Depression and Anxiety are the most common causes of academic failure and social dysfunction in college students that remain underdiagnosed. With the use of a brief 4-question screener, these problems can easily be detected, says a new report from Ball State University.

The Psychometric Properties of PHQ-4 Depression and Anxiety Screening Scale Among College Students, assessed 934 college students and their psychosocial characteristics. Almost 10% students reported having depression and 20% reported having anxiety diagnosed by a healthcare professional within the past year.

"There are thousands of college students and young adults across the nation silently suffering from depression and anxiety," said Jagdish Khubchandani, a community health education professor at Ball State. "Among the many reasons for underdiagnoses of depression and anxiety in college students, a prominent reason is the lack of reliable, efficient, and time saving way to screen for these mental health issues", he added. To address the problem, Khubchandani and colleagues developed a brief survey to diagnose anxiety and depression and tested the survey properties. The students were given a 4-item survey to predict depression (2 questions) or anxiety (2 questions). The study, the first of its type, was published in the Archives of Psychiatric Nursing.

According to various estimates, 15-25% American college students and young adults have diagnosable and treatable mental health issues. Among the mental health issues, depression and anxiety are the most common problems, frequently occur together, and start at an earlier age than other mental health issues. Depression is among the leading causes of disability in persons 15 years or older. It accounts for $30-50 billion in lost productivity and direct medical costs annually in the U.S. "Unfortunately, majority of the youth do not get timely treatment for mental health issues due to lack of diagnosis and even if they get treatment, it is inadequate or not disorder specific". Khubchandani mentioned.

The study also found:

  • Depression can be diagnosed with 2 questions with 78% sensitivity and accuracy (i.e. 78% youth with depression can be caught with the scale).
  • Anxiety can be diagnosed with 2 questions with 84% sensitivity and accuracy.
(i.e. 84% youth with anxiety can be caught with the scale).
  • The 4 questions (2 on depression and 2 on anxiety) can help diagnose depression (79% sensitivity and accuracy) and anxiety (85% sensitivity and accuracy).
  • Reliability analysis indicated that the 2 depression questions are 77% reliable and the 2 anxiety questions are 82% reliable over time. Overall, the 4 questions have a reliability of 81% in diagnosing anxiety and depression.

While the data show that the demand for college counseling services has increased nationwide, a lot has to be done to reach out to the tens of thousands of students who suffer from anxiety and depression and lack a regular source of care and treatment. "A major problem is diagnosis and screening. The existing tools for diagnosis of depression and anxiety are elaborate and time consuming which prevents their use on population basis" Khubchandani said.

Khubchandani pointed out that underdiagnosed or undiagnosed students have a greater risk of engaging in risk behaviors, social dysfunction, and academic failure. "Our 4-item survey is a valid, reliable, and efficient way to diagnose students with depression and anxiety. Timely detection can help adequate treatment and prevent future risk of health and social problems," he said. "Our study is very timely as the US Department of Health and Human Services has released a national recommendation in February 2016 recommending routine screening for depression in adolescents and young adults. However, healthcare professionals have often cited lack of effective screening tools as a reason for avoiding routine screening for depression and anxiety in youth. Our brief 4 question screening tool could certainly help fill that gap."

"Future research should focus on the various ways through which college campuses can use our four-item survey to detect anxiety and depression in their student population," Khubchandani said. "A wide spread implementation of our survey to detect anxiety and depression would require campus partnerships across various divisions of universities nationwide such as academic affairs, health education centers, clinics and counseling centers. Faculty and students can certainly play a central role in increasing awareness and assisting those who need help."