Mental Wellness of Students at Harvard Chan

HARVARD CHAN MENTAL HEALTH STUDENT ALLIANCE Mental Wellness of Students at Harvard Chan SPRING 2017 SURVEY Executive Summary Overview of Results & Recommendations

HARVARD CHAN MENTAL HEALTH STUDENT ALLIANCE Mental Wellness of Students at Harvard Chan SPRING 2017 SURVEY Executive Summary The mission and objectives of the Harvard Chan Mental Health Student Alliance (MHSA) include the promotion of a positive and inclusive environment for student mental health, such as developing a culture of self-care, peer support, and institutional resources. To support our efforts toward this goal, we conducted an anonymous graduate student survey in April 2017. The intent of this survey and its results are threefold: (1) inform the student body of the current state of mental wellness, i.e., non-clinical, general psychological well-being; (2) design MHSA programs to be responsive to student needs and interests; and (3) collaborate with administrators on institutional improvements. Who answered the survey? About a quarter of the student body (287 students) participated in the survey. Roughly half were master s students and half were doctoral students; about a third were international students; and the majority of respondents were non-hispanic white (43%) or Asian (37%), female (82%), and straight (82%). Among these students, 90% agree that graduate programs have a responsibility to promote student mental wellness, and 80% would like to see Harvard Chan do more about student mental wellness. What is the current state of mental wellness? Among the respondents, 71% said they felt changes in their mental wellness that they attribute to the coursework, culture, expectations, or other facets of this school. Only about half of students knew about mental health resources at school or felt comfortable seeking them out. Less than a third felt comfortable talking to faculty or administrators about mental health. Thematic analysis indicated that the learning environment is frequently experienced as unsupportive, stressful, stigmatizing, and restrictively competitive. In particular, poor funding and department/program-specific disorganization are major stressors. Students want shifts in institutional culture that are focused on core causes of mental stress, not quick fixes. On a validated measure of depressive symptoms, the most common symptoms were somatic (tired, anxious, issues sleeping, irritated, loss of interest). Some groups had significantly higher total depressive symptoms than others: doctoral students (vs. masters students); racial and ethnic minority students (vs. non-hispanic white students); and LGBTQ students (vs. straight students). MHSA Recommendations for Next Steps: Based on these findings, we recommend the following priorities to promote positive mental health at Harvard Chan. 1. Demonstrate an explicit institutional and actionable commitment to student mental wellness, including designating an Associate Dean to work on recommendations. 2. Improve navigation of mental health resources within Harvard Chan, Harvard, and the wider community, including for international students who are less likely to seek help. 3. Train faculty and staff to respond to students stress experiences with informed guidance, empathy, and understanding. 4. Target outreach strategies and tailor programming for doctoral students. 5. Initiate suicide prevention activities by identifying and extending existing Harvard undergraduate and graduate practices to Harvard Chan. 2

HARVARD CHAN MENTAL HEALTH STUDENT ALLIANCE Mental Wellness of Students at Harvard Chan SPRING 2017 SURVEY Overview of Results & Recommendations Demographics Who completed the survey? Our survey was completely voluntary and anonymous; therefore the results represent the views of only the respondents and do not necessarily reflect the thoughts and feelings of all Harvard Chan students. Interpretation of all results must take this into account and we do not attempt to generalize beyond our sample. Male 15.5% Prefer not to answer 2.8% Asian 37.2% Other 5.3% Non-Hispanic White/Caucasian 42.6% Doctoral 47.6% Other 0.4% Gender Race Current Degree Program Female 81.7% Hispanic/Latino 6.9% Black 8% Masters 52% 3

