Friday, April 21, 2017

Literature Review #5

1. Literature Review
Shayla Carroll

Mark S. Salzer, PhD

2. Salzer, M. "A Comparative Study of Campus Experiences of College Students With Mental Illnesses Versus a General College Sample."Journal of American College Health, Vol. 60, No.1, 2012.

3. The research article examined college students with mental illness compared to student norms using a questionnaire. The article began by giving statistics, such as 85% of students with mental illness withdraw from college in relation to the 45% for the general student population. The questionnaire given to 499 students included demographic questions, psychiatric history, and questions regarding campus engagement and experiences. This research article concluded that both students with and without mental illness face the same college struggles. These struggles include tuition payments, academic stress, and lack of confidence. However, students with mental illness such as depression and anxiety showed greater problems when it came to these stressors. Because of such a high negative impact, these students were more likely to drop out of college. After dropping out of college, it was likely that these students never received help for their mental illness. This puts them at risk for being on unemployment.

4. Mark Salzer received his Postdoctoral fellowship in mental health services research at Vanderbilt University, has a Ph.D. in clinical psychology, and a bachelors in Psychology and Sociology. He currently is a professor and chair of the department of rehabilitation sciences at Temple University. He has received degrees and worked in four prestigious universities, which include Vanderbilt University, University of Illinois, Yale School of medicine, and the University of Wisconsin. He has plenty of experience in both the clinical and research side of psychology. Salzer has published more than 80 articles in this area, as well as given more than 200 presentations around the world.

5. Two key terms in this article are campus engagement and stigma. Campus engagement is the extent to which the students develop positive relationships with others on campus, and engage in activities, clubs, etc. Stigma is mentioned in this article because of the fear some students have of reaching out for help for mental illness. Fear of being stigmatized is something that can keep students from not receiving help, and leading them to drop out.

6. "This is borne out by findings that students with mental illnesses do not seek accommodations because they fear being stigmatized by faculty, are concerned about experiencing discrimination, and report that faculty can be uncooperative or unreceptive to the requests" (2). This is important because it can prevent students from receiving help.  Uncooperative and unreceptive can refer to many different issues on behalf of the counseling center.

"Eighty-six percent of students with mental illnesses withdraw from college prior to completing their degree6 compared to a 45% withdrawal rate for the general student population.7 College campuses around the country are struggling with how to address the needs of these students,8,9 with some arguing that we have reached a “campus mental health crisis" (Pg. 1). My paper will hopefully be able to address this quote and the mental health crisis this article speaks of.

"Fairly robust findings show strong relationships between student engagement on campus and academic outcomes and retention. Applying this normative engagement framework to understand the experiences of students with mental illnesses might partly explain the academic challenges and stress these students experience, resulting in a greater likelihood of withdrawal" (pg. 1-2). This quote is the main focus of this research paper and I plan to use it in my paper. As the likelihood of withdrawal increases, colleges will lose out on their high retention rate, which is what Novotney spoke about in her article.

7. I plan to end my paper discussing the importance of retention to every college. With that being said, this study shows that students with mental health issues are more likely to drop out compared to the average student. If these students do not receive help for their mental illnesses (knowing that depression an anxiety are the most prevalent) they are more likely to drop out, causing retention rates to be lowered. The way to keep them from dropping out would be to implement all of the possible solutions to this issue of an increased waiting list for counseling centers. These solutions, as previously described, include technologies, group therapy, and more awareness.

Argument and Counter Argument

Working Thesis: There has been a substantial increase in anxiety and depression among university students due to socioeconomic status, social drinking, and the every day college stressors. This increase is leaving counseling centers overbooked, and it is essential that universities begin implementing ways to deal with the two week waitlist.

Earlier in my frame i explained my research question and how i plan on answering it. My research question is to what extent has depression and anxiety increased in college students and why has this increase occurred? How are colleges taking action in dealing with this epidemic-- why?

My paper will flow from understanding the increase, to explaining why the increase has occurred. I am tying in all of my research to better understand all possible reasons why, which include lower SES, social drinking, and the usual stressors brought out by college such as increased responsibility. Another important reason that is mentioned in a few different resources of mine is the fact the millennials are not used to failing, and strive to be the best all the time-- this can lead to negative feeling about the self that cause or bring out depression and anxiety. After the reasons are understood, I am discussing what the universities can do to help cope with the increase. This includes, technologies, group therapy, and helping students and faculty to be more educated upon the topic of mental illness. After this, it is important to discuss the problems of not acknowledging the increase, and potential problems the universities may run into while trying to deal with the increase. I will tie this all together by talking about how privatization simply does not allow for the counseling centers to expand in many ways because they are not being funded.

