From the Editor
Social media. An uncertain job market. Increasing academic demands.
Is life for our postsecondary students harder than ever? And are we seeing a surge in mental health disorders as a result?
In the first selection, we consider a new Canadian Journal of Psychiatry paper on postsecondary education and mental illness. While many have opinions on this topic, the University of Toronto’s Kathryn Wiens and her co-authors seek to add data to the discussion. Drawing on the Canadian Community Health Survey, they find: “The results do not imply the emergence of a mental health crisis among postsecondary students.”
In the second selection, we look at a new podcast considering technology and education. I interview some accomplished educators, including the University of Toronto’s David Goldbloom. “This is about challenging our own norms, values and expectations as clinicians.”
And in the final selection, we consider a New York Times essay on bipolar and social media. “Facebook snitched our big family secret: Roland, the literary prodigy, the tenderhearted musician, the Ivy League grad, was bipolar.”
Selection 1: “Mental Health among Canadian Postsecondary Students: A Mental Health Crisis?”
Kathryn Wiens, Asmita Bhattarai, Ashley Dores, Pardis Pedram, Jeanne V. A. Williams, Andrew G. M. Bullock, Scott B. Patten
The Canadian Journal of Psychiatry, 4 September 2019 Online First
Mental health among postsecondary students is an important public health concern due to high rates of psychological distress and suicidal ideation on college and university campuses. Nearly one in five postsecondary students experience mental health issues, with an estimated 11% reporting suicidal ideation in the past year. Unhealthy behaviors related to substance use, physical activity, and poor sleeping habits are common among postsecondary students and are linked to mental illness. High prevalence of mental health concerns among postsecondary students, coupled with elevated enrolment, has led to what has been termed a ‘mental health crisis.’
Widely referenced reports imply the state of student mental health is declining, with one report suggesting depression and anxiety is 6 to 7 times higher among graduate students than the general population. Nonetheless, key threats to validity, such as the selection bias inherent in comparing a convenience sample of postsecondary students to a representative sample of the general population, can misrepresent the appearance of a crisis.
Here’s what they did:
- They drew on the Canadian Community Health Survey (CCHS).
- “Postsecondary students were defined as 18- to 25-year-old current students who completed secondary school and were enrolled full time or part time.”
- Students were asked questions about perceived mental health, sleep, and stress, but also given interviews to establish mental disorders (major depressive disorder); they were asked about past diagnoses and substance use.
- Statistical analyses were done, including a logistic regression “to compare the odds of mental health outcome in current postsecondary students to non-postsecondary students…”
Here’s what they found:
- “Prevalence of perceived low mental health, mood disorders, anxiety disorders, and past-year mental health consultations increased significantly among females.”
- “Prevalence of suicidality also increased (2.1% to 6.3%) and prevalence of binge drinking decreased (31.7% to 26.9%), albeit neither was significant. Conversely, binge drinking decreased from 47% in 2011 to 28% in 2017 among males, with no evidence of a significant change in other mental health outcomes.”
- “With the exception of persistent stress (OR= 1.39; 95% CI: 1.28 to 1.52), the odds of experiencing each mental health outcome were lower among postsecondary students when compared to nonstudents… There were no significant differences detected for past-year MDE, suicidality, or mental health consultations.”
They write: “the findings suggest the assertion of a ‘mental health crisis’ among postsecondary students is premature and not supported by epidemiologic data. One interpretation is that increased mental health literacy contributes to better identification of mental health issues; however, the literature remains limited.”
Of course, we need to be careful with our use of language. When we speak of postsecondary students – as when we speak of so many other groups in Canada – we should recognize the profound difficulties with access to care.
Selection 2: “Quick Takes: What all physicians need to know about technology and education”
Peter Selby, Sanjeev Socklingam, Ivan Silver, David Goldbloom, David Gratzer
Quick Takes, September 2019
This is about challenging our own norms, values and expectations as clinicians. Because, generally, people are conservative and not in a big hurry to change what they do. They look for evidence that reinforces the value of what they’ve been doing for a long time. Many years ago, more than two decades ago, we did a study looking at therapeutic alliance for patients seen via televideo versus in-person in the office. And we found that it was no different. But people still say to me, ‘you know, I don’t think I would feel comfortable seeing a patient on a television monitor…’ Well, frankly, what counts is not your sense of the nuance, but how did the patient like it and did the patient get better? The rest is icing.
