UHS Study Reveals Catholics Don't, 'Dissatisfied' Persons Do Seek Psychiatrists

(The following is from an address being this week at the American college Health Association's annual meeting in Washington, D.C., by Stanley H. King, director of research at UHS. The slides are not included.)

MANY COLLEGE students will use the services of a psychiatrist or psychologist during their undergraduate years, where such services are adequate and readily available. Delineation of the characteristics of students who are likely to seek psychological help can be useful to psychiatric and counseling services in planning for optimum care, both in terms of prevention and treatment. This paper-presents data on students who sought psychiatric help in college and compares them with students who did not receive such help.

The names of all students in the two panel survey samples who visited the Psychiatric Service of the University Health Services at any time during their undergraduate years were noted. The chief of the Psychiatric Service categorized each patient as to the type of disorder and listed the number of visits made to the Psychiatric Clinic. One question in the Final Questionnaire given in the senior year asked for information about psychiatric or counseling help from sources other than the University Health Services. The independent variables for this study thus consist of students who had psychiatric help from the University Health Services and from other sources. For comparison there are those students in the random samples who did not receive any psychiatric help. Slide I presents the distribution of these variables. The two classes are not different; approximately 20 percent of each sample received some kind of psychiatric help before graduation. The size of the sample and its randomness make it possible to generalize this percentage to the entire class as a reasonable approximation of the true rate.

Students who received psychiatric help were then compared with their classmates who received no help on a series of dependent variables. Data for these variables were gathered before or during the freshman year. We wished to determine what factors might be early indicators of the necessity for psychiatric help in terms of social demographic variables, personality characteristics, or various kinds of behavior. A practical matter was also involved. Over the four years there was a certain amount of attrition from the Study, either through leaving Harvard or through unwillingness to participate further in the research. The most complete data, therefore, exist for the freshman year.

A.S. Sophomores Seek No Help

Extent of participation in the Study is shown in Slide 2. For most of the variables to be considered in this paper, data are available on at least 90 per cent of the sample. The material in Slide 2 also brings out an interesting bit of information. Among the students who entered Harvard with advanced standing, that is, as sophomores, not a single one received psychiatric help during the three or four years of college.

The dependent variables have been organized for presentation here into three major groups: background characteristics, present behavior, and scores on personality tests.

Slide 3 lists a number of background characteristics, the majority of which did not differentiate between the group receiving psychiatric help and the controls. Among the variables that did discriminate between the groups, only three could be confirmed by testing on the Class of 1965. These were religious preference of the student, the number of close friends, and the student's evaluation of his past health.

Roman Catholics were the least likely to come for help, while those who stated their preference for a religious affiliation other than the common groups, or who stated they had no preference were most likely to come for help.

On the matter of close friends, the tendency was for students who stated they had none to be more likely to get help, while those who had many friends were less likely to come for help. The association was not as strong the second year but reached a statistically significant level when all categories above three friends were combined.

The third variable, evaluation of past health, showed that students who rated their past health as only fair or good were more likely to come for psychiatric help than those who rated it as excellent.

Among the factors which showed a statistically significant relationship for the Class of 1964 but could not be supported in the following year, mention might be made of the direction of the association. For political preference, students coming for psychiatric help were more likely to list none, independent, or other instead of the standard Republican or Democrat. In answer to the question, how frequently did you date last year, psychiatric patients were more inclined to indicate none or rarely. Students were also asked whether or not their parents were living together, and if not, with whom did the student live. Nine per cent of the Class of 1964 and 12 per cent of the Class of 1965 reported that their parents were not living together. In the first class a higher proportion of the psychiatric patients reported their parents were not living together than the control group, but this was not confirmed in the second class.

Even though data on satisfaction with secondary school are available on only one sample, that for the Class of 1965, the findings are given in slide 7. Dissatisfaction with secondary school was associated with the seeking of psychiatric help. There is good reason to suspect that the association in this table is not due to the one in a hundred chance probability, because satisfaction with the freshman year will prove important in the next section.

