Prevalence and Correlates of Prescription Stimulant Misuse Among US College Students: Results From a National Survey.

Objective: There is a high prevalence of prescription stimulant misuse (PSM) among college students in the United States (US). Preventing and identifying PSM requires an understanding of risk factors and correlates, but large-scale surveys regarding this issue have been lacking. We present the largest multi-institution study to date on the correlates of PSM among US college students.Methods: We performed a secondary analysis of the 2017 American College Health Association-National College Health Assessment (ACHA-NCHA), an annual national survey on the demographics, health, and academic experiences of US college students. Logistic regression models examined associations between past-year PSM in 40,645 undergraduate college students and hypothesized risk factors.Results: PSM was reported in 8% of college students. PSM was associated with past-year diagnosis or treatment of depression (adjusted odds ratio [AOR] = 1.16; 99% CI, 1.01-1.33), anorexia (AOR = 1.44; 99% CI, 1.02-2.03), attention-deficit/hyperactivity disorder (AOR = 1.66; 99% CI, 1.41-1.95), and substance use disorder/other addiction (AOR = 1.79; 99% CI, 1.30-2.46). The odds of PSM were 5.5 times higher for students who endorsed past-month use of "Legal drugs" and 8 times higher for students who endorsed past-month use of "Illegal drugs" than for those who did not. Other factors associated with PSM included academic difficulty, daytime sleepiness, fraternity or sorority involvement, White race, and cis-male gender.Conclusions: This study identifies many potential risk factors for PSM among US undergraduate college students. Targeted outreach, prevention, and clinical management are discussed. As the COVID-19 pandemic has exacerbated psychiatric distress, sleep difficulties, substance use, and attentional challenges among college students, this study may serve as a baseline for future studies examining the impact of COVID-19 on PSM among college students.

COVID-19-related direct and vicarious racial discrimination: Associations with psychological distress among U.S. college students.

BACKGROUND: The COVID-19 pandemic has been accompanied by a myriad of racist incidents targeting minorities in the U.S. Young adults are susceptible to direct and vicarious (indirect) pandemic-related racial discrimination. We sought to examine associations between both types of discrimination experiences and psychological distress among college students across different racial groups. METHODS: We analyzed self-reported data from 64,041 undergraduate students from the Spring 2021 American College Health Association-National College Health Assessment. Logistic regression examined odds of severe distress based on self-reported exposure to direct and vicarious racial discrimination. RESULTS: Even after controlling for sociodemographic characteristics and prior mental health diagnoses, there was a significant association between direct discrimination and distress among Asian (AOR: 1.3, p < 0.001), Hispanic (AOR: 1.6, p < 0.001), and Multiracial (AOR: 1.4, p < 0.001) students. Vicarious discrimination was significantly associated with distress among White (AOR: 1.4, p < 0.001), Asian (AOR: 1.4, p < 0.001), Hispanic (AOR: 1.5, p < 0.001), and Multiracial (AOR: 1.3, p < 0.001) students. Further analysis considering distress as a continuous measure revealed a significant association between vicarious discrimination and distress for Black participants (ß = 0.9, p < 0.001). LIMITATIONS: Self-reported variables are susceptible to recall bias. Minority racial group analyses may be underpowered. CONCLUSIONS: Our findings reveal an overall link between both direct and vicarious racial discrimination and distress across several racial groups. Further studies should examine effective mental health interventions and anti-racism initiatives to support students who have experienced direct or vicarious discrimination due to COVID-19.

Association Between College Course Delivery Model and Rates of Psychological Distress During the COVID-19 Pandemic.

Importance: College students in the US have been heavily affected by the COVID-19 pandemic. In addition to increased rates of depression and anxiety, college students have faced unprecedented stressors, such as geographic relocation and abrupt conversion from in-person classes to online classes. Objective: To study the association between course delivery model and psychological distress among US college students. Design, Setting, and Participants: This cross-sectional analysis used national data from the American College Health Association-National College Health Assessment III data set. Data were gathered from a web-based survey administered from January to early June 2021 to full-time US college students attending 4-year programs. Exposure: Course delivery model was self-reported. Main Outcomes and Measures: Psychological distress was measured using the Kessler Screening Scale for Psychological Distress. Results: This study evaluated 59 250 full-time undergraduate students (68.1% women; 51.5% White students; mean [SD] age, 21.2 [4.3] years); 3.5% attended fully in-person classes, 61.2% attended fully online classes, and 35.3% attended a mixed format of in-person and online classes. Students who attended classes fully online reported higher levels of psychological distress than those who attended a mix of online and in-person classes (b = 0.76 [99% CI, 0.64-0.88]; P < .001). This association remained significant after controlling for geographic region, year in school, gender, race and ethnicity, food security, current anxiety and/or depressive disorders, COVID-19 concerns, and residence (living on campus, off campus with family, or other off-campus arrangements) (b = 0.18 [99% CI, 0.04-0.31]; P = .001), as well as time spent socializing with friends (b = 0.13 [99% CI, 0.002-0.26]; P = .009). Conclusions and Relevance: The findings of this study suggest that mental health professionals may wish to consider the association of course delivery models with mental health outcomes when working with college students. Colleges should be aware of the mental health burden associated with attending fully online classes and consider possible in-person components and supports for students.

Testing positive, losing a loved one, and financial hardship: Real-world impacts of COVID-19 on US college student distress.

