00 0 5 4

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Result s fo r socia l factor s an d depressio n ar e displaye d i n Tabl e 7 Havin g a positiv e scree n fo r depressio n ha d a non-meaningfu l significan t relationshi p wit h curren t financia l situation X 2 (1 ) = 4.35 p = .037 Cramer's V= .037 Havin g a positiv e scree n fo r depressio n di d hav e a significan t relationshi p wit h livin g situation X (1 ) = 10.22 p = .001 Cramer's V = .048 O f thos e wh o live d o n campus a greate r proportio n o f participant s ha d a positiv e scree n fo r depressio n (22.9% ) tha n thos e wh o di d not hav e a positiv e scree n (17.5%) O f thos e wh o live d of f campus a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r depressio n (82.5% ) tha n thos e wh o ha d a positiv e scree n fo r depressio n (77.1%) Additionally havin g a positiv e scree n fo r depressio n ha d a significan t relationshi p wit h relationshi p status X 2 (2 ) = 29.42,/ ? < .001 Cramer's V= .081 O f thos e participant s wh o wer e single divorce d o r widowed a greate r proportio n o f participant s ha d a positiv e scree n fo r depressio n (44.6% ) tha n thos e wh o di d no t (34.0%) O f thos e wh o wer e marrie d o r wer e i n a domesti c partnership a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r depressio n (27.5%) compare d t o thos e wh o di d hav e a positiv e scree n fo r depressio n (20.3%) Lastly havin g a positiv e scree n fo r depressio n ha d a significan t relationshi p wit h financia l problem s growin g up X (1 ) = 18.42 p < .001 Cramer's V = .064 O f thos e wh o di d no t hav e financia l problem s growin g up a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r depressio n (63.8% ) tha n thos e wh o di d (54.9%) O f thos e wh o state d tha t the y ha d financia l problem s growin g up a greate r proportio n o f participant s ha d a positiv e scree n fo r depressio n 5 5

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(45.1%) compare d t o thos e participant s wh o di d not hav e a positiv e scree n fo r depressio n (36.2%) Tabl e 7 Prevalence and Chi Square Analyses of Social Factors and Positive Screen for Depression (n = 4,477) Doe s No t Hav e Doe s Hav e Depressio n Depressio n n % n % x 2 P 10.2 2 .00 1 Livin g Situatio n Liv e o n Campu s Liv e of f Campu s Relationshi p Statu s Single Divorced Widowe d I n a relationshi p Marrie d o r Domesti c Curren t Financia l Situatio n N o Financia l Problem s Financia l Problem s Financia l Situatio n Growin g U p N o Financia l Problem s Ha d Financia l Problem s 67 6 317 6 130 9 148 3 106 0 82 5 302 7 245 9 139 3 17. 5 82. 5 34. 0 38. 5 27. 5 21. 4 78. 6 63. 8 36. 2 14 3 48 2 27 9 21 9 12 7 11 1 51 4 34 3 28 2 22. 9 77. 1 44. 6 35. 0 0. 3 17. 8 82. 2 54. 9 45. 1 29.4 2 .00 0 4.3 5 .03 7 18.4 2 .00 0 5 6

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Result s fo r lifestyl e an d health-relate d behavior s an d depressio n ar e show n i n Tabl e 8 Havin g a positiv e scree n fo r depressio n ha d a non-meaningfu l significan t relationshi p wit h frequenc y o f smokin g behavior frequenc y o f gamblin g behaviors an d us e o f illici t drugs Havin g a positiv e scree n fo r depressio n di d no t hav e a significan t relationshi p wit h engagin g i n bing e drinking X (1 ) = .012 p = .912 Cramer's V= .002 Havin g a positiv e scree n fo r depression however ha d a significan t relationshi p wit h experience d discrimination X 2 (1 ) = 35.27 p < .001 Cramer's V = .089 O f thos e wh o ha d no t experience d discrimination a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r depressio n (72.6%) compare d t o thos e wh o di d hav e a positiv e scree n (61.0%) O f thos e wh o ha d experience d discriminatio n on e o r mor e time s durin g th e pas t year a greate r proportio n o f participant s ha d a positiv e scree n fo r depressio n (39.0%) compare d t o thos e wh o di d no t hav e a positiv e scree n (27.4%) Lastly havin g a positiv e scree n fo r depressio n ha d a significan t relationshi p wit h frequenc y o f exercise X (1 ) = 36.67 p< .001 Cramer's V= .091 O f thos e wh o exercise d les s tha n thre e time s pe r week a greate r proportio n o f participant s ha d a positiv e scree n fo r depressio n (57.3%) compare d t o thos e wh o di d no t (44.3%) O f thos e wh o exercise d thre e o r mor e time s pe r week a greate r proportio n o f participant s di d not hav e a positiv e scree n fo r depressio n (55.7% ) tha n thos e wh o ha d a positiv e scree n fo r depressio n (42.7%) 5 7

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Tabl e 8 Prevalence and Chi Square Analyses of Lifestyle and Health-Related Behaviors by Positive Screen for Depression (n = 4,477) Does No t Hav e Doe s Hav e Depressio n Depressio n n % n % % p_ Experience d 35.2 7 .00 0 Discriminatio n Neve r 279 6 72. 6 On e o r Mor e Time s 105 6 27. 4 Smokin g Tobacc o 11.4 7 .00 1 Non-Smoke r 341 8 88. 7 Smoke r 43 4 11. 3 38 1 24 4 52 5 10 0 37 4 25 1 51 6 10 9 61. 0 39. 0 84. 0 16. 0 59. 8 40. 2 82. 6 17. 4 Bing e Drinkin g .0 1 .91 2 Non e 229 6 59. 6 On e o r Mor e Time s 155 6 40. 4 Gamblin g 6.0 0 .01 4 N o Gamblin g 301 4 78. 2 Gamblin g On e Day 83 8 21. 8 o r Mor e Illici t Dru g Usag e o f 8.7 3 .00 3 An y Typ e N o Illici t Dru g Us e 339 2 88. 1 52 4 83. 8 Use d An y Typ e o f 46 0 11. 9 10 1 16. 2 Illici t Drug s Amount o f Exercis e 36.6 7 .00 0 Les s tha n 3 Time s 170 5 44. 3 35 8 57. 3 pe r Wee k Thre e o r Mor e 214 7 55. 7 26 7 42. 7 Time s pe r Wee k 5 8

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Positiv e scree n fo r anxiet y disorders A serie s o f cross-tabulation s wit h Pearso n ch i squar e analyse s wer e conducte d t o examin e th e relationshi p betwee n demographic social lifestyl e an d health-relate d factor s an d havin g a positiv e scree n fo r anxiet y disorders Result s fo r demographi c factor s an d anxiet y disorder s ar e show n i n Tabl e 9 Havin g a positiv e scree n fo r anxiet y disorder s ha d a significan t relationshi p wit h gender X 2 (1 ) = 43.24 p < .001 Cramer's V = .098 O f thos e wh o wer e females a greate r proportio n o f participant s ha d a positiv e scree n fo r anxiet y (74.3% ) tha n di d no t hav e a positiv e scree n fo r anxiet y disorder s (57.8%) O f thos e wh o wer e male a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r anxiet y disorder s (42.2% ) tha n di d hav e a positiv e scree n fo r anxiet y disorder s (25.7%) I n addition havin g a positiv e scree n fo r anxiet y disorder s ha d a significan t relationshi p wit h sexua l orientation X 2 (1 ) = 19.53 p < .001 Cramer's V= .066 O f thos e wh o wer e heterosexual a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r anxiet y (93.2% ) tha n di d hav e a positiv e scree n (87.3%) O f thos e wh o wer e not heterosexual a greate r proportio n o f participant s ha d a positiv e scree n fo r anxiet y disorder s (12.7%) compare d t o participant s wh o di d not hav e a positiv e scree n (6.8%) Havin g a positiv e scree n fo r anxiet y ha d a significan t relationshi p wit h nationality X (1 ) = 25.72 p < .001 Cramer's V = .076 O f thos e wh o wer e U.S citizens a greate r proportio n o f participant s ha d a positiv e scree n fo r anxiet y disorder s (90.8% ) tha n participant s wh o di d no t hav e a positiv e scree n (80.8%) O f thos e wh o wer e internationa l students a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r anxiet y disorder s (19.2% ) tha n thos e 5 9

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wh o di d (9.2%) Finally havin g a positiv e scree n fo r anxiet y disorder s di d no t hav e a significan t relationshi p wit h age race/ethnicity o r schoo l region Tabl e 9 Prevalence and Chi Square Analyses of Demographic Factors by Positive Screen for Anxiety Disorders (n = 4,477) Ag e 21-2 5 year s ol d 2 6 year s o r olde r Gende r Femal e Mal e Race/Ethnicit y Caucasia n Othe r Ethni c Grou p Schoo l Regio n Midwes t Northeas t Sout h Wes t Sexua l Orientatio n Heterosexua l Othe r Sexua l Orientatio n Nationalit y Yes U S Citize n No Internationa l Studen t Does No t Hav e Anxiet y n 176 4 228 9 234 3 171 0 265 9 139 4 68 0 125 9 20 2 191 2 377 6 27 7 327 5 77 8 Disorder s % 43. 5 56. 5 57. 8 42. 2 65. 6 34. 4 16. 8 31. 1 5. 0 47. 2 93. 2 6. 8 80. 8 19. 2 Doe s Hav e Anxiet y n 16 7 25 7 31 5 10 9 29 7 12 7 6 5 14 0 1 7 20 2 37 0 5 4 38 5 3 9 Disorder s % 39. 4 60. 6 74. 3 25. 7 70. 0 30. 0 15. 3 33. 0 4. 0 47. 6 87. 3 12. 7 90. 8 9. 2 x 2 2.6 8 43.2 4 3.3 8 1.7 2 19.5 3 25.7 2 P .10 2 .00 0 .06 6 .63 3 .00 0 .00 0 6 0

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Result s fo r socia l factor s an d anxiet y disorder s ar e displaye d i n Tabl e 10 Havin g a positiv e scree n fo r anxiet y disorder s ha d a significan t relationshi p wit h curren t financia l situation X (1 ) = 7.38 p = .007 Cramer's V= .041 O f thos e wh o ha d n o curren t financia l problems a greate r proportio n o f participant s di d not hav e a positiv e scree n fo r anxiet y disorder s (21.4%) compare d t o participant s wh o di d hav e a positiv e scree n fo r anxiet y disorder s (15.8%) O f thos e wh o reporte d curren t financia l problems a greate r proportio n o f participant s ha d a positiv e scree n fo r anxiet y disorder s (84.2% ) tha n participant s wh o di d not hav e a positiv e scree n (78.6%) However havin g a positiv e scree n fo r anxiet y disorder s ha d onl y a non-meaningfu l significan t relationshi p wit h financia l situatio n growin g u p an d relationshi p status Havin g a positiv e scree n fo r anxiet y disorder s di d no t hav e significan t relationshi p wit h livin g situation. Result s fo r lifestyl e an d health-relate d behavior s an d anxiet y disorder s ar e show n i n Tabl e 11 Havin g a positiv e scree n fo r anxiet y disorder s ha d a significan t relationshi p wit h frequenc y o f smokin g behaviors X 2 (1 ) = 14.80 p < .001 Cramer's V= .057 O f thos e wh o wer e non-smokers a greate r proportio n o f participant s di d not hav e a positiv e scree n fo r anxiet y disorder s (88.7% ) tha n di d hav e a positiv e scree n (82.3%) O f thos e wh o wer e smokers a greate r proportio n o f participant s ha d a positiv e scree n fo r anxiet y disorder s (17.7%) compare d t o thos e wh o di d not hav e a positiv e scree n (11.3%) 6 1

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Tabl e 1 0 Prevalence and Chi Square Analyses of Social Factors by Positive Screen for Anxiety Disorders (n = 4,477) Doe s No t Hav e Doe s Hav e Anxiet y Disorder s Anxiet y Disorder s n % n % £ Livin g Situatio n Liv e o n Campu s Liv e of f Campu s Relationshi p Statu s Single Divorced Widowe d I n a relationshi p Marrie d o r Domesti c Curren t Financia l Situatio n N o Financia l Problem s Financia l Problem s Financia l Situatio n Growin g U p N o Financia l Problem s Ha d Financia l Problem s 75 4 329 9 143 1 152 5 109 7 86 9 318 4 256 0 149 3 18. 6 81. 4 35. 3 37. 6 27. 1 21. 4 78. 6 63. 2 36. 8 6 5 35 9 15 7 17 7 9 0 6 7 35 7 24 2 18 2 15. 3 84. 7 37. 0 41. 7 21. 2 15. 8 84. 2 57. 1 42. 9 2.7 5 6.9 7 7.3 8 6.0 8 .09 7 .03 1 .00 7 .01 4 6 2

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Tabl e 1 1 Prevalence and Chi Square Analyses of Lifestyle and Health-Related Behaviors by Positive Screen for Anxiety Disorders (n = 4,477) Experience d Discriminatio n Neve r On e o r Mor e Time s Smokin g Tobacc o Non-Smoke r Smoke r Bing e Drinkin g Non e On e o r Mor e Time s Gamblin g N o Gamblin g Gamblin g On e Day o r Mor e Does No t Hav e Anxiet y Disorder s n 289 2 116 1 359 4 45 9 243 1 162 2 316 6 88 7 % 71. 4 28. 6 88. 7 11. 3 60. 0 40. 0 78. 1 21. 9 Doe s Hav e Anxiet y Disorder s n 28 5 13 9 34 9 7 5 23 9 18 5 36 4 6 0 % 67. 2 32. 8 82. 3 17. 7 56. 4 43. 6 85. 8 14. 2 i N o Illici t Dru g Us e Use d An y Illici t Drug s Amoun t o f Exercis e Les s Tha n 3 Times/Wee k Thre e o r Mor e pe r Wee k 356 4 48 9 183 1 222 2 87. 9 12. 1 45. 2 54. 8 35 2 7 2 23 2 19 2 83. 0 17. 0 54. 7 45. 3 3.1 9 .07 4 14.8 0 .00 0 2.0 8 .14 9 13.7 7 .00 0 Illici t Dru g Usag e o f An y 8.4 6 .00 4 Typ e 14.0 6 .00 0 6 3

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Havin g a positiv e scree n fo r anxiet y disorder s ha d a significan t relationshi p wit h frequenc y o f gamblin g behavior X (1 ) = 13.77 p < .001 Cramer's V= .055 O f thos e wh o di d not gamble a greate r proportio n o f participant s ha d a positiv e scree n fo r anxiet y disorder s (85.8%) compare d t o thos e wh o di d not hav e a positiv e scree n (78.1%) O f thos e wh o gamble d a t leas t on e day a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r anxiet y disorder s (21.9% ) tha n thos e wh o di d (14.2%) Furthermore havin g a positiv e scree n fo r anxiet y disorder s ha d a significan t relationshi p wit h us e o f illici t drugs X 2 (1 ) = 8.46 p = .004 Cramer's V .043 O f thos e wh o di d not us e illici t drugs a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r anxiet y disorder s (87.9% ) tha n thos e wh o ha d a positiv e scree n fo r anxiet y (83.0%) O f thos e wh o use d illici t drugs a greate r proportio n o f participant s ha d a positiv e scree n fo r anxiet y disorder s (17.0% ) tha n thos e wh o di d no t hav e a positiv e scree n (12.1%) Havin g a positiv e scree n fo r anxiet y disorder s ha d a significan t relationshi p wit h amoun t o f exercise X 2 (1 ) = 14.06 p < .001 Cramer's V = .056 O f thos e wh o exercise d les s tha n thre e day s pe r week a greate r proportio n o f participant s ha d a positiv e scree n fo r anxiet y disorder s (54.7% ) tha n di d no t hav e a positiv e scree n fo r anxiet y disorder s (45.2%) O f thos e wh o exercise d thre e o r mor e day s pe r week a greate r proportio n o f participant s di d not hav e a positiv e scree n fo r anxiet y disorder s (54.8% ) tha n thos e wh o di d hav e a positiv e scree n fo r anxiet y disorder s (45.3%) Havin g a positiv e scree n fo r anxiet y disorder s di d no t hav e a significan t relationshi p wit h discriminatio n o r bing e drinking 6 4

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Positiv e scree n fo r depressio n o r anxiet y disorders A serie s o f cross tabulation s wit h Pearso n ch i squar e analyse s wer e conducte d t o examin e th e relationshi p betwee n demographic social lifestyl e an d health-relate d factor s an d havin g a positiv e scree n fo r depressio n o r anxiet y disorders Result s fo r demographi c factor s an d depressio n o r anxiet y disorder s ar e show n i n Tabl e 12 Havin g a positiv e scree n fo r depressio n o r anxiet y disorder s ha d a non-meaningfu l relationshi p wit h gende r an d sexua l orientation Havin g a positiv e scree n fo r depressio n o r anxiet y disorders however ha d a significan t relationshi p wit h race/ethnicity X 2 (1 ) = 10.25 p < .001 Cramer's V= .048 O f thos e wh o wer e no t Caucasia n (Othe r racial/ethni c group) a greate r proportio n o f participant s ha d a positiv e scree n fo r depressio n o r anxiet y disorder s (38.6% ) tha n thos e wh o di d no t hav e a positiv e scree n (32.9%) Havin g a positiv e scree n fo r depressio n o r anxiet y disorder s di d no t hav e a significan t relationshi p wit h age schoo l region o r nationality Result s fo r socia l factor s an d depressio n o r anxiet y disorder s i s displaye d i n Tabl e 13 Havin g a positiv e scree n fo r depressio n o r anxiet y disorder s ha d a significan t relationshi p wit h relationshi p status X 2 (1 ) = 28.38 p < .001 Cramer's V= .080 O f thos e wh o wer e single divorce d o r widowed a greate r proportio n o f participant s ha d a positiv e scree n fo r eithe r depressio n o r anxiet y disorder s (42.2%) compare d t o thos e wh o di d not hav e a positiv e scree n (33.9%) O f thos e wh o wer e marrie d o r wer e i n a domesti c relationship a greate r proportio n o f participant s di d not hav e a positiv e scree n fo r eithe r depressio n o r anxiet y disorder s (28.0% ) tha n thos e wh o ha d a positiv e scree n (20.4%) 6 5

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Additionally havin g a positiv e scree n fo r depressio n o r anxiet y disorder s ha d a significan t relationshi p wit h financia l problem s growin g up X 2 (1 ) = 19.03,/ ? < .001 Cramer's V = .065 O f thos e wh o state d tha t the y di d no t hav e financia l problem s growin g up a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r eithe r depressio n o r anxiet y disorder s (64.1% ) tha n thos e wh o di d hav e a positiv e scree n (56.1%) O f thos e wh o ha d financia l problem s growin g up a greate r proportio n o f participant s ha d a positiv e scree n fo r eithe r depressio n o r anxiet y disorder s (43.9% ) tha n thos e wh o di d not hav e a positiv e scree n (35.9%) However havin g a positiv e scree n fo r depressio n o r anxiet y disorder s ha d onl y a non-meaningfu l relationshi p wit h curren t financia l situation X 2 (1 ) = 8.71 / ? = .003 Cramer's V = .044 A positiv e scree n fo r depressio n o r anxiet y disorder s wa s no t significantl y relate d wit h livin g situation. 6 6

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Tabl e 1 2 Prevalence and Chi Square Analyses of Demographic Factors by Positive Screen for Depression or Anxiety Disorders (n = 4,477) Ag e 21-2 5 year s ol d 2 6 year s o r olde r Gende r Femal e Mal e Race/Ethnicit y Caucasia n Othe r Ethni c Grou p Schoo l Regio n Midwes t Northeas t Sout h Wes t Sexua l Orientatio n Heterosexua l Othe r Orientatio n Nationalit y Yes U S Citize n No Internationa l Doe s No t Hav e Depressio n o r Anxiet y n 157 4 204 9 212 0 150 3 243 2 119 1 60 6 114 3 17 7 169 7 338 4 23 9 297 0 65 3 % 43 A 56. 6 58. 5 41. 5 67. 1 32. 9 16. 7 31. 5 4. 9 46. 8 93. 4 6. 6 82. 0 18. 0 Doe s Hav e Depressio n o r Anxiet y n 35 7 49 7 53 8 31 6 52 4 33 0 13 9 25 6 4 2 41 7 76 2 9 2 69 0 16 4 % 41. 8 58. 2 63. 0 37. 0 61. 4 38. 6 16. 3 30. 0 4. 9 48. 8 89. 2 10. 8 80. 8 19. 2 i .7 6 5.7 6 10.2 5 1.2 1 17.6 0 .6 5 P .38 4 .01 6 .00 1 .75 0 .00 0 .42 2 6 7

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Tabl e 1 3 Prevalence and Chi Square Analyses of Social Factors by Positive Screen for Depression or Anxiety Disorders (n = 4,477) Livin g Situatio n Liv e o n Campu s Liv e of f Campu s Relationshi p Statu s Single Divorced Widowe d I n a relationshi p Marrie d o r Domesti c Curren t Financia l Situatio n N o Financia l Problem s Financia l Problem s Financia l Situatio n Growin g U p N o Financia l Problem s Ha d Financia l Problem s Doe s No t Hav e Depressio n o r Anxiet y Disorder s n 64 7 297 6 122 8 138 2 101 3 78 9 283 4 232 3 130 0 % 17. 9 82. 1 33. 9 38. 1 28. 0 21. 8 78. 2 64. 1 35. 9 Doe s Hav e Depressio n o r Anxiet y n 17 2 68 2 36 0 32 0 17 4 14 7 70 7 47 9 37 5 Disorder s % 20. 1 79. 9 42. 2 37. 5 20. 4 17. 2 82. 8 56. 1 43. 9 x 2 2.4 1 28.3 8 8.7 1 19.0 3 P .12 1 .00 0 .00 3 .00 0 6 8

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Result s fo r lifestyl e an d health-relate d behavior s an d a positiv e scree n fo r eithe r depressio n o r anxiet y disorder s ar e show n i n Tabl e 14 Havin g a positiv e scree n fo r eithe r depressio n o r anxiet y disorder s ha d a significan t relationshi p wit h experience d discrimination X (1 ) = 26.15 p< .001 Cramer's V= .076 O f thos e wh o state d tha t the y ha d neve r experience d discrimination a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r depressio n o r anxiet y disorder s (72.6% ) tha n di d (63.8%) O f thos e wh o state d tha t the y ha d experience d discriminatio n on e o r mor e times a greate r proportio n o f participant s ha d a positiv e scree n fo r eithe r depressio n o r anxiet y disorder s (36.2% ) tha n di d not hav e a positiv e scree n (27.4%) Havin g a positiv e scree n fo r depressio n o r anxiet y disorder s ha d a significan t relationshi p wit h frequenc y o f smokin g behaviors X 1 (1 ) = 30.61 p < .001 Cramer's V= .083 O f thos e wh o wer e non-smokers a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r eithe r depressio n o r anxiet y disorder s (89.4% ) tha n thos e wh o di d hav e a positiv e scree n (82.6%) O f thos e wh o wer e smokers a greate r proportio n o f participant s ha d a positiv e scree n fo r eithe r depressio n o r anxiet y disorder s (17.4% ) tha n thos e wh o di d not hav e a positiv e scree n (10.6%) I n addition havin g a positiv e scree n fo r depressio n o r anxiet y disorder s ha d a significan t relationshi p wit h frequenc y o f gamblin g behaviors X (1 ) = 10.41 p = .001 Cramer's V = .04 8 (se e Tabl e 14) O f thos e wh o gamble d on e o r mor e days a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r depressio n o r anxiet y disorder s (22.1% ) tha n thos e wh o di d hav e a positiv e scree n (17.1%) Also havin g a 6 9

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positiv e scree n fo r depressio n o r anxiet y disorder s ha d a significan t relationshi p wit h amoun t o f exercise X (1 ) = 42.55 p < .001 Cramer's V = .097 O f thos e wh o exercise d les s tha n thre e day s pe r week a greate r proportio n o f participant s ha d a positiv e scree n fo r depressio n o r anxiet y disorder s (56.1% ) tha n thos e wh o di d not hav e a positiv e scree n (43.7%) O f thos e wh o exercise d thre e o r mor e day s pe r week a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r depressio n o r anxiet y disorder s (56.3% ) tha n thos e wh o ha d a positiv e scree n (43.9%) A s als o see n i n Tabl e 14 havin g a positiv e scree n fo r depressio n o r anxiet y disorder s ha d a non-meaningfu l significan t relationshi p wit h us e o f illici t drugs X 2 (1 ) = 10.34,/ ? = .001 Cramer's V= .048 Lastly havin g a positiv e scree n fo r depressio n o r anxiet y disorder s di d not hav e significan t relationshi p wit h engagin g i n bing e drinking 7 0

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Tabl e 1 4 Prevalence and Chi Square Analyses of Lifestyle and Health-Related Behaviors by Positive Screen for Either Depression or Anxiety Disorders (n = 4,477) Experience d Discriminatio n Neve r On e o r Mor e Time s Smokin g Tobacc o Non-Smoke r Smoke r Bing e Drinkin g Non e On e o r Mor e Time s Gamblin g N o Gamblin g Gamblin g On e Da y o r Mor e Illici t Dru g Us e o f An y Typ e N o Illici t Dru g Us e Use d Illici t Drug s Amoun t o f Exercis e Les s Tha n 3 Times/Wee k Thre e o r More/Wee k Doe s No t Hav e Depressio n o r Anxiet y Disorder s n 263 2 99 1 323 8 38 5 217 6 144 7 282 2 80 1 319 7 42 6 158 4 203 9 % 72. 6 27. 4 89. 4 10. 6 60. 1 39. 9 77. 9 22. 1 88. 2 11. 8 43. 7 56. 3 Doe s Hav e Depressio n o r Anxiet y Disorder s n 54 5 30 9 70 5 14 9 49 4 36 0 70 8 14 6 71 9 13 5 47 9 37 5 % 63. 8 36. 2 82. 6 17. 4 57. 8 42. 2 82. 9 17. 1 84. 2 15. 8 56. 1 43. 9 1 26.1 5 .00 0 30.6 1 .00 0 1.4 1 .23 5 10.4 1 .00 1 10.3 4 .00 1 42.5 5 .00 0 7 1

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Positiv e scree n fo r depressio n an d anxiet y disorders A serie s o f cross tabulation s wit h Pearso n ch i squar e analyse s wer e conducte d t o examin e th e relationshi p betwee n demographic social lifestyl e an d health-relate d factor s an d havin g a positiv e scree n fo r bot h depressio n an d anxiet y disorders Result s fo r demographi c factor s an d a positiv e scree n fo r bot h depressio n an d anxiet y disorder s ar e show n i n Tabl e 15 Havin g a positiv e scree n fo r bot h depressio n an d anxiet y disorder s ha d a significan t relationshi p wit h sexua l orientation X 2 (1 ) = 14.45 p < .001 Cramer's V= .057 O f thos e wh o wer e heterosexual a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r bot h depressio n an d anxiet y disorder s (92.9%) compare d t o thos e wh o ha d a positiv e scree n fo r bot h disorder s (85.6%) O f thos e wh o wer e not heterosexual a greate r proportio n o f participant s ha d a positiv e scree n fo r bot h depressio n an d anxiet y disorder s (14.4% ) tha n di d no t hav e a positiv e scree n fo r bot h depressio n an d anxiet y (7.1%) Havin g a positiv e scree n fo r bot h depressio n an d anxiet y disorders however ha d a non-meaningfu l significan t relationshi p wit h gender X (1 ) = 3.89 p = .049 Cramer's V= .029 Havin g a positiv e scree n fo r bot h depressio n an d anxiet y disorder s di d no t hav e a significan t relationshi p wit h age race/ethnicity schoo l region o r nationality Result s fo r socia l factor s an d a positiv e scree n fo r depressio n an d anxiet y disorder s ar e displaye d i n Tabl e 16 Havin g a positiv e scree n fo r bot h depressio n an d anxiet y disorder s ha d a non-meaningfu l significan t relationshi p wit h financia l problem s growin g up X 2 (1 ) = 5.89,/ ? = .015 Cramer's V= .036 Also havin g a positiv e scree n 7 2

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fo r bot h depressio n an d anxiet y disorder s di d no t hav e a significan t relationshi p wit h livin g situation relationshi p status o r curren t financia l situation. Tabl e 1 5 Prevalence and Chi Square Analyses of Demographic Factors by Positive Screen for Both Depression and Anxiety Disorders (n = 4,477) Ag e 21-2 5 year s ol d 2 6 year s o r olde r Gende r Femal e Mal e Race/Ethnicit y Caucasia n Othe r Ethni c Grou p Schoo l Regio n Midwes t Northeas t Sout h Wes t Sexua l Orientatio n Heterosexua l Othe r Sexua l Orientatio n Nationalit y U S Citize n Internationa l Studen t Does No t Hav e Depressio n an d Anxiet y n % 185 8 242 4 252 9 175 3 283 8 144 4 71 7 134 1 20 9 201 5 397 9 30 3 349 7 78 5 43. 4 56. 6 59. 1 40. 9 66. 3 33. 7 16. 7 31. 3 4. 9 47. 1 92. 9 7. 1 81. 7 18. 3 Doe s Hav e Depressio n an d Anxiet y n % 7 3 12 2 12 9 6 6 11 8 7 7 2 8 5 8 1 0 9 9 16 7 2 8 16 3 3 2 37. 4 62. 6 66. 2 33. 8 60. 5 39. 5 14. 4 29. 7 5. 1 50. 8 85. 6 14. 4 83. 6 16. 4 x 2 2.7 0 3.8 9 2.7 6 1.3 5 14.4 5 .4 6 P .10 1 .04 9 .09 6 .71 7 .00 0 .49 7 7 3

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Tabl e 1 6 Prevalence and Chi Square Analyses of Social Factors by Positive Screen for Both Depression and Anxiety Disorders (n = 4,477) Livin g Situatio n Liv e o n Campu s Liv e of f Campu s Relationshi p Statu s Single Divorced Widowe d I n a relationshi p Marrie d o r Domesti c Curren t Financia l Situatio n N o Financia l Problem s Financia l Problem s Financia l Situatio n Growin g U p N o Financia l Problem s Ha d Financia l Problem s Doe s No t Hav e Depres s io n an d Anxiet y n 78 3 349 9 151 2 162 6 114 4 90 5 337 7 269 6 158 6 % 18. 3 81. 7 35. 3 38. 0 26. 7 21. 1 78. 9 63. 0 37. 0 Doe s Hav e Depres s io n an d Anxiet y n 3 6 15 9 7 6 7 6 4 3 3 1 16 4 10 6 8 9 % 18. 5 81. 5 39. 0 39. 0 22. 1 15. 9 84. 1 54. 4 45. 6 x 2 .0 0 2.2 9 3.0 9 5.8 9 P .95 1 .31 9 .07 9 .01 5 7 4

