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Objective: To investigate the association between psychological flexibility and physical violence perpetration among a large sample of college students. Participants: We analyzed data from the 2018-2019 national Healthy Minds Study, which included 21,850 undergraduate and graduate student participants at 78 U.S. campuses. Methods: We used multivariable logistic regression analysis to estimate the association between psychological flexibility, measured by the Acceptance and Action Questionnaire-II (AAQ), and a 12-month history of self-reported physical violence perpetration. Results: Mean scores on the AAQ were higher (p < 0.001) among participants who reported physical violence perpetration (25.6, SD 10.7) compared to those who did not (21.7, SD 9.9). Logistic regression results revealed that psychological inflexibility was associated with slightly higher odds of physical violence perpetration (AOR 1.03, 95% CI 1.02-1.04) while controlling for potential confounders. Conclusions: Campus violence prevention efforts should include programming aimed at increasing psychological flexibility as a means to reduce potential violence.

Objective: Despite the increasing prevalence of psychological distress in university and college students, little is known about their use of coping strategies. This study explored healthy and unhealthy coping strategies in this population. Participants: A representative sample of 509 students at a large public university in the US. Methods: This study analyzed survey data from a special version of the Healthy Minds Study. Results: The most frequently used healthy strategies were distraction, deep breathing, relaxation and social activity. The most frequently used unhealthy coping strategies were spending time alone and eating. Students who used more unhealthy coping and fewer healthy strategies were more likely to have clinical levels of depression and anxiety symptoms. Relatively few students with clinical symptoms used professional support as a coping strategy. Conclusions: The results suggest that population-level monitoring and coping interventions may be promising avenues to improve university student wellbeing.

Objective: The objective of this study was to identify university-sponsored activities associated with increased odds of menstrual disturbance among female college students. Participants: The sample included 3,277 female-identifying students at 12 colleges and universities participating in the Healthy Bodies Study during the 2013-2014 and 2014-2015 academic years. Methods: Crude and adjusted logistic regression models were run to report odds of any menstrual disturbance and amenorrhea (AMN) for participants in sports, dance, and Greek Life. Survey weights were used to account for response bias. Results: In the adjusted models, participation in varsity sport (OR = 1.82, CI 1.37, 2.37), dance (OR = 1.68, CI 1.37, 2.05) and Greek life (OR= 2.12, CI 0.13, 0.18) was significantly associated with increased odds of menstrual disturbance, compared to non-participants. Conclusions: Findings suggest additional need for prevention and intervention programming against menstrual disturbance in varsity sports, dance, and Greek life activities.

Objective: To assess the relationship between dietary self-monitoring and problematic alcohol use including binge drinking, increased body confidence while drinking, and restricting food intake to compensate for alcohol consumption, among college students. Participants: Undergraduate and graduate students from 12 US colleges participating in the Healthy Bodies Study in 2013-2014 and 2014-2015 school years (n = 10,133). Methods: Weighted prevalence was calculated for dietary self-monitoring and problematic alcohol use. Gender-stratified logistic regressions were used to assess relationships. Results: Knowing nutrition facts was associated with restricting to compensate for alcohol consumption among women (OR = 2.42, p < 0.0001) and men (OR = 1.64, p = 0.002). Among women, knowing and counting calories predicted all problematic alcohol use behaviors. Among men, knowing calories was associated with restricting to compensate (OR = 2.69, p < 0.0001) and counting calories was associated with restricting to compensate (OR = 5.10, p < 0.0001) and increased body confidence while drinking (OR = 2.25, p < 0.0001). Conclusions: Dietary self-monitoring predicts problematic alcohol use among college students, particularly women.

U.S. college students are a distinct population facing major challenges due to the COVID-19 pandemic. Before the pandemic, students were already experiencing substantial mental health concerns, putting both their health and academic success in jeopardy. College students now face increasing housing and food insecurity, financial hardships, a lack of social connectedness and sense of belonging, uncertainty about the future, and access issues that impede their academic performance and well-being. There is also reason to believe that COVID-19 is exacerbating inequalities for students of color and low-income students. We provide several recommendations for institutions of higher education to mitigate these obstacles, including engaging in data-driven decision making, delivering clear and informative messaging to students, prioritizing and expanding student support services, and using an equity framework to guide all processes.

Objective: To compare the effect of sexual orientation, history of sexual assault and sense of belonging on depression and suicidality among lesbian, gay, bisexual, queer and questioning (LGBQ) and heterosexual students. Participants: A total of 60,194 students from 60 US campuses who participated in the 2017-2018 Healthy Minds Study. Methods: Three-way interaction effects were analyzed using PROCESS macro models in SPSS. Results: Significant three-way interaction effects were found for sexual orientation, sexual assault and sense of belonging predicting depressive symptoms (b = -0.06, p= 0.042, CI: -0.12 to -0.00), and suicidality (b = -0.10, p= 0.004, CI: -0.01 to -0.003). The effect of sexual assault on mental health differed depending on sexual orientation and sense of belonging. Particularly among LGBQ students, high sense of belonging was protective in the presence of sexual assault, and its absence had a deleterious effect on mental health. Conclusion: Enhancing sense of belonging may represent a strategy to mitigate depression and promote suicide prevention, particularly among LGBQ students.

