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“I Just Don’t Want People to Feel Broken and Misunderstood”

May 16/2023

DLSPH Students Lead Studies to Support Student Mental Health

By Heidi Singer

Two research teams at the Dalla Lana School of Public Health are studying student mental health in close partnership with the best experts on the subject – students themselves. Both teams received funding from a new University of Toronto initiative that supports research to improve student mental health.

There have been dozens of studies documenting the rise and fall of student mental health challenges at various points during the three years of the COVID-19 pandemic. But Profs. France Gagnon and Shaza Fadel, working with three master’s students, discovered that researchers know very little about why mental health levels have varied so greatly. Drawing on the students’ own lived experiences during the pandemic, the team began examining existing data in the context of tightening and loosening public health restrictions.

They believe this knowledge will strengthen post-pandemic recovery strategies and allow researchers to better advise on preparation for future health crises.

“The magnitude and nature of depression, anxiety, and stress related symptoms in the student population are currently unknown,” says Altea Kthupi, a co-principle investigator who recently graduated with a master’s degree in Social and Behavioural Health Sciences. “But we also want to identify and understand the factors associated with student improvement or deterioration. Who are the students improving despite the progression of the pandemic, who’s not improving – and what can be done to help them?

From left: Bill Liu, Altea Kthupi, Antonio Lorenzo

“Despite the resumption of most in-person school activities, now is not the time to neglect or abandon the resources made available to students at the onset of the pandemic. Rather, now is the time to continue supporting students’ mental health beyond the pandemic, identifying those who are most at risk despite the relaxation of public health measures and advising policymakers and administrators on how to refine current interventions to better meet students’ needs.”

Although it’s common enough for students to work with researchers, in this case students played an unusually large role in designing the research question, which received a grant from the Inlight Student Mental Health Research Initiative, says Gagnon, who is also DLSPH’s Associate Dean of Research.

“We had diverse voices, students from different academic and cultural backgrounds, and they led the proposal,” she says. “They became very engaged with it, and they remained involved even though they graduated and entered the work force. It was an inspiring experience.”

The three students began working with their professors early in the pandemic, when Gagnon and Fadel moved quickly to launch an ambitious study to understand the levels of COVID-19 infection among U of T students on campus. To help analyze the data, they recruited Kthupi, along with Bill Liu and Antonio Lorenzo, who were studying biostatistics and epidemiology, respectively.

Fifteen hundred students participated in that study and filled out questionnaires at several points during the pandemic. Kthupi noticed that mental health was the biggest challenge for the students who responded to a broad set of questions about their health and wellbeing. At the time, awareness of police abuse, racism and war were particularly intense; the pandemic was not always the most important reason students gave for their mental health challenges. And this was similar in studies from other countries.

“We saw in the literature high levels of depression and anxiety during the pandemic, but it was world events causing students to be stressed,” Kthupi notes.

The project gives all three students co-authorship on two studies that will be published:  an earlier one that focussed on data generated by U of T students were followed for the first year after the return of limited in-person activities on campus in 2020-21; and the current meta-analysis led by Kthupi, which looks specifically at mental health in studies of postsecondary students around the world.

Another DLSPH team partnering closely with students and other members of the DLSPH community also received an Inlight grant recently. This was to address gaps in data regarding the needs and experiences of 2SLGBTQ+ students experiencing mental health challenges at U of T.

Supervised by Prof. Daniel Grace, the team will work with students to co-create accessible mental health resources for diverse 2SLGBTQ+ students, along with recommendations to increase and improve existing services.

The project will complement current efforts on the part of the University to improve student mental health services to address needs that were identified even before the COVID-19 pandemic.

“We’re convening a group of students to build a 2SLGBTQ+ student advisory board that will help us better understand where there are unmet needs,” says Grace, director of DLSPH’s Centre for Sexual and Gender Minority Health Research. “We would like to help improve the experiences of 2SLGBTQ+ students across the University, including their use of existing mental health services. We need to address 2SLGBTQ+ mental health as an intersectional and structural issue and support students throughout their time at the University in and beyond their classroom experiences.”

For the team, it’s crucial to ask how intersecting axes of oppression such as racism, sexism, classism and ableism compound mental health issues. And they are examining what a student-informed approach to 2SLGBTQ+ mental health might look like.

“As a queer person who deals with mental health issues I’ve been through a lot in the system,” says researcher Sarah Smith, a PhD candidate at Queen’s University and Research Associate at the Centre. “I’ve had some terrible experiences and some life-changing, amazing ones. Nobody deserves the awful parts and everyone deserves the amazing ones.

“I want to make sure other people don’t go through the stuff I’ve had to go through,” she adds. “Everything from long wait times to very uncompassionate people; feeling unsafe; being misunderstood and overpathologized; encountering people who aren’t trauma informed —  who just see a person who’s broken and needs to be fixed. I just don’t want people to feel broken and misunderstood.”

Another member of the research team, Wren Gould, was drawn to the project because of research showing that post-pandemic, 2SLGBTQ+ people are experiencing greater mental health challenges than the population overall. As a social worker in the trans community, Gould came to realize they could contribute to the health of all trans people by studying public health. They are now pursing a PhD at DLSPH in transgender mental health.

“I’m really excited about this project because of how I think it can be used to support people who are in pain and suffering,” says Gould. “I feel privileged to be able to hear people’s stories and I feel mostly a sense of responsibility to use these stories to do the most good.”

The team is looking for a diverse set of student voices to help shape all aspects of the project, and is offering participants honarariums.  (Interested students can email the researchers to learn more.)

The two research groups share a passion for improving student mental health – and are committed to an approach that allows those most affected by the outcomes to drive the research questions.

“I was so interested in doing this work because I have lived experience with being a student during the pandemic,” says Kthupi. “I know what it’s like to experience school closures, social isolation. I moved to Toronto for my master’s degree hoping to make connections with other students, but through the duration I was online.

“It was hard to collaborate on projects. It was just a hard time for everybody,” she adds. “It continues to impact students beyond graduation, and you can’t help but think of what you missed —  those connections that shape your career. So this motivates me to see what can be done in the future if this ever happens again.”

Banner photo from left: Wren Gould, Sarah Smith