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Result s fo r lifestyl e an d health-relate d behavior s an d a positiv e scree n fo r depressio n an d anxiet y disorder s ar e show n i n Tabl e 17 Havin g a positiv e scree n fo r bot h depressio n an d anxiet y disorder s ha d a significan t relationshi p wit h experience d discrimination X (1 ) = 7.86 p = .005 Cramer's V = .042 O f thos e wh o ha d neve r experience d discrimination a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r bot h depressio n an d anxiet y disorder s (71.4% ) tha n thos e wh o ha d a positiv e scree n fo r bot h disorder s (62.1%) O f thos e wh o experience d discriminatio n on e o r mor e times a greate r proportio n o f participant s ha d a positiv e scree n fo r bot h depressio n an d anxiet y disorder s (37.9% ) tha n thos e wh o di d no t hav e a positiv e scree n (28.6%) Havin g a positiv e scree n fo r bot h depressio n an d anxiet y disorder s ha d a significan t relationshi p wit h frequenc y o f gamblin g behaviors X 2 (1 ) = 10.70 p = .001 Cramer's V = .049 O f thos e wh o di d no t gamble a greate r proportio n o f participant s ha d a positiv e scree n fo r bot h depressio n an d anxiet y disorder s (88.2% ) tha n thos e wh o di d not hav e a positiv e scree n fo r bot h disorder s (78.4%) O f thos e wh o ha d gamble d a t leas t once a greate r proportio n o f participant s di d not hav e a positiv e scree n fo r bot h depressio n an d anxiet y disorder s (21.6% ) tha n thos e wh o ha d a positiv e scree n fo r bot h disorder s (11.8%) Additionally a positiv e scree n fo r bot h depressio n an d anxiet y disorder s ha d a significan t relationshi p wit h illici t dru g usc,X 2 (1 ) = 9.00, p = .003 Cramer's V= .045 O f thos e wh o di d no t us e illici t drugs a greate r proportio n o f participant s di d no t hav e a positiv e scree n fo r bot h depressio n an d anxiet y disorder s (87.8%) compare d t o thos e wh o ha d a positiv e scree n fo r bot h disorder s (80.5%) O f thos e wh o use d illici t drugs a greate r 7 5

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proportio n o f participant s ha d a positiv e scree n fo r bot h depressio n an d anxiet y disorder s (19.5% ) tha n thos e wh o di d no t hav e a positiv e scree n fo r bot h disorder s (12.2%) Furthermore a s show n i n Tabl e 17 havin g a positiv e scree n fo r bot h depressio n an d anxiet y disorder s ha d a significan t relationshi p wit h amoun t o f exercise X (1 ) = 9.65 p .002 Cramer's V = .046 O f thos e wh o exercise d les s tha n thre e day s a week a greate r proportio n o f participant s ha d a positiv e scree n fo r bot h depressio n an d anxiet y disorder s (56.9% ) tha n thos e wh o di d no t hav e a positiv e scree n fo r bot h disorder s (45.6%) O f thos e wh o exercise d thre e o r mor e day s pe r week a greate r proportio n o f participant s di d not hav e a positiv e scree n fo r bot h depressio n an d anxiet y disorder s (54.4% ) tha n thos e wh o ha d bot h (43.1%) Finally havin g a positiv e scree n fo r bot h depressio n an d anxiet y disorder s di d no t hav e a significan t relationshi p wit h smokin g behavio r o r bing e drinking 7 6

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Tabl e 1 7 Prevalence and Chi Square Analyses of Lifestyle and Health-Related Behaviors by Positive Screen for Depression and Anxiety Disorders (n = 4,477) Doe s No t Hav e Depressio n an d Anxiet y n % Doe s Hav e Depressio n an d Anxiet y n % X Experience d Discriminatio n Neve r On e o r Mor e Time s Smokin g Tobacc o Non-Smoke r Smoke r Binge Drinkin g Non e On e o r Mor e Time s Gamblin g N o Gamblin g Gamblin g a t Leas t On e Day o r Mor e 305 6 122 6 377 4 50 8 255 1 173 1 335 8 92 4 71. 4 28. 6 88. 1 11. 9 59. 6 40. 4 78. 4 21. 6 12 1 7 4 16 9 2 6 11 9 7 6 17 2 2 3 62. 1 37. 9 86. 7 13. 3 61. 0 39. 0 88. 2 11. 8 7.8 6 .3 8 .1 6 10.7 0 .00 5 .53 6 .68 6 .00 1 Illici t Dru g Usag e o f An y Typ e N o Illici t Dru g Us e 375 9 87. 8 Use d An y Typ e o f Illici t 52 3 12. 2 Drug s 15 7 3 8 80. 5 19. 5 9.0 0 .00 3 Amount o f Exercis e Les s tha n 3 Time s pe r Wee k 195 2 45. 6 Thre e o r Mor e pe r Wee k 233 0 54. 4 11 1 8 4 56. 9 43. 1 9.6 5 .00 2 7 7

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Hypothesi s Testin g fo r Hypothesi s 2 Th e secon d hypothesi s examine d i f demographi c variables socia l factors o r lifestyl e an d health-relate d behavior s wer e eithe r predictiv e o r protectiv e o f a positiv e screenin g for : a ) depression ; b ) anxiet y disorders ; c ) bot h depressio n an d anxiet y disorders ; an d d ) depressio n o r anxiet y disorders A s wit h th e firs t hypothesis du e t o th e larg e sampl e siz e (N = 4477) onl y significan t finding s wit h Odd s Ratio s les s tha n .8 5 o r greate r tha n 1.3 0 wer e reported I f a findin g wa s significant but th e Odd s Rati o wa s betwee n .8 5 an d 1.30 tha t findin g wa s considere d a statisticall y significant but non meaningfu l result I n addition becaus e o f th e relativel y larg e sampl e size thre e rando m sub-sample s wer e create d an d cross-validation s wer e conducte d t o eithe r validat e o r fai l t o validat e th e mai n logisti c regression s complete d usin g th e ful l dat a set Predictin g positiv e scree n fo r depression A s show n i n Tabl e 18 a multipl e logisti c regressio n analysi s wa s conducte d t o predic t positiv e scree n fo r depressio n fro m demographi c factor s (age gender race/ethnicity nationality sexua l orientation an d schoo l region) Th e overal l mode l predictin g depressio n fro m demographi c factor s wa s significant X 2 (8 ) = 55.85 p < .001 pseudo R 2 = .022 Race/ethnicit y wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n (Odds Ratio = 1.541 p < .001) Participant s wh o wer e not Caucasia n ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depression compare d t o Caucasians Sexua l orientatio n wa s als o a significan t predicto r o f havin g a positiv e scree n fo r depressio n (Odds Ratio 1.642 p = .001) Participant s wh o wer e not heterosexuals compare d t o participant s wh o wer e 7 8

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heterosexuals ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depression Nationalit y wa s a non-meaningfu l significan t predicto r o f havin g a positiv e scree n fo r depressio n {Odds Ratio = 1.267 p = .042) Ther e wer e n o othe r significan t demographi c variabl e predictor s o f havin g a positiv e scree n fo r depression Thes e results however wer e no t validate d b y th e cross-validatio n analyse s (se e Tabl e 19) Tabl e 1 8 Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression from Demographic Factors Odd s 95 % C I B SE Wal d p Rati o Lowe r Uppe r Olde r Age a Males' 3 Othe r Race/Ethnicities c Internationa l Studen t No t Heterosexual 6 Midwest f Northeast 8 South' 1 .0 4 .0 9 .4 3 .2 4 .5 0 -.0 5 -.1 4 .1 2 .0 9 .0 9 .1 0 .1 2 .1 5 .1 2 .1 0 .2 0 .2 1 1.0 3 19.0 1 4.1 3 11.5 1 .1 5 1.9 3 .3 9 .64 8 .31 1 .00 0 .04 2 .00 1 .69 5 .16 5 .53 0 1.0 4 1.0 9 1.5 4 1.2 7 1.6 4 .9 5 .8 7 1.1 3 .8 8 .9 2 1.2 7 1.0 1 1.2 3 .7 5 .7 1 .7 7 1.2 4 1.3 0 1.8 7 1.5 9 2.1 9 1.2 1 1.0 6 1.6 6 Note: a compare d t o younge r age ; b compare d t o females; c compare d t o Caucasians ; d compare d t o U S citizen; e Compare d t o Heterosexual; f compare d t o Wes t region; E compare d t o Wes t region; h Compare d t o Wes t region 7 9

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Tabl e 1 9 Cross-validation of Multiple Logistic Regressions Predicting Positive Screen for Depression from Demographic Factors Olde r Age a Males b Othe r Race/Ethnicities c Internationa l Student d No t Heterosexual 6 Midwest f Northeast 8 South' 1 Rando m Sampl e 1 Odd s Rati o .8 7 .9 4 1.2 8 1.5 0 1.3 3 1.1 3 .9 1 1.4 0 Rando m Sampl e 2 Odd s Rati o .9 6 1.4 4 2.2 6 ** 1.1 8 1.3 2 .8 1 .8 1 1.2 8 Rando m Sampl e 3 Odd s Rati o 1.1 9 1.3 6 1.4 3 1.4 9 2.4 2 * 1.0 9 .9 4 1.1 3 Note: a compare d t o younge r age ; compare d t o females; c compare d t o Caucasians ; compare d t o U S citizen; e Compare d t o Heterosexual; f compare d t o Wes t region; s compare d t o Wes t region; h Compare d t o Wes t region */?<.05 ; **p<. 01; ***p < 001. A separat e multipl e logisti c regressio n wa s conducte d t o predic t a positiv e scree n fo r depressio n fro m socia l factor s (relationshi p status livin g situation curren t financia l problem s an d financia l problem s growin g up) A s show n i n Tabl e 20 th e overal l model predictin g a positiv e scree n fo r depressio n fro m th e socia l factor s wa s significant X (5 ) = 58.89 p < .001 pseudo R 2 = .024 A deepe r examinatio n o f th e result s reveale d tha t bein g single divorce d o r widowe d wa s a significan t predicto r o f havin g a positiv e scree n 8 0

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fo r depressio n (Odds Ratio = 1.769 p < .001) Bein g single widowed o r divorced compare d t o bein g marrie d o r i n a domesti c relationship ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depression Financia l problem s growin g u p wa s als o a significan t predicto r o f positiv e scree n fo r depressio n (Odds Ratio = 1.457 p < .001) Participant s wh o ha d financia l problem s growin g up compare d t o thos e wh o di d not hav e financia l problem s growin g up ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depression Livin g situatio n wa s anothe r significan t predicto r o f positiv e scree n fo r depressio n (Odds Ratio = .748 p = .006) Thos e wh o live d of f campus compare d t o thos e wh o live d o n campus ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r depression Ther e wer e n o othe r significan t predictor s i n thi s model A s show n i n Tabl e 21 th e cross-validatio n analyse s validate d th e finding s tha t bein g single divorce d o r widowe d an d havin g financia l problem s growin g u p wer e predictor s o f havin g a positiv e scree n fo r depression 8 1

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Tabl e 2 0 Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression from Social Factors Livin g Of f Campus 3 Single Divorced o r Widowed I n Relationship 0 Curren t Financia l Problems' 1 Financia l Problem s Growin g Up e B -.29 .5 7 .2 2 .1 9 .3 8 SE .1 1 .1 2 .1 2 .1 1 .0 9 Wal d 7.4 7 24.0 4 3.4 1 2.8 1 17.8 7 P .00 6 .00 0 .06 5 .09 4 .00 0 Odd s Rati o .7 5 1.7 7 1.2 5 1.2 1 1.4 6 95 % C I Lowe r Uppe r .6 1 .9 2 1.4 1 2.2 2 .9 9 1.5 8 .9 7 1.5 2 1.2 2 1.7 4 Note: a compare d t o livin g o n campus; b compare d t o marrie d o r i n domesti c partnership; c compare d t o marrie d o r i n domesti c partnership; d compare d t o n o curren t financia l problems; e compare d t o n o financial problem s growin g up Tabl e 2 1 Cross-validation of Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression from Social Factors Livin g Of f Campus a Single Divorced o r Widowe d I n Relationship 0 Curren t Financia l Problems' 1 Financia l Problem s Growin g Up e Rando m Sampl e 1 Odd s Rati o .7 1 1.6 6 1.3 3 1.3 2 1.5 4 * Rando m Sampl e 2 Odd s Rati o .6 8 1.9 0 * 1.4 9 1.1 1 1.2 8 Rando m Sampl e 3 Odd s Rati o .9 0 1.3 6 .8 5 1.0 8 1.6 4 * Note: a compare d t o livin g o n campus ; b compare d t o marrie d o r i n domesti c relationship; c compare d t o marrie d o r i n domesti c relationship; d compare d t o n o curren t financia l problems; e compare d t o n o financial problem s growin g up */?<.05 ; **/?<.01 ; *** p < 001 8 2

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A s show n i n Tabl e 22 a multipl e logisti c regressio n wa s conducte d t o predic t positiv e scree n fo r depressio n fro m lifestyl e an d health-relate d factor s (experience d discrimination frequenc y o f smoking engagin g i n bing e drinking usin g illici t drugs frequenc y o f gambling an d amoun t o f exercise) Th e overal l mode l predictin g a positiv e scree n fo r depressio n wa s significant X (6 ) = 89.99 p < .001 pseudo R = .036 Experiencin g discriminatio n wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n {Odds Ratio = 1.67 p < .001) Participant s wh o hav e experience d discrimination compare d t o thos e wh o hav e not experience d discrimination ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depression Frequenc y o f gamblin g behavio r wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n {Odds Ratio = .732 p = .007) Thos e wh o gamble d a t leas t on e tim e ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r depression compare d t o thos e wh o di d not gamble Usin g illici t drug s wa s als o a significan t predicto r o f havin g a positiv e scree n fo r depression Participant s wh o use d illici t drugs compare d t o thos e wh o di d not us e illici t drugs ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depressio n {Odds Ratio = 1.433 p = .005) Amoun t o f exercis e wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n {Odds Ratio = .609 p < .001) Thos e wh o exercise d thre e o r mor e time s pe r week compare d t o thos e wh o exercise d les s tha n thre e time s pe r week ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r depression Frequenc y o f smokin g behavio r wa s a non-meaningfu l significan t predicto r o f havin g a positiv e scree n fo r depressio n {Odds Ratio = 1.337 p = .024) 8 3

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Ther e wa s n o othe r significan t lifestyl e o r health-relate d behavio r predictor s o f havin g a positiv e scree n fo r depression Th e cross-validatio n analysi s verifie d tha t experiencin g discriminatio n an d exercis e wer e significan t predictor s o f havin g a positiv e scree n fo r depressio n (se e Tabl e 23) Finally a separat e multipl e logisti c regressio n wa s conducte d t o predic t a positiv e scree n fo r depressio n fro m demographi c factors socia l factor s an d lifestyl e an d health relate d behaviors A s show n i n Tabl e 24 th e overal l mode l predictin g a positiv e scree n fo r depressio n fro m al l factor s wa s significant X (19 ) = 159.60 p < .001 pseudo R = .063 A s als o show n i n Tabl e 24 sexua l orientatio n wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n {Odds Ratio = 1.448 p = .013) Thos e wh o wer e no t heterosexual compare d t o thos e wh o wer e heterosexual ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depression Bein g single divorce d o r widowe d wa s als o a significan t predicto r o f havin g a positiv e scree n fo r depressio n (Odds Ratio = 1.824 p < .001) Bein g single widowed o r divorced compare d t o bein g marrie d o r i n a domesti c relationship ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depression Furthermore bein g i n a relationship compare d t o bein g marrie d o r i n a domesti c relationship ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depressio n (Odds Ratio = 1.339 p = .022) Additionally experiencin g discriminatio n wa s als o a significan t predicto r o f havin g a positiv e scree n fo r depressio n (Odds Ratio = 1.380 p = .001) Participant s wh o hav e experience d discrimination compare d t o thos e wh o hav e not experience d discrimination ha d significantl y increase d odd s o f havin g a positiv e 8 4

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scree n fo r depression Frequenc y o f gamblin g was a significan t predicto r o f havin g a positiv e scree n fo r depressio n (Odds Ratio = .749 p = .014) Thos e wh o gamble d a t leas t on e tim e ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r depression compare d t o thos e wh o di d no t gamble A s als o show n i n Tabl e 24 usin g illici t drug s wa s als o a significan t predicto r o f havin g a positiv e scree n fo r depressio n (Odds Ratio = 1.424 p .008) Participant s wh o use d illici t drugs compare d t o not thos e wh o di d not us e illici t drugs ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depression Amount o f exercis e wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n (Odds Ratio = .612 p < .001) Participant s wh o exercise d thre e o r mor e time s pe r week compare d t o thos e wh o exercise d les s tha n thre e time s pe r week ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r depression Finally havin g financia l problem s growin g u p wa s considere d a non-meaningfu l significan t predicto r o f havin g a positiv e scree n fo r depressio n (Odds Ratio = 1.265 p = .011) Th e cross-validatio n analyse s verifie d tha t amoun t o f exercis e an d bein g single divorce d o r widowe d wer e a significan t predictor s o f havin g a positiv e scree n fo r depressio n (se e Tabl e 25) 8 5

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Tabl e 2 2 Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression from Lifestyle and Health-Related Behaviors B SE Wal d Odd s 95 % C I p Rati o Lowe r Uppe r Experience d Discrimination Smoker b Engag e Bing e Drinking 0 Engag e i n Gamblin g Behavior d Illici t Dru g Use e Exercis e 3 x pe r Week f Note: a compare d t o neve r experience d discrimination ; compare d t o non-smoker; c compare d t o n o bing e drinking ; d compare d t o n o gamblin g behavior; e compare d t o n o illici t dru g use; f compare d t o exercis e les s tha n 3 x pe r week .5 1 .2 9 .0 2 .3 1 .3 6 .5 0 .0 9 .1 3 .0 9 .1 1 .1 3 .0 9 32.2 0 5.0 8 .0 3 7.4 0 7.7 4 31.6 8 .00 0 .02 4 .85 2 .00 7 .00 5 .00 0 1.6 7 1.3 4 .9 8 .7 3 1.4 3 .6 1 1.4 0 1.0 4 .8 2 .5 9 1.1 1 .5 1 2.0 0 1.7 2 1.1 8 .9 2 1.8 5 .7 2 Tabl e 2 3 Cross-Validation of Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression from Lifestyle and Health-Related Behaviors Experience d Discrimination 3 Smoker b Engag e Bing e Drinking 0 Engag e i n Gamblin g Behavior d Illici t Dru g Use e Exercis e 3 x pe r Week / Rando m Sampl e 1 Odd s Rati o j 7 i * 1.1 9 1.0 2 .8 6 1.3 8 .6 0 * Rando m Sampl t i2 Odd s Rati o 1.9 5 .9 4 1.0 3 .8 1 1.2 0 .6 2 ** * Rando m Sampl e 3 Odd s Rati o 1.5 2 1.7 1 .8 6 .7 1 1.5 7 .6 7 Note: a compare d t o neve r experience d discrimination ; compare d t o non-smoker; c compare d t o n o bing e drinking; d compare d t o n o gamblin g behavior; e compare d t o n o illici t dru g use; f compare d t o exercis e les s tha n 3 x pe r week p < .05 ; * p < .01 ; ** p < .001 8 6

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Tabl e 2 4 Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression from Demographic Factors, Social Factors, and Lifestyle and Health-Related Behaviors Odd s 95 % C I B SE Wal d p Rati o Lowe r Uppe r Olde r Age a Males b Othe r Race/Ethnicities c Internationa l Student d No t Heterosexual 6 Midwest f Northeast 8 South 1 1 Livin g Of f Campus 1 Single Divorced o r Widowed 1 I n Relationship" 5 Curren t Financia l Problem s Financia l Problem s Growin g Up m Experience d Discrimination Smoker 0 Engag e Binge Drinking p Gamblin g Behavior q Illici t Dru g Use r Exercis e 3 x pe r Week s Note: a compare d t o younge r age ; "compare d t o females; c compare d t o Caucasians; d compare d t o U S citizen; e compare d t o Heterosexual; f compare d t o Wes t region; g compare d t o Wes t region; h compare d t o Wes t region; compare d t o livin g o n campus; J compare d t o marrie d o r i n domesti c relationship; k compare d t o marrie d o r i n domesti c relationship; compare d t o n o curren t financia l problems ; m compare d t o n o financia l problem s growin g up ; n compare d t o neve r experience d discrimination ; compare d t o non smoker ; p compare d t o n o bing e drinking ; q compare d t o n o gamblin g behavior; r compare d t o n o illici t dru g use; s compare d t o exercis e les s tha n 3 x pe r week .1 5 .1 1 2 0 ,2 2 .3 7 1 1 1 8 1 0 .1 4 .6 0 .2 9 .1 3 .2 4 .3 2 ,2 5 ,0 4 ,2 9 ,3 5 ,4 9 .1 0 .0 9 .1 1 .1 2 .1 5 .1 3 .1 1 .2 0 .1 2 .1 2 .1 3 .1 2 .0 9 .1 0 .1 3 .1 0 .1 2 .1 3 .0 9 2.5 6 1.4 3 3.4 6 3.2 0 6.1 3 .6 7 2.6 4 .2 5 1.4 4 23.2 2 5.2 3 1.2 9 6.4 8 10.3 7 3.4 9 .1 8 6.0 4 7.1 1 29.4 4 .10 9 .23 2 .06 3 .07 3 .01 3 .41 2 .10 4 .61 5 .23 0 .00 0 .02 2 .25 7 .01 1 .00 1 .06 2 .66 8 .01 4 .00 8 .00 0 1.1 7 1.1 2 1.2 3 1.2 4 1.4 5 .9 0 .8 4 1.1 1 .8 7 1.8 2 1.3 4 1.1 4 1.2 7 1.3 8 1.2 8 1.0 4 .7 5 1.4 2 .6 1 .9 7 .9 3 .9 9 .9 8 1.0 8 .7 0 .6 8 .7 5 .6 9 1.4 3 1.0 4 .9 1 1.0 6 1.1 3 .9 9 .8 6 .5 9 1.1 0 .5 1 1.4 1 1.3 4 1.5 2 1.5 8 1.9 4 1.1 6 1.0 4 1.6 4 1.0 9 2.3 3 1.7 2 1.4 3 1.5 2 1.6 8 1.6 5 1.2 7 .9 4 1.8 5 .7 3 8 7

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Tabl e 2 5 Cross-Validation of Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression from Demographic Factors, Social Factors, and Lifestyle and Health-Related Behaviors Olde r Age a Males b Othe r Races/Ethnicities c Internationa l Studen t No t Heterosexua l Midwest f Northeast 8 South h Livin g Of f Campus 1 Single Divorced o r Widowed J I n Relationshi p Curren t Financia l Problems 1 Financia l Problem s Growin g Up m Experience d Discrimination Smoker 0 Engag e Binge Drinking p Engag e i n Gamblin g Behavior q Illici t Dru g Use r Exercis e 3 x pe r Week s Rando m Sampl e 1 Odd s Rati o 1.0 0 .8 7 1.0 0 1.4 3 1.1 6 1.1 7 .8 8 1.3 3 .7 8 1.6 1 1.3 1 1.1 9 1.4 1 1.4 3 1.1 8 1.0 3 .9 1 1.4 6 .6 4 * Rando m Sampl e ; 2 Odd s Rati o 1.0 8 1.5 0 1.8 6 1.1 6 1.1 5 .7 7 .7 6 1.2 4 .9 7 1.8 6 1.6 6 1.1 1 1.0 4 1.4 5 .9 4 1.1 3 .8 2 1.1 9 .6 2 * * * * Rando m Sampl e 3 Odd s Rati o 1.2 1 1.4 5 1.2 2 1.6 4 2.2 4 * .9 6 .8 5 1.0 9 1.1 5 1.5 0 .9 1 1.0 4 1.5 6 1.2 4 1.7 7 .9 9 .7 2 1.6 3 .7 0 Note: a compare d t o younge r age ; compare d t o females; c compare d t o Caucasians ; compare d t o U S citizen; e compare d t o Heterosexual; f compare d t o Wes t region; 8 compare d t o Wes t region; h compare d t o Wes t region; compare d t o livin g o n campus; J compare d t o marrie d o r i n domesti c relationship ; k compare d t o marrie d o r i n domesti c relationship; compare d t o n o curren t financia l problems ; m compare d t o n o financia l problem s growin g up ; n compare d t o neve r experience d discrimination ; "compare d t o non smoker ; p compare d t o n o bing e drinking; q compare d t o n o gamblin g behavior; r compare d t o n o illici t dru g use; s compare d t o exercis e les s tha n 3 x pe r week p < .05 ; * p < .01 ; ** p < .001 8 8

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Predictin g positiv e scree n fo r anxiet y disorders A s show n i n Tabl e 26 a multipl e logisti c regressio n wa s conducte d t o predic t a positiv e scree n fo r anxiet y disorder s fro m demographi c factor s (age gender ethnicity nationality sexua l orientation an d schoo l region) Th e overal l mode l predictin g anxiet y fro m demographi c factor s wa s significant X 2 (8 ) = 89.92 p < .001 pseudo R 2 = .043 A deepe r examinatio n o f th e result s reveale d tha t gende r wa s a significan t predicto r o f havin g a positiv e scree n fo r anxiet y disorder s (Odds Ratio .496 p < .001) Mal e participants compare d t o femal e participants ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r anxiet y disorders Nationalit y wa s als o a significan t predicto r o f havin g a positiv e scree n fo r anxiet y disorder s (Odds Ratio = .461 p < .001) Thos e wh o wer e a n internationa l student compare d t o thos e wh o wer e U.S citizens ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r anxiet y disorders Additionally sexua l orientatio n wa s a significan t predicto r o f havin g a positiv e scree n fo r anxiet y disorder s (Odds Ratio = 1.953 p < .001) Participant s wh o wer e not heterosexual compare d t o thos e wh o wer e heterosexual ha d significantl y increase d odd s o f havin g a positiv e scree n fo r anxiet y disorders Ther e wer e n o othe r significan t predictor s o f havin g a positiv e scree n fo r anxiet y disorders Finally nationality sexua l orientation an d gende r wer e validate d i n th e cross-validatio n analyse s (se e Tabl e 27) 8 9

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Tabl e 2 6 Summary of Multiple Logistic Regressions Predicting Positive Screen for Anxiety Disorders from Demographic Factors Odd s 95 % C I B SE Wal d p Rati o Lowe r Uppe r Olde r Age a Males b Othe r Race/Ethnicities c Internationa l Student d No t Heterosexual 6 Midwest f Northeast 8 South 1 1 .1 9 -.7 0 .0 5 -.7 7 .6 7 -.1 9 -.0 6 -.4 0 .1 1 .1 2 .1 2 .1 9 .1 6 .1 5 .1 2 .2 7 3.2 8 35.7 0 .1 4 17.2 6 17.3 7 1.6 0 .2 7 2.3 1 .07 0 .00 0 .70 4 .00 0 .00 0 .20 6 .60 2 .12 9 1.2 1 .5 0 1.0 5 .4 6 1.9 5 .8 3 .9 4 .6 7 Note: a compare d t o younge r age ; "compare d t o females; c compare d t o Caucasians ; citizen; e compare d t o Heterosexual; f compare d t o Wes t region; g compare d t o Wes t .9 8 .3 9 .8 3 .3 2 1.4 3 .6 1 .7 5 .4 0 d compare d region; h c c 1.4 9 .6 2 1.3 3 .6 6 2.6 8 1.1 1 1.1 9 1.1 2 t o U S impare d t o Tabl e 2 7 Cross-Validation of Summary of Multiple Logistic Regressions Predicting Positive Screen for Anxiety Disorders from Demographic Factors Rando m Rando m Rando m Sampl e 1 Sampl e 2 Sampl e 3 Odd s Rati o Odd s Rati o Odd s Rati o Olde r Age a Males b Othe r Race/Ethnicity c Internationa l Student d No t Heterosexual 6 Midwest f Northeast 8 South h 1.7 1 .5 2 .7 8 .3 8 2.0 5 .7 9 .9 4 .7 6 * * * Note: a compare d t o younge r age ; "compare d t o females; c i citizen; e Compare d t o Heterosexual; f compare d t o Wes t r e Westregion */?<.05 ; **/?<.01 ; *** p < 001 1.0 8 .4 8 1.3 9 .3 4 2.1 6 .7 0 1.1 5 .7 0 * * compare d t o Caucasians; :gion; g compare d t o Wes t 1.0 2 4 7 ** .8 9 .6 7 1.7 8 1.0 5 .8 5 .5 6 1 compare d t o U S region; h Compare d t o 9 0

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A separat e multipl e logisti c regressio n wa s conducte d t o predic t a positiv e scree n fo r anxiet y disorder s fro m socia l factor s (relationshi p status livin g situation curren t financia l problem s an d financia l problem s growin g up) A s show n i n Tabl e 28 th e overal l mode l predictin g a positiv e scree n fo r anxiet y disorder s fro m thes e socia l factor s wa s significant X (5 ) = 23.15 p < .001 pseudo R =.011 Bein g single divorce d o r widowe d wa s a significan t predicto r o f havin g a positiv e scree n fo r anxiet y disorder s (Odds Ratio = 1.399 p = .016) Thos e wh o wer e single divorce d o r widowed compare d t o thos e wh o wer e marrie d o r i n a domesti c partnership ha d significantl y increase d odd s o f havin g a positiv e scree n fo r anxiet y disorders Bein g i n a relationshi p wa s als o a significan t predicto r o f havin g a positiv e scree n fo r anxiet y (Odds Ratio = 1.468 p = .005) Participant s wh o wer e i n a relationship compare d t o thos e wh o wer e marrie d o r i n a domesti c partnership ha d significantl y increase d odd s o f havin g a positiv e scree n fo r a n anxiet y disorder Curren t financia l problem s wa s a significan t predicto r o f havin g a positiv e scree n fo r anxiet y disorder s (Odds Ratio = 1.346 p = .035) Participant s wh o reporte d havin g curren t financia l problems compare d t o thos e wh o di d no t hav e curren t financia l problems ha d significantl y increase d odd s o f havin g a positiv e scree n fo r anxiet y disorders Financia l problem s growin g up however wa s considere d t o b e a non meaningfu l significan t predicto r (Odds Ratio = 1.280 p = .019) ; whereas livin g situatio n wa s not a significan t predicto r (Odds Ratio = 1.277 p = .085) Thes e result s wer e not validate d throug h cross-validatio n analyse s (se e Tabl e 29) 9 1

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Tabl e 2 8 Summary of Multiple Logistic Regressions Predicting Positive Screen for Anxiety Disorders from Social Factors Livin g Of f Campus 3 Single Divorced o r Widowed b I n Relationship 0 Curren t Financia l Problems' 1 Financia l Problem s Growin g Up e B .2 4 .3 4 .3 8 .3 0 .2 5 SE .1 4 .1 4 .1 4 .1 4 .1 1 Wal d 2.9 6 5.8 0 7.8 9 4.4 6 5.5 3 P .08 5 .01 6 .00 5 .03 5 .01 9 Odd s Rati o 1.2 8 1.4 0 1.4 7 1.3 5 1.2 8 95 % C I Lowe r .9 7 1.0 6 1.1 2 1.0 2 1.0 4 Uppe r 1.6 9 1.8 4 1.9 2 1.7 7 1.5 7 Note: a compare d t o livin g o n campus ; compare d t o marrie d o r i n domesti c relationship; c compare d t o marrie d o r i n domesti c relationship; d compare d t o curren t n o financia l problems; e compare d t o n o financia l problem s growin g up Tabl e 2 9 Cross-Validation of Summary of Multiple Logistic Regressions Predicting Positive Screen for Anxiety Disorders from Social Factors Livin g Of f Campus 3 Single Divorced o r Widowed b I n Relationship 0 Curren t Financia l Problems' 1 Financia l Problem s Growin g Up e Rando m Sampl e 1 Odd s Rati o 1.2 2 .8 1 1.0 2 1.0 3 1.4 4 Rando m Sampl e 2 Odd s Rati o 1.3 8 1.3 9 1.8 5 1.6 7 1.0 0 Rando m Sampl e 3 Odd s Rati o 1.5 6 1.6 3 1.4 2 1.1 8 1.3 2 Note: a compare d t o livin g o n campus ; compare d t o marrie d o r i n domesti c relationship; c compare d t o marrie d o r i n domesti c relationship; d compare d t o n o curren t financia l problems; e compare d t o n o financia l problem s growin g up p < .05 ; ** p < .01 ; ** p < .001 9 2