In summary, the majority of background factors showed no significant relationship with seeking psychiatric help, whether these factors were education, ethnic membership, region of the country, or intelligence and previous academic performance of the student.

Present Behavior

The number of significant differences in this area is once again not large. Those that are significant bring out further the relationship of religion to the independent variables, as well as the relationship of health behavior.

Students who report that they never go to church tend to be somewhat over-represented in the psychiatric help group, while those who attend regularly are underrepresented. Bear in mind once again that the reported church attendance is relative to the freshman year, while psychiatric ehlp pertains to all four years, Furthermore, if the student attends the same church each time he worships, he is less likely to come for hlep.

In a questionnaire on opinions, students were asked about religious belief by checking one of a series of statements ranging from belief in a personal God to atheism. The question was identical with one that was used in the Cornell Values Survey. Students were separated into those who believed in God (the first two statements) and those who did not (all the rest of the statements). For the Class of 1964 there was a significant association between belief and use of the Psychiatric Service. Nonbelievers were overrepresented in the psychiatric population. The association did not hold up, however, when tested on the 1965 sample.

Not only was the psychiatric patient more likely to report that his past health was less than excellent, he also used the medical and surgical clinics more frequently during college. Another health-related variable comes from a question on the medical form filled out by the student at the time of his freshman physical examination. "Do you have any problems that you would like to discuss with any doctor?" About a sixth of the students answered yes and among this group a rather high proportion eventually sought psychiatric help. Apparently at time of matriculation some students could articulate their need for help and many of them eventually sought professional aid.

Dissatisfaction With Harvard

The third major variable in present behavior is dissatisfaction with the college situation. We note a steady increase in the proportion using the Psychiatric Service as the level of dissatisfaction with the freshman year rises. The statistical significance of this relationship for both samples makes us more willing to accept the results of the 1965 sample concerning dissatisfaction with the last year of secondary school.

Suggestive correlations with the use of psychiatric help were also observed in two other questions: "Have you ever felt out of place at Harvard?" and "What kind of a time are you having at Harvard?" Both questions have an element of the satisfaction-dissatisfaction continuum in them. For the 1964 sample only, students who admitted they had felt out of place, or who said they were not having a very good time at Harvard were overrepresented in the psychiatric group. Although the association could not be replicated, the data do tend to strengthen our findings about the dissatisfaction variable.

To recapitulate, three factors emerge in this section which are associated with use of the Psychiatric Service: religious affiliation and attendance, use of medical facilities, and a sense of dissatisfaction with the environment.

Personality Test Results

Among the numerous personality tests that comprised the battery used for the Haravrd Student Study, there are a series of differences, many of them interconnected.

The group seeking psychiatric help was lower on the F-scale, a test designed to measure the extent to which the subject accepts authoritarian positions in various areas. Students in the psychiatric group were lower on a measure of social desirability, that is they were less likely to endorse statements about values in a conventional and confirming manner. They were lower on a scale which measures the need to be different. For example, they were more inclined to say dislike rather than like to such statements as "Going along with a decision made by a supervisor or leader rather than starting an argument," or "Listening to older persons about how they did things when they were young." The psychiatric group was higher on a scale which measures the need for emotional expressiveness. For example, they were more inclined to say like rather than dislike to such statements as "Letting loose and having a good cry sometimes," or "Being unrestrained and open about my feelings and emotions." Finally, the psychiatric group was higher on a test called Impulse Expression, which measures the willingness and need to be free in bringing out impulses in behavior. This test is very much like the scale for emotional expressiveness.

The interpretation that might be drawn from these results is that students who used the Psychiatric Service were less willing to be conformists in social situations, less willing to be deferent in their relationships with others, and felt a stronger pressure to give vent to their impulse in overt behavior.

Further support for these themes, although less definite, comes from test results that were significant on only one of the two samples. The psychiatric group was lower on a test of traditional value orientation, which means they were less inclined to emphasize the work success ethic, future time orientation, individualism, and puritan morality. They were also lower on the Self-Deception Scale, a test which is really a measure of conformity. At the same time, those seeking psychiatric help were higher on a scale which measure of conformity. At the same time, those seeking psychiatric help were higher on a scale which measures the need to be aggressive and on a scale which measures the need for self-display and attention seeking.

