Award Date

5-1-2019

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Kinesiology and Nutrition Sciences

First Committee Member

Brach Poston

Second Committee Member

Carolyn Yucha

Third Committee Member

John Mercer

Fourth Committee Member

Anne Weisman

Fifth Committee Member

Jenifer Utz

Number of Pages

135

Abstract

Depression is a serious illness characterized by persistent low mood, reduced cognitive capacity, and fatigue. Although treatable, depression is the leading cause of disability and ill-health worldwide and a significant contributor to suicide, the second leading cause of death for young Americans. In any given two-week period, 8.1% of adults in the United States had moderate to severe depression (2013-2016). The rate of depression for females was twice that of males and compared to the majority, sexual and gender minorities (SGM) were at a threefold risk. Furthermore, evidence suggests that depression incidence is three times higher in college students than the adult U.S. population, and SGM students may suffer at a disproportionate rate. For all individuals, depressive symptoms can result in difficulty to function socially, at home, or work. College students also may also have low academic performance and difficulty persisting to graduation.

Depression has an inverse, bidirectional relationship with physical fitness and many students do not meet minimum recommended guidelines of physical activity. Low fitness and increased depression are also associated with obesity, a health burden that may disproportionately affect SGM female students. Despite the well-established relationships between fitness, weight status, and mental health, exercise-based depression interventions for college students are rarely investigated. Counseling is recommended as the primary non-pharmaceutical antidepressant treatment and is offered at most university mental health centers. On some campuses, however, increased service requests have overwhelmed institutional resources and many students remain unserved. To compound the issue, many college students, even those with major depression or suicide ideation, are reluctant to seek university counseling. Nonetheless, relatively little information exists regarding college student depression and fitness,

SGM health disparities, or student willingness to pursue alternative depression treatments. Therefore, this dissertation is comprised of three primary investigations entitled: (a) “Estimated Cardiorespiratory Fitness and Depression in College Students;” (b) “A Disaggregated Categorical Analysis of Gender Identity and Sexual Orientation in University Students: Depression, BMI, and Physical Activity;” and (c) “An Examination of College Student Depression, Diversity, Fitness, and Willingness to Seek Help Through Counseling and Alternative Options.”

At the end of the spring and fall semesters of 2018, a total of N = 780 students attending a large, diverse, southwestern university completed a web-based survey. The questionnaire collected demographic and student status information, anthropomorphic variables, the frequency, duration, and intensity of weekly physical exercise, and responses to questions from a validated depression instrument (Patient Health Questionnaire (PHQ-9)). Students were also asked if they were currently participating in counseling or taking medication for the treatment of depression. Willingness to seek depression counseling through university mental health services and alternative treatment options, such as exercise or meditation, were assessed with responses of “Yes,” “Maybe,” or “No.” When a student answered “No” to campus counseling, they were prompted to write-in a reason for their reluctance.

For the first investigation, the relationship between depression and fitness was assessed from the spring data collection (n = 437) using results from the PHQ-9 and a validated non-exercise estimation of cardiorespiratory fitness (eCRF), which is an indicator of the body’s ability to consume oxygen. Descriptive, regression, and odds ratio analyses evaluated PHQ-9 scores with eCRF, race, sexual orientation, and grade point average (GPA). Results indicated that low eCRF was associated with mild to severe (p < 0.01) and moderate to severe depression (p = 0.02). Predictors of increased PHQ-9 scores were sexual orientation (p < 0.01), current depression treatment (p < 0.01), Hispanic race (p < 0.01), and GPA (p < 0.01). Those with low fitness were 3.21 times more likely to report any level of depression (95% CI=1.79-5.78) and 2.39 times more likely to report moderate to severe depression (95% CI=1.17-4.87). Surprisingly, students in the high-fitness category did not report a significantly reduced depression risk compared to those with age-appropriate fitness levels. Results from this inquiry suggest that a simple eCRF algorithm could be used to help identify depression and inform potential interventions to help reduce its ill-effects effects in college students.

For the second study, PHQ-9 scores, depression-related functional difficulty, BMI, and an index of physical activity were analyzed by disaggregated categories of gender identification (female, male, and nonbinary) and sexual orientation (heterosexual female and male, bisexual female and male, lesbian female, gay male, and a self-identified group). Nonparametric analyses resulted in several findings. Males, and specifically heterosexual males, reported significantly less depression and perceived depression-related difficulty, as well as a higher BMI and more participation in exercise than other genders or orientations. Bisexual and lesbian females reported the highest PHQ-9 scores and functional difficulty. Many of these results are comparable to extant evidence. Bisexual and gay males in this study did not report significantly more depression than other groups. These findings were not consistent with that from previous investigations. This evidence is intended to contribute to the scholarship that supports the reduction of health disparities for those attending institutions of higher education.

For the final investigation, college student willingness to seek help for depression (N=780) was examined using chi-square and multinomial regression analyses. The primary finding determined that most students (77%) said “Yes” regarding willingness to seek alternative treatments for depression, such as exercise or meditation. Only 30% responded positively to seeking counseling through university mental health services. Preferences were not associated with race, ethnicity, or sexual orientation. Those with low fitness levels and students in-treatment for depression were more likely to say “Yes” to counseling. Males were more likely than females to answer “No” to alternative options. Younger students, those with low fitness, and depressed individuals were also more likely to say “No” to alternatives. Results from this examination can inform antidepressant programming on college campuses.

In summary, prominent findings from these three investigations include the overall rate of mild depression (28.3%) and moderate to severe depression (30.9%), meaning six of every ten college students reported some level of depression. Additionally, less than half of the participants met or exceeded their age-predicted level of eCRF. Evidence from this dissertation suggests that depression in college students is a mental and physical health concern that deserves an open-minded, interdisciplinary approach. Future research should focus on intervention strategies that are translatable, practical, and desirable for students pursuing higher education.

Keywords

Counseling; Diversity; Exercise; Mental health; University

Disciplines

Education | Kinesiology | Psychology

Language

English

Available for download on Friday, May 15, 2020


Share

COinS