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A s show n i n Tabl e 30 a separat e multipl e logisti c regressio n wa s conducte d t o predic t a positiv e scree n fo r anxiet y disorder s fro m lifestyl e an d health-relate d behavior s (experience d discrimination frequenc y o f smoking engagin g i n bing e drinking usin g illici t drugs frequenc y o f gambling an d amoun t o f exercise) Thi s overal l mode l wa s significant X (6 ) = 51.69 p < .001 pseudo R =.025 A deepe r examinatio n o f th e result s reveale d tha t frequenc y o f smokin g behavio r wa s a significan t predicto r o f havin g a positiv e scree n fo r anxiet y disorder s (Odds Ratio = 1.502 p = .005) Thos e wh o smoked compare d t o thos e wh o di d not smoke ha d significantl y increase d odd s o f havin g a positiv e scree n fo r anxiet y disorders Furthermore frequenc y o f gamblin g behavio r wa s als o a significan t predicto r o f havin g a positiv e scree n fo r anxiet y disorder s (Odds Ratio = .554 p < .001) Thos e wh o gamble d a t leas t on e time compare d t o thos e wh o di d no t gamble ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r anxiet y disorders Usin g illici t drug s wa s a significan t predicto r o f havin g a positiv e scree n fo r anxiet y disorder s (Odds Ratio = 1.368 p = .035) Thos e wh o use d illici t drugs compare d t o thos e wh o di d no t us e illici t drugs ha d significantl y increase d odd s o f havin g a positiv e scree n fo r anxiet y disorders Additionally amoun t o f exercis e wa s a significan t predicto r o f havin g a positiv e scree n fo r anxiet y disorder s (Odds Ratio = .690 p < .001) Participant s wh o exercise d thre e o r mor e time s pe r week compare d t o thos e wh o di d not exercis e thre e o r mor e time s a week ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r anxiet y disorders Ther e wer e n o othe r 9 3

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Tabl e 3 0 Summary of Multiple Logistic Regressions Predicting Positive Screen for Anxiety Disorders from Lifestyle and Health-Related Behaviors Experience d Discrimination 3 Smoker Engag e Bing e Drinking 0 Engag e i n Gambling* 1 Illici t Dru g Use e Exercis e 3 x pe r Week f B .1 9 .4 1 .1 3 -.5 9 .3 1 -.3 7 SE .1 1 .1 5 .1 1 .1 5 .1 5 .1 0 Wal d 2.9 4 7.7 7 1.3 7 16.3 5 4.4 3 12.8 1 P .08 7 .00 5 .24 2 .00 0 .03 5 .00 0 Odd s Rati o 1.2 1 1.5 0 1.1 4 .5 5 1.3 7 .6 9 95 % C I Lowe r .9 7 1.1 3 .9 2 .4 2 1.0 2 .5 6 Uppe r 1.5 0 2.0 0 1.4 1 .7 4 1.8 3 .8 5 Note: compare d t o neve r experience d discrimination ; compare d t o non-smoker; c compare d t o n o bing e drinking ; d compare d t o n o gamblin g behavior; e compare d t o n o illici t dru g use; f compare d t o exercis e les s tha n 3 x pe r week Tabl e 3 1 Cross-Validation of Summary of Multiple Logistic Regressions Predicting Positive Screen for Anxiety Disorders from Lifestyle and Health-Related Behaviors Experience d Discrimination 3 Smoker b Engag e Binge Drinking 0 Engag e i n Gambling d Illici t Dru g Use e Exercis e 3 x pe r Week f Rando m Sampl e 1 Odd s Rati o .9 8 1.1 8 1.4 0 .5 3 .9 5 .8 1 Rando m Sampl e 2 Odd s Rati o 1.1 9 1.3 3 1.1 1 .6 2 1.1 3 .7 5 Rando m Sampl e 3 Odd s Rati o 1.3 4 1.6 6 .9 9 .5 9 1.9 1 .7 0 Note: compare d t o neve r experience d discrimination ; compare d t o non-smoker ; compare d t o n o bing e drinking ; d compare d t o n o gamblin g behavior; e compare d t o n o illici t dru g use; f compare d t o exercis e les s tha n 3 x pe r week p < .05 ; ** p < .01 ; *** p < .001 9 4

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significan t predictors Gamblin g a s a protecto r fro m havin g a positiv e scree n fo r anxiet y disorder s wa s validate d throug h cross-validatio n analyse s (se e Tabl e 31) Finally a multipl e logisti c regressio n wa s conducte d t o predic t positiv e scree n fo r anxiet y disorder s fro m demographi c factors socia l factors an d lifestyl e an d health relate d behaviors A s show n i n Tabl e 32 th e overal l mode l wa s significant X 2 (19 ) = 156.34 p < .001 pseudo R .074 A deepe r examinatio n o f th e result s reveale d tha t gende r wa s a significan t predicto r o f havin g a positiv e scree n fo r anxiet y disorder s {Odds Ratio = .512 p < .001) Mal e participants compare d t o femal e participants ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r anxiet y disorders Furthermore nationalit y wa s a significan t predicto r o f havin g a positiv e scree n fo r anxiet y disorder s {Odds Ratio = .451 p < .001) Thos e wh o wer e internationa l students compare d t o thos e wh o wer e U.S citizens ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r anxiet y disorders Additionally sexua l orientatio n wa s a significan t predicto r o f havin g a positiv e scree n fo r anxiet y disorder s {Odds Ratio = 1.735 p = .001) Participant s wh o wer e not heterosexual compare d t o thos e wh o wer e heterosexual ha d significantl y increase d odd s o f havin g a positiv e scree n fo r anxiet y disorders Bein g single divorce d o r widowe d was als o a significan t predicto r o f havin g a positiv e scree n fo r anxiet y disorder s {Odds Ratio = 1.440 p = .015) Thos e wh o wer e single divorce d o r widowed compare d t o thos e wh o wer e marrie d o r i n a domesti c partnership ha d significantl y increase d odd s o f havin g a positiv e scree n fo r a n anxiet y disorder Furthermore bein g i n a relationshi p wa s a significan t predicto r o f havin g a 9 5

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positiv e scree n fo r anxiet y disorder s {Odds Ratio = 1.514,/ ? =.005) Participant s wh o wer e i n a relationship compare d t o thos e wh o wer e marrie d o r i n a domesti c partnership ha d significantl y increase d odd s o f havin g a positiv e scree n fo r a n anxiet y disorders A s show n i n Tabl e 32 frequenc y o f smokin g behavio r wa s a significan t predicto r o f havin g a positiv e scree n fo r anxiet y disorders Thos e wh o smoked compare d t o thos e wh o di d no t smoke, ha d significantl y increase d odd s o f havin g a positiv e scree n fo r anxiet y disorde r (Odds Ratio = 1.579 p = .002) Additionally havin g experience d discriminatio n wa s als o a significan t predicto r o f havin g a positiv e scree n fo r anxiet y disorder s (Odds Ratio = 1.327 p = .021) Thos e wh o experience d discrimination compare d t o thos e wh o di d no t experienc e discrimination wer e significantl y mor e likel y t o hav e a positiv e scree n fo r anxiet y disorders Frequenc y o f gamblin g behavio r wa s als o a significan t predicto r o f havin g a positiv e scree n fo r anxiet y disorder s (Odds Ratio = .607 p = .001) Participant s wh o gamble d a t leas t on e time compare d t o thos e wh o di d no t gamble ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r anxiet y disorders Amoun t o f exercis e wa s a significan t predicto r o f havin g a positiv e scree n fo r anxiet y disorder s (Odds Ratio = .675 p < .001) Participant s wh o exercise d thre e o r mor e time s pe r week compare d t o thos e wh o di d not exercis e thre e o r mor e time s a week ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r anxiet y disorders Finally olde r ag e (Odds Ratio = 1.31,/ ? < .017 ) an d havin g financia l problem s growin g u p (Odds Ratio = 1.259 p = .035 ) wer e non-meaningfu l significan t predictor s o f havin g a positiv e scree n fo r anxiet y disorders Sexua l 9 6

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orientation nationality an d gende r wer e validate d a s predictor s o f havin g a positiv e scree n fo r anxiet y disorder s throug h a cross-validatio n analysi s (se e Tabl e 33) Tabl e 3 2 Summary of Multiple Logistic Regressions Predicting Positive Screen for Anxiety Disorders from Demographic Factors, Social Factors, and Lifestyle and Health-Related Behaviors B SE Wal d Odd s 95 % C I Rati o Lowe r Uppe r Olde r Age a Males Othe r Race/Ethnicities c Internationa l Student* 1 No t Heterosexual 6 Midwest f Northeast 8 South h Livin g Of f Campus 1 Single Divorced o r Widowed 1 I n Relationship k Curren t Financia l Problem s Financia l Prob Growin g Up m Experience d Discrimination Smoker 0 Engag e Binge Drinking p Engag e i n Gambling* 1 Illici t Dru g Use r Exercis e 3 x pe r Week s .2 7 -.6 7 -.1 6 -.8 0 .5 5 -.2 7 -.1 2 -.4 6 -.0 7 .3 6 .4 1 .1 9 .2 3 .2 8 .4 6 .0 5 -.5 0 .2 1 -.3 9 .1 1 .1 2 .1 3 .1 9 .16 .1 6 .1 2 .2 7 .1 6 .1 5 .1 5 .1 4 .1 1 .1 2 .1 5 .1 1 .1 5 .1 5 .1 1 5.6 5 29.9 4 1.5 0 17.4 1 11.3 6 2.9 8 .9 9 2.8 9 .1 7 5.9 5 8.0 0 1.7 0 4.4 5 5.3 0 9.2 9 .1 7 11.2 1 1.9 6 13.6 2 .01 7 .00 0 .22 0 .00 0 .00 1 .08 4 .31 9 .08 9 .67 7 .01 5 .00 5 .19 3 .03 5 .02 1 .00 2 .68 4 .00 1 .16 2 .00 0 1.3 1 .5 1 .8 5 .4 5 1.7 4 .7 6 .8 9 .6 3 .9 4 1.4 4 1.5 1 1.2 1 1.2 6 1.3 3 1.5 8 1.0 5 .6 1 1.2 4 .6 7 1.0 5 .4 0 .6 5 .3 1 1.2 6 .5 6 .7 0 .3 7 .6 9 1.0 7 1.1 4 .9 1 1.0 2 1.0 4 1.1 8 .8 4 .4 5 .9 2 .5 5 1.6 4 .6 5 1.1 0 .6 6 2.3 9 1.0 4 1.1 3 1.0 7 1.2 7 1.9 3 2.0 2 1.6 0 1.5 6 1.6 9 2.1 2 1.3 1 .8 1 1.6 7 .8 3 Note: compare d t o younge r age ; compare d t o females ; compare d t o Caucasians ; compare d t o U.S citizen; e compare d t o Heterosexual; f compare d t o Wes t region; 8 compare d t o Wes t region; h compare d t o Wes t region; compare d t o livin g o n campus; J compare d t o marrie d o r i n domesti c relationship; k compare d t o marrie d o r i n domesti c relationship; compare d t o n o curren t financia l problems ; m compare d t o n o financia l problem s growin g up; n compare d t o neve r experience d discrimination ; compare d t o non smoker ; p compare d t o n o bing e drinking ; q compare d t o n o gamblin g behavior; r compare d t o n o illici t dru g use; s compare d t o exercis e les s tha n 3 x pe r week 9 7

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Tabl e 3 3 Cross-Validation of Summary of Multiple Logistic Regressions Predicting Positive Screen for Anxiety Disorders from Demographic Factors, Social Factors, and Lifestyle and Health-Related Behaviors Olde r Age a Males b Othe r Races/Ethnicities 0 Internationa l Student d No t Heterosexual 6 Midwest f Northeast 6 South' 1 Livin g Of f Campus 1 Single Divorced o r Widowed 0 I n Relationship k Curren t Financia l Problems 1 Financia l Problem s Growin g Up m Experience d Discrimination Smoker 0 Engag e Binge Drinking 1 5 Engag e i n Gamblin g Behavior q Illici t Dru g Use r Exercis e 3 x pe r Week s Rando m Sampl i 2 l Odd s Rati o 1.8 2 .5 1 .6 7 .3 5 1.9 2 .7 6 .9 0 .6 4 .8 1 .9 3 1.1 0 1.0 4 1.5 5 1.2 5 1.1 9 1.4 9 .5 9 .9 4 .7 3 * * * * Rando m Sampl e : 2 Odd s Rati o 1.1 4 .5 3 1.2 3 .3 2 1.9 1 .6 4 1.0 6 .6 9 1.1 0 1.3 3 1.7 6 1.4 6 .9 3 1.3 1 1.4 0 .9 6 .6 7 1.0 4 .7 2 * * * Rando m Sampl e 3 Odd s Rati o 1.0 8 .4 8 * .7 1 .7 4 1.6 3 .8 9 .7 4 .5 1 1.2 8 1.6 1 1.3 6 1.0 2 1.3 1 1.4 8 1.9 8 .9 0 .6 3 1.6 3 .7 1 Note: a compare d t o younge r age ; "compare d t o females; c compare d t o Caucasians ; compare d t o U.S citizen; e compare d t o Heterosexual; f compare d t o Wes t region ; g compare d t o Wes t region; h compare d t o Wes t region; compare d t o livin g o n campus; compare d t o marrie d o r i n domesti c relationship ; k compare d t o marrie d o r i n domesti c relationship; compare d t o n o curren t financia l problems ; m compare d t o n o financia l problem s growin g up; n compare d t o neve r experience d discrimination ; compare d t o non smoker ; p compare d t o n o bing e drinking; q compare d t o n o gamblin g behavior; r compare d t o n o illici t dru g use; s compare d t o exercis e les s tha n 3 x pe r week *p<.05; **p<.01; ***p<.00\. 9 8

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Predictin g positiv e scree n fo r depressio n o r anxiet y disorders A s show n i n Tabl e 34 a multipl e logisti c regressio n was conducte d t o predic t a positiv e scree n fo r depressio n o r anxiet y disorder s fro m demographi c factor s (age gender race/ethnicity nationality sexua l orientation an d schoo l region) Th e overal l mode l predictin g a positiv e scree n fo r eithe r o f thes e tw o disorder s wa s significant X 2 (8 ) = 35.22 p < .001 pseudo R = .013 Gende r wa s a significan t predicto r o f havin g a positiv e scree n fo r eithe r depressio n o r anxiet y disorde r {Odds Ratio = .813 p = .010) Mal e participants compare d t o femal e participants ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r depressio n o r anxiet y disorders Race/ethnicit y wa s als o a significan t predicto r o f havin g a positiv e scree n fo r eithe r depressio n o r anxiet y disorder s {Odds Ratio = 1.310,/ ? = .002) Participant s wh o wer e no t Caucasian compare d t o thos e wh o wer e Caucasian ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depressio n o r anxiet y disorders Furthermore sexua l orientatio n wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n o r anxiet y disorder s {Odds Ratio = 1.723 p < .001) Participant s wh o wer e not heterosexual compare d t o thos e wh o wer e heterosexual ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depressio n o r anxiet y disorders Ther e wer e n o othe r significan t predictor s o f havin g a positiv e scree n fo r eithe r depressio n o r anxiet y disorders Finally sexua l orientatio n wa s validate d a s a significan t predicto r throug h cross-validatio n analysi s (se e Tabl e 35) 9 9

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Tabl e 3 4 Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression or Anxiety Disorders from Demographic Factors Odd s 95 % C I B SE Wal d p Rati o Lowe r Uppe r Olde r Age a Males b Othe r Race/Ethnicity c Internationa l Student d No t Heterosexual 6 Midwest f Northeast 8 South h .0 7 -.2 1 .2 7 -.0 4 .5 4 -.0 8 -.1 0 -.0 8 .0 8 .0 8 .0 9 .1 1 .1 3 .1 1 .0 9 .1 8 .7 7 6.7 1 9.3 4 .1 0 17.6 3 .4 8 1.2 0 .2 1 .38 0 .01 0 .00 2 .74 8 .00 0 .48 8 .27 4 .64 9 1.0 7 .8 1 1.3 1 .9 7 1.7 2 .9 3 .9 1 .9 2 .9 2 .6 9 1.1 0 .7 8 1.3 4 .7 5 .7 6 .6 4 1.2 5 .9 5 1.5 6 1.2 0 2.2 2 1.1 5 1.0 8 1.3 1 Note: a compare d t o younge r age ; compare d t o females; c compare d t o Caucasians ; compare d t o U.S citizen; e compare d t o Heterosexual; f compare d t o Wes t region; 8 compare d t o Wes t region ; h compare d t o Wes t region Tabl e 3 5 Cross-Validation of Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression or Anxiety Disorders from Demographic Factors Rando m Rando m Rando m Sampl e 1 Sampl e 2 Sampl e 3 Odd s Rati o Odd s Rati o Odd s Rati o Olde r Age a Males Othe r Race/Ethnicities c Internationa l Student d No t Heterosexua l Midwest f Northeast 8 South 1 1 1.0 6 .7 4 1.1 1 .9 8 1.5 3 1.0 0 .8 9 1.0 8 .9 7 .9 4 1.8 0 * .8 9 1.9 0 .7 9 .9 2 .8 2 1.1 0 .8 7 1.1 9 1.1 1 2.1 0 1.1 1 .9 8 1.0 7 Note: a compare d t o younge r age ; compare d t o females; c compare d t o Caucasians ; compare d t o U.S citizen; e compare d t o Heterosexual; f compare d t o Wes t region; 8 compare d t o Wes t region; h compare d t o Wes t region p < .05 ; * p< .01 ; ** p < .001 10 0

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A s show n i n Tabl e 36 a separat e multipl e logisti c regressio n wa s conducte d t o predic t a positiv e scree n fo r depressio n o r anxiet y disorder s fro m socia l factor s (relationshi p status livin g situation curren t financia l problem s an d financia l problem s growin g up) Th e overal l mode l wa s significant X 2 (5 ) = 57.31 p < .001 pseudo R 2 = .020 Bein g single divorce d o r widowe d wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n o r anxiet y disorder s (Odds Ratio = 1.732 p < .001) Thos e wh o wer e single divorce d o r widowed compare d t o thos e wh o wer e marrie d o r i n a domesti c partnership ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depressio n o r anxiet y disorders Furthermore bein g i n a relationshi p wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n o r anxiet y disorder s (Odds Ratio = 1.379 p — .002) Participant s wh o wer e i n a relationship compare d t o thos e wh o wer e marrie d o r i n a domesti c partnership ha d significantl y increase d odd s o f havin g a positiv e scree n fo r a n depressio n o r anxiet y disorders Additionally havin g financia l problem s growin g u p wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n o r anxiet y disorder s (Odds Ratio 1.402 p < .001) Participant s wh o ha d financia l problem s growin g up compare d t o thos e wh o di d not ha d significantl y increase d odd s o f havin g a positiv e scree n fo r eithe r depressio n o r anxiet y disorders Curren t financia l problem s wa s a non meaningfu l significan t predicto r o f havin g a positiv e scree n fo r depressio n o r anxiet y disorder s (Odds Ratio = 1.268 p = .019) Finally livin g situatio n wa s no t a significan t predicto r o f havin g a positiv e scree n fo r depressio n o r anxiet y disorder s (Odds Ratio = 10 1

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.257 p = .895) A s show n i n Tabl e 37 havin g financia l problem s growin g u p an d bein g single divorce d o r widowe d wer e validate d throug h th e cross-validatio n analyses Tabl e 3 6 Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression or Anxiety Disorders from Social Factors Livin g Of f Campus 3 Single Divorced o r Widowed I n Relationship 0 Curren t Financia l Probs. d Financia l Probs Growin g Up e B .1 1 .5 5 .3 2 .2 4 .3 4 SE .1 0 .1 0 .1 0 .1 0 .0 8 Wal d 1.2 8 28.4 4 9.5 5 5.4 8 18.3 5 P .25 7 .00 0 .00 2 .01 9 .00 0 Odd s Rati o .9 0 1.7 3 1.3 8 1.2 7 1.4 0 95 % Lowe r .7 4 1.4 2 1.1 2 1.0 4 1.2 0 C I Uppe r 1.0 8 2.1 2 1.6 9 1.5 5 1.6 4 ~B Note: compare d t o livin g o n campus ; compare d t o marrie d o r i n domesti c relationship ; compare d t o marrie d o r i n domesti c problem s growin g up marrie d o r i n domesti c relationship ; d compare d t o hav e n o financia l problems; e compare d t o n o financia l 10 2

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Tabl e 3 7 Cross-Validation of Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression or Anxiety Disorders from Social Factors Livin g Of f Campus 3 Single Divorced o r Widowed b I n Relationship 0 Curren t Financia l Problems' 1 Financia l Problem s Growin g Up e Rando m Sampl e 1 Odd s Rati o .8 4 1.4 0 1.3 1 1.1 5 1.7 0 * Rando m Sampl e 2 Odd s Rati o .8 2 1.8 8 * 1.6 9 1.3 7 1.1 1 Rando m Sampl e 3 Odd s Rati o 1.1 9 1.5 7 1.0 8 1.1 6 1.5 6 * Note: a compare d t o livin g o n campus ; compare d t o marrie d o r i n domesti c relationship; c compare d t o marrie d o r i n domesti c relationship; d compare d t o n o curren t financia l problems; e compare d t o n o financia l problem s growin g up p < .05 ; * p < .01 ; ** p < .001 A s show n i n Tabl e 3 8 a multipl e logisti c regressio n wa s conducte d t o predic t positiv e scree n fo r depressio n o r anxiet y disorder s fro m lifestyl e an d health-relate d factor s (experience d discrimination frequenc y o f smoking engagin g i n bing e drinking usin g illici t drugs frequenc y o f gambling an d amoun t o f exercise) Th e overal l mode l wa s significant X (6 ) = 108.96,/ ? < .001 pseudo R = .039 Havin g experience d discriminatio n wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n o r anxiet y disorder s (Odds Ratio = 1.486 p < .001) Participant s wh o ha d experience d discrimination compare d t o thos e wh o ha d not experience d discrimination ha d 10 3

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significantl y increase d odd s o f havin g a positiv e scree n fo r depressio n o r anxiet y disorders Frequenc y o f smokin g behavio r wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n o r anxiet y disorder s {Odds Ratio = 1.602 p < .001) Participant s wh o smoked compare d t o thos e wh o di d no t smoke, ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depressio n o r anxiet y disorders Additionally frequenc y o f gamblin g behavio r was als o a significan t predicto r o f havin g a positiv e scree n fo r depressio n o r anxiet y disorder s (Odds Ratio .686 p < .001) Participant s wh o gamble d a t leas t on e tim e durin g th e pas t year compare d t o thos e wh o di d no t gamble ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r depressio n o r anxiet y disorders Us e o f illici t drug s was a significan t predicto r o f havin g a positiv e scree n fo r depressio n o r anxiet y disorder s (Odds Ratio = 1.306 p = .021) Thos e wh o use d illici t drugs compare d t o thos e wh o di d not ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depressio n o r anxiet y disorders Finally amoun t o f exercis e wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n o r anxiet y disorder s (Odds Ratio = .621 p <.001) Participant s wh o exercise d thre e o r mor e time s pe r week compare d t o thos e wh o di d no t exercis e thre e o r mor e time s a week ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r depressio n o r anxiet y disorders Experiencin g discrimination amoun t o f exercis e an d smokin g behavio r wer e cross-validate d a s predictor s (se e Tabl e 39) 10 4

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Tabl e 3 8 Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression or Anxiety Disorders from Lifestyle and Health-Related Behaviors Experience d Discrimination 3 Smoker b Bing e Drinking 0 Engag e i n Gambling* 1 Illici t Dru g Use 6 Exercis e 3x/Wee k B .4 0 .4 7 .0 8 -.3 8 .2 7 -.4 8 SE .0 8 .1 1 .0 8 .1 0 .1 2 .0 8 Wal d 23.6 0 17.6 2 .8 1 13.7 6 5.3 3 37.5 5 P .00 0 .00 0 .36 8 .00 0 .02 1 .00 0 Odd s Rati o 1.4 9 1.6 0 1.0 8 .6 9 1.3 1 .6 2 95 % C I Lowe r 1.2 7 1.2 9 .9 2 .5 6 1.0 4 .5 3 Uppe r 1.7 4 2.0 0 1.2 7 .8 4 1.6 4 .7 2 Note: a compare d t o neve r experience d discrimination ; compare d t o non-smoker; c compare d t o n o bing e drinking; d compare d t o n o gamblin g behavior; e compare d t o n o illici t dru g use; f compare d t o exercis e les s tha n 3 x pe r week Tabl e 3 9 Cross-Validation of Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression or Anxiety Disorders from Lifestyle and Health-Related Behaviors Rando m Sampl e 1 Odd s Rati o Rando m Sampl e 2 Odd s Rati o Rando m Sampl e 3 Odd s Rati o Experience d Discrimination 3 Smoker b Bing e Drinking 0 Engag e i n Gambling* 1 Illici t Dru g Use 6 Exercis e 3x/Wee k 1.4 2 1.1 1 1.2 4 .8 0 1.0 1 .5 9 * 1.5 6 1.4 5 1.0 7 .7 4 1.1 2 .6 5 * * 1.6 8 2.3 9 .9 8 .6 2 1.7 4 .6 6 * ** * Note: a compare d t o neve r experience d discrimination ; compare d t o non-smoker; c compare d t o n o bing e drinking ; d compare d t o n o gamblin g behavior; e compare d t o n o illici t dru g use; f compare d t o exercis e les s tha n 3xpe r week p < .05 ; ** p < .01 ; ** p < .001 10 5

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Finally a multipl e logisti c regressio n wa s conducte d t o predic t a positiv e scree n fo r depressio n o r anxiet y disorder s fro m demographi c factors socia l factors an d lifestyl e an d health-relate d behaviors Th e overal l multipl e logisti c regressio n mode l wa s significant X 2 (19 ) = 174.12 p < .001 pseudo R 2 = .061 A s show n i n Tabl e 40 gende r wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n o r anxiet y disorder s (Odds Ratio = .821 p .019) Males compare d t o females ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r depressio n o r anxiet y disorders Sexua l orientatio n wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n o r anxiet y disorder s (Odds Ratio = 1.525 p = .002) Participant s wh o wer e not heterosexuals compare d t o thos e wh o wer e heterosexuals ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depressio n o r anxiet y disorders Bein g single divorce d o r widowe d wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n o r anxiet y disorder s (Odds Ratio = 1.768 p < .001) Thos e wh o wer e single divorce d o r widowed compare d t o thos e wh o wer e marrie d o r i n a domesti c partnership ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depressio n o r anxiet y disorders Furthermore bein g i n a relationshi p was a significan t predicto r (Odds Ratio = 1.440 p = .001) Participant s wh o wer e i n a relationship compare d t o thos e wh o wer e marrie d o r i n a domesti c partnership ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depressio n o r anxiet y disorder s (se e Tabl e 40) 10 6

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Tabl e 4 0 Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression or Anxiety Disorders from Demographic and Social Factors, Lifestyle and Health-Related Behaviors Olde r Age a Males Othe r Race/Ethnicities c Internationa l Student d No t Heterosexual 6 Midwest f Northeast 8 South 1 1 Livin g Of f Campus Single Divorced o r Widowed J I n Relationship 1 4 Curren t Financia l Problems 1 Financia l Probs Growin g Up m Experience d Discrimination Smoker 0 Bing e Drinking p Engag e i n Gambling* 1 Illici t Dru g Use r Exercis e 3x/Week s B .1 8 -.2 0 .0 5 -.0 7 .4 2 -.1 5 -.1 5 -.1 2 -.1 4 .5 7 .3 6 .1 6 .2 6 .3 0 .4 6 .0 7 -.3 3 .2 2 -.4 8 SE .0 8 .0 8 .1 0 .1 1 .1 3 .1 1 .0 9 .1 9 .1 1 .1 1 .1 1 .1 0 .0 8 .0 9 .1 1 .0 9 .1 0 .1 2 .0 8 Wal d 4.4 7 5.4 8 .2 5 .3 5 10.0 6 1.6 7 2.5 4 .4 2 1.5 4 26.5 9 10.7 8 2.3 3 9.8 4 11.4 8 16.3 7 .6 5 9.8 2 3.5 0 35.7 7 P .03 4 .01 9 .61 5 .55 7 .00 2 .19 6 .11 1 .51 5 .21 4 .00 0 .00 1 .12 7 .00 2 .00 1 .00 0 .41 9 .00 2 .06 2 .00 0 Odd s Rati o 1.2 0 .8 2 1.0 5 .9 3 1.5 2 .8 6 .8 6 .8 9 .8 7 1.7 7 1.4 4 1.1 7 1.2 9 1.3 6 1.5 9 1.0 7 .7 2 1.2 5 .6 2 95 % C I Lowe r Uppe r 1.0 1 .7 0 .8 7 .7 5 1.1 7 .6 9 .7 2 .6 1 .7 0 1.4 2 1.1 6 .9 6 1.1 0 1.1 4 1.2 7 .9 1 .5 9 .9 9 .5 3 1.4 1 .9 7 1.2 7 1.1 7 1.9 8 1.0 8 1.0 4 1.2 8 1.0 8 2.2 0 1.7 9 1.4 3 1.5 2 1.6 2 1.9 9 1.2 7 .8 9 1.5 7 .7 3 Note: a compare d t o younge r age ; compare d t o females; c compare d t o Caucasians ; compare d t o U.S citizen; e compare d t o Heterosexual; f compare d t o Wes t region; 8 compare d t o Wes t region; h compare d t o Wes t region; compare d t o livin g o n campus; J compare d t o marrie d o r i n domesti c relationship ; k compare d t o marrie d o r i n domesti c relationship; compare d t o n o curren t financia l problems ; m compare d t o n o financia l problem s growin g up; n compare d t o neve r experience d discrimination ; compare d t o non smoker ; p compare d t o n o bing e drinking ; q compare d t o n o gamblin g behavior; r compare d t o n o illici t dru g use; s compare d t o exercis e les s tha n 3 x pe r week 10 7

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Frequenc y o f smokin g behavio r wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n o r anxiet y disorder s {Odds Ratio = 1.589 p < .001) A s show n i n Tabl e 40 participant s wh o smoked compare d t o thos e wh o di d not smoke, ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depressio n o r anxiet y disorders Experiencin g discriminatio n wa s a significan t predicto r o f havin g a positiv e scree n fo r eithe r depressio n o r anxiet y disorder s {Odds Ratio = 1.357 p = .001) Participant s wh o ha d experience d discriminatio n on e o r mor e time s durin g th e pas t year compare d t o thos e wh o hav e neve r experience d discrimination ha d significantl y increase d odd s o f havin g a positiv e scree n fo r eithe r depressio n o r anxiet y disorders Frequenc y o f gamblin g behavio r wa s als o a significan t predicto r o f havin g a positiv e scree n fo r depressio n o r anxiet y disorder s {Odds Ratio = .722 p = .002) Thos e wh o gamble d a t leas t on e time compare d t o thos e wh o di d no t gamble ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r depressio n o r anxiet y disorders Amoun t o f exercis e wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n o r anxiet y disorder s {Odds Ratio = .621 p < .001) Participant s wh o exercise d thre e o r mor e time s pe r week compare d t o thos e wh o di d not exercis e thre e o r mor e time s a week ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r depressio n o r anxiet y disorders Ag e an d financia l problem s growin g u p wer e non-meaningfu l significan t predictor s o f havin g a positiv e scree n fo r eithe r depressio n o r anxiet y disorders Finally bein g single divorce d o r widowe d an d exercis e wer e validate d a s predictor s i n thi s mode l (se e Tabl e 41) 10 8

