Journal of College Student Psychotherapy

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Journal of College Student Psychotherapy

ISSN: 8756-8225 (Print) 1540-4730 (Online) Journal homepage: https://www.tandfonline.com/loi/wcsp20

Psychotropic Medication and Academic Success:

Supportive Evidence

Alan M. Schwitzer, Dan St. John, Catherine Moss, Dana Burnett, Jennifer Foss

& Lenora Thompson

To cite this article: Alan M. Schwitzer, Dan St. John, Catherine Moss, Dana Burnett, Jennifer Foss & Lenora Thompson (2019): Psychotropic Medication and Academic Success: Supportive Evidence, Journal of College Student Psychotherapy, DOI: 10.1080/87568225.2019.1607644 To link to this article: https://doi.org/10.1080/87568225.2019.1607644

Published online: 29 Apr 2019.

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Psychotropic Medication and Academic Success: Supportive Evidence

Alan M. Schwitzer^a, Dan St. John^b, Catherine Moss^c, Dana Burnett^d, Jennifer Foss^e, and Lenora Thompson^f

aDepartment of Counseling and Human Services, Old Dominion University, Norfolk, VA, USA;^bDirector of Academic Development, Eastern Virginia Medical School, Norfolk, VA, USA;^cStudent Assistance Center, Old Dominion University, Norfolk, VA, USA;^dDepartment of Educational Foundations and Leadership, Old Dominion University, Norfolk, VA, USA;^eStudent Health Center, Old Dominion University, Norfolk, VA, USA;^fStudent Counseling Center, Old Dominion University, Norfolk, VA, USA

ABSTRACT

This brief study reports on health center visits for psychotropic medication prescriptions and academic success. We analyzed records for students with mental health needs from 2000 to 2008. Building on previous research, we found two significant variables predicting post-treatment 6-year graduation among health center mental-health clients: returning for services beyond intake and utilization of psychiatric medication.

Students who returned beyond their first health center contact graduated with better rates than intake-only students, and mediation utilization appeared especially beneficial. Although these results require tightly controlled replication, our findings support a beneficial role for psychotropic medication in pro- moting some students’academic success.

KEYWORDS Academic success;

counseling outcome;

evidence-based practice;

health centers; psychotropic medication

The high prevalence of mental health concerns and high steady demand for counseling and psychotherapeutic services among contemporary college students have been well documented (Fink,2014; Gallagher,2013). In fact, when Rudd (2004) compared college trends with young-adult trends in off-campus settings, he concluded that on-campus psychological services essentially have become community mental health clinics in a specialized institutional context. In this context, counseling centers and their partner health centers are often viewed as specialized offices that support their institutions’ academic missions by addressing issues that affect their constituents’ “academic success and personal development”(Dungy, 2003; pp. 339–357). From this perspec- tive, counseling (and health) centers are expected to produce student outcomes that benefit their institution’s efforts at creating successful learners and graduates (Boyd et al., 2003; Lee, Olson, Locke, Michelson, & Odes, 2009; Schwitzer & Van Brunt, 2015). In practice, more than 10% of today’s students utilize college counseling centers (Gallagher, 2013), while an

CONTACTAlan Schwitzer aschwitz@odu.edu Department of Counseling and Human Services, Old Dominion University, Norfolk, VA 23529, USA

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estimated 25% of health center patients may present symptoms of a diagnosable mental disorder (Alschuler, Hoodin, & Byrd, 2009) – and many of these would be unable or unlikely to remain, or success, in college without support (Gallagher,2013; Rudd, 2004).

Mental health concerns “directly affect a student’s ability to perform in school,”with almost 15% of the students in one study reporting depression, anxiety, and other mental health needs as “causes of academic difficulty”

(Alschuler et al., 2009, p. 177). Likewise, the positive effects of college psychotherapy for addressing such mental health needs have been well established (Minami et al.,2009). However, clear evidence about the connection between mental health outcomes and positive effects on academics has been more elusive. Along these lines, only very recently, actual evidential research supporting the effects of counseling experiences on academic outcomes has begun to slowly accumulate in order to fill this longstanding gap in the college psychotherapy literature. For example, Lee et al. (2009) reported that students receiving counseling services had better academic performance and retention than their peers without counseling. Bishop (2016) similarly reported positive academic benefits of counseling while also suggesting that such outcomes may partially depend on students’ risk levels. More specifically, Schwitzer et al.

(2018) found that clients with moderate risk and those who remained in counseling through termination as recommended by their counselors were most likely to see increases in grade point average (GPA).

