What kinds of factors affect the academic outcomes of university students with mental disorders? A retrospective study based on medical records.

AIMS: University students that suffer from mental disorders seem to have difficulty graduating. Therefore, we investigated risk and protective factors of dropping out with the aim of improving such students' academic outcomes. METHODS: First, we statistically compared the academic outcomes of 203 undergraduate students who received treatment in the Department of Psychiatry of the Tsukuba University Health Center to those of matched controls. Second, clinical factors of 370 mentally ill students were statistically compared between the dropout and graduate groups. RESULTS: Mentally ill students experienced significantly greater difficulties graduating. Furthermore, the ratio of females and the year of study at initial consultation were significantly lower in the dropout group. However, duration of illness, social withdrawal, temporary leaves of absence, percentage of diagnosis of F2, history of truancy, CGI-S/GI score, number of suicide attempts, visits to us, family consultations with us and grade repeating were longer or greater in the dropout group. Ultimately, the number of suicide attempts, CGI-S score, social withdrawal and leaves of absence were significantly associated with dropping out. Moreover, duration of social withdrawal and leaves of absence were significantly correlated with CGI-GI score. CONCLUSION: We found that the number of suicide attempts, CGI-S score, social withdrawal and extended enrollment were risk factors for dropping out, while the therapeutic effect seemed to be a protective factor. As risk factors involved states of social maladjustment, it is necessary not only to treat mental disorders, but also to provide assistance such as educational and individual support for daily living.

[Effects of Mental Disorders on the Academic Outcomes of University Students--A Retrospective Study Using Medical Records from a Health Services Center].

OBJECTIVE: Falling behind in class is a serious problem for university students as it can lead to social problems and increase the risk of suicide. Although it is common for students suffering from mental disorders to fall behind academically, there have been few studies investigating the difficulties these students face in order to graduate from university. Therefore, we investigated factors associated with dropping out of school with the purpose of creating a strategy to improve the academic outcomes of students who regularly seek psychiatric consultation. SUBJECTS: We investigated undergraduate students who received consultation at Tsukuba University's Health Services Center Psychiatry Department and whose academic outcomes between the 2004 and 2013 academic years were known. METHODS: Academic outcomes were obtained from Tsukuba University's grade management system by permission of the authority. The students were divided into either a graduate or dropout group depending on their academic outcomes. The medical records for both groups were retrospectively investigated, and factors that were predicted to affect academic outcomes were assessed using statistical methods. RESULTS: The dropout group was younger in grade and had a greater severity of illness at initial consultation. Moreover, this group had a greater number of consultation visits, showed less cooperation with the instructor in charge, had a significantly longer duration of social with drawal and temporary leave of absence from school, and had a significantly greater number of students with grade retention. When a time factor was incorporated in the analysis, the presence of grade retention/temporary leave of absence from school and social withdrawal was significantly correlated with dropping out of school. CONCLUSION: It was revealed that not only the mental disorder itself, but also psychosocial severity and the maladjusted state that occur secondary to such mental disorder influence academic outcomes. These results indicated that in order to improve academic outcomes, it is necessary not only to appropriately treat the disorder, but to also provide university community support for social maladjusted states of the students in psychiatric treatments, such as social withdrawal, educational support for daily living, individual support for daily living, and academic support, through cooperation with the educational organization.

[A case of "oneiroid Erlebnisform" influenced by the Great East Japan Earthquake].

Following the Great East Japan Earthquake, although there are a growing number of reports on the care of the mental health of victims and supporters, the influence of this disaster on individuals with mental disorders has not yet been sufficiently clarified. Here, we present a case of "oneiroid Erlebnisform" (Mayer-Gross, W.), which was influenced by the disaster and relapsed one year after the earthquake. We discussed the meaning of this experience and the factors leading to recurrence in this case. A male international student in his thirties had repeatedly suffered from acute episodic alteration of consciousness. Although he had experienced anxiety just after the disaster, he showed improvement during his temporary evacuation to Western Japan. Nearly one year after the disaster, however, he relapsed, with symptoms characteristic of an oneiroid state. The patient stated that he was a fuel rod in the Fukushima nuclear power plant, and he then immersed himself in a bathtub full of water in order to avoid meltdown. According to ICD-10, the patient was diagnosed with acute polymorphic psychotic disorder without symptoms of schizophrenia (F23.0). In addition to the alteration of consciousness as the main symptom, since there was no decrease in the level of personolity function, it was also considered that the diagnosis of this case was atypical psychosis, as proposed by Mitsuda and Hatotani. In the oneiroid experience, a variety of visual hallucinations, illusions, and images had appeared one after another. We can find catastrophe and salvation as the main themes in this state, related to the disaster and nuclear accident. Unloading situation after thesis defense, insufficient sleep, poor medication adherence, and the increased frequency of earthquakes were important factors in the recurrence of the present case. To continue research in Japan after the earthquake, the decision was accompanied by anxiety for the patient. One year after the earthquake, the patient was trying to enter a doctoral program with continued anxiety over the nuclear accident. When the frequency of earthquakes increased again, the patient was taking an entrance examination. There is a possibility that the anxiety in this situation led to the recurrence. People are vulnerable to being exposed to the fear of a disaster even after experiencing relief. This situation may increase the risk of recurrence.

[An analysis of mental disorders of international students visiting the Mental Health Service at Tsukuba University Health Center].

With the expected increase in the number of international students coming to Japan as part of the Ministry of Education, Culture, Sports, Science & Technology's "300,000 Foreign Student (Global 30) Plan", the demands on university mental health facilities will also increase. However, the rate of mental disorders of recent international students has not been fully evaluated. As part of an initiative to establish effective treatment measures for the mental health of international students, we investigated the present status and recent trends of these students who visited the Mental Health Service (MHS) in the Tsukuba University Health Center. The demographic characteristics, pathway, stress, and diagnosis of international students who visited the MHS from 2005 to 2010 were investigated retrospectively based on medical records. The subjects were 59 international students (15 male, 44 female; mean age: 28.4). The consultation rate of international students was significantly lower than that of Japanese students each year. Although the rate is almost stable in Japanese students (2.1-2.5%), it has increased significantly in international students, from 0.5% in 2005 to 1.4% in 2010. A larger percentage of the subjects were from Asia (66%), compared to the former Soviet Union (10%) and Europe (7%). A greater proportion of the subjects were graduate students (67%). The diagnoses were as follows: depression (34%), adjustment disorder (32%), insomnia (15%), and schizophrenia (9%). The percentage requiring emergency consultation was 24%, including the most severe cases that had to return to their home country. Sixty-nine percent of the subjects stayed in Japan for more than 1 year. Half of the subjects decided to visit the MHS themselves. The results of the present study show that the consultation rate of international students was lower than that of Japanese students in spite of the "culture shock" experienced by international students. This result is in agreement with previous reports. Among international students, however, there is a trend indicating an increase of visits to the MHS in recent years, approaching the rate for Japanese students. Preparations for emergency consultation are still important.