During my research, i came across an article that showed college anxiety had no effect on student's post undergraduate decisions. This article implied that though students may deal with a great deal of anxiety in the moment, it has no long last effects on decisions such as applying to graduate school. Unfortunately, I did not save this link and do not have the time to search for it at this moment. I will hopefully find this research article tomorrow, and post the link in the comments. This focuses on the long term effects, not the potential hazards of the mental illness going unnoticed at the present moment. If a person cannot get through college because of anxiety, graduate school is no longer an option. Potential job opportunities after college will also not be an option being that the student never obtained a degree.


Finding a chief case for my paper seems to be my biggest obstacle. As of right now, I am using the article "A dangerous wait: colleges can't meet soaring student needs for mental health care" by Megan Thielking. This article discusses the actual wait times for counseling services are real universities across the nation. These numbers are appalling. The wait times range from one to two weeks, sometimes a few days more than two weeks. This article discusses a person named Nick and Constance. Constance was in an abusive relationship and struggled with depression. When constance tried to make a counseling appointment, she was told she would have to wait at least two weeks. Constance attempted suicide one day before her appointment and was found by her roommate. She needed urgent counseling, and had to wait two weeks. These wait lists are causing problems at almost every university. If students begin taking matters into their own hands, we can expect suicide rates to rise and retention rates to drop. I can tie this into many different parts of my paper because the case starts with the waitlist and ends with a negative consequence of not being seen in a reasonable amount of time. Nick went into college with depression and had no coping mechanisms for his mental illness. He sought help early on and had difficult getting appointments with the college counseling center, so he went to a private mental health specialist off campus. Nick was lucky... unfortunately, not many people in college have the luxury of being able to afford a private mental health specialist. Instead of having to pay for a mental health specialist, the university should be funding counseling centers more. However, with privatization on the rise, this is extremely difficult. Both Nick and Constance had to deal with consequences of a waitlist, as do many university students.


My research took off with the article "Prevalence and Correlates of Depression, Anxiety, and Suicidality Among University Students" by Eisenberg, Gollust, Golberstein, and Hefner. This article gives statistics about the rise of anxiety and depression among college students. An interesting conclusion of this study was that students who had financial struggles were at higher risk for mental illness. The study concluded that mental illness needs to be addresses in order to keep college success rates high and diverse. This last sentence ties in with retention rates, which i will discuss in the next paragraph. I used the terms anxiety and depression from this article and defined them in the beginning of my paper.

From the article, "Students Under Pressure" by Amy Novotney I plan to use some statistics about the prevalence of anxiety and depression. She touches upon the increase in the number of students reaching out for clinical help. An interesting technology she spoke about was the Therapist Assisted Online (TAO) program. I will go into detail about this technology in the portion of my paper that explains what can be done to help the universities deal with the increased rates of students seeking help. Another technology known as the brief assessment and referral team (BART) is also used to help shorten the time of the initial interview. Implementing new technologies like the BART and the TAO program will be able minimize the waitlist problem. An important term which fueled the direction my paper is taking is the term retention rates. Colleges care a lot about retention rates, and the likelihood that students drop out have a high correlation with the students struggling with mental illness. To keep retention rates up, most students need to be receiving help if they struggle with anxiety/ depression.

One of the articles I am planning on using throughout my entire paper is the "Increased demand for mental health services on college campuses" article. The researchers asked plenty of question to administrators from a variety amount of schools, all leading to the same conclusion. The administrators and the researchers concluded that there is an increase (gives some reasons why),  what the universities can do to help, and potential problems they may run into while doing so. This leads me to the next article, "Time-Limited Service Alternatives: Using Therapeutic Enactment in Open Group Therapy." I will use this article in my paper to explain how group therapy could be a viable option for all universities. There are so many benefits of group therapy to both the students and the universities, that it would be absurd not to use it. Psychosocial factors is a key term that comes up in both of these articles, which i will define earlier on in my paper.

My paper will flow from understanding the increase, to explaining why the increase has occurred. I am tying in all of my research to better understand all possible reasons why, which include lower SES, social drinking, and the usual stressors brought out by college such as increased responsibility. Another important reason that is mentioned in a few different resources of mine is the fact the millennials are not used to failing, and strive to be the best all the time-- this can lead to negative feeling about the self that cause or bring out depression and anxiety. After the reasons are understood, I am discussing what the universitites can do to help cope with the increase. This includes, technologies, group therapy, and helping students and faculty to be more educated upon the topic of mental illness. After this, it is important to discuss the problems of not acknowledging the increase, and potential problems the universities may run into while trying to deal with the increase. I will tie this all together by talking about how privatization simply does not allow for the counseling centers to expand in many ways because they are not being funded.