On the other hand, almost no extant research has examined the efficacy of psychotropic medications on college student academic outcomes. As Grayson and Meilman (2014) described, understanding psychotropic medication applications on campuses “is not a marginal concern” (p. 171). Seventy- one percent of campuses have psychotropic prescription arrangements in their counseling center, health center, or both (Grayson & Meilman, 2014).

In fact, according to one national survey of counseling center directors, 24%

of the clients were taking psychiatric medications (Gallagher,2013), and the use of such medications in counseling and health centers is on the rise (Hammonds et al., 2015). In spite of these trends, prescribing practices and their effects are not very well understood (Alschuler et al.,2009; Grayson &

Meilman, 2014; Kirsch, Doerfler, & Truong, 2015). Improving our understanding is critical to today’s practice since, as Grayson and Meilman noted,

“ultimately it is…counseling center administrators who oversee all aspects of clients’mental health care” (p. 172).

In response to this research need, in the current brief study, we focused specifically on students who visited our institution’s health center for psychological concerns. Nationally, some campuses prescribe medications out of the counseling center, some from both the health and counseling center, and others only out of the health center (Grayson & Meilman, 2014). At our institution, students who receive medication prescriptions are those who visit

2 A. M. SCHWITZER ET AL.

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the health center only or the health and counseling centers conjointly. To guide our research questions, we used our findings from our recent counseling center outcome research, which suggested that the extent of support beyond the intake has an influence on the academic benefits of a client’s counseling experiences Schwitzer et al. (2018). In turn, we asked a combination of two straightforward research questions corresponding to health center services and treatment received: First, was the student’s number of professional contacts (number of sessions; number of newly initiated courses of treatment over the student’s college career) associated with academic outcomes (GPA, graduation)? Second, regarding treatment received, were comparisons of (a) intake-only versus intake-plus-additional-sessions and (b) medication management versus no medication management, pre- dictive of post-treatment academic outcomes?

Method

This study was part of a larger research program examining evidence-based college counseling outcomes. For the overall research program, we collected retrospective archival student data for students utilizing the counseling and health centers at a large metropolitan university during the years 2000–2008.

We obtained client data from actual counseling and health center records and academic data from institutional sources. We utilized older client records from 2000 to 2008 because these data were fully available, and we were able to form an intact dataset from them. We utilized data from the widest range of years for which we could access the records to create the largest dataset available to us. This design allowed us to investigate data from actual client records rather than student self-reports. A natural limitation was the data were historic and any newer trends in very recent client records were not investigated in this study.

Participants

The larger dataset supporting the overall research program comprised students utilizing the health center only, health center and counseling center conjointly, and counseling center only. For context, 2029 students utilized the counseling center only. Schwitzer et al. (2018) discussed this client population in great detail. In the current study, we were interested in the students utilizing the health center (only or conjointly). A total of 450 students utilized the health center only. The majority of this group (N = 313) were female (67%) and 31% (N = 14) were male. Regarding age, 45.7%

were 21 years or younger, 33.4% were 21–25 years, and 20.9% were 25 years or older. Institutional data pertaining to ethnicity and academic status were unavailable for the health center-only participants. A total of 71 students

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utilized both the health center and counseling center. Demographic charac- teristics of these clients are as follows: The majority of this group (N = 51) were female (71.8%) and 28.2% (N= 20) were male. Regarding age, 31% were 21 years or younger, 45.1% were 21– 25 years, and 23.8% were 25 years or older. With respect to ethnicity, 59.6% were White, 16.9% were African American, 1.4% (N = 1) were Asian-American, 2.8% were Latina/o, 2.8%

were self-described as Multiracial or other ethnicity, and 1.4% (N = 1) were international students. Regarding academic status, 8.5% were first-year students (0–26 academic credits), 19.7% were sophomores (27–58 credits), 28.2% were juniors (59– 90 credits), 29.6% were seniors (23.9%), and 14.1% were graduate students.

Representativeness

Because this study relied on data from a single institution, we were concerned about demographic representativeness of the sample. Using binary gender constructs, the proportion of females and males in the research sample was comparable to national counseling center utilization trends (Reetz, Barr, & Krylowicz,2013). In comparison with the national data, our sample reflected a greater proportion of African American and a somewhat smaller proportion of White students (Reetz et al.,2013). However, regarding race, our research sample closely reflected the demographic composition of the campus on which the study took place. According to the campus’

assessment office data, 22% of the student population self-identified as African American (N= 1925) and 59% as White (N= 5165).