BACKGROUND: The COVID-19 pandemic has taken a particularly heavy toll on U.S. college students. In addition to facing academic-related stress and social pressures, these individuals are now increasingly susceptible to experiences such as contracting the virus, losing loved ones to COVID-19, or facing financial hardship due to the pandemic. The effects of such personal, pandemic-related experiences on young adult mental health - and the inherent racial disparities within these outcomes - remain largely understudied. METHODS: We analyzed 65,568 undergraduate students from the Spring 2021 American College Health Association-National College Health Assessment (ACHA-NCHA). RESULTS: The rates of the aforementioned COVID-19-related stressors were unevenly distributed across racial groups. A logistic regression analysis to identify predictors of moderate and serious psychological distress revealed that participants who had experienced the death of a loved one had 1.14 times greater odds of developing psychological distress (p < 0.0001). Those who experienced financial hardship had an odds ratio of 1.78 (p < 0.0001). Surprisingly, testing positive for COVID-19 was associated with an odds ratio of 0.82 of psychological distress (p < 0.0001). LIMITATIONS: Self-reported measures are susceptible to recall bias and misinterpretation. Exposure and outcome variables were measured simultaneously in this cross-sectional study which limits inference on causality. CONCLUSIONS: Financial burdens and bereavement are especially impactful stressors among college students during the pandemic, whereas contracting COVID-19 seemingly exhibits less impact on distress levels. When addressing student wellbeing, institutions should consider prioritizing the implementation of resources to support individuals affected by pandemic-related financial and familial losses.

Perceived COVID-19-related anti-Asian discrimination predicts post traumatic stress disorder symptoms among Asian and Asian American young adults.

OBJECTIVE: This study investigates the prevalence of COVID-19-related discrimination and the extent to which COVID-19-related discrimination is associated with mental health symptoms among Asians and Asian American (A/AA) young adults during the first three months of the COVID-19 pandemic. METHODS: We used data from the COVID-19 Adult Resilience Experiences Study (CARES), a cross-sectional online survey conducted in the U.S. Out of 1,001 respondents, 211 A/AA young adults were analyzed for this study. RESULTS: Sixty-eight percent of A/AA young adults reported that they or their family have experienced COVID-19-related discrimination and approximately 15% of respondents reported verbal or physical assaults. After controlling for covariates including predisposing factors, lifetime discrimination, and pre-existing mental health diagnoses, COVID-19-related discrimination was significantly associated with an increased level of symptoms of posttraumatic stress disorder (PTSD), but not of anxiety or depression. Our study results suggest that COVID-19-related discrimination may contribute to PTSD symptoms among A/AA young adults. LIMITATIONS: This was cross-sectional data which was collected through online and self-report rather than clinical evaluation. CONCLUSION: This finding adds greater urgency to develop and implement policy- and individual-level interventions to reduce race-based discrimination among A/AA.

Potential Impact of COVID-19-Related Racial Discrimination on the Health of Asian Americans.

Anti-Asian discrimination and assaults have increased significantly during the Coronavirus disease 2019 (COVID-19) pandemic, contributing to a "secondary contagion" of racism. The United States has a long and well-documented history of both interpersonal and structural anti-Asian discrimination, and the current pandemic reinforces longstanding negative stereotypes of this rapidly growing minority group as the "Yellow Peril."We provide a general overview of the history of anti-Asian discrimination in the United States, review theoretical and empirical associations between discrimination and health, and describe the associated public health implications of the COVID-19 pandemic, citing relevant evidence from previous disasters in US history that became racialized.Although the literature suggests that COVID-19 will likely have significant negative effects on the health of Asian Americans and other vulnerable groups, there are reasons for optimism as well. These include the emergence of mechanisms for reporting and tracking incidents of racial bias, increased awareness of racism's insidious harms and subsequent civic and political engagement by the Asian American community, and further research into resilience-promoting factors that can reduce the negative health effects of racism.

Priorities for addressing the impact of the COVID-19 pandemic on college student mental health.

The COVID-19 pandemic has already produced profound impacts on college students, with unprecedented directives for student relocation from their college campuses and dormitories mid-semester and coursework that took place through virtual learning. The current disruptions and anticipated potential long-term changes call for immediate prioritization regarding next steps for addressing college mental health and well-being. This viewpoint article highlights two urgent priorities for addressing current college mental health needs: the development of strategies for ensuring mental health service access, and intentional outreach to college students with special circumstances. The current crisis also represents an opportunity for campus administrators, mental health professionals, researchers, and policymakers to leverage innovative models of care as well as identity-related student assets, strengths, and resilience-promoting factors to support students' eventual return to campus and to respond more effectively to future massive disruptions.

COVID-19 and telepsychiatry: Early outpatient experiences and implications for the future.

The COVID-19 pandemic has dramatically transformed the U.S. healthcare landscape. Within psychiatry, a sudden relaxing of insurance and regulatory barriers during the month of March 2020 enabled clinicians practicing in a wide range of settings to quickly adopt virtual care in order to provide critical ongoing mental health supports to both existing and new patients struggling with the pandemic's impact. In this article, we briefly review the extensive literature supporting the effectiveness of telepsychiatry relative to in-person mental health care, and describe how payment and regulatory challenges were the primary barriers preventing more widespread adoption of this treatment modality prior to COVID-19. We then review key changes that were implemented at the federal, state, professional, and insurance levels over a one-month period that helped usher in an unprecedented transformation in psychiatric care delivery, from mostly in-person to mostly virtual. Early quality improvement data regarding virtual visit volumes and clinical insights from our outpatient psychiatry department located within a large, urban, tertiary care academic medical center reflect both the opportunities and challenges of virtual care for patients and providers. Notable benefits have included robust clinical volumes despite social distancing mandates, reduced logistical barrieres to care for many patients, and decreased no-show rates. Finally, we provide clinical suggestions for optimizing telepsychiatry based on our experience, make a call for advocacy to continue the reduced insurance and regulatory restrictions affecting telepsychiatry even once this public health crisis has passed, and pose research questions that can help guide optimal utilization of telepsychiatry as mainstay or adjunct of outpatient psychiatric treatment now and in the future.