With College comes a lot of responsibility and freedom. With all of the new responsibilities and freedom comes many stressful events. When not properly coping with such stressful occurrences in a time of transition, anxiety and depression can develop. College students may already be predisposed to such mental illness and the stressors of college can bring the mental illness out. 

This picture is a great illustration of how many students actually feel stressed, overwhelmed, and depressed. The fact that these numbers are so high, not only in this picture but in plenty of research articles, proves that something regarding college depression and anxiety needs to be done. My paper will focus on why this increase has occurred and what colleges can do to cope with this increase. 

This picture illustrates one of the main things that colleges can do to reduce the long wait times for a student to see a counselor -- group therapy. Group therapy can help the students cope with anxiety by offering an alternative space for students to reflect on their issues. The students will feel included, in control, and cohesion/ sense of belonging to a group, which in and of itself poses benefits. This is one of the many ways universities can tackle the serious influx of students seeking out help from the counseling centers their school offers. 

Literature Review #4

1. Literature Review
Shayla Carroll

-one of the authors, Patrice A. Keats

2. Keats, P., Sabharwal, V. “Time-Limited Service Alternatives: Using Therapeutic Enactment in Open Group Therapy.” The Journal For Specialists In Group Work, Vol. 33, No. 4, 2008, pp. 297-316.

3. It is evident at this point in my research that there has been a drastic increase in depression and anxiety among college students. This increase has led to implementations of potential ways to fix the long waitlists almost every university has been encountering. This article talks about the implementation of group therapy to provide effective treatment to students. By combining group counseling with therapeutic enactment, researchers plan to offer some relief to students with psychosocial issues. Group counseling is said to be more of a flexible and adaptive approach to therapy for college students. The students will feel more involved, included, influential, and committed. The session involves a welcome section, a warm-up section, the central activity, and a closing exercise. Through the open group therapy experience, students can learn to cope with eating disorders, stress management, and relaxation -- all of which are important coping mechanisms of anxiety.

4. Dr. Patrice Keats is an Associate Professor in the faculty of education at Simon Fraser University. Her research interests are in traumatic stress studies and counselor education. Her experience in counselor education gives her the background necessary for a research article about group therapy. The second researcher who worked on this study was V. Vanita Sabharwal, from the University of British Columbia. Sabharwal is a counselor in the University of British Columbia's Counseling Services. It was hard for me to find more information regarding more of her background.

5. Some key terms in this article are therapeutic enactment, open group, and experiential therapy. Therapeutic enactment is a structured way to conduct change using the open group therapy process. The students in the group re-enact conflicts or situations that they have encountered. By using therapeutic enactment, counselors hope that the clients will better understand their own struggles, and learn alternate ways to work through the issue. Experiential therapy is similar in that the clients use role playing to identify hidden or subconscious issues. An open group is a group therapy session that allows students to come in and out as they please. 

6. The first important quote sums up the structure of an open group therapy session. "As co-facilitators of the group, we adapted the group structure from the Friedman and Mayne Devine’s (2000) open group format. Each two hour session is divided into four sections: welcome, warm-up, central activity, and a closing exercise (see case composition below for further details)" (pg. 306). The structure and goals of group interviews are important, so the summation of how the group therapy session plays out is an important part of this article. 

A second important quotes states, "Although there is great value in longer term group work, therapeutic enactment in open group therapy in a university setting offers an alternative possibility for students to reflect on their issues in a safe contained space, and has good potential to meet the needs of students with less complex issues" (pg. 315). Group therapy is a great way for universities to face the problem of long wait lists, while also providing benefits for the members of therapy sessions. 

Lastly, the benefits posed by group therapy are extremely important because the therapy session has to be successful in order for students to keep coming back. Students who engage int eh group therapy sessions will be able to reap all of the benefits. A quote that sums this thought up states, " In our group, development is monitored within a structured format that provides members with the opportunity to feel a sense of inclusion (acceptance and belonging to the group), control (personal power and influence over what happens as a member), and affection=openness (closeness, cohesion, and attachment to others in the group)" (Pg. 300).