We also were concerned about the representativeness of the health center sample on the basis of severity of presenting counseling concerns. In turn, as a preliminary step pertaining to the location of services, we asked whether a student’s selection of services (health center, counseling center, and conjoint health and counseling center) would predict the severity of the concerns leading to their help-seeking (Maximum, High, Medium, and Mild). UsingDSM-IV-TR diagnostic classification, student concerns were organized in four categories:

Maximum Severity (e.g., Schizophrenic and Other Psychotic Disorders, Mental Disorders Due to Medical Conditions): High Severity (e.g., ADHD; Major Depressive, Bipolar, Anxiety, Eating Disorders); Medium Severity (e.g., Learning Disorders; Moderate Depressive, Anxiety, Eating, Substance-Related, Personality Disorders); and Mild Severity (Other Conditions). A multivariate analysis of covariance (MANCOVA) with location of services as an independent variable and pre-treatment GPA as a covariate revealed no significant effects on severity of presenting diagnosis [F (4, 848) + .36, p = .84; Partial η² =.00;

Observed Power (using α = .05) = .13]. We concluded the sub-sample was representative of mental health help-seekers in general on our campus.

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Variables

For the first research question pertaining to extent of health center services, the independent variableswere: (a) total number of health center visits for the specified mental health concern and (b) number of newly initiated health center contacts (operationalized as the number of times the student sought out a new course of treatment over their college years). Academic outcomes were post-treatment GPA and graduation within 6 years (pre-treatment GPA was a co-variate). For the second research question pertaining to the nature of health center treatment, theindependent variableswere: (a) intake-only versus intake-plus-treatment service conditions and (b) utilization of medication versus no medication utilization.

Here, academic outcome was graduation within 6 years.

Results

For the first research question, pertaining to extent of health center services, we asked whether a student’s total number of health center visits and the total number of new health center contact (new courses of treatment over the college years) for the specified mental health concern would predict post-treatment academic outcomes. A two-way MANCOVA with number of visits, and number of new courses of treatment, as the independent variables and pre-treatment GPA as a covariate revealed no significant effects on post-treatment GPA [F(69, 53) = .77,p= .78; Partialη²= .31; Observed Power = .57] or graduation within 6 years [F(69, 53) = 1.36.,p= 1.6; Partialη²= .45; Observed Power = .88].

For the second research question, pertaining to nature of health center treatment, we asked whether returning for professional contacts beyond the initial intake, and whether utilization of medication when prescribed, would predict a post-treatment academic outcome, graduation within 6 years. A logistic regression revealed that the model of compliance with treatment (intake-only versus intake-plus-treatment service conditions) and utilization of medication management predicted graduation within 6 years.Table 1presents the logistic regression analysis including Wald statistics, Nagelkerke’sR², Hosmer and Lemeshow goodness-of-fit test results, and confidence intervals.

Table 1.Health center treatment compliance, medication management compliance, and six-year graduation: Logistical regression analyses.

95% CI

β SE Wald df p Odds Lower Upper

Treatment compliance (N= 525) −0.64 0.32 4.06 1 .04 0.526 −1.31 −0.01 Medication management (N= 525) 0.66 0.33 4.08 1 .04 1.940 0.05 1.33

Constant 0.16 0.12 1.62 1 .20 1.170 −0.90 0.41

Note. SE = beta standard error; CI = confidence interval (bootstrapped);p< .05; Cox & Snell R²= .02, NagelkerkeR²= .02; Hosmer & Lemeshow Goodness of Fit Text =X²= 5.53,p= .011, df = 2; For treatment compliance,N= 415 returned, 110 declined; For Medication Management,N= 423 received medication, 102 did not receive medication.

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Discussion

We recently reported findings that, among students visiting counseling services, those who remained in counseling as recommended experienced gains in GPA and that more sessions were associated with greater academic gains (Schwitzer et al. 2018)). However, the reality is that students with mental health distress choose services from a variety of alternatives, including counseling services, health centers, and other campus supports.

Correspondingly, to our knowledge, this brief study was among the very few to examine the effects of psychotropic medication utilization as well as health center visits on the academic outcomes of students with mental health needs. Looking at the extent of services, we first asked whether having more individual contacts with health center professionals, and whether returning more often over the college years when needed, might predict better academic outcomes. This seemed to be an important question because of our findings regarding counseling center use (Schwitzer et al.2018)–and earlier evidence that more counseling center contacts, and more separate visits over time, predicted at-risk students’ academic gains (Schwitzer, Grogan, Kaddoura, & Ochoa,1993).