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Tabl e 4 1 Cross-Validation of Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression or Anxiety Disorders from Demographic Factors, Social Factors, and Lifestyle and Health-Related Behaviors Olde r Age a Males' 5 Othe r Race/Ethnicities c Internationa l Student d No t Heterosexua l Midwest f Northeast 8 South h Livin g Of f Campus 1 Single Divorced o r Widowed 1 I n Relationship 1 4 Curren t Financia l Problems 1 Financia l Problem s Growin g Up m Experience d Discrimination Smoker 0 Engag e Binge Drinking p Engag e i n Gamblin g Behavior q Illici t Dru g Use r Exercis e 3 x pe r Week s Rando m Samp L e l Odd s Rati o 1.2 1 .6 9 .8 8 .8 9 1.3 9 1.0 2 .8 6 .9 9 .7 7 1.4 6 1.3 3 1.0 7 1.6 8 1.3 4 1.0 7 1.2 6 .8 8 1.0 5 .5 9 * * Rando m Sampl e 2 Odd s Rati o 1.1 0 .9 7 1.5 6 .8 4 1.6 5 .7 4 .8 6 .8 1 .9 2 1.8 1 1.7 3 1.3 0 .9 6 1.3 2 1.5 0 1.0 6 .7 8 1.0 6 .6 4 * * * Rando m Sampl e : 3 Odd s Rati o 1.1 3 .9 0 .9 6 1.2 2 1.9 5 .9 4 .8 5 .9 7 1.2 5 1.6 0 1.0 7 1.0 3 1.5 4 1.5 4 2.6 0 1.0 2 .6 6 1.6 5 .6 8 * * ** * * Note: a compare d t o younge r age ; b compare d t o females; c compare d t o Caucasians ; d compare d t o U.S citizen; e compare d t o Heterosexual; f compare d t o Wes t region; 8 compare d t o Wes t region; h compare d t o Wes t region; compare d t o livin g o n campus; j compare d t o marrie d o r i n domesti c relationship; k compare d t o marrie d o r i n domesti c relationship; compare d t o n o curren t financia l problems ; m compare d t o n o financia l problem s growin g up; n compare d t o neve r experience d discrimination ; compare d t o non smoker ; p compare d t o n o bing e drinking ; q compare d t o n o gamblin g behavior; r compare d t o n o illici t dru g use; s compare d t o exercis e les s tha n 3 x pe r week p < .05 ; * p < .01 ; ** p < .001 10 9

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Predictin g positiv e scree n fo r depressio n an d anxiet y disorders A s show n i n Tabl e 42 a multipl e logisti c regressio n wa s conducte d t o predic t positiv e scree n fo r depressio n an d anxiet y disorder s fro m demographi c factor s (age gender race/ethnicity nationality sexua l orientation an d schoo l region) Th e overal l mode l wa s significant X 2 (8 ) = 24.72 p = .002 pseudo R = .018 A deepe r examinatio n o f th e result s reveale d tha t gende r wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n an d anxiet y disorde r {Odds Ratio = .734 p = .049) Mal e participants compare d t o femal e participants ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r depressio n an d anxiet y disorders Race/ethnicit y wa s a significant but non-meaningfu l predicto r {Odds Ratio = .1.41 p = .036) Tabl e 4 2 Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression and Anxiety Disorders from Demographic Factors Odd s 95 % C I B SE Wal d p Rati o Lowe r Uppe r Olde r Age a Males b Othe r Race/Ethnicities c Internationa l Student d No t Heterosexual 6 Midwest f Northeast 8 South' 1 Note: a compare d t o younge r age ; "compare d to females; c compare d t o Caucasians; d compare d t o U.S citizen; e compare d t o Heterosexual; f compare d t o Wes t region; 8 compare d t o Wes t region; h compare d t o Wes t region .2 5 -.3 1 .3 5 -.2 7 .7 9 -.2 5 -.1 6 -.1 4 .1 5 .16 .1 7 .2 2 .2 1 .2 2 .1 7 .3 4 2.6 9 3.8 7 4.3 9 1.5 8 13.5 3 1.3 2 .8 8 .1 6 .10 1 .04 9 .03 6 .20 9 .00 0 .25 0 .34 9 .68 9 1.2 8 .7 3 1.4 1 .7 6 2.1 9 .7 8 .8 5 .8 7 .9 5 .5 4 1.0 2 .5 0 1.4 4 .5 0 .6 1 .4 5 1.7 3 1.0 0 1.9 5 1.1 7 3.3 4 1.1 9 1.1 9 1.7 1 11 0

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Als o show n i n Tabl e 42 sexua l orientatio n wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n an d anxiet y disorder s (Odds Ratio = 2.195 p < .001) Participant s wh o wer e not heterosexuals compare d t o thos e wh o wer e heterosexuals ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depressio n an d anxiet y disorders Fo r thi s model ther e wer e n o othe r significan t predictors Finally sexua l orientatio n wa s validate d a s a significan t predicto r o f havin g a positiv e scree n fo r bot h depressio n an d anxiet y disorder s (se e Tabl e 43) Tabl e 4 3 Cross Validation of Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression and Anxiety Disorders from Demographic Factors Olde r Age a Males b Othe r Race/Ethnicities c Internationa l Student d No t Heterosexual 6 Midwest f Northeast 8 South h Rando m Sampl e 1 Odd s Rati o 1.5 9 .6 4 .8 8 .8 0 2.2 1 .8 7 1.0 0 1.1 1 Rando m Sampl e 2 Odd s Rati o 1.1 0 .8 5 2.4 3 * .4 6 1.5 1 .5 7 1.0 3 1.4 5 Rando m Sampl e 3 Odd s Rati o 1.2 0 .8 6 1.1 9 1.2 0 2.7 8 * 1.0 0 .6 7 .2 4 Note: a compare d t o younge r age ; "compare d t o females; c compare d t o Caucasians ; d compare d t o U.S citizen; e compare d t o Heterosexual; f compare d t o Wes t region; g compare d t o Wes t region; h compare d t o Wes t region *p< .05 ; **p < .01 ; *** p < .001 Il l

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A separat e multipl e logisti c regressio n was conducte d t o predic t a positiv e scree n fo r depressio n an d anxiet y disorder s fro m socia l factors A s show n i n Tabl e 44 th e overal l mode l wa s no t significant X 2 (5 ) = 10.76 p = .056 pseudo R 2 = .008 Onl y financia l problem s growin g u p wa s a significan t predicto r o f havin g a positiv e scree n fo r bot h depressio n an d anxiet y disorder s (Odds Ratio = 1.409 p = .022) Thos e wh o ha d financia l problem s growin g up compare d t o thos e wh o di d not ha d significantl y increase d odd s o f havin g a positiv e scree n fo r bot h depressio n an d anxiet y disorders A s show n i n Tabl e 45 financia l problem s growin g u p wa s no t validate d a s a significan t predicto r o f depressio n an d anxiet y disorder s throug h cross-validatio n analyses Tabl e 4 4 Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression and Anxiety Disorders from Social Factors Livin g Of f Campus 3 Single Divorced o r Widowe d I n Relationship 0 Curren t Financia l Problems' 1 Financia l Problem s Growin g Up e B .0 0 .3 2 .2 5 .2 8 .3 4 SE .1 9 .2 0 .2 0 .2 0 .1 5 Wal d .0 0 2.5 7 1.5 9 1.9 0 5.2 4 P .98 8 .10 9 .20 8 .16 9 .02 2 Odd s Rati o 1.0 0 1.3 7 1.2 8 1.3 2 1.4 1 95 % C I Lowe r .6 9 .9 3 .8 7 .8 9 1.0 5 Uppe r 1.4 5 2.0 2 1.8 8 1.9 7 1.8 9 Note: a compare d t o livin g o n campus ; compare d t o marrie d o r i n domesti c relationship; c compare d t o marrie d o r i n domesti c relations financia l problem s growin g up marrie d o r i n domesti c relationship; d compare d t o n o curren t financia l problems; e compare d t o n o 11 2

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Tabl e 4 5 Cross Validation of Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression and Anxiety Disorders from Social Factors Rando m Rando m Rando m Sampl e 1 Sampl e 2 Sampl e 3 Odd s Rati o Odd s Rati o Odd s Rati o Livin g Of f Campus a Single Divorced o r Widowe d I n Relationship 0 Curren t Financia l Problems' 1 Financia l Problem s Growin g Up e Note: a compare d t o livin g o n campus; b compare d t o marrie d o r i n domesti c relationship; c compare d t o marrie d o r i n domesti c relationship ; d compare d t o n o curren t financia l problems; e compare d t o n o financia l problem s growin g up p < .05 ; * p < .01 ; ** p < .001 A s show n i n Tabl e 46 a separat e multipl e logisti c regressio n wa s conducte d t o predic t a positiv e scree n fo r depressio n an d anxiet y disorder s fro m lifestyl e an d health relate d behaviors Th e overal l multipl e logisti c regressio n mode l predictin g a positiv e scree n fo r depressio n an d anxiet y disorder s was significant X (6 ) = 39.15 p = .056 pseudo R = .029 Experiencin g discriminatio n was a significan t predicto r o f havin g a positiv e scree n fo r bot h depressio n an d anxiet y disorder s (Odds Ratio = 1.534,/ ? = .005) Thos e wh o ha d experience d discriminatio n on e o r mor e time s durin g th e pas t year compare d t o thos e wh o hav e neve r experience d discrimination ha d significantl y increase d odd s o f havin g a positiv e scree n fo r bot h depressio n an d anxiet y disorders .9 7 1.1 4 1.0 1 .8 7 1.4 3 1.4 2 .9 2 1.8 4 1.0 3 1.3 9 1.2 8 1.0 5 1.2 4 1.3 6 1.5 7 11 3

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Tabl e 4 6 Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression and Anxiety Disorders from Lifestyle and Health-Related Behaviors Experience d Discrimination Smoke r Engag e Binge Drinking 0 Engag e i n Gamblin g Behavior* 1 Illici t Dru g Use e Exercis e 3 x pe r Week f B .4 3 -.0 5 -.0 6 -.7 5 .6 8 -.4 4 SE .1 5 .2 3 .1 6 .2 3 .2 0 .1 5 Wal d 7.8 5 .0 4 .1 5 11.0 0 11.2 5 8.5 3 P .00 5 .83 8 .69 9 .00 1 .00 1 .00 3 Odd s Rati o 1.5 3 .9 5 .9 4 .4 7 1.9 7 .6 5 95 % C I Lowe r 1.1 4 .6 1 .6 8 .3 0 1.3 3 .4 8 Uppe r 2.0 7 1.5 0 1.2 9 .7 3 2.9 4 .8 7 Note: a compare d t o neve r experience d discrimination ; b compare d t o non-smoker; c compare d t o n o bing e drinking; d compare d t o n o gamblin g behavior; e compare d t o n o illici t dru g use; f compare d t o exercis e les s tha n 3 x pe r week Als o show n i n Tabl e 46 frequenc y o f gamblin g behavio r wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n an d anxiet y disorder s (Odds Ratio = .471 p = .001) Thos e wh o gamble d a t leas t on e tim e i n th e pas t year compare d t o thos e wh o di d no t gamble ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r depressio n an d anxiet y disorders Amoun t o f exercis e wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n an d anxiet y disorder s (Odds Ratio = .647 p = .003) Participant s wh o exercise d thre e o r mor e time s pe r week compare d t o thos e wh o di d not exercis e thre e o r mor e time s a week ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r depressio n an d anxiet y disorders Finally us e 11 4

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o f illici t drug s wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n an d anxiet y disorder s {Odds Ratio = 1.975 p = .001) Thos e wh o use d illici t drugs compare d t o thos e wh o di d not ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depressio n an d anxiet y disorders A s show n i n Tabl e 47 cross-validatio n analysi s reveale d n o significan t predictor s o f depressio n an d anxiet y disorder s i n thi s model Tabl e 4 7 Cross-Validation of Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression and Anxiety Disorders from Lifestyle and Health-Related Behaviors Experience d Discrimination 3 Smoke r Engag e Binge Drinking 0 Engag e i n Gamblin g Behavior d Illici t Dru g Use 6 Exercis e 3 x pe r Week f Rando m Sampl e 1 Odd s Rati o 1.3 3 1.5 2 1.0 6 .3 5 1.7 8 .9 0 Rando m Sampl e 2 Odd s Rati o 2.0 0 * .4 2 1.0 7 .5 7 1.4 6 .6 1 Rando m Sampl e 3 Odd s Rati o 1.1 1 .9 3 .6 9 .6 2 2.3 5 .6 0 Note: a compare d t o neve r experience d discrimination; b compare d t o non-smoker; c compare d t o n o bing e drinking ; d compare d t o n o gamblin g behavior; e compare d t o n o illici t dru g use; f compare d t o exercis e les s tha n 3 x pe r week p <. 05 ; **p<. 01 ; *** p < 001 Finally a multipl e logisti c regressio n wa s conducte d t o predic t a positiv e scree n fo r depressio n an d anxiet y disorder s fro m demographi c factors socia l factors an d lifestyl e an d health-relate d behaviors A s show n i n Tabl e 48 th e overal l mode l wa s significant X 2 (19 ) = 64.08 p < .001 pseudo R 2 = .047 Sexua l orientatio n wa s a 11 5

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significan t predicto r o f havin g a positiv e scree n fo r depressio n an d anxiet y disorder s {Odds Ratio = 1.919 p = .003) Participant s wh o wer e no t heterosexual compare d t o thos e wh o wer e heterosexual ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depressio n an d anxiet y disorders Experiencin g discriminatio n wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n an d anxiet y disorder s {Odds Ratio = 1.421 p = .038) Thos e wh o ha d experience d discriminatio n on e o r mor e time s durin g th e pas t year compare d t o thos e wh o ha d neve r experience d discrimination ha d significantl y increase d odd s o f havin g a positiv e scree n fo r bot h depressio n an d anxiet y disorders Frequenc y o f gamblin g behavio r wa s als o a significan t predicto r o f havin g a positiv e scree n fo r depressio n an d anxiet y disorder s {Odds Ratio = .496 p — .002) Thos e wh o gamble d a t leas t on e tim e durin g th e pas t year compare d t o thos e wh o di d no t gamble ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r depressio n an d anxiet y disorders Us e o f illici t drug s wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n an d anxiet y disorder s {Odds Ratio = 1.796 p = .005) Thos e wh o use d illici t drugs compare d t o thos e wh o di d not ha d significantl y increase d odd s o f havin g a positiv e scree n fo r depressio n an d anxiet y disorders Finally amoun t o f exercis e wa s a significan t predicto r o f havin g a positiv e scree n fo r depressio n an d anxiet y disorder s {Odds Ratio = .648 p = .004) Participant s wh o exercise d thre e o r mor e time s pe r week compare d t o thos e wh o di d no t exercis e thre e o r mor e time s a week ha d significantl y decrease d odd s (protective ) o f havin g a positiv e scree n fo r 11 6

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depressio n an d anxiet y disorders A s show n i n Tabl e 49 ther e wa s n o significan t validatio n fo r thi s mode l i n th e cros s validatio n analysis Tabl e 4 8 Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression and Anxiety Disorders from Demographic Factors, Social Factors, and Lifestyle and HealthRelated Behaviors B SE Wal d Odd s 95 % C I Rati o Lowe r Uppe r Olde r Age a Males Othe r Race/Ethnicities c Internationa l Student d No t Heterosexual Midwest f Northeast 8 South' 1 Livin g Of f Campus 1 Single Divorced o r Widowed J I n Relationship 1 1 Curren t Financia l Problems Financia l Probs Growin g Up m Experience d Discrimination Smoker 0 Engag e Bing e Drinking p Engag e i n Gamblin g Behavior q Illici t Dru g Use r Exercis e 3 x pe r Week s Note: a compare d t o younge r age ; compare d t o females; c compare d t o Caucasians ; compare d t o U.S citizen; e compare d t o Heterosexual; f compare d t o Wes t region; 8 compare d t o Wes t region; h compare d t o Wes t region; compare d t o livin g o n campus; J compare d t o marrie d o r i n domesti c relationship ; k compare d t o marrie d o r i n domesti c relationship; compare d t o n o curren t financia l problems ; m compare d t o n o financia l problem s growin g up; n compare d t o neve r experience d discrimination ; "compare d t o non smoker ; p compare d t o n o bing e drinking ; q compare d t o n o gamblin g behavior; compare d t o n o illici t dru g use; s compare d t o exercis e les s tha n 3 x pe r week .3 1 .2 3 .0 9 .2 7 .6 5 .3 0 .1 9 ,1 7 0 6 ,3 8 .3 3 .1 9 .2 3 .3 5 .0 6 .0 5 .7 0 .5 9 .4 3 .1 6 .1 6 .1 8 .2 3 .2 2 .2 3 .1 8 .3 5 .2 1 .2 1 .2 1 .2 1 .1 5 .1 7 .2 3 .1 7 .2 3 .2 1 .1 5 3.5 9 2.0 2 .2 3 1.4 6 8.9 7 1.8 3 1.1 7 .2 5 .0 9 3.3 4 2.5 4 .8 7 2.1 5 4.3 1 .0 6 .0 9 9.2 6 8.0 6 8.1 4 .05 8 .15 6 .63 3 .22 6 .00 3 .17 6 .28 0 .61 6 .75 8 .06 7 .11 1 .35 0 .14 2 .03 8 .81 1 .75 8 .00 2 .00 5 .00 4 1.3 6 .7 9 1.0 9 .7 6 1.9 2 .7 4 .8 3 .8 4 .9 4 1.4 6 1.3 9 1.2 1 1.2 5 1.4 2 .9 5 .9 5 .5 0 1.8 0 .6 5 .9 9 .5 8 .7 6 .4 9 1.2 5 .4 7 .5 8 .4 3 .6 2 .9 7 .9 3 .8 1 .9 3 1.0 2 .6 0 .6 9 .3 2 1.2 0 .4 8 1.8 8 1.0 9 1.5 6 1.1 8 2.9 4 1.1 5 1.1 7 1.6 6 1.4 2 2.2 0 2.0 9 1.8 1 1.7 0 1.9 8 1.4 9 1.3 1 .7 8 2.6 9 .8 7 11 7

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Tabl e 4 9 Cross-Validation of Summary of Multiple Logistic Regressions Predicting Positive Screen for Depression and Anxiety Disorders from Demographic Factors, Social Factors, and Lifestyle and Health-Related Behaviors Olde r Age a Males 1 5 Othe r Race/Ethnicities 0 Internationa l Studen t No t Heterosexua l Midwest f Northeast 8 South 1 1 Livin g Of f Campus 1 Single Divorced o r Widowed 1 I n Relationship k Curren t Financia l Problems 1 Financia l Problem s Growin g Up m Experience d Discrimination Smoker 0 Engag e Binge Drinking p Engag e i n Gamblin g Behavior q Illici t Dru g Use r Exercis e 3 x pe r Week s Rando m Sampl e 1 Odd s Rati o 1.7 0 .5 8 .7 2 .8 2 1.9 1 .8 6 .9 2 .9 9 .7 7 .9 0 .9 4 1.3 4 1.2 1 1.5 3 1.6 0 1.1 4 .3 9 1.8 8 .8 9 Rando m Sampl e 2 Odd s Rati o 1.1 1 .9 8 1.7 8 .4 6 1.3 4 .5 2 .9 2 1.3 3 1.3 3 1.3 9 1.9 4 1.1 9 1.1 2 1.8 2 .4 3 1.0 7 .5 7 1.3 4 .6 2 Rando m Sampl e 3 Odd s Rati o 1.2 8 .9 7 .9 8 1.3 2 2.3 3 .9 0 .6 3 .2 5 1.1 5 1.6 2 1.1 5 1.0 7 1.4 3 1.0 3 1.0 4 .7 5 .5 9 2.0 9 .6 5 Note: a compare d t o younge r age ; b compare d t o females; c compare d t o Caucasians; d compare d t o U.S citizen; e compare d t o heterosexual; f compare d t o Wes t region; 8 compare d t o Wes t region; h compare d t o Wes t region; compare d t o livin g o n campus; J compare d t o marrie d o r i n domesti c relationship ; k compare d t o marrie d o r i n domesti c relationship; compare d t o n o curren t financia l problems ; m compare d t o n o financia l problem s growin g up; n compare d t o neve r experience d discrimination ; compare d t o non smoker ; p compare d t o n o bing e drinking ; q compare d t o n o gamblin g behavior; r compare d t o n o illici t dru g use; s compare d t o exercis e les s tha n 3 x pe r week *p<.05;**p<.0l; ***/?<.001 11 8

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Summar y o f Result s Th e curren t stud y use d secondar y dat a collecte d fro m graduat e student s durin g th e nationa l 201 0 HM S surve y t o examin e th e prevalenc e o f demographi c factors socia l factors an d lifestyl e an d health-relate d behaviors Also th e prevalenc e o f screenin g positiv e fo r depressio n and/o r anxiet y disorder s was determined an d th e correlate s an d predictor s o f screenin g positiv e fo r thes e menta l illnesse s wer e als o studied Descriptiv e analyse s o f th e prevalenc e o f demographi c factor s showe d tha t th e majorit y o f participant s wer e female Caucasian age d 2 1 t o 2 5 years an d U.S citizens Th e overwhelmin g majorit y identifie d themselve s a s heterosexual Almos t hal f o f th e participant s wer e attendin g universitie s locate d i n th e Wes t geographica l regio n o f th e U.S. wit h th e nex t larges t proportio n comin g fro m th e Northeast Regardin g th e prevalenc e o f socia l factors a larg e majorit y o f participant s wer e livin g off-campu s i n non-universit y housing Abou t one-thir d indicate d tha t thei r relationshi p statu s wa s "single" an d a slightl y large r proportio n state d tha t the y wer e "i n a relationship" but wer e no t marrie d o r i n a domesti c partnership Slightl y ove r one-quarte r indicate d tha t the y wer e i n th e married/domesti c partnershi p group Th e vas t majorit y o f participant s identifie d thei r curren t financia l situatio n a s "tight but doin g fine" an d mos t gre w u p i n comfortabl e financia l circumstances Prevalenc e testin g o f lifestyl e an d health-relate d behavior s showe d tha t th e vas t majorit y o f participant s ha d no t engage d i n bing e drinkin g durin g th e pas t tw o weeks use d illici t drug s o f an y kin d withi n th e pas t 3 0 days o r gamble d withi n th e pas t year 11 9

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Mos t als o ha d no t smoke d tobacc o withi n th e pas t 3 0 days Ove r one-quarte r reporte d havin g experience d discriminatio n becaus e o f thei r race ethnicit y o r cultura l backgroun d withi n th e pas t year Slightl y ove r hal f o f participant s reporte d exercisin g thre e o r mor e time s pe r week I n thi s study th e prevalenc e o f screenin g positiv e fo r depression includin g majo r depressio n o r othe r depressiv e disorder wa s 14% an d th e prevalenc e o f screenin g positiv e fo r anxiet y disorders whic h include d generalize d anxiet y disorde r an d pani c disorder wa s 9.5% Th e prevalenc e o f havin g a positiv e scree n fo r eithe r depressio n o r anxiet y disorder s wa s 19.1% ; while th e prevalenc e o f screenin g positiv e fo r bot h depressio n an d anxiet y disorder s wa s onl y 4.4% I n additio n t o prevalenc e testing thi s stud y als o explore d th e clinicall y significan t relationship s betwee n screenin g positiv e fo r depressio n and/o r anxiet y disorder s an d th e demographi c an d socia l factor s an d lifestyle/health-relate d behavior s describe d abov e (hypothesi s 1) Severa l clinicall y significan t relationship s wer e discovered Havin g a positiv e scree n fo r depressio n ha d a significan t relationshi p with : race/ethnicity nationality livin g situation financia l situatio n growin g up discrimination relationshi p status an d exercise Nationalit y an d exercis e wer e als o significantl y relate d t o havin g a positiv e scree n fo r anxiet y disorders alon g wit h gender sexua l orientation curren t financia l situation gambling smoking an d usin g illici t drugs Havin g a positiv e scree n fo r eithe r depressio n o r anxiet y disorder s ha d a significan t relationshi p with : race/ethnicity financia l problem s growin g up discrimination relationshi p status 12 0

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gambling smoking illici t dru g use an d exercise Discrimination gambling an d exercis e wer e als o significantl y relate d t o havin g a positiv e scree n fo r bot h depressio n an d anxiet y disorders a s wer e illici t dru g use sexua l orientation an d exercise Logisti c regressio n analyse s wer e complete d t o determin e whethe r an y o f th e demographi c an d socia l factor s an d lifestyle/health-relate d behavior s wa s predictiv e o r protectiv e o f screenin g positiv e fo r depressio n and/o r anxiet y disorder s (hypothesi s 2) Whe n usin g al l th e factor s an d behavior s i n th e model significan t predictor s o f screenin g positiv e fo r depressio n include d experiencin g discrimination usin g illici t drugs bein g single divorce d o r widowed bein g i n a relationship an d not bein g heterosexual Exercisin g thre e o r mor e time s pe r wee k an d gamblin g wer e protective A simila r analysi s wa s complete d t o identif y predictor s an d protector s o f screenin g positiv e fo r anxiet y disorders Finding s i n thi s model simila r t o thos e fo r depression showe d tha t experiencin g discrimination bein g single divorce d o r widowed bein g i n a relationship an d not bein g heterosexua l wer e predictiv e o f screenin g positiv e fo r anxiet y disorders I n addition smokin g tobacc o wa s als o predictiv e o f anxiety A s wit h depression gamblin g an d exercisin g wer e protective Bein g mal e an d a n internationa l studen t wer e als o protectiv e o f anxiet y disorders Logisti c regressio n analyse s conducte d t o predic t a positiv e screenin g fo r eithe r depressio n o r anxiet y disorder s reveale d tha t al l o f th e followin g wer e significan t predictors : experiencin g discrimination bein g single divorce d o r widowed bein g i n a relationship no t bein g heterosexual an d smokin g tobacco Bein g male gamblin g an d 12 1

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exercisin g thre e o r mor e time s pe r wee k wer e protectiv e i n thi s model I n th e analyse s complete d t o predic t screenin g positiv e fo r bot h depressio n an d anxiet y disorders no t bein g heterosexual experiencin g discrimination an d illici t dru g us e wer e al l predictors Exercisin g an d gamblin g wer e protective I n al l fou r models not bein g heterosexua l an d experiencin g discriminatio n wer e predictive ; while exercisin g thre e o r mor e time s pe r wee k an d gamblin g a t leas t onc e i n th e pas t yea r wer e protective 12 2

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CHAPTE R V CONCLUSIO N AN D RECOMMENDATION S Thi s chapte r provide s a discussio n o f th e summar y an d conclusio n fo r th e curren t study specificall y addressin g th e researc h question s an d rejectio n o r acceptanc e o f th e study' s hypotheses Th e study' s limitation s ar e als o explained Implication s an d recommendation s fo r th e professio n o f healt h education/promotio n ar e discussed Summar y Th e purpos e o f thi s stud y wa s t o examin e th e prevalence correlate s an d predictor s o f depressio n (majo r depressio n an d othe r depressiv e disorder ) and/o r anxiet y disorder s (generalize d anxiet y disorde r [GAD ] an d pani c disorder[PD] ) amon g a sampl e o f U.S graduat e students Relationship s betwee n screenin g positiv e fo r depressio n and/o r anxiet y disorder s an d demographi c factors socia l factor s an d lifestyl e an d health relate d behavior s wer e determined Thi s stud y als o examine d i f an y o f thes e factor s o r behavior s wer e predictiv e o r protectiv e o f screenin g positiv e fo r depressio n and/o r anxiet y disorders Secondar y dat a collecte d a s par t o f th e Healthy Mind s Stud y (HMS ) wa s use d fo r thi s research Th e sampl e consiste d o f 4,47 7 graduat e student s wh o voluntaril y complete d th e HM S surve y conducte d i n 201 0 a t 2 5 differen t U.S college s an d universitie s acros s th e nation Screening positiv e fo r depressio n o r anxiet y disorder s wa s measure d usin g th e Patien t Healt h Questionnair e (PHQ) a validate d an d reliabl e screenin g instrumen t tha t ha s bee n widel y use d i n clinica l an d communit y settings 12 3

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Descriptiv e statistic s wer e calculate d t o describ e th e sampl e an d determin e th e prevalenc e o f demographi c an d socia l factors lifestyl e an d healt h behaviors an d screenin g positiv e fo r depressio n and/o r anxiet y disorders Pearso n Ch i Squar e analyse s wer e conducte d t o explor e relationship s betwee n th e factor s an d behavior s an d screenin g positiv e fo r thes e menta l illnesses Multipl e logisti c regressio n analyse s wer e performe d t o establis h i f an y o f th e factor s o r behavior s unde r stud y wa s predictiv e o r protectiv e o f screenin g positiv e fo r depressio n and/o r anxiet y disorders Conclusio n Th e firs t researc h questio n i n thi s stud y aske d abou t th e prevalenc e amon g U.S graduat e student s o f certai n demographi c factors socia l factors an d ke y lifestyle/health relate d behaviors Demographi c factor s included : a ) age ; b ) gender ; c ) race/ethnicity ; d ) nationality whic h categorize d participant s a s U.S citizen s versus internationa l students ; e ) sexua l orientation ; an d f ) schoo l region Prevalenc e testin g o f ag e categorie s showe d tha t th e majorit y o f participant s wer e 2 1 t o 2 5 year s ol d (43.1%) followe d b y 2 6 t o 3 0 year s (36.8%) wit h th e smallest grou p ove r 3 0 year s o f ag e (20.1%) Th e majorit y wa s femal e (59.4% ) an d Caucasia n (66.0%) wit h 34 % comin g fro m othe r racial/ethni c groups Abou t 18 % wer e internationa l students B y far mos t participant s identifie d themselve s a s heterosexual wit h onl y 7.4 % indicatin g tha t the y wer e bisexual gay/lesbian questionin g o r o f anothe r non-heterosexua l orientation Th e larges t proportio n o f participant s wa s studyin g a t school s locate d i n th e Wes t (47.2% ) 12 4

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geographica l region followe d b y th e Northeas t (31.2% ) an d th e Midwes t (16.6%) Th e smalles t proportio n wa s attendin g school s i n th e Sout h (4.9%) Socia l factor s included : a ) livin g situation ; b ) relationshi p status ; c ) curren t financia l situation ; an d d ) financia l situatio n growin g up Prevalenc e testin g o f livin g situatio n reveale d tha t 75.5 % o f participant s live d of f campu s i n non-universit y housing wit h th e remainin g 24.5 % livin g i n universit y housin g o r wit h parents Ove r one-thir d (35.5% ) reporte d thei r relationshi p statu s a s single divorce d o r widowed abou t 38 % wer e "i n a relationship" an d ove r 26 % wer e marrie d o r i n a domesti c partnership A larg e majorit y (79.1% ) indicate d tha t thei r curren t finance s wer e tigh t o r a n outrigh t struggle an d 37.4 % indicate d tha t thei r financia l situatio n growin g u p wa s difficult Lifestyl e an d health-relate d behavior s included : a ) experience d discriminatio n du e t o race ethnicit y o r cultur e withi n th e pas t year ; b ) smokin g tobacc o withi n th e pas t 3 0 days ; c ) bing e drinkin g durin g th e pas t tw o weeks ; d ) gamblin g withi n th e pas t year ; e ) illici t dru g us e withi n th e pas t 3 0 days ; an d f ) amoun t o f exercis e pe r week Interestingly 29 % o f participant s indicate d tha t the y experience d discriminatio n on e o r mor e time s withi n th e pas t year Almos t 12 % smoke d tobacc o i n th e pas t month an d a substantia l 40.4 % reporte d tha t the y ha d engage d i n bing e drinkin g on e o r mor e time s withi n th e pas t tw o weeks A smal l proportio n (12.5% ) reporte d usin g illici t drugs includin g marijuana withi n th e pas t 3 0 days Ove r 21 % indicate d tha t the y ha d gamble d a t leas t onc e durin g th e pas t year an d almos t 54 % reporte d tha t the y exercise d thre e o r mor e time s pe r week 12 5

