Response to college students’ mental health needs: a rapid review

Gaiotto, Emiliana Maria Grando; Trapé, Carla Andrea; Campos, Celia Maria Sivalli; Fujimori, Elizabeth; Carrer, Fernanda Campos de Almeida; Nichiata, Lucia Yassuko Izumi; Cordeiro, Luciana; Bortoli, Maritsa Carla de; Yonekura, Tatiana; Toma, Tereza Setsuko; Soares, Cassia Baldini

doi:10.11606/s1518-8787.2021055003363

Emiliana Maria Grando Gaiotto

Universidade de São Paulo. Escola de Enfermagem. Departamento de Enfermagem em Saúde Coletiva. São Paulo, SP, Brasil

https://orcid.org/0000-0002-1673-7395

Carla Andrea Trapé

Universidade de São Paulo. Escola de Enfermagem. Departamento de Enfermagem em Saúde Coletiva. São Paulo, SP, Brasil

https://orcid.org/0000-0002-3272-6565

Celia Maria Sivalli Campos

Universidade de São Paulo. Escola de Enfermagem. Departamento de Enfermagem em Saúde Coletiva. São Paulo, SP, Brasil

https://orcid.org/0000-0002-1149-9025

Elizabeth Fujimori

Universidade de São Paulo. Escola de Enfermagem. Departamento de Enfermagem em Saúde Coletiva. São Paulo, SP, Brasil

https://orcid.org/0000-0002-7991-0503

Fernanda Campos de Almeida Carrer

Universidade de São Paulo. Faculdade de Odontologia. Departamento de Odontologia Social. São Paulo, SP, Brasil

https://orcid.org/0000-0003-3745-2759

Lucia Yassuko Izumi Nichiata

Universidade de São Paulo. Escola de Enfermagem. Departamento de Enfermagem em Saúde Coletiva. São Paulo, SP, Brasil

https://orcid.org/0000-0001-6515-4404

Luciana Cordeiro

Universidade Federal de Pelotas, Faculdade de Medicina. Curso de Terapia Ocupacional. Pelotas, RS, Brasil

https://orcid.org/0000-0003-2912-1087

Maritsa Carla de Bortoli

Secretaria de Estado da Saúde. Instituto de Saúde. São Paulo, SP, Brasil

https://orcid.org/0000-0001-8236-7233

Tatiana Yonekura

Hospital do Coração. Laboratório de Implementação do Conhecimento em Saúde. São Paulo, SP, Brasil

https://orcid.org/0000-0001-8271-6691

Tereza Setsuko Toma

Secretaria de Estado da Saúde. Instituto de Saúde. São Paulo, SP, Brasil

https://orcid.org/0000-0001-9531-9951

Cassia Baldini Soares

Universidade de São Paulo. Escola de Enfermagem. Departamento de Enfermagem em Saúde Coletiva. São Paulo, SP, Brasil

https://orcid.org/0000-0002-8457-3775

Correspondence: Carla Andrea Trapé. Av. Dr. Enéas Carvalho de Aguiar, 419. 05403-000 Cerqueira César, São Paulo, SP. E-mail: carlaens@usp.br

Authors’ Contribution: Study design and planning: EMGG, CBS, CMSC, LYIN, LC. Data collection, analysis and interpretation: EMGG, CAT, CMSC, EF, FCA, LYIN, LC, MCB, TY, TST, CBS. Manuscript preparation or revision: EMGG, CAT, CMSC, EF, FCA, LYIN, LC, MCB, TY, TST, CBS. Final version approval: CAT, CMSC, CBS, EF, EMGG, LC. Public responsibility for article content: EMGG, CAT, CMSC, EF, FCA, LYIN, LC, MCB, TY, TST, CBS.

Conflict of Interest: The authors declare no conflict of interest.