Background: College is a critical life stage for alcohol-related harms to others (AHTOs), gender, and sexual identity. We tested associations between inclusively-defined gender and sexual identities (separately) and AHTOs among college students. Methods: The Healthy Minds Study (n = 8,308) provided data about three AHTOs: (1) babysitting a drunk student, (2) alcohol-related unwanted sexual advance, and (3) alcohol-related sexual assault. Independent variables included gender and sexual identity. Results: One in four students (25.5%) reported babysitting, 6.2% reported unwanted advances, and 1.2% reported sexual assaults. Compared to cisgender males, cisgender females had higher odds of reporting babysitting (aOR = 1.36, p < 0.001) and unwanted advances (aOR = 2.59, p < 0.001); trans masculine students had higher odds of reporting sexual assaults (aOR = 4.49, p = 0.04). Conclusions: AHTOs are prevalent on college campuses, and cisgender female and trans masculine students have higher odds of experiencing them. Alcohol interventions may protect cisgender female and gender minority students from the drinkers around them. [ABSTRACT FROM AUTHOR]

Objective: This study examined joint trends over time in associations between substance use (heavy drinking, cannabis, and cigarette smoking) and mental health concerns (depression, anxiety, and suicidal ideation) among US post-secondary students. Participants: Data came from 323,896 students participating in the Healthy Minds Study from 2009 to 2019, a national cross-sectional survey of US post-secondary students. Weighted two-level logistic regression models with a time by substance interaction term were used to predict mental health status. Results: Use of each substance was associated with a greater odds of students endorsing depression, anxiety, and suicidal ideation. Over time, the association with mental health concerns strengthened substantially for cannabis, modestly for heavy drinking, and remained stable for smoking. Conclusion: Given co-occurrence is common and increasing among post-secondary students, college and university health systems should prioritize early identification, psychoeducation, harm-reduction, and brief interventions to support students at risk. [ABSTRACT FROM AUTHOR]

Objective: This study examined symptoms of anxiety, depression and suicidality in a national sample of college students. Participants: Using national survey data from the Healthy Minds Study (HMS), a random sample from 184 U.S. campuses from fall 2016 to spring 2019 was analyzed (N = 119,875). Methods: Prevalence rates were examined with the Generalized Anxiety Disorder 7-Item scale, Patient Health Questionnaire-9 and suicidality questions. Relationships between anxiety, depression and suicidality were assessed through Spearman's correlations, the Kruskal-Wallis H test and logistic regressions. Results: Findings revealed that screening only for depression would pick up 23% of suicidal ideation, increasing to 35% when also screening for anxiety. Those with anxiety and no to minimal depression had the second highest likelihood of suicide attempt, following those with anxiety and depression. The symptom "feeling afraid something awful might happen" doubled the odds of suicidal ideation. Conclusions: College campuses may benefit from assessing particular anxiety symptoms in relation to suicide. [ABSTRACT FROM AUTHOR]

Introduction: There are documented inequities in eating disorders (EDs) by gender and race/ethnicity, yet, little is known about population‐level prevalence of ED risk factors, symptoms, and diagnosis at the intersection of diverse gender and racial/ethnic identities. Methods: Data from the Healthy Minds Study 2015–2019 (N = 251,310 U.S. university students) were used in a multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Participants were nested in 35 intersectional strata given by all combinations of 5 gender and 7 racial/ethnic categories. Multilevel logistic models with participants at level 1 and intersectional strata at level 2 were used to estimate stratum‐specific predicted prevalence estimates for self‐reported thin‐ideal internalization, ED symptoms, and ED diagnosis. The variance partition coefficient (VPC) was calculated to quantify the contextual effect of the strata. Results: There was considerable heterogeneity in the predicted prevalence of our ED outcomes across the strata (e.g.,.3%–18.3% for ED diagnoses). There were large disparities in all three outcomes, with transgender participants of color having a higher predicted prevalence than expected based on the additive effects of gender and race/ethnicity. Moderation by race/ethnicity was also apparent, such that racial/ethnic disparities were wider within the cisgender groups relative to the transgender groups. VPCs indicated that ~10% of the total variance in ED outcomes was due to intersectionality between gender and race/ethnicity, over and above variance due to individual‐level differences. Conclusion: Findings suggest that gender and racial/ethnic disparities in EDs are interrelated, underscoring the need to develop preventive interventions centering health equity. Public significance: Despite evidence that sexism, racism, and cissexism (i.e., anti‐transgender prejudice) can impact EDs risk, little research examines the social patterning of EDs at the intersection of diverse gender and racial/ethnic identities. Using data from a sample of 250,000 U.S. university students, this study found that gender and racial/ethnic disparities in eating disorder risk are interrelated, highlighting the need to develop health equity centered preventive interventions. [ABSTRACT FROM AUTHOR]