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Th e secon d researc h questio n aske d abou t th e prevalenc e amon g U.S graduat e student s o f screenin g positiv e fo r a ) depression ; b ) anxiet y disorders ; c ) eithe r depressio n o r anxiet y disorders ; an d d ) bot h depressio n an d anxiet y disorders Prevalenc e testin g showe d tha t 14 % screene d positiv e fo r depression whic h include d majo r depressio n an d othe r depressiv e disorder an d 9.5 % screene d positiv e fo r anxiet y disorders whic h include d GA D an d PD I n thi s study 19.1 % screene d positiv e fo r eithe r depressio n o r anxiet y disorders an d onl y 4.4 % screene d positiv e fo r both Th e firs t hypothesi s investigate d whethe r significan t relationship s existe d betwee n an y o f th e factor s o r lifestyle/healt h behavior s an d screenin g positiv e fo r an y o f th e fou r combination s o f depressio n an d anxiet y disorder s mentione d previously Severa l significan t association s wer e identifie d an d th e result s ar e summarize d i n Tabl e 50 Screening positiv e fo r depressio n wa s significantl y associate d with : a ) belongin g t o a race/ethnicit y othe r tha n Caucasian ; b ) bein g a n internationa l student a s oppose d t o a U.S citizen ; c ) livin g o n campus ; d ) havin g financia l problem s growin g up ; e ) bein g single divorce d o r widowed ; f ) experiencin g discrimination ; an d g ) exercisin g les s tha n thre e time s pe r week Screenin g positiv e fo r anxiet y disorder s wa s significantl y associate d with : a ) bein g female ; b ) bein g a U.S citizen a s oppose d t o a n internationa l student ; d ) not bein g heterosexual ; d ) curren t financia l problems ; e ) smoking ; f ) not gamblin g a t leas t onc e i n th e pas t year a s oppose d t o thos e wh o di d gambl e a t leas t once ; g ) usin g illici t drugs ; an d h ) exercisin g les s tha n thre e time s pe r week 12 6

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Tabl e 5 0 Conclusion of Results for Hypothesis 1 Hypothesi s 1 : Depressio n Anxiet y Depressio n Depressio n an d Disorder s o r Anxiet y Anxiet y Disorder s Disorder s Ag e Gende r Race/Ethnicit y Schoo l Regio n Sexua l Orientatio n Nationalit y Livin g Situatio n Relationshi p Statu s Curren t Financia l Financia l Growin g U p Discriminatio n Smokin g Tobacc o Bing e Drinkin g Gamblin g Illici t Dru g Us e Exercis e No t Rejecte d No t Rejecte d Rejecte d No t Rejecte d Partiall y Rejec t Rejecte d Rejecte d Rejecte d Partiall y Rejec t Rejecte d Rejecte d Partiall y Rejec t No t Rejecte d Partiall y Rejec t Partiall y Rejec t Rejecte d No t Rejecte d Rejecte d No t Rejecte d No t Rejecte d Rejecte d Rejecte d No t Rejecte d Partiall y Rejec t Rejecte d Partiall y Rejec t No t Rejecte d Rejecte d No t Rejecte d Rejecte d Rejecte d Rejecte d No t Rejecte d Partiall y Rejec t Rejecte d No t Rejecte d Partiall y Rejec t No t Rejecte d No t Rejecte d Rejecte d Partiall y Rejec t Rejecte d Rejecte d Rejecte d No t Rejecte d Rejecte d Partiall y Rejec t Rejecte d No t Rejecte d Partiall y Rejec t No t Rejecte d No t Rejecte d Rejecte d No t Rejecte d No t Rejecte d No t Rejecte d No t Rejecte d Partiall y Rejec t Rejecte d No t Rejecte d No t Rejecte d Rejecte d Rejecte d Rejecte d Note : Nul l hypothesi s wa s rejecte d lip < .01 I f p valu e wa s .0 1 t o .05 nul l hypothesi s wa s onl y partiall y rejected 12 7

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A s show n i n Tabl e 50 screenin g positiv e fo r eithe r depressio n o r anxiet y disorder s wa s significantl y associate d with : a ) belongin g t o a race/ethnicit y othe r tha n Caucasian; b ) havin g financia l problem s growin g up ; c ) bein g single divorce d o r widowed ; d ) smokin g tobacco ; e ) experiencin g discriminatio n withi n th e pas t year ; f ) not gamblin g a t leas t onc e i n th e pas t year a s oppose d t o thos e wh o di d gambl e a t leas t once ; an d g ) exercisin g les s tha n thre e time s pe r week Screening positiv e fo r bot h depressio n an d anxiet y disorder s wa s significantl y associate d with : a ) no t bein g heterosexual ; b ) experiencin g discrimination ; c ) not gamblin g a t leas t onc e i n th e pas t year a s oppose d t o thos e wh o di d gambl e a t leas t once ; d ) usin g illici t drugs ; an d e ) exercisin g les s tha n thre e time s pe r week Th e secon d hypothesi s investigate d i f an y o f th e factor s o r lifestyle/healt h behavior s wa s predictiv e (o r protective ) o f screenin g positiv e fo r an y o f th e fou r combination s o f depressio n and/o r anxiet y disorders Logisti c regressio n analyse s wer e conducte d suc h tha t fou r model s wer e create d fo r eac h combination : a ) a demographi c model ; b ) a socia l model ; c ) a lifestyle/healt h behavio r model ; an d d ) a model includin g al l factor s an d behaviors Thi s resulte d i n a tota l o f 1 6 models I n addition du e t o th e relativel y larg e sampl e size a cross-validatio n procedur e wa s conducte d fo r eac h model t o determin e i f th e predictor s o r protector s remaine d significan t wit h smalle r sampl e sizes A s show n i n Tabl e 51 fiftee n ou t o f th e sixtee n regressio n model s wer e significant ; th e onl y model no t significan t wa s th e socia l mode l predictin g bot h 12 8

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depressio n an d anxiet y disorders O f th e remainin g 1 5 models however fou r wer e not validated whic h lef t a tota l o f 1 1 model s tha t wer e significan t an d validated Tabl e 5 1 Conclusion of Results for Hypothesis 2 Demographi c Mode l Socia l Mode l Lifestyle/Healt h Behavior s Mode l Al l Factor s Mode l Depressio n No t Rejecte d Rejecte d Rejecte d Rejecte d Anxiet y Disorder s Rejecte d No t Rejecte d Rejecte d Rejecte d Depressio n o r Anxiet y Disorder s Rejecte d Rejecte d Rejecte d Rejecte d Depressio n an d Anxiet y Disorder s Rejecte d No t Rejecte d No t Rejecte d No t Rejecte d Note : Nul l hypothesi s wa s rejecte d i f p < .01 an d mode l wa s cross-validated Thre e model s predictin g a positiv e scree n fo r depressio n wer e significan t an d validated : a ) th e socia l model b ) th e lifestyle/healt h behavio r model an d c ) th e al l factor s model (se e Tabl e 51) Result s fo r th e socia l model showe d tha t bein g single divorce d o r widowe d an d havin g financia l problem s growin g u p wer e significan t an d validate d predictors Livin g of f campu s wa s a significan t protecto r o f depression but wa s not validated I n th e lifestyle/healt h behavio r model gamblin g a t leas t on e da y i n th e pas t yea r an d exercisin g thre e time s o r mor e pe r wee k wer e bot h protectiv e o f screenin g 12 9

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positiv e fo r depression Experiencin g discrimination smokin g an d usin g illici t drug s wer e predictive I n thi s model exercis e an d discriminatio n wer e bot h significan t an d validated Result s fo r th e thir d significan t model whic h include d al l th e factor s an d lifestyle/healt h behaviors reveale d tha t th e significan t predictor s were : a ) no t bein g heterosexual ; b ) experiencin g discrimination ; c ) bein g single divorce d o r widowed ; d ) bein g i n a relationship a s oppose d t o bein g marrie d o r i n a domesti c relationship ; an d e ) usin g illici t drugs Onc e again exercisin g thre e o r mor e time s pe r wee k an d gamblin g on e o r mor e day s pe r yea r wer e bot h protective Exercis e an d bein g single divorce d o r widowe d wer e bot h validated Thre e model s wer e significan t an d validate d fo r predictin g a positiv e scree n fo r anxiet y disorders : a ) th e demographi c model ; b ) th e lifestyle/healt h behavio r model ; an d c ) th e al l factor s model (se e Tabl e 51) Th e socia l mode l wa s significant but not validated No t identifyin g a s heterosexua l wa s a significan t predicto r i n th e demographi c model Bein g mal e an d a n internationa l studen t wer e bot h protective Al l thre e o f thes e factor s fro m th e demographi c mode l predictin g a positiv e scree n fo r anxiet y disorder s wer e validated Result s fo r th e lifestyle/healt h behavior s model showe d tha t smokin g tobacc o an d usin g illici t drug s wer e bot h predictive ; while exercisin g thre e o r mor e time s pe r wee k an d gamblin g a t leas t on e da y i n th e pas t yea r wer e protective Onl y gamblin g wa s a significan t protecto r i n th e cross-validatio n analyses I n th e al l factor s model fiv e factor s wer e predictive : a ) not identifyin g a s heterosexual ; b ) bein g single divorce d o r widowed ; c ) bein g i n a relationship a s oppose d t o bein g marrie d o r i n a domesti c 13 0

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partnership ; d ) experiencin g discrimination ; an d e ) smoking A s wit h th e lifestyle/healt h behavio r model exercisin g thre e o r mor e time s pe r wee k an d gamblin g wer e bot h protective I n addition bein g mal e an d a n internationa l studen t wer e als o protectiv e i n thi s model Th e cross-validatio n confirme d tha t not bein g heterosexua l wa s a significan t predictor an d tha t bein g mal e an d internationa l studen t statu s wer e significan t protectors Al l fou r model s wer e significan t fo r predictin g a positiv e scree n fo r eithe r depressio n o r anxiet y disorder s (se e Tabl e 51) I n th e demographi c model th e significan t predictor s include d no t bein g Caucasia n an d not identifyin g a s heterosexual ; whereas bein g mal e wa s a significan t protector Onl y not identifyin g a s heterosexua l wa s validated Result s fo r th e socia l mode l showe d tha t thre e factor s wer e significan t predictors : a ) bein g single divorce d o r widowed b ) bein g i n a relationship a s oppose d t o bein g marrie d o r i n a domesti c relationship an d c ) havin g financia l problem s growin g up Two o f thes e three bein g single divorce d o r widowe d an d havin g financia l problem s growin g up wer e significan t predictor s i n th e cross-validatio n analysis I n th e lifestyle/healt h behavio r model thre e factor s wer e predictive : a ) experiencin g discrimination ; b ) smoking ; an d c ) usin g illici t drugs Gamblin g an d exercisin g thre e o r mor e time s pe r wee k wer e bot h protective I n th e cross-validatio n analysis experiencin g discrimination exercis e an d gamblin g wer e validated Th e al l factor s model reveale d fiv e significan t predictors : a ) no t identifyin g a s heterosexual ; b ) experiencin g discrimination ; c ) bein g single divorce d o r widowed ; d ) bein g i n a relationship ; an d e ) smokin g tobacco Thre e factor s wer e significan t protectors : a ) bein g male ; b ) gamblin g 13 1

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on e o r mor e day s i n th e pas t year ; an d c ) exercisin g thre e o r mor e time s pe r week Cross validatio n analysi s confirme d tha t bein g single divorce d o r widowe d remaine d a significan t predictor an d exercisin g thre e o r mor e time s pe r wee k wa s a significan t protector A s show n i n Tabl e 51 onl y th e demographi c mode l wa s a significan t predicto r o f screenin g positiv e fo r bot h depressio n an d anxiet y disorders No t identifyin g a s heterosexua l wa s a significan t predictor an d bein g mal e wa s a significan t protector Onl y not identifyin g a s heterosexua l remaine d significan t i n th e cross-validatio n analysis Discussio n Prevalenc e o f Depressio n an d Anxiet y Disorder s Havin g a positiv e screenin g fo r depressio n o r a positiv e screenin g fo r anxiet y disorder s wer e bot h prevalen t amon g th e graduat e student s i n th e curren t stud y (14 % an d 9.5 % respectively) Whil e positiv e screening s d o no t equat e wit h clinica l diagnoses thes e finding s sugges t tha t depressio n an d anxiet y disorder s ar e prevalen t i n thi s population Thes e finding s ar e als o generall y consisten t wit h wha t ha s bee n reporte d i n th e literatur e fo r graduat e students Eisenberg Gollust Golberstei n an d Hefne r (2007 ) use d th e PH Q t o scree n fo r thes e menta l illnesse s amon g graduat e student s an d foun d ove r 11 % screene d positiv e fo r depressio n an d 4 % fo r anxiet y disorders Usin g a differen t screenin g instrument Loude n an d Skee m (2008 ) reporte d tha t abou t 17 % o f graduat e student s screene d positiv e fo r a DSM-IV Axi s I menta l disorder Moreover th e finding s fro m th e curren t stud y indicat e tha t clinica l depressio n an d anxiet y disorder s ma y b e mor e prevalen t amon g graduat e student s tha n amon g th e genera l U.S population 13 2

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wher e th e 12-mont h prevalenc e o f depressio n i s abou t 7 % amon g adults abou t 3 % fo r PD an d 3 % fo r GA D (Nationa l Institute s o f Menta l Healt h [NIMH] 2010c ; NIMH 2010b ; NIMH 2010a) Th e finding s fro m th e curren t stud y indicat e tha t depressio n an d anxiet y disorder s ar e considerabl e problem s amon g graduat e student s tha t meri t additiona l researc h an d intervention Association s fo r Depressio n an d Anxiet y Disorder s Age I n th e curren t study ag e wa s no t significantl y associate d wit h an y o f th e combination s o f screenin g positiv e fo r depressio n an d anxiet y disorders I n th e genera l population th e average ag e o f onse t fo r depressio n wa s 3 2 years an d th e 12-mont h prevalenc e rate s indicate d tha t adult s age d 18-2 9 year s wer e 200 % mor e likel y t o hav e experience d depressio n compare d t o adult s ag e 6 0 year s an d olde r (NIMH 2010c) A s wit h depression th e average ag e o f onse t i n th e genera l populatio n fo r GA D an d P D i s young 3 1 year s an d 2 4 year s respectivel y (NIMH 2010a ; NIMH 2010b) Th e 12-mont h prevalenc e rate s fo r GA D an d PD ar e significantl y highe r amon g adult s age d 18-2 9 tha n amon g thos e ag e 6 0 year s an d older Considerin g tha t 80 % o f th e sampl e i n th e curren t stud y wa s les s tha n 3 0 year s o f age som e relationshi p wit h ag e an d depression/anxiet y disorder s migh t b e expected ; however comparison s wer e mad e betwee n tw o relativel y youn g ag e group s (2 1 t o 2 5 year s an d 2 6 year s an d older) a s oppose d t o comparin g wit h adult s ove r th e ag e o f 6 0 years Therefore th e lac k o f significan t associatio n betwee n ag e an d depressio n an d anxiet y disorder s ma y hav e bee n du e t o th e manne r i n whic h th e dat a wa s collecte d an d analyzed whic h shoul d b e addresse d i n futur e studies 13 3

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Gender Femal e gende r wa s significantl y associate d wit h screenin g positiv e fo r anxiet y disorders a findin g tha t i s consisten t wit h th e existin g literatur e fo r th e genera l populatio n (Bebbingto n e t al. 2003 ; Calvet e & Cardenoso 2005 ; Cyranowski Frank Youn g & Shear 2000 ; Kessler Chiu Dernier & Walters 2005) a s wel l a s wit h th e literatur e fo r colleg e students includin g graduat e student s (Lein o & Kisch 2005 ; Eisenber g Gollust Golberstei n & Hefner 2007) O n th e othe r hand gende r di d no t hav e a significan t relationshi p wit h depressio n i n th e curren t study whic h support s th e finding s Eisenberg Gollus t e t al (2007 ) reporte d i n thei r stud y o f undergraduate s an d graduate s a t on e midwester n university Th e existin g literatur e abou t gende r an d depression however i s conflicting a s Lein o an d Kisc h (2005 ) foun d tha t femal e gende r wa s associate d wit h depressio n amon g a mixe d sampl e o f ove r 20,00 0 undergraduat e an d graduat e students Moreover depressio n ha s bee n significantl y associate d wit h femal e gende r i n th e genera l U.S populatio n wher e wome n wer e 70 % mor e likel y tha n me n t o experienc e depressio n durin g thei r lifetime s (NIMH 2010c) Additiona l researc h explorin g gende r an d depressio n amon g graduat e student s i s neede d t o bette r understan d thi s relationship Race/ethnicity Belongin g t o a race/ethnicit y othe r tha n Caucasia n wa s significantl y relate d t o screenin g positiv e fo r depressio n an d als o t o screenin g positiv e fo r eithe r depressio n o r anxiet y disorders Thi s i s a nove l findin g becaus e previou s studie s o f colleg e student s hav e foun d n o associatio n (Lein o & Kisch 2005 ) o r a n associatio n onl y betwee n depressio n an d self-identifyin g a s belongin g t o mor e tha n on e (multi ) 13 4

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racial/ethni c grou p (Eisenberg Gollus t e t al. 2007) I n th e genera l U.S population jus t th e opposite ha s bee n reported Riolo Nguyen Grede n an d Kin g (2005 ) foun d tha t depressio n wa s significantl y associate d wit h bein g Caucasian an d not wit h bein g fro m a minorit y racial/ethni c group Othe r studie s reporte d tha t bein g Africa n American Asia n o r Hispani c decrease d th e odd s (protective ) o f havin g a psychiatri c disorde r (Blanc o e t al. 2008 ; Kessle r e t al. 2005) I t ca n b e speculate d tha t graduat e student s fro m minorit y groups whic h comprise d 34 % o f th e sampl e i n th e curren t study ma y b e mor e dispose d t o depressio n an d anxiet y tha n th e genera l U.S minorit y populatio n becaus e o f th e uniqu e stressor s tha t graduat e schoo l present s fo r thes e minorit y students N o conclusions however ca n b e draw n withou t additiona l researc h i n thi s area Nationality I n th e curren t study internationa l studen t statu s wa s significantl y associate d wit h screenin g positiv e fo r depression ; whereas U.S citize n statu s wa s significantl y relate d t o screenin g positiv e fo r anxiet y disorders Ho w cultur e affect s th e manifestatio n o f th e symptom s o f depressio n an d anxiet y disorder s an d th e diagnosti c criteri a use d t o measur e thes e menta l illnesse s mus t b e considere d whe n interpretin g thi s finding Lewis-Fernande z e t al (2009 ) reporte d tha t symptom s o f PD an d GAD i n particular var y acros s culture s an d ma y b e under-reporte d whe n measure d usin g instrument s validate d wit h western primaril y Caucasia n populations Fo r example i n Puert o Rican Dominica n an d othe r Lati n America n culture s a n ataque de nervios (attac k o f nerves ) ma y actuall y b e a pani c attack but instea d i s characterize d a s a n ange r o r grie f episod e becaus e th e cultura l symptom s manifeste d d o no t mee t th e DSM-I V criteri a fo r 13 5

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PD Th e absenc e o f thes e cultura l symptom s i n DSM-I V criteri a contribute s t o under recognitio n o f menta l illnesse s an d lac k o f treatmen t (Lewis-Fernande z e t al 2009) T o accuratel y measur e depressio n an d anxiet y disorder s amon g internationa l students screenin g instrument s tha t conside r cross-cultura l presentation s o f thes e illnesse s mus t b e develope d an d used Althoug h th e PH Q use d i n th e curren t stud y ha s bee n validate d i n clinica l an d communit y setting s i n th e U.S. i t ha s no t bee n widel y validate d internationally an d therefore ma y no t b e accuratel y screenin g internationa l student s fo r depressio n an d anxiet y disorders Sexua l orientation Self-identificatio n a s bisexual gay/lesbian questionin g o r a s anothe r non-heterosexua l orientatio n wa s significantl y associate d wit h screenin g positiv e fo r anxiet y disorder s an d wit h screenin g positiv e fo r bot h depressio n an d anxiet y disorders Ove r 7 % o f graduat e student s i n th e curren t stud y wer e i n thi s group Thi s associatio n support s earlie r studie s tha t linke d homosexuality bisexualit y an d trans sexualit y wit h depressio n amon g colleg e student s (Eisenberg Gollus t e t al. 2007 ; Leino & Kisch 2005) an d tha t linke d menta l healt h problem s wit h sexua l orientatio n amon g th e genera l U.S populatio n (Ferguson Horwood Ridder & Beautrais 2005 ; Garfalo Wolf Wissow Woods & Goodman 1999 ; Russel l & Joyner 2001) Som e studie s hav e show n tha t increase d prevalenc e o f depressio n an d anxiet y amon g peopl e wh o ar e not heterosexua l ha s bee n associate d wit h experiencin g stres s fro m sexua l stigma prejudic e an d alienatio n fro m friends famil y an d societ y (Cochra n & Mays 2006 ; Ferguso n e t al. 2005 ; Garofal o e t al. 1999) Althoug h reason s fo r increase d depressio n an d anxiet y hav e 13 6

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no t bee n specificall y explore d amon g non-heterosexua l graduat e students i t i s plausibl e tha t the y ar e simila r t o th e stresse s experience d i n th e genera l population makin g thes e student s vulnerabl e t o thes e menta l illnesses Relationshi p status Bein g single divorce d o r widowe d wa s significantl y associate d wit h screenin g positiv e fo r depressio n an d fo r eithe r depressio n o r anxiet y disorders Ove r 35 % o f graduat e student s i n th e curren t stud y wer e i n th e single divorce d o r widowe d relationshi p group wit h mos t i n thi s grou p reportin g a s single Thi s significan t associatio n i s consisten t wit h result s fro m studie s involvin g th e U.S genera l populatio n an d wit h researc h usin g mixe d sample s o f undergraduat e an d graduat e student s (Eisenberg Golberstei n e t al. 2007 ; Eisenberg Gollus t e t al. 2007 ; Kessle r e t al. 2005 ; Lein o & Kisch 2005) I t ca n b e speculate d tha t graduat e student s wh o ar e single divorce d o r widowe d ma y b e mor e likel y t o experienc e feeling s o f isolatio n an d poo r socia l suppor t compare d wit h student s wh o ar e marrie d o r i n domesti c partnerships an d a s a result ar e a t greate r ris k t o experienc e anxiet y an d depressiv e symptom s a s the y dea l wit h th e academi c an d financia l pressure s o f graduat e school Financia l problems Almos t 80 % o f graduate s student s i n th e curren t stud y indicate d tha t thei r curren t financia l situatio n wa s tigh t o r a n outrigh t struggle I n addition havin g curren t financia l problem s wa s significantl y associate d wit h screenin g positiv e fo r anxiet y disorders Durin g preliminar y analyses havin g curren t financia l problem s an d experiencin g financia l problem s growin g u p wer e als o significantl y related Ove r 37 % o f graduat e student s i n th e curren t stud y reporte d experiencin g financia l 13 7

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problem s growin g up Moreover experiencin g financia l problem s growin g u p wa s significantl y relate d t o screenin g positiv e fo r depressio n an d fo r depressio n an d anxiet y disorders Thes e findin g ar e generall y consisten t wit h th e result s Hyu n e t al (2006 ) reporte d i n thei r stud y o f graduat e student s wher e havin g inadequat e financia l resource s wa s significantl y relate d t o poore r menta l health Eisenberg Golberstei n e t al (2007 ) als o foun d tha t undergraduat e an d graduat e student s wh o reporte d curren t financia l problem s wer e mor e likel y t o hav e menta l healt h problems Similarly Eisenberg Gollus t e t al (2007 ) foun d tha t colleg e student s wh o gre w u p i n poo r familie s wer e significantl y mor e likel y t o hav e depressio n o r anxiet y compare d t o student s wh o gre w u p i n financiall y comfortabl e circumstances Th e finding s fro m th e curren t stud y an d fro m thes e additiona l researc h effort s provid e suppor t fo r th e assertio n tha t financia l problem s contribut e substantiall y t o increase d level s o f anxiet y an d depressio n amon g graduat e students Considerin g ho w prevalen t financia l problem s ar e amon g graduat e students an d tha t tuitio n cost s an d livin g expense s ar e expecte d t o continu e t o increase th e impac t o f pursuin g graduat e educatio n o n menta l healt h ha s th e potentia l t o b e considerable I t i s no t full y understood however i f anxiet y an d depressiv e symptom s persis t afte r graduatio n o r i f the y subside Unfortunately explorin g thi s issu e wa s beyon d th e scop e o f th e curren t study Discrimination Experiencin g discriminatio n wa s significantl y relate d t o screenin g positiv e fo r depression eithe r depressio n o r anxiety an d bot h depressio n an d anxiet y disorders Almos t 30 % o f graduat e student s i n th e curren t stud y reporte d 13 8

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experiencin g discriminatio n du e t o thei r race ethnicit y o r cultur e a t leas t onc e durin g th e pas t year Thi s relativel y hig h proportio n ma y b e unexpecte d amon g student s i n a n advance d academi c environmen t tha t i s ofte n viewe d a s mor e toleran t an d libera l tha n genera l society ; however discriminatio n amon g graduat e student s ha s not bee n full y explored I n th e preliminar y analyse s fo r th e curren t study experiencin g discriminatio n wa s significantl y associate d wit h internationa l studen t statu s an d belongin g t o a racial/ethni c grou p othe r tha n Caucasian A n associatio n betwee n depressio n an d racial/ethni c discriminatio n ha s bee n recognize d amon g Africa n American Hispani c an d Asia n undergraduate s (Hwan g & Goto 2008 ; Lightse y & Barnes 2007 ; Okazaki 1997 ; Prelow Moshe r & Bowman 2006 ; Seller s & Shelton 2003 ; Siegel Aneshensel Taub Cantwell & Driscoll 1998) Furthermore th e associatio n betwee n racia l discriminatio n an d depressiv e symptoms anxiet y an d negativ e psychologica l well-bein g amon g th e U.S genera l populatio n i s wel l documented specificall y fo r Africa n American s (Dol e e t al. 2004 ; Kwate Valdimarsdottir Guevarr a & Bovbjerg 2003 ; No h & Kaspar 2003) Asian s (Lee, 2003 ; No h Beiser Kaspar k Ho u & Rummens 1999 ; Yo o & Lee 2005) an d Hispanic s (Arauj o & Borrell 2006 ; Greene Wa y & Pahl 2006 ; Szalac h e t al. 2003) Give n tha t almos t one-thir d o f graduat e student s i n th e curren t stud y reporte d experiencin g discrimination couple d wit h th e evidenc e o f th e detrimenta l impac t tha t thi s ha s o n menta l health indicate s tha t graduat e educatio n doe s not full y offse t th e detrimenta l healt h effect s o f discrimination Th e degre e t o whic h thes e detrimenta l 13 9

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effect s persis t afte r graduatio n ar e relativel y unknow n an d explorin g thi s issu e wa s beyon d th e purpos e o f th e curren t study Gambling I n th e curren t study not gamblin g a t leas t on e da y o r mor e withi n th e pas t yea r wa s significantl y associate d wit h a highe r prevalenc e o f screenin g positiv e fo r anxiety eithe r depressio n o r anxiety an d bot h depressio n an d anxiet y disorders Thos e wh o di d gambl e ha d significantl y lowe r proportion s o f thes e menta l illnesses Thi s findin g i s contrar y t o recen t literatur e reportin g tha t gamblin g was significantl y relate d t o a n increase d prevalenc e o f depressio n an d anxiet y amon g th e genera l populatio n (Barry Stefanovics Desai & Potenza 2011 ; Barry Stefanovics Desai & Potenza 2008 ; Hople y & Nicki 2010 ; Lloy d e t al. 2010 ; Shead Hodgins & Scharf 2008) Th e associatio n betwee n not gamblin g an d depression/anxiet y i n th e curren t stud y ma y b e relate d t o gende r an d ho w th e dat a wa s collected I n th e curren t sample male s wer e les s likel y tha n female s t o scree n positiv e fo r depressio n o r anxiet y disorder s an d accounte d fo r significantl y mor e o f th e proportio n o f thos e wh o gambled Also th e HM S surve y onl y aske d abou t th e numbe r o f day s a participan t gamble d i n th e pas t year not makin g an y distinctio n betwee n differen t form s o f gamblin g (onlin e poker casin o gambling versu s th e casua l neighborhoo d game ) o r askin g i f th e participan t though t gamblin g wa s a proble m o r create d problem s fo r the m i n thei r persona l lives Th e finding s o f th e curren t stud y mus t b e considere d i n ligh t o f thes e limitations Smoking Smokin g tobacc o wa s significantl y associate d wit h screenin g positiv e fo r anxiet y disorder s an d depressio n o r anxiet y disorders Almos t 12 % o f graduat e 14 0

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student s reporte d smokin g withi n th e pas t 3 0 days Thi s findin g linkin g smokin g an d anxiet y disorder s i s not unexpected a s thi s relationshi p i s wel l documente d i n th e curren t literature particularl y regardin g a relationshi p wit h pani c disorde r (Goodwin Lewinsohn & Seeley 2005 ; McCab e e t al. 2003 ; Morissette Tull Gulliver Kamhol z & Zimering 2007) Cranford Eisenber g an d Serra s (2009 ) als o foun d tha t smokin g cigarette s wa s significantl y associate d wit h anxiet y an d depressio n i n a stud y tha t include d ove r 55 % graduat e students Ther e i s evidenc e tha t nicotin e reduce s negativ e affec t an d tha t individual s experiencin g anxiet y an d depressiv e symptom s ma y b e usin g nicotin e a s a for m o f self-medicatio n (McCab e e t al. 2003 ; Morrissett e e t al. 2007) Researc h als o suggests however tha t continue d nicotin e intak e t o ameliorat e feeling s o f anxiet y ma y increas e th e ris k o f developin g pani c disorde r late r (Goodwi n e t al. 2005 ; Morrissett e e t al. 2007) I t wa s beyon d th e scop e o f th e curren t stud y t o explor e thes e issue s in-depth bu t give n th e hig h level s o f anxiet y an d stres s tha t graduat e student s commonl y experience i t i s plausibl e tha t the y ar e self-medicatin g thei r anxiet y wit h nicotine Bing e drinking I n th e curren t study bing e drinkin g wa s no t associate d wit h anxiet y o r depression A n episod e o f bing e drinkin g wa s define d a s fiv e o r mor e alcoholi c drink s i n a ro w fo r males an d fou r o r mor e drink s i n a ro w fo r females Slightl y ove r 40 % o f graduat e student s reporte d engagin g i n thi s behavio r a t las t onc e i n th e pas t tw o weeks Th e lac k o f associatio n i n th e curren t stud y i s contrar y t o th e result s reporte d b y Cranford Eisenber g an d Serra s (2009 ) wher e bing e drinkin g wa s significantl y associate d wit h majo r depressio n an d GA D amon g a mixe d sampl e o f 14 1

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undergraduat e an d graduat e students Thi s findin g als o doe s no t lin e u p wit h researc h o n th e genera l populatio n tha t foun d significan t association s betwee n depressiv e symptom s an d bing e drinkin g (Gilma n & Abraham 2001 ; Hayne s e t al. 2005 ; Naim i e t al. 2003) However Vicker s e t al (2004 ) foun d tha t bing e drinkin g wa s no t associate d wit h depressiv e symptom s i n a sampl e o f femal e colleg e students an d suggeste d tha t copin g wit h negativ e affec t an d stres s ma y not b e a significan t motivatio n fo r bing e drinkin g amon g undergraduat e women McCab e (2002 ) als o foun d gende r difference s i n ris k factor s an d motivation s fo r bing e drinkin g amon g colleg e students especiall y amon g uppe r leve l femal e undergraduates Althoug h bot h o f thes e studie s involve d undergraduates th e lac k o f associatio n i n th e curren t stud y ma y hav e bee n influence d b y th e preponderanc e (almos t 60% ) o f wome n i n th e sample Regardless bing e drinkin g predispose s graduat e student s t o a hos t o f health-relate d consequences includin g drun k driving risk y sexua l behavior physica l injury violence an d lega l problem s (Perkins 2002 ; Wechsle r e t al. 2002) Considerin g th e hig h prevalenc e o f bing e drinkin g amon g graduat e student s i n th e curren t study thes e relationship s an d ris k factor s meri t furthe r study Usin g illici t drugs Usin g illici t drug s withi n th e pas t 3 0 day s wa s significantl y associate d wit h screenin g positiv e fo r anxiet y disorder s an d wit h screenin g positiv e fo r depressio n an d anxiet y disorders Abou t 12 % o f graduat e student s reporte d usin g illici t drug s durin g th e pas t 3 0 days wit h marijuan a accountin g fo r ove r three-quarter s o f th e illici t dru g us e i n thi s group Thi s associatio n betwee n illici t dru g us e an d anxiet y 14 2