So comments Dr. David Goldbloom. In this new Quick Takes podcast, I interview accomplished educators about technology and medical education.
David Goldbloom joins me (I’m the one with the snappy shirt and khakis)
A few highlights:
Past. Dr. Ivan Silver on the bumpy start to technology’s use in education.
I noticed in my first year at McGill as a science student. I’d come from a little town in New Brunswick where everything might have been five to 10 years behind. But even so, I’d never seen video-based lectures before. When it began it was the era of the theory of ‘education as transmission.’ All you had to do is turn on a video, leave the room, and of course good things would happen. Information would be transmitted into your brain and it would be just as good as being there, and being there to answer questions, which, of course, were absent.
Present. Dr. Peter Selby on smoking cessation and education that doesn’t involve classrooms.
When the Syrian refugees arrived in Toronto nobody realized that they smoked. Much of their money was going towards cigarettes and there was no assistance to help them quit smoking. The problem was they mostly spoke Arabic… We created an Arabic resource that can be used anywhere in the province when anybody is doing smoking cessation with Arabic-speaking refugees, even if they are not native Arabic speakers.
Future. Dr. Sanjeev Sockalingam on the great potential.
What excites me is the possibility of using these technologies in a way that might make it more accessible for individuals. We have many of those traditional methods of teaching where people come to conferences, come to classrooms, they have the sage on the stage who provides that wisdom. We’ve moved the bar in terms of using more interactive evidence-based longitudinal kinds of programs and seminars. But I do think there’re unique opportunities to bring education technology to the forefront across that learner continuum. So some specific examples are things that are currently available, like synchronous types of training where people come together in learning communities or in online videoconferencing. So this allows people in their breaks to dial into those networks and have an opportunity to share best practices, cases, and have that truly workplace-based kind of moment with their community of practice.
The podcast is 14 minutes.
And for those interested in more, the full interviews with our colleagues can be found at the bottom of that webpage.
Selection 3: “Social Mania”
The New York Times, 27 September 2019
My brother Roland’s Facebook post set off a flurry of concern throughout his social network.
He’d been assaulted, he wrote, by ‘old-world mentality Agent Smiths who are threatening our ability to bring natural plant-based Medicine and intelligent health care to the world.’ In caps, he told his followers to ALERT THE PRESS AND BRING SIGNS OF PROTEST.
The yogis sent positive vibes; the rebels cried fight the man; the good Samaritans offered to jump in their cars and rescue him.
Except that Roland hadn’t exactly been assaulted. He’d been placed under an involuntary psychiatric hold and forcibly subdued in an emergency room at the same institution where he was training to become a psychiatrist.
And, with that, four years ago, Facebook snitched our big family secret: Roland, the literary prodigy, the tenderhearted musician, the Ivy League grad, was bipolar.
So begins Liz Eavey in a New York Times essay about her brother and his illness.
Roland’s bipolar disorder came of age during the same era as social media. His episodes were unpredictable in every way except for how predictably they manifested on Facebook: Between 11 p.m. and 5 a.m., he’d push out dozens of posts per hour, mostly psychedelic graphics and YouTube conspiracy videos.
The author notes her brother’s manic episodes, which people could witness through his social media presence.
She also describes the depressive episodes:
During his depressions, Roland would fall silent for weeks at a time, unable to get out of bed, caught in a dizzying suicide spiral. I’d hop on a flight to help my heroic parents and brother Ryan clean up the manic wreckage: vintage clothes piled high, business ventures gone wrong, strangers inhabiting Roland’s home. Every time my phone rang, I’d prepare to receive the news that Roland had killed himself.
This is a moving essay, describing a common problem: the burden of illness not just on patients, but on their families. But it notes a modern twist: mental illness in the era of social media. At a time of less privacy, Facebook doesn’t just reveal details of holidays and birthdays, but of illness episodes, too.
Reading of the Week. Every week I pick articles and papers from the world of Psychiatry.