Objective: Early COVID‐19 eating disorders (EDs) research used regionally restricted samples with little sociodemographic diversity. The present study aimed to address these research gaps by examining whether pandemic‐related changes in ED symptoms and mental healthcare prevalence differed for historically marginalized groups within a national sample of US college students. Method: Participants included 242,906 US college students (Mage = 23.45, SD = 7.04; MBMI = 25.28, SD = 5.91) who completed the repeated cross‐sectional multi‐institute Healthy Minds Study between January 2019 and May 2021. Moderated logistic regressions examined whether pandemic‐related changes in individuals' likelihoods of exhibiting current probable ED, reporting lifetime ED diagnoses, and—among individuals with current probable ED—mental healthcare engagement differed for diverse gender, sexual, and racial/ethnic identity groups, and by body mass index (BMI) and financial stress. Results: There were increases of 5% and 12% in individuals' likelihoods of exhibiting current probable ED and symptomatic individuals' mental healthcare engagement, respectively, pre‐ to post‐COVID‐19 onset, but no pandemic‐related changes in lifetime ED diagnosis prevalence. There were also important variations in these time‐trends for different marginalized groups. For example, individuals identifying as genderqueer/gender nonconforming and lesbian exhibited increasing ED symptoms pre‐ to post‐COVID‐19 onset, and individuals with current probable ED and higher BMIs were increasingly likely to receive mental healthcare. Associations between financial stress, and the ED and mental healthcare outcomes did not change over time. Discussion: These findings provide insight into groups of US college students that experienced disproportionate ED burden during the pandemic at the population level, and directions for research and interventions that warrant consideration. [ABSTRACT FROM AUTHOR]

Evidence consistently indicates associations between eating disorders (EDs) and childhood emotional, physical, and sexual abuse, but the relationship between EDs and abuse occurring later in development has largely been unexplored. Therefore, the objective of this study was to examine associations between past-year abuse and ED symptoms among college students. Participants represented 12 U.S. colleges and universities participating in the Healthy Bodies Study (HBS) between 2013 and 2015 (N = 10,204; M age = 23.38 years). Students self-reported experiences of emotional, physical, and sexual abuse over the past year. Cognitive ED symptoms (i.e., dietary restraint, shape/weight overvaluation, body dissatisfaction) were measured via the Short-Eating Disorder Examination-Questionnaire (S-EDE-Q), and behavioral ED symptoms (i.e., binge eating, purging) were measured via items from the full EDE-Q. Regression models that adjusted for demographics and weight status were conducted to examine associations between past-year abuse and ED symptoms. Past-year emotional, physical, and sexual abuse each exhibited independent associations with ED symptoms. When mutually adjusting for emotional, physical, and sexual abuse, past-year emotional abuse was associated with higher levels of dietary restraint (b = 0.20, p =.02), shape/weight overvaluation (b = 0.85, p <.001), body dissatisfaction (b = 0.63, p <.001), binge eating (prevalence ratio [PR] = 1.23, p =.002), and purging (PR = 1.68, p <.001), and past-year sexual abuse was associated with shape/weight overvaluation (b = 0.35, p =.03) and purging (PR = 1.71, p =.009) but no other ED symptoms. No associations were observed for past-year physical abuse in mutually adjusted models. In summary, past-year emotional abuse emerged as a key correlate of all ED symptoms examined in this sample of U.S. college students, while past-year sexual abuse also emerged as a key correlate of shape/weight overvaluation and purging. Findings emphasize the need to screen for abuse and implement abuse prevention efforts on college campuses. [ABSTRACT FROM AUTHOR]

Sexual assault victimization and eating disorder rates are high among college populations and have significant psychological, physiological, and social outcomes. Previous research has found a positive relationship between experiences of sexual assault and eating disorder symptoms; however, these analyses have primarily focused on female students. Using data from the 2017-2018 Healthy Minds Study, the aim of this study was to investigate the relationship between experiencing a sexual assault within the previous 12 months and screening positive for an eating disorder among cisgender college-enrolled men. It was hypothesized that college-enrolled men who report experiencing a sexual assault within the previous 12 months would be more likely to screen positive for an eating disorder. Analyses were conducted using a sample of 14,964 cisgender college-enrolled men. Among the sample, nearly 4% reported a sexual assault within the previous 12 months and nearly 16% screened positive for an eating disorder. Results from logistic regression analyses indicated that college-enrolled men who reported experiencing a sexual assault in the previous 12 months, compared to those who did not, had significantly greater odds of screening positive for an eating disorder (OR = 1.40, p <.01). Analyses also indicated that college-enrolled men who identified as gay, queer, questioning, or other sexual orientation and reported experiencing a sexual assault in the previous 12 months had greater odds of screening positive for an eating disorder (OR = 2.50, p <.001) compared to their heterosexual peers who did not experience a sexual assault in the previous 12 months. These results indicate that eating disorders may be a negative outcome among college-enrolled men who have experienced a sexual assault, particularly among sexual minority men. Thus, mental health professionals need to be adequately prepared to treat the underserved population of men who experience an eating disorder and who have experienced sexual assault. [ABSTRACT FROM AUTHOR]