7. I will use this article to give background of group therapy, how it works, why it is important, and how it can help universities tackle the long waitlist problem they are encountering. This articles explains how the group session is ran, and gives a case near the end of the paper to illustrate group therapy in action. This article will be useful near the end of my paper when I list ways that universities can help their students who struggle with mental illness. By using group therapy, universities will be able to see a group of students in the time where they would only see one or two. Group therapy is an effective measure of therapy for both the students and the counseling centers. 

Literature Review #3

1. Literature Review
Shayla Carroll

-one of the authors: Daphne C. Watkins

2. Watkins, D., Hunt, J., Eisenberg, D. “Increased demand for mental health services on college campuses: Perspectives from administrators.” Qualitative Social Work, Vol.11, No. 3, 2011, pp. 319-337.

3. This research article sought out the changes in demand in mental health services. What is particularly interesting about this article is that the responses are coming from the administrators, not the students, of ten different colleges. The obvious increase in severity of mental health concerns in college students was characterized by four themes. The first is an increase in the severity of mental health concerns and demand for services, the second is the overall psychosocial differences in today's college student population, the third is the changes in roles of counseling centers, and the fourth is the institutional challenges and the responses to the challenges. These conclusions came from the responses the mental health centers provided to the researchers.

The questions asked include, " How has the demand for services, and actual provision of services, changed in the past 5 years? How have you dealt with this increase? What barriers have been present? What are the perceived reasons for changes in the demand for services? What are the most significant challenges with respect to student mental health? How are you dealing with these challenges?

The responses to these questions fueled this research article. Reasons for this increase according to some administrators include increase in severity of mental health across people in general, increased alcohol and drug use, and people with mental health issues now feel like they are able to attend college. Administrators commented on millennials being more competitive than older generations, and not understanding how to fail-- which can lead to increase in anxiety and depression. As counseling centers begin to fill up, a main common way the schools seem to coping is by using group therapy. These administrators commented on a variety of potential ways to help with the increase, but explain that they still run into problems because of physical space and money.

4. Daphne C Watkins is the director of a PhD program at the University of Michigan.This program is a joint program in Social Work and Social Science. Watkins has done plenty of research in the mental health field.

Justin Hunt is the director of the University of Arkansas Faculty Wellness program and the Medical Director of a new healthcare center. He is a psychiatrist and mental health services researcher, who has had lots of experience in the field of psychology and medicine.

Daniel Eisenberg is also a member of the University of Michigan team, who's name has come up in my literature review before. Daniel Eisenberg is a Stanford Graduate who is currently a professor, and also the director of the doctoral program of Health Services Organization and Policy at UM. His goal in research is to "improve understanding of how to invest effectively and efficiently in the mental health of young people." 

5. Some key terms used in this article were college counseling centers and psychosocial factors. The college counseling centers are where this study received its information and interviews from. The researchers interviewed people who would work with the students, making them a valid source of information. Psychosocial factors are factors that encompass both social and psychological factors, such as peer pressure and being predisposed for a psychological disorder. Many things come together that cause someone to seek out help at a counseling center. 

6. One important quote is given my an administrator from a college, the administrator says "... one thing this past year, there’s been a real up kick in drug use on our campus.... We’ve got more poly-substance abuse going on, at least that the kids are reporting to us as counselors. We’re seeing more students with toxic blood-alcohol levels...." I plan to link this to the social drinking article.

Another quote states, "...I think that this is a generation that has grown up relying heavily on having things done for them; participating in structured activities, etc., and being a relatively dependent group and one that’s, you know, closer to the apron strings than previous generations. That translates into people breaking down with more frequency and more willingness to ask for help and to expect help to be there." This is an important quote because it shows that a potential reason for the increase in students seeking out help stems from millennials just being, well, millennials.

Regarding another potential reason for increase, an administrator says "Lowered [mental illness] stigma among college students and their parents regarding mental health services [has led to increased services] for sure." This is important because it shows why so many college students are open to getting help --  that is because the stigma of mental health has decreased, so the students know they are not alone, they know they are not crazy, and they know they will not be judged for getting help.

7. This article is extremely valuable to my research question. Part of my research question focuses on why there has been such an increase in students going to counseling centers. This article gives insight from administrators from a variety of counseling centers. This gives first hand opinions on why this increase has occurred, which i can tie into other articles i have found to prove that the opinions these administrators have are valid reasons. Facts and percentages are needed, but it is always good to be backed up with actual clinical evidence from people who have experience in the field. The quotes also give good ways this increase can be brought under control. I can use this article in many parts of paper, not just one, which I think will help to create a better flow.