(((((((((((“Students, Medical”[Mesh] OR Medical Students OR Student, Medical OR Medical Student)) OR (“Students, Public Health”[Mesh] OR Health Student, Public OR Health Students, Public OR Public Health Student OR Student, Public Health OR Public Health Students)) OR (“Students, Nursing”[Mesh] OR Pupil Nurses OR Student, Nursing OR Nurses, Pupil OR Nurse, Pupil OR Pupil Nurse OR Nursing Student OR Nursing Students)) OR (((“Nutritionists”[Mesh] OR Nutritionist OR Dieticians OR Dietician OR Dietitians OR Dietitian)) AND (“Students”[Mesh] OR Student OR School Enrollment OR Enrollment, School OR Enrollments, School OR School Enrollments))) OR (((“Physical Therapists”[Mesh] OR Physical Therapist OR Therapist, Physical OR Therapists, Physical OR Physiotherapists OR Physiotherapist)) AND (“Students”[Mesh] OR Student OR School Enrollment OR Enrollment, School OR Enrollments, School OR School Enrollments))) OR (((“Occupational Therapists”[Mesh] OR Occupational Therapist OR Therapist, Occupational OR Therapists, Occupational)) AND (“Students”[Mesh] OR Student OR School Enrollment OR Enrollment, School OR Enrollments, School OR School Enrollments))) OR ((speech therapist) AND (“Students”[Mesh] OR Student OR School Enrollment OR Enrollment, School OR Enrollments, School OR School Enrollments)))) AND (((((“Universities”[Mesh] OR university)) OR (“Hospitals, University”[Mesh] OR university hospitals)) OR (“Academic Medical Centers”[Mesh] OR medical center, university OR university medical center OR medical centers, university OR university medical centers OR center, university medical OR center, academic medical OR centers, academic medical OR medical center, academic OR medical centers, academic OR centers, university medical OR academic medical center))) AND (((((((((((((“Mental Health”[Mesh] OR health, mental OR mental hygiene OR hygiene, mental)) OR (“Anxiety”[Mesh] OR hypervigilance OR nervousness OR social anxiety OR anxieties, social OR anxiety, social OR social anxieties)) OR (“Performance Anxiety”[Mesh] OR anxieties, performance OR anxiety, performance OR performance anxieties)) OR (“Anxiety Disorders”[Mesh] OR anxiety disorder OR disorder, anxiety OR disorders, anxiety OR neuroses, anxiety OR anxiety neuroses OR anxiety states, neurotic OR anxiety state, neurotic OR neurotic anxiety states OR neurotic anxiety states OR state, neurotic anxiety OR states, neurotic anxiety)) OR (“Phobia, Social”[Mesh] OR phobias, social OR social phobia OR social phobias OR social anxiety disorder OR anxiety disorder, social OR anxiety disorders, social OR disorder, social anxiety OR disorders, social anxiety OR social anxiety disorders)) OR (“Depression”[Mesh] OR depressions OR depressive symptoms OR depressive symptom OR symptom, depressive OR symptoms, depressive OR emotional depression OR depression, emotional OR depressions, emotional OR emotional depressions)) OR (“Depressive Disorder”[Mesh] OR depressive disorders OR disorder, depressive OR disorders, depressive OR neurosis, depressive OR depressive neuroses OR depressive neurosis OR neuroses, depressive OR depression, endogenous OR depressions, endogenous OR endogenous depression OR endogenous depressions OR depressive syndrome OR depressive syndromes OR syndrome, depressive OR syndromes, depressive OR depression, neurotic OR depressions, neurotic OR neurotic depression OR neurotic depressions OR melancholia OR melancholia OR unipolar depression OR depression, unipolar OR depressions, unipolar OR unipolar depressions)) OR (“Adjustment Disorders”[Mesh] OR reactive disorders OR disorder, reactive OR disorders, reactive OR reactive disorder OR adjustment disorder OR disorder, adjustment OR disorders, adjustment OR depression, reactive OR depressions, reactive OR reactive depression OR reactive depressions OR anniversary reaction OR anniversary reactions OR reaction, anniversary OR reactions, anniversary OR transient situational disturbance OR disturbance, transient situational OR disturbances, transient situational OR situational disturbance, transient OR situational disturbances, transient OR transient situational disturbances))) OR ((“Substance-Related Disorders”[Mesh] OR drug abuse OR abuse, drug OR drug dependence OR dependence, drug OR drug addiction OR addiction, drug OR substance use disorders OR disorder, substance use OR substance use disorder OR drug use disorders OR disorder, drug use OR drug use disorder OR organic mental disorders, substance-induced OR organic mental disorders, substance induced OR substance abuse OR abuse, substance OR abuses, substance OR substance abuse OR substance dependence OR dependence, substance OR substance addiction OR addiction, substance OR prescription drug abuse OR abuse, prescription drug OR drug abuse, prescription OR drug habituation OR habituation, drug))) OR ((((((“Stress, Psychological”[Mesh] OR psychological stress OR psychological stresses OR stresses, psychological OR life stress OR life stresses OR stress, life OR stresses, life OR stress, psychologic OR psychologic stress OR stressor, psychological OR psychological stressor OR psychological stressors OR stressors, psychological OR mental suffering OR suffering, mental OR suffering OR sufferings)) OR (“Occupational Stress”[Mesh] OR occupational stresses OR stress, occupational OR stresses, occupational OR job stress OR job stresses OR stress, job OR stresses, job OR work-related stress OR stress, work-related OR stresses, work-related OR work related stress OR work-related stresses OR workplace stress OR stress, workplace OR stresses, workplace OR workplace stresses OR workplace stress OR stress, workplace OR stresses, work place OR work place stresses OR professional stress OR professional stresses OR stress, professional OR stresses, professional OR job-related stress OR job related stress OR job-related stresses OR stress, job-related OR stresses, job-related)) OR (“Burnout, Psychological”[Mesh] OR psychological burnout OR burn-out syndrome OR burn out syndrome OR burnout OR burnout syndrome OR burn-out OR burn out OR psychological burn-out OR burn-out, psychological OR psychological burn out OR burnout, student OR school burnout OR student burnout OR burnout, school OR burnout, caregiver OR caregiver burnout OR caregiver exhaustion OR exhaustion, caregiver)) OR (“Burnout, Professional”[Mesh] OR professional burnout OR occupational burnout OR burnout, occupational OR career burnout OR burnout, career)) OR (“Workload”[Mesh] OR workloads OR work load OR work loads OR employee workload OR employee workloads OR workload, employee OR workloads, employee OR employee work load OR employee work load OR work load, employee OR work loads, employee OR staff workload OR staff workloads OR workload, staff OR workloads, staff OR staff work load OR staff work load OR work load, staff OR work loads, staff))) OR ((((“Suicide”[Mesh] OR suicides)) OR (“Suicide, Attempted”[Mesh] OR attempted suicide OR parasuicide OR parasuicides)) OR (“Suicide, Completed”[Mesh] OR completed suicides OR suicides, completed OR completed suicide)))))) AND (“Systematic Review” [Publication Type] OR Review, Systematic)