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disorder s i s consisten t wit h othe r researc h o n th e genera l population a s wel l a s wit h colleg e student s (Deaco n & Valentiner 2000 ; Liang Chikritzh s & Lenton 2011 ; Metrik Kahler McGeary Mont i & Rohsenow 2011) Individual s wit h anxiet y an d pani c disorder i n particular hav e bee n foun d t o us e marijuan a t o ameliorat e thei r symptom s an d graduat e student s ar e likel y n o differen t (Agosti Nune s & Levin 2002 ; Deaco n & Valentiner 2000 ; Metri k e t al 2011 ; Stinson Ruan Pickerin g & Grant 2006 ; Zvolensk y e t al. 2008) Simila r t o smokin g tobacco graduat e student s wh o screene d positiv e fo r anxiet y disorder s ma y b e usin g marijuan a t o self-medicate especiall y i f the y hav e not bee n clinicall y diagnosed Exercise Exercisin g les s tha n thre e time s pe r wee k wa s significantl y associate d wit h screenin g positiv e fo r al l fou r combination s o f depressio n an d anxiet y disorders Thi s associatio n i s consisten t wit h a larg e bod y o f researc h tha t ha s linke d physica l activit y wit h menta l healt h benefits includin g reduce d anxiet y an d depressiv e symptom s (Conn 2010 ; Daley 2008 ; Dunn Trivedi & O'Neal 2001 ; Lawlo r & Hopker 2001 ; Mea d e t al. 2008 ; Oeland Laessoe Olese n & Munk-Jorgensen 2010 ; Saeed Antonacc i & Bloch 2010 ; Stathopoulou Powers Berry Smit s & Otto 2006) I n randomize d clinica l trials exercis e was foun d t o reduc e depressiv e symptom s a t a rat e simila r t o cognitiv e behaviora l therap y (Lawlo r & Hopker 2001 ; Mea d e t al. 2008 ; Stathopoulo u e t al. 2006) an d som e evidenc e wa s als o foun d tha t exercis e produce d result s comparabl e t o th e anti-depressan t dru g sertralin e (Zoloft ) (Babya k e t al. 2000 ; Blumenthal e t al. 2007) I n ligh t o f thi s research thi s associatio n betwee n exercis e an d 14 3

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depressio n an d anxiet y disorder s i n th e curren t stud y o f graduat e student s ma y no t b e surprising ; however wha t i s concernin g i s tha t almos t hal f o f graduat e student s i n th e curren t stud y reporte d tha t the y di d no t exercis e a t leas t 3 time s pe r week Give n th e menta l an d physica l benefit s o f regula r exercise thi s raise s question s abou t wh y a considerabl e proportio n o f graduat e student s di d not exercis e i n spit e o f bein g highl y educate d an d likel y awar e o f it s benefits Othe r factors I n th e curren t study th e geographica l regio n o f th e schoo l wa s not significantl y associate d wit h an y o f th e combination s o f depressio n an d anxiet y disorder s i n graduat e students O n th e othe r hand livin g situation specificall y livin g o n campus wa s significantl y associate d wit h depression but no t wit h anxiet y disorder s o r an y o f th e othe r combinations I n th e preliminar y analyse s fo r th e curren t study livin g situatio n wa s relate d t o relationshi p status an d bein g single divorce d o r widowe d wa s significantl y relate d t o screenin g positiv e fo r depression Speculatio n tha t thos e graduat e student s livin g o n campus ar e singl e i s plausible Becaus e o f th e associatio n betwee n livin g situatio n an d relationshi p status lookin g a t livin g situatio n o n it s ow n i n th e curren t stud y di d no t provid e ne w insights Predictio n Model s Whe n interpretin g th e finding s o f th e logisti c regressio n analyse s predictin g a positiv e scree n fo r depressio n an d anxiet y disorders i t i s mos t insightfu l t o ste p bac k fro m th e minuti a o f eac h model an d instea d examin e th e overal l trends Takin g thi s approac h allow s th e developmen t o f a broader perspectiv e o n depressio n an d anxiet y 14 4

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disorder s amon g graduat e students whic h i s sensibl e give n th e clos e clinica l relationshi p tha t thes e tw o menta l illnesse s share Thi s approac h als o make s sens e becaus e man y o f th e predictor s an d protector s identifie d i n th e curren t stud y wer e applicabl e t o bot h illnesses I n th e significan t demographi c models identifyin g a s bisexual gay/lesbian questioning o r wit h anothe r non-heterosexua l orientatio n wa s a significan t predicto r o f bot h depressio n an d anxiety A s previousl y discussed thi s connectio n i s wel l establishe d i n th e literatur e regardin g th e U.S genera l populatio n an d undergraduate s (Eisenberg Gollus t e t al. 2007 ; Ferguso n e t al. 2005 ; Lein o & Kisch 2005) Th e abilit y o f sexua l orientatio n t o predic t a positiv e screenin g fo r anxiet y an d depressio n i n th e curren t stud y suggest s tha t graduat e student s ar e not les s susceptibl e t o th e negativ e effect s o f sexua l stigm a an d socia l isolatio n i n spit e o f thei r highe r educationa l status. Thi s assumption however mus t b e confirme d wit h furthe r research Two factor s i n th e demographi c model s wer e foun d t o b e protectiv e o f screenin g positiv e fo r anxiet y disorders : bein g mal e an d internationa l studen t status Thes e tw o factors however wer e not protectiv e o f screenin g positiv e fo r depression Mal e gende r ha s bee n repeatedl y linke d wit h lowe r rate s o f bot h depressio n an d anxiet y disorder s i n th e literature, s o thi s findin g wa s not unexpecte d (Eisenberg Gollus t e t al. 2007 ; NIMH 2010a ; NIMH 2010b ; NIMH 2010c) I t wa s interesting however tha t femal e gende r wa s no t predictiv e o f depression a s thi s relationshi p ha s als o bee n documente d i n othe r studie s (Lein o & Kisch 2005 ; NIMH 2010c) Reason s fo r thi s amon g graduat e student s 14 5

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requir e furthe r investigation Th e findin g tha t internationa l studen t statu s wa s protectiv e o f anxiet y disorder s mus t als o b e studie d furthe r because a s previousl y discussed th e cultura l biase s inheren t i n th e PH Q screenin g instrumen t ma y hav e influence d thi s finding I n th e significan t socia l models relationshi p statu s wa s a significan t predicto r o f depressio n an d anxiet y disorders Graduat e student s wh o reporte d bein g single divorce d o r widowe d consistentl y ha d greate r odd s o f screenin g positiv e fo r depressio n an d anxiet y disorders compare d t o thos e wh o wer e marrie d o r livin g i n a domesti c partnership Thi s finding, a s note d previously i s generall y i n lin e wit h othe r researc h indicatin g tha t bein g singl e i s a ris k facto r fo r depressio n an d anxiet y (Eisenberg Golberstei n e t al. 2007 ; Eisenberg Gollus t e t al. 2007 ; Kessle r e t al. 2005 ; Leino & Kisch 2005) an d therefore wa s no t a surprisin g finding Wha t wa s surprisin g i n th e socia l model s wa s tha t havin g financia l problem s growin g u p wa s a significan t predicto r o f thes e menta l illnesses Onl y on e othe r stud y ha s reporte d thi s link Eisenberg Gollus t e t al (2007 ) conducte d a stud y o f undergraduat e an d graduat e student s a t on e midwester n universit y an d foun d tha t thos e wit h financia l problem s growin g u p wer e considerabl y mor e likel y t o scree n positiv e fo r depressio n o r anxiet y disorder s an d als o t o repor t suicida l thoughts Thi s stud y als o use d th e sam e basi c HM S survey a s th e curren t study althoug h i t wa s conducte d fiv e year s earlier Eisenberg Gollus t e t al (2007 ) note d tha t thi s findin g occurre d eve n thoug h menta l healt h service s wer e availabl e fre e o f charge 14 6

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indicatin g tha t reducin g financia l barrier s was not sufficien t t o addres s depressio n an d anxiet y an d tha t educatio n an d outreac h wer e als o needed I n th e lifestyle/health-relate d behavio r models severa l differen t item s wer e predictiv e o f screenin g positiv e fo r depressio n an d anxiet y disorders Experiencin g discriminatio n du e t o race ethnicit y o r cultur e was consistentl y predictive a findin g which a s previousl y discussed i s consisten t wit h existin g literatur e (Hwan g & Goto 2008 ; Lightse y & Barnes 2007 ; Okazaki 1997 ; Prelo w e t al. 2006 ; Seller s & Shelton 2003 ; Siege l e t al. 1998) I t i s notabl e tha t almos t one-thir d o f student s i n thi s stud y reporte d experiencin g discriminatio n withi n th e pas t year Thes e finding s sugges t tha t considerabl e discriminatio n ma y exis t i n graduat e school a settin g tha t i s typicall y though t o f a s mor e libera l an d toleran t tha n mainstream society an d tha t addressin g discriminatio n shoul d b e include d a s par t o f menta l healt h intervention s fo r graduat e students Smokin g an d usin g illici t drug s wer e othe r health-relate d behavior s tha t wer e als o significan t predictors I n th e curren t study thos e graduat e student s tha t engage d i n thes e behavior s durin g th e pas t 3 0 day s ha d greate r odd s o f screenin g positiv e fo r depressio n an d anxiet y disorders Furthe r exploratio n o f thes e finding s i s needed however t o understan d th e temporalit y o f thes e relationships I t i s plausibl e tha t thes e behavior s d o no t trul y precee d positiv e screenings but rathe r wer e form s o f self treatmen t i n respons e t o illnesse s tha t alread y existed Two lifestyle/health-relate d behavior s wer e protectiv e o f screenin g positiv e fo r depressio n an d anxiet y disorders Mos t notabl e o f thes e wa s tha t gamblin g o n on e o r 14 7

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mor e day s durin g th e pas t yea r wa s protective Thi s rathe r unexpecte d findin g ma y b e relate d t o th e predominantl y mal e gende r distributio n amon g gambler s an d tha t bein g mal e wa s protectiv e o f screenin g positiv e fo r anxiet y i n th e curren t study Regardless thi s findin g shoul d b e viewe d wit h a cautiou s ey e give n th e limitation s i n ho w th e gamblin g dat a wa s collected Furthe r investigatio n usin g instrument s tha t collec t dat a abou t th e specifi c typ e o f gamblin g an d it s impac t amon g graduat e student s i s needed Exercis e wa s th e othe r behavio r tha t wa s protectiv e i n th e curren t study Thos e graduat e student s wh o exercise d thre e o r mor e time s pe r wee k ha d lowe r odd s o f screenin g positiv e compare d t o thos e wh o di d not A s previousl y discussed existin g researc h ha s indicate d tha t exercis e reduce s depressiv e symptom s an d i n som e case s was a s effectiv e a s antidepressan t drug s (Babya k e t al. 2000 ; Blumenthal e t al. 2007) A s wit h th e othe r healt h behavior s examine d i n th e curren t study th e temporalit y o f thi s relationshi p mus t als o b e examine d further I n th e curren t study th e cross-validatio n o f th e model s wit h smalle r sub-sample s serve d t o identif y th e stronges t predictor s an d protector s o f screenin g positiv e fo r depressio n o r anxiet y disorders Th e predictor s tha t consistentl y remaine d significan t durin g thi s procedur e included : a ) bein g bisexual gay/lesbian questionin g o r fro m anothe r non-heterosexua l orientation ; b ) bein g single divorce d o r widowed ; c ) havin g financia l problem s growin g up ; an d d ) experiencin g discrimination Exercisin g thre e o r mor e time s pe r wee k wa s th e mos t consisten t protector 14 8

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Implication s fo r Healt h Educatio n Th e finding s fro m curren t stud y hav e importan t implication s fo r th e healt h educatio n profession particularl y i n th e are a o f colleg e healt h promotion Traditionally menta l healt h program s a t universitie s hav e focuse d o n undergraduate s based o n th e assumptio n tha t older mor e academicall y seriou s graduat e student s ar e not i n nee d o f suc h interventions Th e curren t stud y add s t o a small bu t growin g bod y o f literatur e indicatin g tha t thi s i s no t th e case an d that instead graduat e student s ar e a s a t ris k fo r depressio n an d anxiet y disorder s a s thei r undergraduat e counterparts College s an d universitie s ar e i n a uniqu e positio n t o identif y an d interven e befor e menta l healt h problem s occu r o r becom e serious but ar e largel y missin g thi s opportunit y whe n i t come s t o graduat e students Th e implicatio n fo r colleg e healt h educatio n professional s i s tha t graduat e student s mus t b e considere d a legitimat e priorit y populatio n fo r menta l healt h programming an d routinel y include d i n need s assessmen t activitie s t o gai n a n improve d understandin g o f graduat e students menta l healt h status. Thi s understandin g shoul d b e use d t o infor m universit y menta l healt h programmin g designe d specificall y fo r graduat e student s suc h tha t a n appropriat e combinatio n o f preventio n initiative s an d diagnosti c an d treatmen t service s coul d b e provided Thi s woul d als o hel p justif y th e us e o f resource s fo r graduat e studen t menta l healt h initiative s a t U.S universities I n addition healt h educator s shoul d embrac e a multi-disciplinar y approac h t o colleg e menta l healt h intervention s tha t facilitate s collaboratio n amon g universit y menta l 14 9

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healt h providers psychiatrists/psychologists socia l workers dru g an d alcoho l counselor s an d th e universit y administration Suc h a n approac h i s necessar y because a s th e curren t stud y shows th e factor s an d behavior s relate d t o depressio n an d anxiet y disorder s amon g graduat e student s ar e divers e an d complicated Intervention s wil l requir e th e knowledg e an d skill s o f al l thes e differen t profession s t o b e successful Healt h educator s ar e uniquel y qualifie d t o lea d thi s collaboratio n an d mak e a vita l contributio n t o improvin g menta l healt h amon g graduat e students Limitation s Th e finding s reporte d mus t b e understoo d withi n th e contex t o f th e study' s limitations A positiv e screenin g outcom e usin g th e PH Q instrumen t i s no t equivalen t t o a clinica l diagnosi s o f depressio n o r anxiet y disorders althoug h th e PH Q ha s bee n successfull y validate d agains t clinica l diagnose s an d foun d t o b e a mor e reliabl e indicato r tha n self-report s o f bein g diagnose d wit h thes e illnesse s (Klein Ciotoli & Chung 2011 ; Kroenke Spitze r & Williams 2001 ; Martin Rief Klaiber g & Braehler 2006 ; Spritzer Kroenke William s & th e Patien t Healt h Questionnair e Primar y Car e Stud y Group 1999) Th e PH Q ha s als o not bee n specificall y validate d a s a n onlin e screenin g tool I t ha s bee n validate d a s a self-administered pape r an d penci l instrument an d th e onlin e versio n use d i n th e curren t stud y mirrore d th e self-administere d versio n exactl y (Eisenberg Gollust e t al. 2007 ; HMS 2010) I n addition th e curren t stud y use d onl y self-reporte d dat a tha t canno t b e corroborate d and a s a result introduce s th e potentia l fo r error Moreover althoug h 15 0

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rando m samplin g wa s use d a t eac h universit y t o recrui t participant s fo r th e study graduat e student s wit h existin g menta l healt h concern s ma y hav e bee n mor e incline d t o respon d t o th e recruitmen t invitation s tha n thos e withou t menta l healt h problems whic h coul d als o bia s th e results Also respons e rate s fo r th e 201 0 HM S surve y varie d widel y fro m institutio n t o institution wit h a n overal l respons e rat e o f onl y abou t 25% Graduat e school s fro m al l geographi c area s o f th e U.S wer e not uniforml y represente d i n th e sample bu t rathe r concentrate d i n th e Wes t an d Northeast Furthermore participatin g institution s joine d th e 201 0 HM S dat a collectio n o n a voluntar y basis and a s a result ma y reflec t a grou p o f school s wher e menta l healt h problem s ar e mor e prevalen t an d perhap s o f greate r concern tha n a t thos e school s tha t chos e not t o participate Fo r thes e reasons th e generalizabilit y o f th e result s o f thi s stud y i s limited I n spite o f thes e limitations severa l insightfu l finding s wer e discovere d i n th e curren t stud y tha t serv e t o advanc e healt h educators knowledg e an d understandin g o f menta l healt h issue s amon g U.S graduat e students Recommendation s Th e finding s o f th e curren t stud y sugges t prioritie s an d recommendation s fo r futur e research First a vali d an d reliabl e screenin g instrumen t fo r depressio n an d anxiet y disorder s mus t b e develope d tha t takes th e cultura l variatio n o f symptom s int o consideration Th e prevalenc e o f depressio n an d anxiet y symptom s amon g internationa l an d certai n minorit y student s canno t b e determine d accuratel y withou t suc h a n instrument Thi s wil l becom e increasingl y importan t a s mor e minorit y an d internationa l 15 1

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student s ar e expecte d t o enrol l i n graduat e school s durin g th e comin g years Secondly th e scop e o f futur e studie s shoul d b e expande d t o includ e collectio n an d analysi s o f dat a abou t suicida l ideation Thi s wa s no t include d i n th e curren t study an d yet suicid e i s th e mos t sever e consequence o f depressio n an d anxiet y disorders Finally a bette r understandin g o f th e temporalit y o f th e relationshi p betwee n healt h ris k behavior s an d depression/anxiet y disorder s amon g graduat e student s i s needed I n addition determinin g t o wha t exten t depression/anxiet y symptom s persis t afte r graduatio n an d wha t factor s promot e recover y i s als o criticall y important Suc h question s canno t b e answere d wit h cross-sectiona l designs but instea d requir e a longitudina l approac h tha t woul d follo w student s durin g graduat e schoo l an d fo r severa l year s afterwards Althoug h longitudina l studie s ca n b e expensiv e an d challengin g t o conduct suc h a n effor t i s require d t o appropriatel y addres s thes e issue s an d ultimatel y infor m campu s menta l healt h programming 15 2

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Studen t Menta l Healt h Committee Universit y o f California (2006) Executive summary: Student Mental Health Committee final report. Retrieve d fro m th e Universit y o f California Offic e o f th e Presiden t a t http://www.universityofcalifornia.ed u /regents/regmeet/sept06/303attach.pd f Sullivan T. & Repak N (2011 April) Financial pressure for grad students. Retrieve d fro m Gra d Resource s a t http://www.gradresources.org/article s /financialpressures shtm l Swaner L E (2007 Winter) Linkin g engage d learning studen t menta l healt h an d well being an d civi c development : A revie w o f th e literature Liberal Education, 93(1), 16-25 Szalach L A. Erkut S. Coll C G. Alarcon O. Fields J P. & Ceder I (2003) Discriminatio n an d Puert o Rica n children' s an d adolescent' s menta l health Cultural Diversity & Ethnic Minority Psychology, 9, 141-155 Tija J. Givens J L. & Shea J A (2005) Factor s associate d wit h undertreatmen t o f medica l studen t depression Journal of American College Health, 53(5) 219-224 Toews J A. Lockyer J M. Dobson D J. Simpson E. Brownell A K. Brenneis F. .. Cohen G S (1997) Analysi s o f stres s level s amon g medica l students residents an d graduat e student s a t fou r Canadia n school s o f medicine Academic Medicine, 72(11) 997-1002 17 1

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Turner A L. & Berry T R (2000) Counselin g cente r contribution s t o studen t retentio n an d graduation : A longitudina l assessment Journal of College Student Development, 41(6), 627-636 Vickers K S. Patten C A. Bronars C Lane K. Stevens S R. Croghan I T. .. Clark M M (2004) Binge drinkin g i n femal e colleg e students : Th e associatio n o f physica l activity weigh t concern, an d depressiv e symptoms Journal of American College Health, 53(3), 133-140 Wechsler H. Lee J E. Kuo M. Seibring M. Nelson T F. & Lee H (2002) Trend s i n colleg e bing e drinkin g durin g a perio d o f increase d preventio n efforts Journal of American College Health, 50, 203-217 Wei C C Berkner L. He S. Cominole M. & Siegel P (2009) 2007-2008 National postsecondary student aid study (NPSAS:08): Student financial aid estimates for 2001-2008: First look [NCE S 2009-166) Retrieve d fro m th e Nationa l Cente r fo r Educatio n Statistics Institut e o f Educatio n Sciences U.S Departmen t o f Educatio n a t http://nces.ed.gov/pubs2009/2009166.pd f Weistraub N V. McOrnish C Hanks J. & Gingrich J A (2010) Role o f th e corte x i n regulatio n o f anxiet y states I n H B Simpson Y Neria R Lewis-Fernandez & F Schneie r (Eds.) Anxiety disorders: Theory, research and clinical perspectives (pp 168-179) Cambridge UK : Cambridg e Universit y Press 17 2

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Worl d Healt h Organization (2004) Prevention of mental disorders: Effective interventions and policy implications: Summary report. Retrieve d fro m http://www.who.int/mental_health/evidence/en/prevention_of_mental_disorders_ s r.pd f Worl d Healt h Organization (2007) Par t 1 : Ten statistical highlights in global public health. Retrieve d fro m http://www.who.int/whosis/whostat200 7 _10highlights.pd f Worl d Healt h Organization (2008) The global burden of disease: 2004 update. Retrieve d fro m http://www.who.int/healthinfo/global_burden_diseas e /2004_report_update/en/inde x .htm l Worl d Healt h Organization (2011) Depression. Retrieve d fro m http://www.who.int/mental_health/management/depression/definition/en / index.htm l Yoo H C & Lee R M (2005) Ethni c identit y an d approach-typ e copin g a s moderator s o f th e racia l discrimination/well-bein g relatio n i n Asia n Americans Journal of Counseling Psychology, 52, 497-506 Zivin K. Eisenberg D. Gollust S E. Golberstein E (2009) Persistenc e o f menta l healt h problem s an d need s i n a colleg e studen t population Journal of Affective Disorders, 117, 180-185 Zlotnick C Johnson J. Kohn R. Vicente B. Rioseco P. & Saldivia S (2008) Childhoo d trauma traum a i n adulthood an d psychiatri c diagnoses : Result s fro m a communit y sample Comprehensive Psychiatry, 49, 163-169 17 3

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Zvolensky M J. Lewinsohn P. Bernstein A. Schmidt N B. Buckner J D. Seeley J. Bonn-Miller M O (2008) Prospectiv e association s betwee n cannabi s use abuse an d dependenc e an d pani c attack s an d disorder Journal of Psychiatric Research, 42, 1017-1023 17 4

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APPDENDI X A Healthy Mind s Questionnair e 17 5

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Health y Mind s Stud y questionnair e hms@ssgresearch.co m Fo r emergenc y 2 4 h r help : Psychiatri c Emergenc y Service s a t (loca l number ) O r 1-800-273-TAL K Genera l Programmin g Note s 1 An y word s i n al l cap s wil l b e emphasize d i n bol d blu e tex t o n th e web W e hav e replace d al l underline d emphasi s wit h thi s forma t (i t i s ou r standard) W e believ e i t i s a bette r approach bu t w e ca n modif y thi s i f desired 2 Al l question s ar e optiona l unles s otherwis e specified 3 Al l question s ar e place d on e pe r screen unles s otherwis e note d o r i f specifie d a s a "grid question 4 Suppor t emai l addres s t o display : healthyminds@ssgresearch.co m 5 Shor t UR L fo r surve y shoul d be : https:www.ssgresearch.com/hm s 6 Log o t o use : Eac h schoo l wil l hav e a uniqu e log o t o displa y drive n fro m QPRE1 7 Heade r wil l contai n th e followin g information : hm s @ ssgresearch.co m Fo r emergenc y 2 4 h r help : Psychiatri c Emergenc y Service s a t (QPRE3 ) O r 1-800-273-TAL K PRELOAD S CUSTOMID=customi d QPRE1=schoo l numbe r QPRE2=schoo l nam e QPRE3=loca l counselin g phon e numbe r QPRE4=gra d vs undergra d Welcom e t o th e Health y Mind s Survey Pleas e clic k Star t Surve y t o begin Use r I D [INSTITUTIO N NAME ] [LOCA L IR B CONTAC T PERSON ] [LOCA L IR B CONTAC T E-MAIL ] [LOCA L RESOURCE S FO R INTERVENTION/MENTA L HEALT H ASSISTANCE ] CONSEN T 17 6

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CONSEN T Health y Mind s Stud y Consen t Form : Mai n Surve y • Wh o i s doin g thi s study ? Thi s stud y i s a partnershi p betwee n Danie l Eisenberg PhD Assistan t Professo r a t th e Universit y o f Michiga n Schoo l o f Publi c Healt h an d [inser t loca l contact] • Wh y ar e yo u doin g thi s research ? W e ar e tryin g t o bette r understan d issue s relate d t o undergraduat e an d graduat e students well-being source s o f support an d menta l an d emotional health Thi s stud y i s importan t t o furtherin g knowledg e abou t ho w student s ar e handlin g th e stresse s o f universit y lif e an d ho w wel l thei r menta l an d emotional healt h need s ar e bein g met W e wil l provid e th e result s (withou t an y individuall y identifiabl e information ) t o schoo l administrator s an d othe r communit y member s t o hel p the m thin k abou t ho w t o improv e studen t life • Wha t wil l takin g thi s surve y b e like ? Th e surve y take s 10-2 0 minute s fo r mos t student s t o complete thoug h i t ma y tak e les s o r mor e tim e fo r som e students Yo u mus t b e 1 8 o r olde r t o tak e thi s survey Yo u wil l b e aske d question s abou t you r mood s an d emotions menta l healt h an d emotional issue s yo u hav e experienced suppor t yo u ma y o r ma y not hav e received an d you r academi c life Whil e i n th e survey yo u wil l b e abl e t o sto p a t an y tim e b y closin g you r browser Yo u ma y the n retur n t o th e questionnair e later Al l response s yo u ha d entere d an d submitte d wil l b e saved W e as k tha t yo u complet e th e surve y withi n 1 4 days • Wha t ar e th e risk s associate d wit h m y participation ? Som e o f th e question s wil l as k yo u abou t sensitiv e o r persona l informatio n suc h a s you r emotiona l health Thes e question s migh t mak e yo u fee l uncomfortabl e o r anxious Yo u ca n ski p an y question s yo u d o not wan t t o answer A t th e conclusio n o f th e surve y yo u wil l receiv e a lis t o f resource s o n campus tha t ca n provid e yo u wit h hel p an d support I f respondin g t o an y question s makes yo u fee l worrie d o r unhappy w e urg e yo u t o cal l an y o f th e resource s listed You r participatio n i s voluntar y — you r refusa l t o participat e wil l involv e n o penalt y o f an y sort Yo u ma y discontinu e participatio n a t an y time • Wh o wil l benefi t fro m m y participatio n i n thi s research ? W e expec t thi s researc h t o b e use d t o improv e studen t life s o student s a t you r schoo l an d nationwid e ma y ultimatel y benefi t fro m th e knowledg e obtaine d i n thi s study 17 7

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Additionally yo u wil l b e entere d int o a sweepstake s t o b e conducte d o n Jun e 15 201 0 fo r cas h prize s totalin g $4,00 0 (te n $25 0 prize s an d thre e $50 0 prizes ) regardles s o f whethe r yo u complet e th e survey Th e drawin g wil l b e conducte d b y th e Surve y Science s Group LL C o n 22 0 E Huro n St i n An n Arbor MI Th e chanc e o f winnin g a priz e i s approximatel y 1 i n 300 Winner s wil l b e notifie d immediatel y b y email an d prize s wil l b e maile d a s checks • Ho w wil l m y privac y an d confidentialit y b e protected ? You r confidentialit y wil l b e maintaine d t o th e degre e permitte d b y th e technolog y used Specifically n o guarantee s ca n b e mad e regardin g th e interceptio n o f dat a sen t vi a th e Interne t b y an y thir d parties Th e surve y wa s designe d t o protec t you r privac y an d confidentiality Th e Surve y Science s Group LL C (SSG) ha s bee n hire d t o hel p ensur e you r confidentialit y b y maintainin g al l stud y records The y wil l us e Secur e Socket s Laye r (SSL ) encryptio n technolog y t o ensur e tha t you r response s ar e not intercepte d i n transmission an d wil l provid e physica l an d logica l restriction s t o protec t you r dat a onc e i t ha s bee n collected Th e researcher s wil l neve r kno w you r name emai l address o r an y othe r identifiabl e information An y report s o r article s tha t w e writ e wil l describ e th e dat a i n th e aggregat e an d wil l contai n n o informatio n tha t coul d allo w somebod y t o identif y you Surve y Science s Group LL C ha s conducte d severa l studie s o f sensitiv e issue s amon g colleg e studen t populations an d the y us e th e mos t sophisticate d technolog y availabl e t o assur e security an d confidentiality Th e securit y an d confidentialit y maintaine d b y th e Surve y Science s Grou p ha s neve r bee n breached Th e dat a fro m thi s study withou t an y identifiabl e information wil l b e retaine d i n a secur e repositor y fo r futur e researc h purposes Record s wil l b e kep t confidentia l t o th e exten t provide d b y federal state an d loca l law However th e Institutiona l Revie w Board th e sponso r o f th e study o r universit y an d governmen t official s responsibl e fo r monitorin g thi s stud y ma y inspec t thes e records Also pleas e b e awar e tha t eve n thoug h researcher s wil l not kno w you r name th e dat a collectio n fir m wil l hav e you r nam e i n orde r t o sen d yo u follo w u p email s i f necessary I f yo u participat e i n th e presen t study yo u ma y b e contacte d i n futur e year s fo r a follow-u p study T o provid e additional protection s t o you r privacy w e hav e obtaine d a Certificat e o f Confidentialit y fro m th e Nationa l Institute s o f Health Wit h thi s Certificate th e researcher s canno t b e force d t o disclos e informatio n tha t ma y identif y you eve n b y a cour t subpoena i n an y federal state o r loca l civil criminal administrative legislative o r othe r proceedings Th e researcher s wil l us e th e Certificat e t o resis t an y demand s fo r informatio n tha t woul d identif y you excep t a s explaine d below Th e Certificat e canno t b e use d t o resis t a deman d fo r informatio n fro m personne l o f th e Unite d State s Governmen t tha t i s use d fo r auditin g o r evaluatio n o f federall y funde d project s o r fo r informatio n tha t mus t b e disclose d i n orde r t o mee t th e requirement s o f th e federa l Foo d an d Dru g Administratio n (FDA) Yo u shoul d understan d tha t a Certificat e o f 17 8