Interestingly, in the current study, we found no significant effects on post- treatment academics on the basis of the extent and frequency of services.

However, when we turned to the nature of health center treatment, two sugges- tive patterns emerged. Here, looking at the health center treatment, first we asked whether a student's continued supportive health center contact beyond the initial intake meeting was associated with graduation. Second we asked whether a student's compliance with medication management, when indicated, was associated with graduation. These seemed to be important questions because the ability to facilitate a student’s return for counseling-related services beyond the first meeting (the engagement quotient) historically has been linked with outcomes (Schwitzer et al.,1993) and, as we have stated, because psychopharmacology in college health and mental health requires attention (Grayson &

Meilman,2014; Kirsch et al.,2015).

According to our logistic regression results, the combined model of continuing health center contacts beyond the intake, plus the use of medication management, successfully predicted graduation within 6 years. The overall accuracy of the weighted averages for 6-year graduation was 55.8% and effect sizes for the model were small. This indicates that although certainly there were additional factors associated with graduation besides the health center variables we examined, returning for treatment and use of medication both were among the significant predictors of 6-year degree completion (54% of intake-plus-treatment students graduated in 6 years compared with 48% of intake-only students; 60% of medication management patients graduated compared with 54% if non-medication-management patients). Further,

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collinearity diagnostics were run for these analyses and showed no evidence of multicollinearity – indicating the two variables were not overly highly correlated. Odds ratios for returning-for-services (.53) and medication management (1.94) suggest that utilization of medication was an especially valu- able contributor to graduation outcomes, where students following medication regimes may be 1.94 times more likely to graduate.

Taken together, our findings offer evidence that among students with mental health concerns who seek health center services, those who return for supportive contacts beyond their initial intake, and follow-through with psychotropic medication when prescribed, may see positive effects on academic success.

Most clearly, consistent with recent suggestions in the literature (Hammonds et al.,2015; Kirsch et al.,2015), our findings provide supportive evidence for the use of psychotropic medication. Our findings also are consistent with previous studies showing the critical importance that facilitating college students’accu- rate help-seeking for mental health concerns when needed and then facilitating their return following the initial session have on counseling outcomes.

These findings suggest several implications for practice. First, given the negative academic implications faced by psychologically at-risk students (Bishop, 2016; Schwitzer et al., 2018), this study once again underscores the need to target this campus population. In turn, counseling centers should continue their longstanding consultation and outreach efforts with student affairs partners such as disability services, ombudspersons, and related services to encourage psychologically at-risk students to disclose their needs and to seek support–and because such students do not always distinguish readily among counseling centers, health centers, and other supports, health educators, disability staff, and others should increase the same type of targeted outreach, guided by the growing evidence that psychological support from the counseling or health center can mitigate academic pitfalls. Next, because our evidence suggests that academic benefits are accrued by students who persevere with medication and other services, counseling staff and health practitioners should work together specifically on the implementation of motivational interviewing techniques, positive psychology tactics, and other high-engagement strategies during counseling center intakes and initial health center appointments. This seems critical since college students are especially likely to terminate care prematurely, due to perceived negative social norms (Vogel, Wester, & Larson, 2007) or the developmental barrier of associating counseling and medication with personal inadequacy (Wilson & Deane,2012). Finally, following Grayson &

Meilman’s (2014) recommendations, we encourage counseling center directors to take the lead in working in coordination with health center administrators to amplify mutual programs and coordination of care with the specific aim of capitalizing on the evidence-based benefits students experience from continuing in psychotherapy at counseling centers through termination, maintaining their

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supportive visits at health centers beyond the first meeting, and following psychotropic medication regimens when prescribed.

This was a brief study with limitations. Although the study examined efficacy, it did not examine the broader “complicated questions” about professional-practice standards for psychotropic medication that Grayson and Meilman asked the college psychotherapy field to consider (2014, p. 172). These are especially salient since, for example on our campus, health center contacts provide support but not psychotherapy and medications are prescribed by physicians but not psychiatrists. Effects of the statistically significant findings were modest and therefore additional variables require exploration for a more complete model. Tightly designed replication studies next are needed. Overall, our findings add to the accumulation of support for the beneficial contributions to student academic success that clinical staff can make when they successfully engage students during their initial meeting and provide new support for academic benefits when psychotropic medication is appropriately used. In sum, our brief study advances the critically needed conversation about the role of medication in college mental health that contemporary practice requires (Grayson & Meilman, 2014).

Disclosure statement

No potential conflict of interest was reported by the authors.

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