Demographics Cont. Nativity Sexual Orientation US Students 65% 34.1% In US >=8 years 16.1% Intl. Students In US 0 1 year 26.3% Straight or heterosexual Lesbian, gay, or homosexual Bisexual Something else Don t know Prefer not to answer 82.1% 2.8% 7.5% 2.4% 0.8% 4.4% Intl. Students In US 4 7 years 28.8% In US 1 3 years 28.8% What is the current state of mental wellness? Felt any changes in mental wellness since being at Harvard Chan (n=286): 70.7% of respondents have felt changes in their mental wellness that they attribute to the coursework, culture, expectations, or other facets of this school. Sought mental health support since being at Harvard Chan (n=286): 37.5% of respondents reported having sought mental health support; significant differences by nativity (p=0.04; US students were more likely to seek support compared to international), race (p=0.03; black, Hispanic and other were more likely to seek support compared to non-hispanic white and Asians), gender (p=0.02; females and those preferring not to answer were more likely to seek support compared to males), sexual orientation (p=0.03; individuals identifying as bisexual, something else, or preferring not to answer were more likely to seek support than straight or lesbian, gay or homosexual identifying individuals) and program (p=0.008; doctoral students were more likely to seek support compared to masters). Depressive symptoms among respondents (n=268): Respondents reported frequency of common depressive symptoms they experienced over the past 2 weeks, mean score was 6.2 (standard deviation: 4.7) and range was 0-24. The most frequently reported symptoms were somatic; out of the past two weeks, 81.5% reported feeling tired, 72.6% reported feeling anxious, 69.3% experienced issues sleeping, 62.2% felt irritated, 57.8% felt loss of interest, and 56% felt depressed at least several of the days. Doctoral students had significantly higher total depressive symptoms compared to masters students (p<.0001), racial and ethnic minority students had significantly higher total depressive symptoms compared to non-hispanic white students (p=0.046), LGBTQ students had significantly higher total depressive symptoms compared to straight students (p=0.004), and depressive symptoms did not differ significantly by nativity or gender. 4

Campus Climate General experience surrounding mental wellness at school (n=265) Comfort with talking about mental wellness I feel comfortable talking about mental wellness with (faculty, administrators, other students) at school. Faculty 24.2% 24.2% reported feeling comfortable talking about mental wellness with faculty at school US students felt less comfortable compared to international students (p=0.001) Doctoral students felt less comfortable compared to master students (p=0.02) Administrators 29.4% 29.4% reported feeling comfortable talking about mental wellness with administrators at school Doctoral students felt less comfortable compared to master students (p=0.02) Other Students 64.9% 64.9% reported feeling comfortable talking about mental wellness with other students at school Males felt less comfortable compared to females (p=0.05) Accessing Mental Health Resources: Comfort, Knowledge and Barriers Feel Comfortable 54.7% 54.7% reported feeling comfortable seeking out mental health resources at school Have Knowledge of Resources 54.3% 54.3% reporting having knowledge of mental health resources at the school Feel Barriers are Present 37.4% 37.4% reported that barriers are present that prevent them from accessing mental health resources at school Graduate Programs Role in Mental Wellness Grad Program Responsibility 89.9% 89.9% agree that graduate programs have responsibility to promote positive mental wellness of students Harvard Chan s Role 79.7% 79.7% would like to see Harvard Chan do more about students mental wellness 5