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Confidentialit y doe s no t preven t yo u o r a membe r o f you r famil y fro m voluntaril y releasin g informatio n abou t yoursel f o r you r involvemen t i n thi s research I f a n insurer employer o r othe r perso n obtain s you r writte n consen t t o receiv e researc h information the n th e researcher s ma y no t us e th e Certificat e t o withhol d tha t information Th e Certificat e o f Confidentialit y doe s not preven t th e researcher s fro m disclosin g voluntarily withou t you r consent informatio n tha t woul d identif y yo u a s a participan t i n th e researc h projec t i f yo u indicat e tha t yo u ar e a t imminen t an d seriou s ris k t o har m yoursel f o r others • Wha t i f I hav e question s abou t th e survey ? I f yo u hav e question s abou t thi s research th e surve y questions o r thi s consen t process yo u ca n contac t th e researcher s a t info@healthymindsstudy.ne t o r (734 ) 213-4600 ex t 470 Yo u ma y als o contac t th e P I o f thi s study Dr Danie l Eisenber g a t (daneis@umich.edu ) o r 734-615-7764 o r th e loca l PI [inser t loca l contac t info] Shoul d yo u hav e question s regardin g you r right s a s a researc h participan t o r fee l tha t yo u hav e bee n harme d b y thi s research pleas e contac t th e Institutiona l Revie w Boar d a t th e Universit y o f Michigan 54 0 E Libert y Street Suit e 202 An n Arbor M I 48104-2210 (734 ) 936-0933 email : irbhsbs@umich.edu Pleas e clic k th e lin k a t th e botto m o f th e scree n i f yo u wis h t o prin t a cop y o f thi s consen t form & Yes, I have read the information given above, I am at least 18 years old, and I CONSENT to participate in this study. is. No, I do not wish to participate in this study and understand that there is no penalty for not participating. 17 9

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A BASI C INFORMATIO N Al Ho w ol d ar e you ? (You must be 18 years or older to complete this survey) 1 2 3 4 5 6 7 8 9 1 0 1 8 year s ol d 1 9 year s ol d 2 0 year s ol d 2 1 year s ol d 2 2 year s ol d 23-2 5 year s ol d 26-3 0 year s ol d 31-3 5 year s ol d 36-4 0 year s ol d 41 + year s ol d A2 Wha t gende r ar e you ? 1 Femal e 2 Mal e 3 Other(specify ) A3 Ho w d o yo u usuall y describ e you r rac e and/o r ethnicity ? (Check all that apply) 1 2 3 4 5 6 7 8 Whit e o r Caucasia n Africa n American/Blac k Hispanic/Latin o America n Indian/Alaska n Nativ e Arab/Middl e Easter n o r Ara b America n Asian/Asian-America n Pacifi c Islande r Othe r (specify ) A4 Ar e yo u a U S citize n o r permanen t resident ? 1 Ye s 2 N o 18 0

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A5 Ho w woul d yo u describ e you r sexua l orientation ? 1 Heterosexua l 2 Bisexual 3 Gay/Lesbian/Quee r 4 Questionin g 5 Othe r (specify ) A6 Wher e d o yo u live ? 1 Campu s residenc e hal l 2 Fraternit y o r sororit y hous e 3 Othe r Universit y housin g 4 Off-campus non-universit y housin g 5 Paren t o r guardian' s hom e 6 Othe r (specify ) A7 Wha t yea r ar e yo u i n you r curren t degre e program ? 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 + A8 I n wha t degre e progra m ar e yo u currently ? (Check all that apply) 1 Associate' s degre e 2 Bachelor' s degre e 3 Master' s degre e 4 J D 5 M D 6 Ph D o r equivalen t 7 Othe r (specify ) 18 1

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A9 Wha t i s you r fiel d o f study ? (Check all that apply) 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 2 0 2 1 2 2 Humanitie s (English language history philosophy anthropology etc. ) Socia l scienc e (Economics psychology sociology politica l science etc. ) Natura l scienc e an d mathematic s (Math biology chemistry physics etc. ) Ar t an d Desig n Architectur e an d Urba n Plannin g Busines s Dentistr y Educatio n Engineerin g Informatio n Kinesiolog y La w Medicin e Musi c Natura l Resource s an d Environmen t Nursin g Pharmac y Publi c Health Publi c Polic y Socia l Wor k Othe r (specify ) Undecide d AlO Ho w religiou s woul d yo u sa y yo u ar e ver y religious fairl y religious not to o religious o r no t religiou s a t all ? 1 Ver y religiou s 2 Fairl y religiou s 3 No t to o religiou s 4 No t religiou s a t al l All Ho w woul d yo u characteriz e you r curren t financia l situation ? 1 It' s a financia l struggl e 2 It' s tigh t but I' m doin g fin e 3 Finance s aren' t reall y a proble m 18 2

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A12 Whic h o f th e followin g bes t describe s you r family' s financia l situatio n growin g up ? 1 Ver y poor no t enoug h t o ge t b y 3 Ha d enoug h t o ge t b y bu t no t man y "extras 4 Comfortabl e 5 Wel l t o d o A 12a Wha t i s th e highes t leve l o f educatio n complete d b y you r mother ? 1 2 3 4 5 6 7 8 Eight h grad e o r lowe r Betwee n 9 an d 12 1 grad e (bu t n o hig h schoo l degree ) Hig h schoo l degre e Som e colleg e (bu t n o colleg e degree ) Associate' s degre e Bachelor' s degre e Graduat e degre e Don' t kno w A 12b Wha t i s th e highes t leve l o f educatio n complete d b y you r father ? 1 2 3 4 5 6 7 8 Eight h grad e o r lowe r Betwee n 9 t h an d 12 t h grad e (bu t n o hig h schoo l degree ) Hig h schoo l degre e Som e colleg e (bu t n o colleg e degree ) Associate' s degre e Bachelor' s degre e Graduat e degre e Don' t kno w A13 Ho w woul d yo u characteriz e you r curren t relationshi p status ? 1 Singl e 2 I n a relationshi p 3 Marrie d o r domesti c partnershi p 4 Divorce d 5 Widowe d 18 3

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B HO W YO U AR E DOIN G Th e nex t se t o f question s wil l as k yo u abou t you r genera l well-bein g an d emotiona l health 18 4

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BO Pleas e answe r th e followin g question s ar e abou t ho w yo u hav e bee n feelin g i n th e pas t month Plac e a chec k mar k i n th e bo x tha t bes t represent s ho w ofte n yo u hav e experience d o r fel t th e following : I n th e pas t month ho w ofte n di d yo u fee l .. 1.happ y 2 intereste d i n lif e 3 satisfie d 4 tha t yo u ha d somethin g importan t t o contribut e t o societ y 5 tha t yo u belonge d t o a communit y (lik e a socia l group you r neighborhood you r city ) 6 tha t ou r societ y i s becomin g a bette r plac e fo r peopl e 7 tha t peopl e ar e basicall y goo d 8 tha t th e wa y ou r societ y work s make s sens e t o yo u 9 tha t yo u like d mos t part s o f you r personalit y 10 goo d a t managin g th e responsibilitie s o f you r dail y lif e 11 tha t yo u ha d war m an d trustin g relationship s wit h other s 12 tha t yo u hav e experience s tha t challeng e yo u t o gro w an d becom e a bette r perso n 13 confiden t t o thin k o r expres s you r ow n idea s an d opinion s 14 tha t you r lif e ha s a sens e o f directio n o r meanin g t o i t NEVE R ONC E O R TWIC E ABOU T ONC E A WEE K 2 O R 3 TIME S A WEE K ALMOS T EVER Y DA Y EVER Y DA Y 18 5

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Bl Ove r th e LAS T 2 WEEKS ho w ofte n hav e yo u bee n bothere d b y an y o f th e followin g problems ? Bla Littl e interes t o r pleasur e i n doin g thing s 1 No t a t al l 2 Severa l day s 3 Mor e tha n hal f th e day s 4 Nearl y ever y da y B lb Feelin g down depresse d o r hopeles s 1 No t a t al l 2 Severa l day s 3 Mor e tha n hal f th e day s 4 Nearl y ever y da y Blc Troubl e fallin g o r stayin g asleep o r sleepin g to o muc h 1 No t a t al l 2 Severa l day s 3 Mor e tha n hal f th e day s 4 Nearl y ever y da y Bid Feelin g tire d o r havin g littl e energ y 1 No t a t al l 2 Severa l day s 3 Mor e tha n hal f th e day s 4 Nearl y ever y da y Ble Poo r appetit e o r overeatin g 1 No t a t al l 2 Severa l day s 3 Mor e tha n hal f th e day s 4 Nearl y ever y da y 18 6

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Blf Feelin g ba d abou t yourself—o r tha t yo u ar e a failur e o r hav e le t yoursel f o r you r famil y dow n 1 No t a t al l 2 Severa l day s 3 Mor e tha n hal f th e day s 4 Nearl y ever y da y Big Troubl e concentratin g o n things suc h a s readin g th e newspape r o r watchin g televisio n 1 No t a t al l 2 Severa l day s 3 Mor e tha n hal f th e day s 4 Nearl y ever y da y B lh Movin g o r speakin g s o slowl y tha t othe r peopl e coul d hav e noticed ? O r th e opposite—bein g s o fidget y o r restles s tha t yo u hav e bee n movin g aroun d a lo t mor e tha n usua l 1 No t a t al l 2 Severa l day s 3 Mor e tha n hal f th e day s 4 Nearl y ever y da y B li Thought s tha t yo u woul d b e bette r of f dea d o r o f hurtin g yoursel f i n som e way 1 No t a t al l 2 Severa l day s 3 Mor e tha n hal f th e day s 4 Nearl y ever y da y {as k i f an y o f Bla-Bl i > = 2 } Blj I f yo u checke d of f any problems ho w difficul t hav e thes e problem s mad e i t fo r yo u t o d o you r work tak e car e o f thing s a t home o r ge t alon g wit h othe r people ? 1 No t difficul t a t al l 2 Somewha t difficul t 3 Ver y difficul t 4 Extremely difficul t 18 7

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Thin k abou t the two week period in the past year whe n yo u experience d th e tw o problem s belo w th e mos t frequently Durin g tha t period ho w ofte n wer e yo u bothere d b y thes e problems ? Blk Littl e interes t o r pleasur e i n doin g thing s 1 No t a t al l 2 Severa l day s 3 Mor e tha n hal f th e day s 4 Nearl y ever y da y Bll Feelin g down depresse d o r hopeles s 1 No t a t al l 2 Severa l day s 3 Mor e tha n hal f th e day s 4 Nearl y ever y da y B2 I n th e LAS T 4 WEEKS hav e yo u ha d a n anxiet y attack—suddenl y feelin g fea r o r panic ? 1 Ye s 2 N o {I F B2= l AS K B2 a OTHERWIS E G O T O B4 } B2a Has thi s happene d before ? 1 Ye s 2 N o {IFB2= 1 ASKB2b } B2b D o som e o f thes e attack s com e suddenl y ou t o f th e blue—tha t is i n situation s wher e yo u don' t expec t t o b e nervou s o r uncomfortable ? 1 Ye s 2 N o 18 8

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(IFB2= 1 ASKB2c } B2c D o thes e attack s bothe r yo u a lo t o r ar e yo u worrie d abou t havin g anothe r attack ? 1 Yes 2 N o {I F B2= l AS K B 3 OTHERWIS E G O T O B4 } B3 Thin k abou t you r las t ba d anxiet y attack B3a Wer e yo u shor t o f breath ? 1 Yes 2 N o B3b Di d you r hear t race poun d o r skip ? 1 Yes 2 N o B3c Di d yo u hav e ches t pai n o r pressure ? 1 Ye s 2 N o B3d Di d yo u sweat ? 1 Yes 2 N o B3e Di d yo u fee l a s i f yo u wer e choking ? 1 Ye s 2 N o B3f Di d yo u hav e hot flashe s o r chills ? 1 Yes 2 N o 18 9

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B3g Di d yo u hav e nause a o r a n upse t stomach o r th e feelin g tha t yo u wer e goin g t o hav e diarrhea ? 1 Ye s 2 N o B3h Di d yo u fee l dizzy unsteady o r faint ? 1 Ye s 2 N o B3i Di d yo u hav e tinglin g o r numbnes s i n part s o f you r body ? 1 Ye s 2 N o B3j Di d yo u trembl e o r shake ? 1 Ye s 2 N o B3k Wer e yo u afrai d yo u wer e dying ? 1 Ye s 2 N o B4a Ove r th e LAS T 4 WEEKS ho w ofte n hav e yo u bee n bothere d b y feelin g nervous anxious o n edge o r worryin g a lo t abou t differen t things ? 1 No t a t al l 2 Severa l day s 3 Mor e tha n hal f th e day s {I F B4a=23 AS K B4bg OTHERWIS E G O T O B5 } B4 Ove r th e LAS T 4 WEEKS ho w ofte n hav e yo u bee n bothere d b y an y o f th e followin g problems ? B4b Feelin g restles s s o tha t i t i s hard t o si t still 1 No t a t al l 2 Severa l day s 3 Mor e tha n hal f th e day s 19 0

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B4c Gettin g tire d ver y easil y 1 No t a t al l 2 Severa l day s 3 Mor e tha n hal f th e day s B4d Muscl e tension aches o r sorenes s 1 No t a t al l 2 Severa l day s 3 Mor e tha n hal f th e day s B4e Troubl e fallin g aslee p o r stayin g aslee p 1 No t a t al l 2 Severa l day s 3 Mor e tha n hal f th e day s B4f Troubl e concentratin g o n things suc h a s readin g a boo k o r watchin g T V 1 No t a t al l 2 Severa l day s 3 Mor e tha n hal f th e day s B4g Becomin g easil y annoye d o r irritabl e 1 No t a t al l 2 Severa l day s 3 Mor e tha n hal f th e day s {SHO W B5ah I F NE W SAMPLE } B5a D o yo u currentl y weig h les s tha n othe r peopl e thin k yo u ought t o weigh ? 1 Yes muc h les s 2 Yes moderatel y les s 3 Yes slightl y les s 4 N o 19 1

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B5b Durin g th e pas t si x months di d yo u ofte n ea t withi n an y tw o hou r perio d wha t mos t peopl e woul d regar d a s a n unusuall y larg e amoun t o f food ? 1 Ye s 2 N o {IFYEStoB5b askB5c} : B5c Durin g th e time s whe n yo u at e thi s way di d yo u ofte n fee l yo u couldn' t sto p eatin g o r contro l wha t o r ho w muc h yo u wer e eating ? 1 Ye s 2 N o {IFYEStoB5c askB5d} : B5d Durin g th e pas t si x months ho w often o n average di d yo u hav e time s whe n yo u at e thi s wa y tha t is larg e amount s o f foo d plu s th e feelin g tha t you r eatin g wa s out o f control ? (Ther e ma y hav e bee n som e week s whe n i t wa s not presen t -jus t averag e thos e in) 1 Les s tha n on e da y a wee k 2 On e da y a wee k 3 Tw o o r thre e day s a wee k 4 Fou r o r fiv e day s a wee k 5 Nearl y everyday {I f FEMALE as k B5e} : B5e Hav e yo u eve r los t you r menstrua l perio d a s a resul t o f bein g a t a lo w weight ? 1 Yes I misse d 3 o r mor e menstrua l period s i n a ro w 2 Yes I misse d 1 o r 2 menstrua l period s 3 I thin k I a m onl y menstruatin g becaus e I tak e th e birt h contro l pil l 4 N o B5f I s you r bod y shap e an d weigh t amon g th e mos t importan t thing s tha t affec t ho w yo u fee l abou t yourself ? 1 Yes i t i s th e mos t importan t aspec t o f m y self-regar d 2 Yes i t i s on e o f th e mos t importan t aspect s o f m y self-regar d 3 No othe r aspect s ar e mor e importan t 19 2

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B5g D o yo u nee d t o b e ver y thi n i n orde r t o fee l goo d abou t yourself ? 1 Ye s 2 N o B5h D o yo u stil l fee l to o fa t eve n thoug h other s sa y yo u ar e thin ? 1 Ye s 2 N o B6 Hav e yo u eve r bee n diagnose d wit h an y o f th e followin g condition s b y a healt h professiona l (e.g primar y car e doctor psychiatrist psychologist etc.) ? (Check all that apply) 1 Depressio n (e.g. majo r depressiv e disorder bipolar/mani c depression dysthymia ) 2 Anxiet y (e.g. generalize d anxiet y disorder phobias obsessive-compulsiv e disorder post-traumati c stres s disorder ) 3 Attentio n disorde r o r learnin g disabilit y (e.g. attentio n defici t disorder attentio n defici t hyperactivit y disorder learnin g disability ) 4 Eatin g disorde r (e.g. anorexi a nervosa bulimi a nervosa ) 5 Psychosi s (e.g. schizophrenia schizo-affectiv e disorder ) 6 Personalit y disorde r (e.g. antisocia l personalit y disorder paranoi d personalit y disorder schizoi d personalit y disorder ) 7 Substanc e abus e disorde r (e.g. alcoho l abuse abus e o f othe r drugs ) 8 No non e o f thes e 9 Don' t kno w I f B6=non e o f 18 O R i f B6= 8 JUM P T O B 7 {IFB6= 1 ASKB6a.l } B6a. l Specifically whic h o f th e followin g DEPRESSIO N problem s wer e yo u diagnose d wit h b y a professional ? (Check all that apply) 1 Majo r depressiv e disorde r 2 Dysthymi a (chroni c depression ) 3 Bipolar/mani c depressio n 4 Cyclothymi a (ca n b e though t o f a s low-leve l bipola r disorder ) 5 Othe r (specify ) 6 Don' t kno w 19 3

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{IfB6=2ASKB6a.2 } B6a.2 Specifically whic h o f th e followin g ANXIET Y DISORDER S wer e yo u diagnose d wit h b y a professional ? (Check all that apply) 1 2 3 4 5 6 7 8 9 1 0 Generalize d anxiet y disorde r Pani c disorde r Agoraphobi a Specifi c phobia (e.g claustrophobia arachnophobia etc ) Socia l phobi a Obsessive-compulsiv e disorde r Acut e stres s disorde r Pos t traumati c stres s disorde r (PTSD ) Othe r (specify ) Don' t kno w {IfB6= 3 ASKB6a.3 } B6a.3 Specificall y whic h o f th e followin g ATTENTIO N o r LEARNIN G DISABILIT Y DISORDER S wer e yo u diagnose d wit h b y a professional ? (Check all that apply) 1 Attentio n defici t hyperactivit y disorde r (ADH D o r ADD ) 2 Othe r learnin g disabilit y 3 Othe r (specify ) 4 Don' t kno w {IFB6=4ASKB6a.4. } B6a.4 Specifically whic h o f th e followin g EATIN G DISORDER S wer e yo u diagnose d wit h b y a professional ? (Check all that apply) 1 Anorexi a 2 Bulimi a 3 Binge-eatin g Disorde r 4 Othe r (specify ) 5 Don' t kno w 19 4

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{IfB6=5ASKB6a.5 } B6a.5 Specifically whic h o f th e followin g PSYCHOTI C DISORDER S wer e yo u diagnose d wit h b y a professional ? (Check all that apply) 1 2 3 4 5 6 7 8 Schizophreni a Schizo-affectiv e disorde r Brie f psychoti c disorde r Delusiona l disorde r Schizophrenifor m disorde r Share d psychoti c disorde r Othe r (specify ) Don' t kno w {IfB6=6ASKB6a.6 } B6a.6 Specifically whic h o f th e followin g PERSONALITY DISORDER S wer e yo u diagnose d wit h b y a professional ? (Check all that apply) 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2 Antisocia l personalit y disorde r Avoidan t personalit y disorde r Borderlin e personalit y disorde r Dependen t personalit y disorde r Histrioni c personalit y disorde r Narcissisti c personalit y disorde r Obsessive-Compulsiv e personalit y disorde r Paranoi d personalit y disorde r Schizoi d personalit y disorde r Schizotypa l personalit y disorde r Othe r (specify ) Don' t kno w {IfB6=7ASKB6a.7 } B6a.7 Specifically whic h o f th e followin g SUBTANC E ABUS E DISORDER S wer e yo u diagnose d wit h b y a professional ? (Check all that apply) 1 Alcoho l abus e o r othe r alcohol-relate d disorder s 2 Othe r (specify ) 3 Don' t kno w 19 5

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B8 I n th e PAS T 4 WEEKS ho w man y day s hav e yo u fel t tha t emotiona l o r menta l difficultie s hav e hur t you r academi c performance ? 1 Non e 2 12 day s 3 35 day s 4 6 o r mor e day s B9 Thi s questio n ask s abou t way s yo u ma y hav e hur t yoursel f o n purpose withou t intendin g t o kil l yourself I n th e pas t year hav e yo u eve r don e an y o f th e followin g intentionally ? (Check all that apply) 1 Cu t mysel f 2 Burne d mysel f 3 Punche d o r bange d mysel f 4 Scratche d mysel f 5 Pulle d m y hai r 6 Bi t mysel f 7 Interfere d wit h woun d healin g 8 Carve d word s o r symbol s int o ski n 9 Rubbe d shar p object s int o ski n 1 0 Punche d o r bange d a n objec t t o hur t mysel f 1 1 Othe r (specify ) 1 2 No non e o f thes e {IfB9=l-9 } B9a O n average ho w ofte n i n th e pas t yea r di d yo u hur t yoursel f o n purpose withou t intendin g t o kil l yourself ? 1 Onc e o r twic e 2 Onc e a mont h o r les s 3 2 o r 3 time s a mont h 4 Onc e o r twic e a wee k 5 3 t o 5 day s a wee k 6 Nearl y everyday o r everyday BIO I n th e PAS T YEAR di d yo u eve r seriousl y thin k abou t attemptin g suicide ? 1 Ye s 2 N o 19 6

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{I F B 10= 1 AS K BlO b OTHERWIS E G O T O CI } BlOb I n th e PAS T YEAR di d yo u mak e a pla n fo r attemptin g suicide ? 1 Ye s 2 N o {I f B10= l AS K BlO c OTHERWIS E G O T O CI } BlOc I n th e PAS T YEAR di d yo u attemp t suicide ? 1 Ye s 2 N o C LIFESTYL E No w w e woul d lik e t o as k yo u a fe w question s abou t you r curren t lifestyle CI O N AVERAGE ho w man y cigarette s di d yo u smok e i n th e PAS T 3 0 DAYS ? 1 Non e 2 Les s tha n on e cigarett e pe r da y 3 On e t o fiv e cigarette s pe r da y 4 Abou t one-hal f pac k pe r da y 5 Abou t on e pac k pe r da y 6 Abou t on e an d one-hal f pack s pe r da y 7 Two o r mor e pack s pe r da y 8 Don' t kno w 9 I refus e t o answe r thi s C2 I n th e PAST 3 0 DAYS hav e yo u use d an y o f th e followin g drugs ? (check all that apply) 1 Marijuan a (als o know n a s grass weed pot hash o r has h oil ) 2 Cocain e (an y form includin g crack powder o r freebase ) 3 Heroi n (als o know n a s smack junk o r Chin a White ) 4 Methamphetamine s (als o know n a s speed crystal meth o r ice ) 5 Othe r stimulant s (e.g Ritalin Adderall etc ) withou t a prescriptio n 5 Ecstas y (als o know n a s MDMA ) 6 Othe r drug s withou t a doctor' s prescriptio n (specify ) 7 Non e o f th e abov e 19 7

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C3 I n th e PAST 3 0 DAYS abou t ho w man y HOUR S PE R WEE K o n average di d yo u spen d exercising ? (include any exercise of moderate or higher intensity, where "moderate intensity" would be roughly equivalent to brisk walking or bicycling) 1 Les s tha n 1 2 12 3 34 4 5 o r mor e C3a Abou t ho w muc h d o yo u weigh ? [NUMERI C RESPONS E 50-1000 ] pound s {DESIGN : SAM E LIN E C9a-C9b } C3b Abou t ho w tal l ar e you ? C3b_ a [NUMERI C RESPONS E 3-7]fee t C3b_ b [NUMERI C RESPONS E 0-12]inche s (Sho w i f A2=MALE OTHER O R MISSING ) C4m Ove r th e PAS T 2 WEEKS o n ho w man y occasion s hav e yo u ha d 5 drink s i n a row ? 1 2 3 4 5 6 7 8 Non e Onc e Twic e 3 t o 5 time s 69 time s 1 0 o r mor e time s Don' t kno w I refus e t o answe r thi s (ShowifA2=FEMALE ) C4f Ove r th e PAS T 2 WEEKS o n ho w man y occasion s hav e yo u ha d 4 drink s i n a row ? 1 2 3 4 5 6 7 8 Non e Onc e Twic e 3 t o 5 time s 69 time s 1 0 o r mor e time s Don' t kno w I refus e t o answe r thi s 19 8

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C5 I n th e pas t 1 2 months o n approximatel y ho w man y day s di d yo u mak e an y sor t o f bet ? (B y "bet w e mea n bettin g o n sports playin g card s fo r money playin g gamblin g game s online buyin g lotter y tickets playin g poo l fo r money playin g slo t machines bettin g o n hors e races o r an y othe r kin d o f bettin g o r gambling ) 1 Non e 2 (recor d numbe r o f days ) C6 I n th e pas t 1 2 months ho w man y time s hav e yo u bee n treate d unfairl y becaus e o f you r race ethnicity o r cultura l background ? 1 2 3 4 5 6 Neve r Onc e i n a whil e Sometime s A lo t Mos t o f th e tim e Almos t al l o f th e tim e C7 Durin g thi s semeste r s o far abou t ho w man y hour s pe r da y hav e yo u spen t doin g schoo l work ? 1 2 3 4 5 6 7 8 9 Les s tha n 1 hou r 1 hou r 2 hour s 3 hour s 4 hour s 5 hour s 6 hour s 7 hour s 8 o r mor e hour s C7a Durin g thi s semeste r s o far abou t ho w ofte n hav e yo u ha d a one-on-on e conversatio n wit h a n instructor othe r professor o r academi c advisor ? 1 No t a t al l 2 Onc e o r twic e pe r mont h 3 Onc e o r twic e pe r wee k 4 Severa l time s pe r wee k 19 9

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C8 Durin g thi s semeste r s o far abou t ho w man y hour s pe r wee k hav e yo u worke d a t a pai d job ? 1 2 3 4 5 6 7 Non e 15 hour s 6-1 0 hour s 11-1 5 hour s 16-2 0 hour s 21-3 0 hour s Mor e tha n 3 0 hour s C9 Ho w confiden t ar e yo u tha t completin g you r degre e progra m wil l b e wort h th e time cost an d effor t tha t i t wil l require ? 1 Ver y confiden t 2 Somewha t confiden t 3 Neutra l 3 No t confiden t 4 No t a t al l confiden t CIO Ho w d o yo u fee l abou t you r jo b prospect s fo r afte r yo u finis h you r education ? 1 Ver y optimisti c 2 Somewha t optimisti c 3 Neutra l 4 Pessimisti c 5 Ver y pessimisti c Cll Ho w satisfie d ar e yo u overal l wit h you r experienc e s o fa r a t [SCHOO L NAME]? 1 Ver y satisfie d 2 Satisfie d 3 Neutra l 4 Dissatisfie d 5 Ver y dissatisfie d 20 0

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CI2 Wha t i s you r bes t gues s abou t th e likelihoo d tha t yo u wil l donat e mone y t o [SCHOO L NAME ] afte r yo u ar e finishe d wit h you r educatio n here ? 1 Ver y likel y 2 Likel y 3 50/5 0 4 Unlikel y 5 Ver y unlikel y 20 1

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D KNOWLEDG E AN D BELIEF S ABOUT SERVICE S Th e nex t question s wil l as k yo u abou t you r leve l o f awarenes s o f service s a t [inser t institution ] tha t ca n hel p wit h students menta l an d emotiona l health Som e question s wil l as k yo u abou t you r attitude s relate d t o menta l health Pleas e indicat e ho w strongl y yo u agre e o r disagre e wit h th e followin g statement : Dl I f yo u neede d t o see k professiona l hel p fo r you r menta l o r emotiona l healt h whil e attendin g [inser t institution] yo u woul d kno w wher e t o go 1 Strongl y disagre e 2 Disagre e 3 Neithe r agre e no r disagre e 4 Agre e 5 Strongl y agre e D2 Wha t hav e yo u hear d fro m othe r student s abou t th e qualit y o f menta l healt h an d psychologica l counselin g service s o n you r campus ? 1 I hav e mostl y hear d negativ e opinion s 2 I hav e hear d a n eve n mi x o f negativ e an d positiv e opinion s 3 I hav e mostl y hear d positiv e opinion s 4 I haven' t hear d anythin g D4 Ho w helpfu l o n averag e d o yo u thin k THERAP Y O R COUNSELIN G is whe n provide d competently fo r peopl e you r ag e wh o ar e clinicall y depressed ? 1 Ver y helpfu l 2 Quit e helpfu l 3 A littl e helpfu l 4 No t a t al l helpfu l D5 Ho w helpfu l o n average d o yo u thin k MEDICATIO N is whe n provide d competently fo r peopl e you r ag e wh o ar e clinicall y depressed ? 1 Ver y helpfu l 2 Quit e helpfu l 3 A littl e helpfu l 4 No t a t al l helpfu l 20 2

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Pleas e indicat e whethe r yo u agre e o r disagre e wit h th e followin g statements D6a Mos t peopl e woul d willingl y accep t someon e wh o ha s receive d menta l healt h treatmen t a s a clos e frien d 1 Strongl y agre e 2 Agre e 3 Somewha t agre e 4 Somewha t disagre e 5 Disagre e 6 Strongl y disagre e D6e Mos t peopl e fee l tha t receivin g menta l healt h treatmen t i s a sig n o f persona l failur e 1 Strongl y agre e 2 Agre e 3 Somewha t agre e 4 Somewha t disagre e 5 Disagre e 6 Strongl y disagre e D6g Mos t peopl e thin k les s o f a perso n wh o ha s receive d menta l healt h treatmen t 1 Strongl y agre e 2 Agre e 3 Somewha t agre e 4 Somewha t disagre e 5 Disagre e 6 Strongl y disagre e 20 3

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Pleas e indicat e whethe r yo u agre e o r disagre e wit h th e followin g statements D7a I woul d willingl y accep t someon e wh o ha s receive d menta l healt h treatmen t a s a clos e frien d 1 2 3 4 5 6 Strongl y agre e Agre e Somewha t agre e Somewha t disagre e Disagre e Strongl y disagre e D7b I woul d thin k les s o f a perso n wh o ha s receive d menta l healt h treatment 1 Strongl y agre e 2 Agre e 3 Somewha t agre e 4 Somewha t disagre e 5 Disagre e 6 Strongl y disagre e D7c I fee l tha t receivin g menta l healt h treatmen t i s a sig n o f persona l failure 1 Strongl y agre e 2 Agre e 3 Somewha t agre e 4 Somewha t disagre e 5 Disagre e 6 Strongl y disagre e D8 A s fa r a s yo u know ho w man y o f you r clos e friend s o r famil y hav e eve r sough t professiona l hel p fo r a n emotiona l o r menta l healt h problem ? 1 Non e 2 A t leas t 1 o r 2 3 3 o r mor e 4 Don' t kno w 20 4

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{SHO W E0-E08 a I F NE W SAMPLE } E EXPERIENCE S WIT H SERVICE S Th e nex t question s wil l as k yo u abou t you r experience s usin g menta l healt h service s (medicatio n o r counseling/therapy) EO I n th e PAS T 1 2 MONTHS di d yo u thin k yo u neede d hel p fo r emotiona l o r menta l healt h problem s suc h a s feelin g sad blue anxiou s o r nervous ? 1 Ye s 2 N o 3 Don' t kno w El I n th e PAST 1 2 MONTH S hav e yo u take n an y o f th e followin g type s o f prescriptio n medications ? Please count only those you took, or are taking, several times per week. (Check all that apply) 1 PSYCHOSTIMULANT S (e.g. methylphenidat e (Ritali n o r Concerta) amphetamin e salt s (Adderall) dextroamphetamin e (Dexedrine) etc. ) 2 ANTIDEPRESSANT S (e.g. fluoxetin e (Prozac) sertralin e (Zoloft) paroxetin e (Paxil) escitalopra m (Lexapro) venlafaxin e (Effexor) buproprio n (Wellbutrin) etc. ) 3 ANTI-PSYCHOTIC S (e.g. haloperido l (Haldol) clozapin e (Clozaril) risperidon e (Risperdal) olanzapin e (Zyprexa) etc. ) 4 ANTI-ANXIET Y MEDICATION S (e.g. lorazepa m (Ativan) clonazepa m (Klonopin) (Xanax) buspiron e (BuSpar) etc. ) 5 MOO D STABLIZER S (e.g. lithium valproat e (Depakote) lamotrigin e (Lamictal) carbamazapin e (Tegretol) etc. ) 6 SLEE P MEDICATION S (e.g. Zolpide m (Ambien) zaleplo n (Sonata) etc. ) 7 Othe r (specify ) 8 Non e 9 Don' t kno w 20 5