Author (year)	Focus of systematic review	Number of studies included	Countries of included studies	AMSTAR article quality	Option
Amanvermez et al. (2020)⁶¹	Stress management programs.	54	Germany, Australia, Canada, Korea, Scotland and USA	7/11 moderate	2
Bakker et al. (2020)⁴⁵	Interventions aimed at improving the mental health of students or novice nurses to prevent course and nursing work dropout.	21	Not reported	6/11 moderate	1
Bamber, Morpeth (2019)⁵¹	Effect of Mindfulness Meditation on Anxiety of College Students.	25	Australia, China, Korea, Spain, USA, UK and Thailand	7/11 moderate	2
Bolinski et al. (2020)⁶⁷	Effectiveness of e-mental health interventions on academic performance of university students.	6	Australia, USA and UK	7/11 moderate	2
Chen et al. (2019)⁵⁴	Effectiveness of non-pharmacological interventions in improving depressive symptoms and depression in nursing students.	13	Australia, China, Korea, USA, Iran, Thailand	8/11 high	2
Conley et al. (2017)⁶²	Effectiveness of prevention programs designed for higher education students at risk for subsequent mental health difficulties.	60	Not reported	8/11 high	2
Conley et al. (2016)⁷⁰	Technological interventions in mental health, aimed at higher education students without any mental health problem (universal prevention) or with mild to moderate subclinical problems (indicated prevention).	48	Australia, Canada, USA, Italy, Norway, Netherlands, UK and Romania	5/11 moderate	2
Conley, Durlak, Kirsch (2015)⁵⁹	Skills training programs with supervised practice.	90	Belgium, Canada, Korea, Spain, USA, England, Japan, UK, Thailand and Turkey	7/11 moderate	2
Dawson et al. (2020)⁵⁵	Effects of mindfulness-based interventions in a general population of college students.	51	Germany, Australia Canada, China, Singapore, Korea, Spain, USA, Netherlands, Japan, Malaysia, Norway, UK, Sweden and Thailand	9/11 high	2
El-Den et al. (2020)⁴⁷	Evaluation of first aid training in mental health among college students.	12	Australia, USA and UK	3/11 low	1
Fernandez et al. (2016)³²	Evaluation of structural and organizational strategies for promoting mental health in universities.	19	Not reported	6/11 moderate	1
Fu et al. (2020)⁵⁸	Qualitative synthesis and effectiveness of psychological interventions in Chinese universities.	93	China	8/11 high	2
Ghilardi et al. (2017)⁶⁰	Effectiveness of psychological interventions/individual or group counseling that meet the needs of university students.	16	Italy	5/11 moderate	2
González-Valero et al. (2019)⁵⁶	Effect produced by cognitive-behavioral programs and meditation strategies on stress, anxiety and depression in university students.	34	Saudi Arabia, Australia, Belgium, China, South Korea, Spain, USA, Wales, England, Japan and Malaysia	7/11 moderate	2
Gulliver et al. (2015)⁶⁸	Effectiveness of technology-based interventions for the use of tobacco and other drugs (except alcohol) in the university environment.	12	Germany, Canada, USA and Netherlands	8/11 high	2
Harrer et al. (2019)⁷¹	Effectiveness of virtual interventions for the mental health of university students.	48	Germany, Australia, Canada, Spain, USA, Finland, Ireland, Norway, UK, Romania and Sweden	8/11 high	2
Harrod et al. (2014)³¹	Primary suicide prevention interventions targeting college students and other post-high school courses to determine their effect on suicide and suicide-related outcomes.	8	Australia and USA	10/11 high	1 and 3
Heim et al. (2019)³⁷	Interventions and methods applied to reduce mental health-related stigma among medical and nursing students.	9	Brazil, China, Malaysia, Nigeria, Somaliland and Turkey	7/11 moderate	1
Huang et al. (2018)⁵²	Interventions for common mental health problems among college students.	51	Not reported	9/11 high	2
Johnson, Kalkbrenner (2017)⁷²	Effect of the use of mHealth technology by university students to provide information related to well-being, identify what type of information is provided and students’ responsiveness.	13	USA and UK	4/11 moderate	3
Khadjesari et al. (2011)⁶⁹	Effects of virtual interventions aimed at reducing alcohol consumption in adult populations.	24	Germany, USA, Netherlands, New Zealand and UK	5/11 moderate	2
Labrague et al. (2017)⁴¹	Identification of stress level and assessment of coping methods used by nursing students during the training course.	13	Australia, China, USA, Ghana, India, Iran, Ireland, Japan, Jordan and Taiwan	5/11 moderate	1
Leckey (2011)³⁸	Effectiveness of creative activities on mental well-being in the context of mental health.	11	Not reported	4/11 moderate	1
Li et al. (2018)⁵⁷	Effectiveness of interventions aimed at improving the mental health of nursing students.	12	Australia, China Korea, USA, UK, Sweden and Taiwan	8/11 high	2
Livingston et al. (2012)³⁴	Evaluation of interventions aimed at reducing stigma related to substance use disorders.	13	Australia, Canada USA and UK	9/11 high	1
Mansfield et al. (2018)³⁹	Effectiveness of participation in sport and dance on subjective well-being among healthy young people aged 15 to 24 years.	11	Not reported	9/11 high	1
Giralt-Palou, Prat-Vigué, Tort-Nasarre (2019)³⁵	Nursing students’ perceptions of stigmatizing attitudes towards people who suffer from a mental health problem.	13	Not reported	6/11 moderate	1
Regehr, Glancy, Pitts (2013)⁵⁰	Effectiveness of interventions aimed at reducing stress in college students.	32	Scotland, USA, Iran, Jordan, Switzerland and Tasmania	7/11 moderate	2
Reid, Carey (2015)⁶⁴	Interventions with behavior change mechanisms, focusing on alcohol, for university students.	47	USA and others	6/11 moderate	2
Samson, Tanner- Smith (2015)⁶⁶	Effectiveness of single-session interventions on alcohol consumption for college students.	73	Australia, Scandinavia, USA, New Zealand, UK and others	6/11 moderate	2
Shiralkar et al. (2013)⁴²	How stress management programs were incorporated into the medical education curriculum for medical students and their impact on psychological distress.	13	Not reported	6/11 moderate	1
Winzer et al. (2018)⁵³	Sustainability of the effects of interventions on the mental health of higher education students.	26	Australia, China, Scotland, Spain, USA, Hong Kong, Jordan and UK	9/11 high	2
Witt et al. (2019)⁴⁶	Universal interventions for all students designed to address mental health problems, suicidal ideation, and behavior among medical students.	39	Germany, Saudi Arabia, Australia, Brazil, Canada, USA, India, Malaysia, Mexico, Norway, New Zealand and the United Kingdom	7/11 moderate	1 and 2
Yamaguchi et al. (2013)³⁶	Reduction of stigma related to mental health problems.	35	Germany, Australia, USA, Japan, New Zealand, UK, Russia, Taiwan and Turkey	7/11 moderate	1