QUALITATIVE RESPONSES What we learned from your comments: The statistical frequencies and averages suggest the regularity and distribution of certain sample population characteristics, but they have limited explanatory power. To better understand compositional dynamics (how and why trends exist) in the data, respondents were invited to share their attitudes and experiences qualitatively using open-ended response options on the following topics: 1. Current mental wellness resources they like and why; 2. Current resources they don t like and why; 3. Barriers to mental wellness; 4. Changes they would like to see implemented at Harvard Chan; and 5. Any additional comments they might have had. We conducted a thematic analysis to identify experiential patterns. Overall, students want shifts in institutional culture that are focused on core causes of mental stress, not quick fixes. Other insights: The learning environment is frequently experienced as unsupportive, stressful, restrictively competitive, disorganized, and prohibitive to health-seeking behavior. Respondents cited the workload and rigorous pace of their programs as direct barriers to seeking psychological support. Students lack of time was one of the most highly cited barriers to care. Poor funding and departmental/ program-specific disorganization are also major stressors for many respondents. Faculty and staff need to be trained to respond to students stress experiences with informed guidance, empathy, and understanding. Respondents described faculty as disconnected, unsupportive, and as having no empathy. HUHS (Harvard University Health Services) care is unreliable. For some students, HUHS provides acceptable care that they are glad exists, but the services can be difficult to access, inconveniently located, incongruent with student schedules, too short-term, and delivered with inconsistent quality. Students have immense difficulty both securing appointments and keeping them due to cancelled sessions. Many students with chronic conditions found HUHS care harmful and too medication-focused. Stigma about psychological stress is reinforced by the school environment and faculty, and is frequently experienced with feelings of depressed mood, anxiety, and isolation. This stigma leads many respondents to hide their feelings and not seek care out of shame, desire for anonymity or private care options, and fear that seeking help may interfere with their academic standing. Stigma-related barriers included feeling weak, selfish, and like a loser or failure. Harvard perpetuates a stigma that everyone is excellent. This generates feelings of anxiety and stress, especially for minority students. It is in my best interest not to seek help from the school. Existing mental health support services are misunderstood and not well promoted. Many students with Harvard insurance think HUHS services are expensive, don t know where they are located, and expressed a need for more resources on external providers. Students want a counselor at Chan and some want peer support groups. One respondent wrote: Even when I had spoken with my program administrators about experiencing challenges with meeting the program s demands, they did not think about referring me to Learning Support or other types of resources. 6

Resources Potential resources or actions to support and promote mental wellness (n=252) 60.7% 55.2% 50.0% 46.8% 37.7% Guide to how to access mental health resources within Harvard 60.7% identified this as Mental health counselor(s) at Harvard Chan 55.2% identified this as Training on student mental health support for faculty and staff 50.00% identified this as Suicide prevention activities 46.8% identified this as Guide to how to access mental health resources in greater Boston 37.7% identified this as Campus-wide recommendations: Based on the results presented above, MHSA has developed a series of recommendations: 1. Demonstrate an explicit institutional and actionable commitment to student mental wellness, including designating an Associate Dean to work with students on climate improvement recommendations. 2. Improve navigation of mental health resources within Harvard and the wider community, including for international students who are less likely to seek help. 3. Train faculty and staff to respond to students stress experiences with informed guidance, empathy, and understanding. 4. Target outreach strategies and tailor programming specifically for doctoral students. 5. Initiate suicide prevention activities by identifying and extending existing Harvard undergraduate and graduate practices to Harvard Chan. 7

Survey Response: There was different numbers of missing values depending on the question, therefore total respondents for each section are noted. Total enrollment data is based on https://www.hsph.harvard.edu/about/key-facts/enrollment-degrees/ information from 2016-2017. If you would like to learn more or have any questions or comments, contact MHSA at: hsph.mhsa@gmail.com https://www.hsph.harvard.edu/mental-health-so/ Statistical Note: All reported p-values are based on Chi-Square statistics or Fisher exact tests (when cell sizes are low) comparing proportions by groups. In some cases, we are likely underpowered to detect differences between subgroups. Qualitative Data: Given the qualitative interpretation of these data segments, the authors have biases and assumptions we would like to disclose: The authors are all graduate students with personal and professional interests in public mental health promotion, which influenced the questions we chose to include and those we left out. We would like to thank Karestan Koenen, PhD and David Williams, PhD, MPH for their scientific guidance, the Office of Students Affairs for their support, and Danielle Nishimi for the design of the current report. MHSA Leadership Board Ruijia Chen, Ayesha McAdams-Mahmoud, Supriya Misra, Kristen Nishimi, Emily Taylor 8