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I f El= 8 (None ) o r 9 (Don' t know ) o r i s blan k Jum p t o E 2 E l a Wh o wrot e you r mos t recen t prescriptio n fo r th e medication(s ) yo u note d i n th e las t question ? (Check all that apply) 1 A genera l practitioner nurs e practitioner o r primar y car e physicia n 2 A psychiatris t 3 Othe r typ e o f docto r (specify ) 4 Too k th e medication(s ) withou t a prescriptio n 5 Don' t kno w Elb I n th e pas t 1 2 month s ho w man y time s hav e yo u discusse d wit h a docto r o r othe r healt h professiona l you r us e o f th e medication(s ) yo u jus t noted ? (Check all that apply) 1 2 3 4 5 No t a t al l 12 time s 35 time s Mor e tha n 5 time s Don' t kno w Elc O f th e medication(s ) yo u jus t noted whic h ar e yo u currently taking ? 1 (displa y answer s 17 note d i n El ) 2 Non e o f th e abov e Eld Durin g th e pas t year fo r ho w long i n total hav e yo u take n th e followin g medicatio n yo u jus t noted : (displa y answe r fro m El ) 1 Les s tha n 1 mont h 2 Betwee n 1 an d 2 month s 3 2 month s o r mor e E2 I n th e PAST 1 2 MONTH S hav e yo u receive d counselin g o r therap y fo r you r menta l o r emotiona l healt h fro m a healt h professiona l (such a s psychiatrist psychologist socia l worker o r primar y car e doctor) ? 1 Ye s 2 N o 20 6

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{I f E2= l ASKE2a } E2a Ar e yo u currently receivin g counselin g o r therapy ? 1 Yes 2 N o {IfE2= l ASKE2b } E2b Ho w man y tota l visit s o r session s fo r counselin g o r therap y hav e yo u ha d i n th e pas t 1 2 months ? 1 13 2 46 3 79 4 1 0 o r mor e {IFE2= 1 ASKE2c } E2c Fro m whic h o f th e followin g place s di d yo u receiv e counselin g o r therapy ? (Check all that apply) 1 [Inser t nam e o f institution' s studen t counselin g services ] 2 [Inser t nam e o f institution' s campus healt h services ] 3 [lis t othe r campu s counselin g o r healt h servic e providers ] 4 Psychiatri c Emergenc y Services/Psyc h Emergenc y Roo m (ER ) 5 Inpatien t psychiatri c hospita l 6 Partia l hospitalizatio n progra m 7 Provide r i n th e loca l communit y (no t o n campus ) 8 Provide r i n anothe r locatio n (suc h a s you r hometown ) 9 Othe r (specify ) 1 0 Don' t kno w 20 7

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{I f E2= l AN D E2B=1-1 2 (i.e an y provider) AS K E2 wit h a separat e gri d fo r eac h provide r type ) E2d Ho w satisfied/dissatisfie d ar e yo u wit h th e followin g aspect s o f you r therap y o r counselin g tha t yo u receive d i n th e pas t 1 2 months ? E2dl Convenien t hour s 1 Ver y dissatisfie d 2 Dissatisfie d 3 Somewha t dissatisfie d 4 Somewha t satisfie d 5 Satisfie d 6 Ver y satisfie d E2d2 Locatio n 1 Ver y dissatisfie d 2 Dissatisfie d 3 Somewha t dissatisfie d 4 Somewha t satisfie d 5 Satisfie d 6 Ver y satisfie d E2d3 Qualit y o f therapists/counselor s 1 Ver y dissatisfie d 2 Dissatisfie d 3 Somewha t dissatisfie d 4 Somewha t satisfie d 5 Satisfie d 6 Ver y satisfie d E2d4 Respec t fo r you r privac y concern s 1 Ver y dissatisfie d 2 Dissatisfie d 3 Somewha t dissatisfie d 4 Somewha t satisfie d 5 Satisfie d 6 Ver y satisfie d 20 8

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E2d5 Abilit y t o schedul e appointment s withou t lon g delay s 1 Ver y dissatisfie d 2 Dissatisfie d 3 Somewha t dissatisfie d 4 Somewha t satisfie d 5 Satisfie d 6 Ver y satisfie d {IFE2= 1 ASKE2g } E2g I f ther e i s anythin g els e yo u woul d lik e t o not e abou t you r satisfaction/dissatisfactio n wit h you r therap y an d counselin g experiences pleas e fee l fre e t o d o s o here [INSER T COMMENTRY ] E2 f I n th e PAST 1 2 MONTH S hav e yo u visite d an y medica l provider suc h a s a primar y car e docto r o r othe r typ e o f doctor fo r a check-u p o r an y othe r healt h reasons ? 1 Ye s 2 N o 3 Don' t kno w E2g I n th e PAS T 1 2 MONTH S hav e yo u receive d counselin g o r suppor t fo r you r menta l o r emotiona l healt h fro m an y o f th e followin g sources ? (Check all that apply) 1 Roommat e 2 Frien d (wh o i s no t a roommate ) 3 Significan t othe r 4 Famil y membe r 5 Religiou s counselo r o r othe r religiou s contac t 6 Suppor t grou p 7 Othe r non-clinica l sourc e (specify ) 8 Non e o f th e above 20 9

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E2h I f yo u wer e experiencin g seriou s emotiona l distress who m woul d yo u tal k t o abou t this ? (Check all that apply) 1 2 3 4 5 6 7 8 Roommat e Frien d (wh o i s no t a roommate ) Significan t othe r Famil y membe r Religiou s counselo r o r othe r religiou s contac t Suppor t grou p Othe r non-clinica l sourc e (specify ) N o on e {SHO W INTR O 1 AN D E 3 I F El=l7 O R E2=YES } INTR O 1 Th e nex t question s wil l as k yo u abou t difficultie s yo u ma y hav e experience d i n receivin g menta l healt h service s (medicatio n and/o r counseling/therapy ) an d reason s yo u did receiv e thes e services Pleas e spen d som e tim e reading th e man y liste d responses an d chec k an y tha t apply Thes e question s ar e lon g bu t you r answer s ar e ver y importan t fo r u s t o understan d wh y students migh t no t alway s ge t hel p the y need 21 0

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E3 I n th e PAS T 1 2 MONTHS whic h o f th e followin g factor s hav e cause d yo u t o receiv e fewe r service s (counseling therapy o r medications ) fo r you r menta l o r emotiona l healt h tha n yo u woul d hav e otherwis e received ? (Check all that apply) 1 Ther e ar e financia l reason s (to o expensive n o insurance ) 2 Th e locatio n i s inconvenien t 2 a Th e hour s ar e inconvenien t 3 I don' t hav e enoug h tim e 4 Th e numbe r o f session s i s to o limite d 5 Th e waitin g tim e unti l I ca n ge t a n appointmen t i s to o lon g 6 I a m concerne d abou t privac y 7 I worr y abou t wha t other s wil l thin k o f m e 8 I worr y tha t m y action s wil l b e documente d i n m y academi c recor d 8 a I worr y tha t m y action s wil l b e documente d i n m y medica l recor d 9 I worr y tha t someon e wil l notif y m y parent s 1 0 I fea r bein g hospitalize d 1 1 Peopl e providin g service s aren' t sensitiv e enoug h t o cultura l issue s 1 2 Peopl e providin g service s aren' t sensitiv e enoug h t o sexua l identit y issue s 1 3 I hav e a har d tim e communicatin g i n Englis h 1 4 I questio n th e qualit y o f m y option s 14 a I questio n whethe r medicatio n o r therap y i s helpfu l 1 5 I hav e ha d ba d experience s wit h medicatio n and/o r therap y 1 6 Th e proble m wil l ge t bette r b y itsel f 16 a I questio n ho w seriou s m y need s ar e 1 7 I don' t thin k anyon e ca n understan d m y problem s 1 8 Stres s i s norma l i n college/graduat e schoo l 18 a I ge t a lo t o f suppor t fro m othe r sources suc h a s friend s an d famil y 18 b I prefe r t o dea l wit h issue s o n m y ow n 1 9 Othe r (specify ) 2 0 Ther e hav e bee n n o barrier s tha t I ca n thin k o f 21 1

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E3a Earlie r i n thi s surve y yo u reporte d tha t yo u hav e take n medicatio n and/o r receive d counseling/therap y i n th e pas t 1 2 month s fo r you r menta l o r emotiona l health Which o f th e followin g ar e importan t reason s wh y yo u receive d thos e services ? (Check all that apply) 1 I decide d o n m y ow n t o see k help 2 A frien d encourage d m e t o see k hel p 3 A frien d pressure d m e t o see k hel p 4 A famil y membe r encourage d m e t o see k help 5 A famil y membe r pressure d m e t o see k help 6 Someon e othe r tha n a frien d o r famil y membe r encourage d m e t o see k hel p (SPECIFY) 7 I wa s mandate d t o see k hel p b y campu s staff 8 I acquire d mor e informatio n abou t m y option s fro m (SPECIFY) 9 Othe r (specify) {SHO W INTR0 2 AN D E 4 I F (El= 8 O R 9 O R N/A ) AN D (E2=N O O R N/A) } INTR0 2 Th e nex t question s wil l as k yo u abou t reason s yo u ma y not hav e use d menta l healt h service s i n th e las t 1 2 months Pleas e spen d som e tim e reading th e man y liste d responses an d chec k an y tha t apply Thes e question s ar e lon g but YOU R ANSWER S AR E VER Y IMPORTAN T FO R U S T O UNDERSTAN D WH Y STUDENT S MIGH T NO T GE T TH E HEL P THE Y NEED E4 I n th e PAS T 1 2 MONTHS whic h o f th e followin g explai n wh y yo u hav e no t receive d medicatio n o r therap y i n th e pas t 1 2 month s fo r you r menta l o r emotiona l health ? (Check all that apply) 1 I hav e not ha d an y nee d fo r menta l healt h service s 2 I haven' t ha d th e chanc e t o g o but I pla n t o 2 a I prefe r t o dea l wit h issue s o n m y ow n 3 Ther e ar e financia l reason s (to o expensive n o insurance ) 4 Th e locatio n i s inconvenien t 4 a Th e hour s ar e inconvenien t 5 I don' t hav e tim e 6 Th e numbe r o f session s i s to o limite d 7 Th e waitin g tim e unti l I ca n ge t a n appointmen t i s to o lon g 8 I a m concerne d abou t privac y 9 I worr y abou t wha t other s wil l thin k o f m e 1 0 I worr y tha t m y action s wil l b e documente d o n m y academi c recor d 10 a I worr y tha t m y action s wil l b e documente d i n m y medica l recor d 1 1 I worr y tha t someon e wil l notif y m y parent s 21 2

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1 2 I fea r bein g hospitalize d 1 3 Peopl e providin g service s aren' t sensitiv e enoug h t o cultura l issue s 1 4 Peopl e providin g service s aren' t sensitiv e enoug h t o sexua l identit y issue s 1 5 I hav e a hard tim e communicatin g i n Englis h 1 6 I questio n th e qualit y o f m y option s 16 a I questio n whethe r medicatio n o r therap y i s helpfu l 1 7 I hav e ha d a ba d experienc e wit h medicatio n and/o r therap y 1 8 Th e proble m wil l ge t bette r b y itsel f 18 a I questio n ho w seriou s m y need s ar e 1 9 I don' t thin k anyon e ca n understan d m y problem s 2 0 Stres s i s norma l i n college/graduat e schoo l 20 a I ge t a lo t o f suppor t fro m othe r sources suc h a s famil y an d friend s 2 1 Othe r (specify ) 2 2 Ther e hav e bee n n o barrier s tha t I ca n thin k o f E5 Wha t i s th e sourc e o f you r curren t healt h insuranc e coverage ? (Check all that apply) 1 I d o not hav e an y healt h insuranc e coverag e (uncovered ) 2 I hav e healt h insuranc e throug h m y parent(s ) o r thei r employe r 3 I hav e healt h insuranc e throug h m y employe r 4 I hav e healt h insuranc e throug h m y spouse' s employe r 5 I hav e a studen t healt h insuranc e pla n 6 I hav e healt h insuranc e throug h a n embass y o r sponsorin g agenc y fo r internationa l student s 7 I hav e individua l healt h insuranc e purchase d directl y fro m a n insuranc e carrie r 8 I hav e Medicai d o r othe r governmenta l insuranc e 9 I a m uncertai n abou t whethe r I hav e healt h insuranc e 1 0 I hav e healt h insuranc e but a m uncertai n abou t wher e i t i s fro m {SHOWIFE5=2-ll } E7 D o yo u kno w i f you r healt h insuranc e pla n woul d provid e AN Y coverag e fo r a visi t t o a menta l healt h professiona l (psychiatrist psychologist clinica l socia l worker etc.) ? 1 Yes i t definitel y woul d 2 I thin k i t woul d but a m no t sur e 3 I hav e n o ide a 4 I thin k i t woul d NO T but a m not sur e 5 no i t definitel y woul d not 21 3

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E8 Doe s you r curren t healt h insuranc e pla n mee t you r need s fo r menta l healt h services ? 1 I hav e no t neede d t o us e m y curren t insuranc e pla n t o cove r menta l healt h service s 2 Yes everythin g I hav e neede d i s covere d 3 No th e coverag e i s inadequat e t o mee t m y need s {SHOWE8aIFE8=3 } E8a I fee l tha t coverage i s inadequat e becaus e m y plan.. (Check all that apply) 1 doesn' t cove r an y menta l healt h service s 2 doesn' t cove r preexistin g condition s 3 doesn' t cove r certai n condition s 4 ha s a co-pa y tha t i s to o expensiv e 5 ha s a deductibl e tha t i s to o expensiv e 6 doesn' t cove r certai n type s o f service s o r provider s 7 ha s a limi t o n th e numbe r o f service s tha t ar e covere d Th e nex t se t o f question s wil l as k yo u abou t you r academi c an d socia l environment Thi s i s th e las t sectio n o f th e survey Fl Durin g thi s schoo l yea r hav e yo u talke d wit h an y academi c personne l (suc h a s instructors advisors o r othe r academi c staff ) abou t an y menta l healt h problem s tha t wer e affectin g you r academi c performance ? 1 Ye s 2 N o {askFlaifFl=l } Fla Overall ho w supportiv e wa s th e respons e o f th e academi c personne l wit h who m yo u talked ? 1 Ver y supportiv e 2 Supportiv e 3 No t supportiv e 4 Ver y unsupportiv e 21 4

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F2 I f yo u ha d a menta l healt h proble m tha t yo u believe d wa s affectin g you r academi c performance whic h peopl e a t schoo l woul d yo u tal k to ? (Check all that apply) 1 Professo r fro m on e o f m y classe s 2 Academi c adviso r 3 Anothe r facult y membe r 4 Teachin g assistan t 5 Studen t service s staf f 6 Dea n o f Student s o r Clas s Dea n 7 N o on e 8 Othe r (specify ) F3 Ho w woul d yo u rat e th e overal l competitivenes s betwee n student s i n you r classes ? 1 Ver y competitiv e 2 Competitiv e 3 Somewha t competitiv e 4 No t competitiv e 5 Ver y uncompetitiv e 6 No t sure/don' t know/not applicabl e F4 Whic h lette r grad e reflect s you r average academi c performanc e a t thi s college/university ? 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2 A + A A B + B B C + C D F I a m ne w t o campu s an d d o not hav e a complet e semeste r o f grade s No t applicable/Don' t kno w 21 5

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F5 Relativ e t o th e averag e perso n i n m y classes m y grade s ar e generally : 1 Fa r belo w averag e 2 Somewha t belo w average 3 Sam e 4 Somewha t above average 5 Fa r above average W e ar e intereste d i n ho w yo u fee l abou t th e followin g statements Pleas e indicat e ho w yo u fee l abou t eac h statement F6a I ge t th e emotiona l hel p an d suppor t I nee d fro m m y famil y 1 2 3 4 5 6 7 Ver y strongl y disagre e Strongl y disagre e Mildl y disagre e Neutra l Mildl y agre e Strongl y agre e Ver y strongl y agre e F6b M y friend s reall y tr y t o hel p m e 1 Ver y strongl y disagre e 2 Strongl y disagre e 3 Mildl y disagre e 4 Neutra l 5 Mildl y agre e 6 Strongl y agre e 7 Ver y strongl y agre e FX I f ther e i s an y additional informatio n yo u fee l i s importan t fo r researcher s t o kno w abou t you r experience s wit h th e topic s i n thi s questionnaire pleas e fee l fre e t o writ e i t here [INSER T COMMENTARY ] 21 6

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ENDIN G 1 : I F SUICIDALIT Y WA S INDICATE D (Bli=2,3,o r 4 o r B10=l ) Th e Health y Mind s Stud y Than k yo u ver y muc h fo r completin g Th e Health y Mind s Study You r respons e i s valuable fo r ou r research whic h w e thin k wil l lea d t o improvement s i n studen t lif e a t [college/university ] an d school s nationwide A s state d befor e yo u bega n th e survey al l o f you r answer s wil l remai n confidential Becaus e yo u indicate d tha t yo u hav e ha d suicida l thought s o r attempt s i n th e pas t year w e ar e especiall y concerne d abou t whethe r yo u ar e receivin g suppor t yo u ma y need W e strongl y urg e yo u t o contac t on e o f th e resource s show n belo w i f yo u ar e not alread y receivin g help I f yo u fee l yo u shoul d tal k t o someon e abou t a menta l healt h issue her e ar e som e resource s availabl e t o yo u o n campus W e urg e yo u t o cal l o n thes e resource s t o giv e yo u menta l healt h suppor t i f yo u thin k yo u nee d help ( a complet e lis t o f loca l menta l healt h resource s wil l b e i n this space ) ENDIN G 2 : I F SUICIDALIT Y WA S NO T INDICATE D Th e Health y Mind s Stud y Than k yo u ver y muc h fo r completin g Th e Health y Mind s Study You r respons e i s valuable fo r ou r research whic h w e thin k wil l lea d t o improvement s i n studen t lif e a t [college/university ] an d school s nationwide A s state d befor e yo u bega n th e survey al l o f you r answer s wil l remai n confidential I f yo u fee l yo u shoul d tal k t o someon e abou t a menta l healt h issue her e ar e som e resource s availabl e t o yo u o n campus W e urg e yo u t o cal l o n thes e resource s t o giv e yo u menta l healt h suppor t i f yo u thin k yo u nee d help ( a complet e lis t o f loca l menta l healt h resource s wil l b e i n thi s space ) 21 7

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APPENDI X B Institutiona l Revie w Boar d Approva l Lette r 21 8

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I is*itu>iersa i Revie w Boar d l Offic e o f Re&emc h cmd Sponso r Proaram s / P O Bo x 42561 9 Denton T X 76204-1563 9 ""j**?:..**^" S | y.^' ' 940-898-337 8 FA X 9408 98-44' 6 8MI0 N SAUA S H0U$t0 N e_mal i R8 tw a ec, u Marc h 8 201 1 V B.1..-. I \ P.:-; I RePrevalence and Correlates of Depression mid Anxiety Disorders Among l/.S, Graduate Students (Protocol ** ; 16574) Th e abov e reference d stud y has bee n reviewed b y th e TW U Institutiona l Revie w Boar d (IRB ) an d wa s determine d t o b e exemp t from furthe r review I f applicable agenc y approva l letters mus t b e submitte d t o th e IR B upo n receip t PRIO R t o an > dat a collectio n a t tha t agency Becaus e a signe d consen t for m i s no t require d fo r exemp t studies th e filin g o f signature s o f participant s wit h th e TW U IR B i s no t necessary An y modification s to this stud y mus t b e submitte d fo r te \ ie w t o th e IR B usin g th e Modificatio n Reques t Form Additionally th e IR B mus t b e notifie d immediatel y o f an y unanticipate d incidents I f yo u hav e an y questions pleas e contac t th e TW U IRB Sincerely Dr Kath y DeOrnellas Chai r Institutiona l Revie w Boar d Dento n Dr Ga y James Departmen t o f Healt h Studie s Dr Kristi n Wiginton Departmen t o f Healt h Studie s Graduat e Schoo l 21 9

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CURRICULU M VITA E Barbar a A Barton PhD RN CHE S bbarton(5>twu.ed u o r Barton795(5)gmail.co m EDUCATIO N Ph.D 201 1 Healt h Studie s Texa s Woman' s University Denton T X M.P.H 200 6 Publi c Healt h Specialization Healt h Educatio n Souther n Connecticu t Stat e University Ne w Haven C T B.S.N 198 4 Nursin g Bowlin g Gree n Stat e University Bowlin g Green O H Dissertatio n Correlate s an d predictor s o f anxiety depressio n an d healt h behavio r i n a nationa l sampl e o f universit y graduat e student s (2011) Chair : Dr Kristi n Wiginto n Thesi s A qualitativ e stud y o f th e experience s o f ADR D famil y caregiver s whe n seekin g an d usin g communit y service s (2006] Chair : Dr Sandr a Bulme r Professiona l Certification/Licensur e Certifie d Healt h Educatio n Specialis t (CHES) 200 6 presen t Registere d Nurse curren t licensur e i n Texa s an d Indian a PROFESSIONA L EMPLOYMEN T August 201 1 Presen t Assistan t Professor Departmen t o f Applie d Healt h Science s Indian a Stat e University Terr e Haute I N • Tenure-trac k facult y positio n i n Departmen t o f Applie d Healt h Science s 2008-201 1 Graduat e Teachin g an d Researc h Assistant Texa s Woman' s University Denton T X • Primar y responsibilit y wa s teachin g undergraduat e course s i n healt h educatio n program includin g onlin e an d traditiona l face-to-fac e teachin g format s Barto n 1

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• Supporte d Healt h Studie s professor s wit h gradin g an d cours e preparatio n fo r undergraduat e an d graduat e courses includin g onlin e an d traditiona l deliver y format s • Researc h assistan t fo r qualitativ e stud y explorin g HIV/AID S i n rura l Africa n America n wome n livin g i n Nort h Texa s 2006-200 8 Adjunc t Professo r Departmen t o f Publi c Health Souther n Connecticu t Stat e University New Haven C T • Taugh t undergraduat e publi c healt h researc h method s course a cor e cours e designe d t o provid e a n introductio n t o method s essentia l fo r planning conductin g an d evaluatin g researc h i n th e publi c healt h fiel d 2002-200 8 Projec t Coordinator/Manage r Yal e University/Yale-Ne w Have n Hospita l Cente r fo r Outcome s Researc h an d Evaluatio n New Haven C T • Provide d projec t managemen t fo r coordinatio n an d implementatio n o f outcome s studies focusin g primaril y o n cardiolog y • Serve d a s projec t coordinato r fo r NIH-funde d hear t failur e clinica l tria l involvin g 2 0 cardiolog y practice s nation-wid e • Responsibl e fo r screening recruitment an d enrollmen t procedures includin g developmen t o f trainin g progra m an d manua l o f operation s fo r sit e coordinator s • Conducte d monitorin g visit s wit h participatin g site s t o ensur e complianc e wit h stud y protoco l an d procedure s • Recruite d physician s an d hospital s nationwid e t o participat e i n qualitativ e studie s involvin g cardiolog y an d ne w technolog y • Conducte d on-sit e qualitativ e interview s wit h physician s an d hospita l personne l i n nationwid e stud y regardin g time-to-reperfusio n therap y • Develope d an d conducte d a web-base d surve y askin g a nationwid e sampl e o f hospital s abou t thei r policie s an d processe s concernin g th e car e o f patient s wit h acut e myocardia l infarctio n 2000-200 2 Communit y Telephon e Triag e Progra m Coordinato r Yal e New Healt h Syste m Cal l Center Ne w Haven C T • Develope d an d implemente d telephoni c nurs e advic e progra m fo r healt h syste m • Wrot e an d implemente d polic y an d procedures includin g a comprehensiv e telephon e triag e orientatio n progra m an d qualit y improvemen t progra m • Expande d progra m t o provid e Interne t use r acces s t o medica l an d healt h informatio n fro m registere d nurse s • Develope d strateg y wit h senio r managemen t t o implemen t smoot h transitio n t o outsourc e vendo r Barto n 2

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1996-200 0 Clinica l Manager/Progra m Manage r Oxfor d Healt h Plans Trumbull C T • Manage d population-base d diseas e managemen t programs includin g progra m development interventio n implementation an d evaluatio n o f proces s an d impac t outcome s • Responsibl e fo r dat a collectio n methods dat a analysis an d reportin g o f financial clinical qualit y o f life an d satisfactio n outcome s fo r asthma dialysis an d transplan t diseas e managemen t program s • Responsibl e fo r hiring performanc e management an d dail y supervisio n o f 2 5 direc t reports consistin g o f nurse s an d administrativ e suppor t staf f • Facilitate d th e desig n an d enhancemen t o f clinica l cas e managemen t processe s fo r asthma dialysis high-ris k maternity an d transplan t diseas e managemen t program s 1995-199 6 Comparativ e Dat a Specialis t Clinica l Resourc e Management Emor y Hospitals Atlanta G A • Create d an d presente d report s an d dashboard s analyzin g varianc e dat a an d qualit y indicator s t o physicia n committees senio r management an d CE O • Facilitate d physicia n wor k team s i n th e developmen t o f clinica l practic e guideline s usin g qualit y improvemen t method s an d tool s • Serve d a s syste m liaiso n fo r benchmarkin g activitie s involvin g a nationwid e universit y hospital s consortiu m 1993-199 5 Coordinator Qualit y Improvement/Ris k Managemen t Southeaster n Dialysi s Center Wilmington N C • Directe d qualit y improvement ris k management an d employe e safet y an d healt h activitie s fo r a chroni c outpatien t hemodialysi s cente r servin g 40 0 patient s i n 6 differen t facilitie s i n southeaster n Nort h Carolin a 1991-199 3 Cas e Manage r Aetn a Healt h Plans Chicago I L • Manage d large-dolla r catastrophi c case s fo r patient s wit h comple x long-ter m car e an d rehabilitatio n needs includin g inpatien t an d outpatien t precertifications concurren t reviews an d medica l recor d audit s fo r healt h benefi t plan s 1988-199 1 Staf f Nurse Medica l Intensiv e Car e Uni t (Adults ) Clevelan d Clini c Foundation Cleveland O H Medica l ICU Clevelan d Clini c Foundation Cleveland O H • Coordinate d uni t activitie s a s charg e nurs e i n Medica l IC U a t 1000-be d teachin g hospita l an d serve d a s uni t liaiso n t o hospita l qualit y committe e Barto n 3

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1984-198 8 Staf f Nurse Neonata l Intensiv e Car e Unit Leve l III ; Adul t Hemodialysi s Uni t Th e Toled o Hospital Toledo O H • Serve d a s Neonata l IC U staf f nurs e an d high-ris k tea m member respondin g t o high-ris k birth s a t 800-be d teachin g hospita l • Serve d a s charg e nurs e a t hospital-base d hemodialysi s unit providin g inpatien t an d outpatien t treatment s fo r u p t o 2 0 patient s pe r da y SCHOLARSHI P Publishe d Referee d Publication s Bulmer S M. Irfan S. Barton B. Vancour M. & Breny,} (2010) Compariso n o f healt h statu s an d healt h behavior s betwee n femal e graduat e an d undergraduat e colleg e students The Health Educator, 42(2) 1-10 Bulmer S M. Irfan S. Mugno R. Barton B A. & Ackerman L (2010) Demographi c trend s i n alcoho l consumptio n amon g undergraduat e student s a t a northeaster n publi c university 200 2 2008 Journal ofAmerican College Health, 58(4) 383-390 Chaudhry S I. Barton B A. Mattera J. Spertus J & Krumholz H M (2007) Randomize d tria l t o improv e hear t failur e outcome s (Tele-HF) : Stud y design Journal of Cardiac Failure, 13{9), 709-714 Bradley E H. Curry L A. Webster T R „ Mattera J A. Roumanis S A. Radford M J. McNamara R L. Barton B A. Berg D N. & Krumholz H K (2006) Achievin g rapi d door-to-balloo n times : Ho w to p hospital s improv e comple x clinica l systems Circulation, 113, 1079-1085. Bradley E H. Herrin J. Wang Y. Barton B A. Webster T R. Mattera J A. e t al (2006) Strategie s fo r reducin g door-to-balloo n time s i n acut e myocardia l infarction New England Journal of Medicine, 355(22) 2308-2320 Bradley E H. Roumanis S A. Radford M J. Webster T R. McNamara R L. Mattera J A. Barton B A. e t al (2005) Reducin g door-to-balloo n time s t o mee t qualit y guidelines : Ho w d o successfu l hospita l d o it ? Journal of the American College of Cardiology, 46, 1236-1241. Massey-Stokes M. Barton B A. Golman M. & Holland D J (2011) A n ecologica l approac h t o th e preventio n o f eatin g disorder s i n childre n an d adolescents I n K Goodheart J Cloptio n & J Robert-McCom b (Eds.) Eating disorders in women and children: A holistic approach to the prevention, management, and treatment of eatindisorders. Boc a Raton FL : CR C Press Barto n 4

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Presentation s a t Professiona l Meetin g Barton B A. Graduat e Researc h Symposium Souther n Connecticu t Stat e University Presentatio n & Webcast Ma y 5 2006 Title : Th e Experience s o f ADR D Caregiver s Whe n Seekin g an d Usin g Communit y Services : A Qualitativ e Study Barton B A. Societ y fo r Publi c Healt h Educatio n (SOPHE ) Nationa l Conference Poste r Presentation Novembe r 3 2006 Title : Th e Experience s o f ADR D Caregiver s Whe n Seekin g an d Usin g Communit y Services : A Qualitativ e Study Honor s an d Award s • Et a Sigm a Gamma Membe r sinc e 200 5 • Ph i Kapp a Ph i Hono r Society 201 1 • Golde n Ke y Internationa l Hono r Society 201 0 • Who' s Wh o Amon g Student s i n America n Universitie s & Colleges 201 1 • Texa s Woman' s Universit y Foundatio n Scholarship 2010-201 1 • Mar y Lyn n Walke r Drew s Endowe d Scholarship 2009-2010 Texa s Woman' s Universit y • Lea d th e Way Dea n o f Healt h Science s Scholarship 2009-2010 Texa s Woman' s Universit y • M.P.H Schola r Award Ma y 2006 fo r highes t GP A i n graduatin g MP H class Souther n Connecticu t Stat e Universit y Fellowship s / Grant s Graduat e Researc h Fellowshi p & Gran t Awar d ($9000) 200 5 2006 Souther n Connecticu t Stat e University Ne w Haven C T PROFESSIONA L SERVIC E Professiona l Organization s an d Membership s • Member Societ y fo r Publi c Healt h Educatio n (SOPHE) 200 4 presen t • Member America n Publi c Healt h Association 200 3 presen t • Member America n Associatio n o f Universit y Women 201 0 • Member Texa s Societ y fo r Publi c Healt h Educatio n (TSOPHE) 200 8 201 0 Servic e t o th e Professio n Chairman Abstract s Committee Societ y fo r Publi c Healt h Educatio n (SOPHE) 200 9 Annua l Nationa l Meeting Philadelphia P A Member Graduat e Progra m Committee Souther n Connecticu t Stat e University 2005-200 6 Barto n 5

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Servic e t o th e Communit y Coalitio n Facilitator Dento n Count y Breas t Healt h Coalition Denton TX 200 9 201 0 Voluntee r Breas t Healt h Educator Pionee r Breas t Healt h an d Communit y Outreac h o f Dento n County TX 2008-201 0 Barto n 6