Author/Year	Study design	Study countries	Study focus	Study quality	Option
Dietz et al. (2020)⁶³	Umbrella review	Germany, China, USA, Italy, Portugal, Poland and UK	Interventions to promote modifiable factors that influence the health of university students.	10/10 high	2
Maito et al. (2019)⁴⁹	Case study	Brazil	Proposal of institutional forms and normative-dogmatic parameters for fighting violence, emphasizing the legal responsibility of higher education institutions.	8/10 high	1 and 3
Meredith et al. (2020)⁴⁰	Scope review	USA, Japan and Sweden	Definition of a time measure of activities in nature that cause positive impacts on the mental health and well-being of university students.	8/10 high	1
Okanlawon (2021)⁴⁸	Narrative review	Nigeria	Overview of homophobic and heterosexist experiences and challenges that LGBT students face in Nigerian schools and universities, such as rejection, bullying and victimization.	12/9 high	1
Reavley, Jorm (2010)⁶⁵	Narrative review	Not reported	Prevention and early intervention in mental health problems (anxiety, depression and alcohol abuse among higher education students).	11/12 high	2
Tamboly, Gauvin (2013)³³	Evidence synthesis	Canada	Mental health needs of McMaster University students and coping options.	19/21 high	1,3 and 4
Cordeiro et al. (2016)⁴³	Experience report	Brazil	Subject program of “Psychoactive Drugs: Education and Harm Reduction”, as well as the projects proposed by students.	7/7 high	1
Bleicher (2018)²⁹	Experience report	Brazil	Mental health actions developed at the Federal University of São Carlos and its project to align with the perspective of psychosocial care.	7/7 high	1, 2 and 4
Metivier (2020)³⁰	Opinion article	USA	Components of reforms needed for anti-racist university education.	6/6 high	1
Leonello et al. (2018)⁷⁴	Experience report	Brazil	Pedagogical follow-up activity and support to students, carried out by the Coordinating Committee of the Bachelor’s Degree in Nursing at the USP School of Nursing.	6/7 high	4
Cromlish (2020)⁴⁴	Opinion article	USA and Finland	Comparison of US and Finnish universities in relation to mental health in higher education.	6/6 high	1 and 4

