A World Without Depression

UCLA is attempting to end the disease entirely, starting with students on its campus.

April 3, 2018
 
UCLA chancellor Gene Block in 2015, announcing free mental health screenings for students

The University of California, Los Angeles, envisions a world where depression has been eliminated.

It sounds like an improbable goal, a moon shot. But that’s the “grand challenge” model -- tackling one of the planet’s greatest crises. And UCLA is starting with its own students.

At least 19 institutions, including UCLA, Carnegie Mellon University and Indiana University, have taken up grand challenges. The Bill & Melinda Gates Foundation introduced the concept in 2003 under a different name and scope.

These projects, which generally are funded by industries and foundations, tend to start small and gradually grow with larger cash investments. UCLA largely paid for the depression project out of traditional operating dollars while also seeking out donors. The university also is looking to partner with companies that have an interest in ending depression.

UCLA estimates this is a $500 million endeavor, said Nelson B. Freimer, director of both UCLA’s depression grand challenge and its Center for Neurobehavioral Genetics -- but the university doesn't know yet where most of the money will come from.

The largest piece of the effort so far is a study of at least 100,000 people over a decade. The study is an attempt to understand the genetic and environmental factors that play into depression, Freimer said, and the prospective subjects of the study would be drawn from those who used the university’s health system for some reason, such as having a baby or being treated for an illness.

“The idea was recruiting these people and studying and understanding depression in a way that was really different from what had been done before,” Freimer said. “The causes of depression, genetic and environmental; the trajectory of depression, because it’s not something that happens in one episode -- it’s usually different episodes across their lifetime.”

But first, the university wanted to help reduce depression among its students, who wouldn't be part of the 100,000-person study.

In September UCLA invited its incoming class, both first-year students and transfers, to free mental health screenings. Should students be identified as having symptoms of depression or anxiety, the university would offer to set up treatment options.

Students with mild depression would be offered an online program, Freimer said. Those with a more severe form would be linked to the university’s counseling system. The university has screened about 3,500 students thus far, with 600 or so being diagnosed with less severe symptoms and about 100 being identified as having more acute ones. Students can be monitored continually, he said, so they can enter or leaving counseling if their symptoms lessen or become worse.

The student population is among the most ideal to study for depression-related issues because the effects of the disease are more readily apparent in a campus setting, Freimer said. Common symptoms of depression and anxiety are exhaustion and a lack of productivity, which are not as easily measured in a workplace environment, he said.

Students with the most severe forms of depression have been routed to the university’s counseling system, which Freimer described as “state-of-the-art.” At many universities, however, these counseling centers are overburdened. More students nationwide are relying on the campus centers, which often have flat or declining staffing levels.

Lisa Adams, president of the American College Counseling Association and the director of counseling and accessibility at the University of West Georgia, said UCLA’s model may work for large, urban campuses. But that approach is less applicable for counseling centers at rural colleges.

She said the influx of students may be mitigated slightly in California, a state that expanded eligibility thresholds for Medicaid after the passage of the Affordable Care Act, and a location that has lots of options for public transportation so students can reach other outside resources if they are referred away from campus.

“Many campuses in the U.S. are in rural areas, where none of those things are available, so the increase in traffic from doing free screenings for everyone would increase the burden on already burdened counseling centers,” Adams said.

In the first week back from spring break at her institution, Adams said, 36 students walked into the center and sought immediate treatment.

The solution isn’t to ignore or not identify the students in need, Freimer said, but to find options outside traditional face-to-face counseling. He said “there’s no system” that can meet current needs.

He pointed to an online counseling program for students and said the answer likely lies in a digital realm. UCLA is working to tweak an existing mobile application that students with milder forms of depression could use. Freimer said UCLA has set up a consortium to improve the app and plans to conduct full-scale testing later this year.

“This is something we decided to go all in on at UCLA,” he said.

Adams said she was optimistic about the university's direction.

“I believe that after working with college students for nearly 20 years that engaging this generation online is probably a great way to go about it,” she said. “Our students are online constantly, and it is their first step for solving any problem they have.”

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