Options for policies	Key message
Option 1: Establish and support a policy to strengthen student mental health in the health area, capable of sensitizing and responding to the identification of mental health needs.	1. Organize a mental health committee within the courses in the health area, with the objective of discussing the main problems that affect students and supporting them in deciding on the best way to face the challenges they are facing; 2. Develop activities to reduce the stigma related to mental health, as well as to promote cultural improvement, well-being and sociability, which can contribute to a change in mentality and strengthen students in the search for improvement in mental health; 3. Propose curricular changes in courses in the health area of the University in order to provide critical elements for students to understand the relationship between mental health and society, detect problems, seek help and support colleagues who are experiencing situations of psychic suffering; 4. Integrate programs and activities to combat racism and prejudice against LGBTI, quota students, and other forms of discrimination against students, as well as programs and activities to support student retention.
Option 2: Integrate and expand the provision of mental health care programs and provide access to them for health students.	5. Formally integrate mental health care services available at the university through a collaborative network of health services offered on and off campus, integrated with SUS services, developing a flow of comprehensive care for university students; 6. Expand health promotion activities and non-pharmacological interventions in mental health services offered by the university; 7. Adopt an assessment program, using virtual technologies, as an application to assess the mental health of university students for referral to appropriate health services.
Option 3: Promote educational programs and communication strategies for students in the health area, regarding psychic suffering in contemporary times and ways of coping, to ensure that students know about services and resources, identify welcoming practices and can access them.	8. Promote communication and make available, in an accessible way, information from all health services and support groups for students focused on mental health, through a cell phone application and links on the university’s official websites; 9. Encourage discussions about current youth problems and stimulate critical debate about racism, prejudice and all forms of discrimination that affect students’ mental health.
Option 4: Continuously monitor and assess the mental health needs of students in health courses.	10. Implement a mental health monitoring program in courses in the health area, for the planning and implementation of actions; 11. Create a support network from a mentoring program to monitor students.

Response to college students’ mental health needs: a rapid review

ABSTRACT