The Myers Briggs Test provides data which can be interpreted as measures of cognitive style, particularly of the kind of perceptual process by which a person interprets sense impressions. The psychiatric group was more inclined to use that perceptive process which depends less on direct perception through the ordinary senses and more on the unconscious meanings attached to direct sense impressions. To put it another way, the students who sought psychiatric help were more intuitive and introspective.

Three other scales from the Myers Briggs Type Indicator add another dimension. The psychiatric group was higher on the scale for unconscious strain, or what might be interpreted as a sense of vulnerability, but lower on the scale for constructive reaction, or what we might think of as a feeling of competence in or capacity for coping. They are also lower on the scale for self-confidence, although the differences reached an acceptable rate of probability for the 1964 sample only. The 1965 sample difference was in the same direction, however.

Other test data that describe self-evaluation and self-activity are worth noting, although they depend on significant differences in only the 1964 sample. The psychiatric group was lower on the Self-Acceptance Scale and higher on the Anxiety Scale. There was also an interesting difference on the Expected Control Scale of the FIRO. This test is designed to measure factors in interpersonal relationships or interpersonal needs. Expected control assesses the extent to which the individual anticipates he can and will exert control over others. To that extent, a low score represents some feeling of a lack of effectiveness in dealing with others.

This study confirms the findings from studies in other colleges that there is a negative association between religious preference and church attendance and the use of psychiatric services. Studies by Davie at Yale, Boyce and Barnes at the University of Western Ontario, and Scheff at the University of Wisconsin showed that students were more likely to seek psychiatric help if they were unaffiliated or were in the "other" category. In our study, Roman Catholic students were less likely than other groups to use the Psychiatric Service. Also, regular church attendance, as reported at the University of Wisconsin and Harvard, is associated with less frequent use of the psychiatric facilities.

These findings can lead to a number of hypothese about the role that religion plays in the handling of personal problems. (1) Religious students who have problems are more likely to turn to members of the clergy for help rather than to the Psychiatric Service. If this is true, it is possible that more religious students would belikely to come to the Psychiatric Service only when they have more severe emotional disorders. (2) Religious participation affords a sense of belongingness and direction that sustains an individual in the face of crises, both the developmental crises of adolescence and the accidental crises in everyday events. Again, the effect might be that religious students would come to the Psychiatric Service only when they cannot handle severe problems. (3) Religious students have a resistance to admitting emotional illness. This might occur because they more frequently use denial as a defense against anxiety.

These hypotheses need investigation. Data in the Harvard Student Study will enable us to pursue some of them, but studies need to be carried out concurrently in other settings.

The present study also confirms the positive association between psychological and physical disorder. The data presented here are from much the same as those reported at Yale, at the University of Western Ontario, and by Kelvin, Lucas, and Ojha at University College, London. One can interpret these data as indicative of the general health preoccupation in many neurotic and phychotic disorders and as illustrative of the essential psychobiologic unity of the organism. There is also the implication that many students who seek psychiatric help may already have been seen in the medical or surgical clinics, and some signs of their psychic distress may have been evident at that time. Many people apparently find it easier to go to the general physician rather than the psychiatrist. The results do indicate the value of close collaboration between the psychiatrist and the internist and surgeon, both before and after psychotherapy has begun.

One theme that appears in two other studies is that of dissatisfaction and depression. A study at Oxford by by Davidson and Hutt found that psychiatric patients had a significantly higher score than controls on the Depression Scale of the MMPI. Like the Harvard Study, that from Yale found dissatisfaction to be much more lent among the psychiatric patient. We might not be surprised to find some depression early in college because of the mourning involved in the break from home. Also we might expect some depression due to loss in self-esteem when students meet stiff competition at college. Yet these depressions should be transient, from a situational and development point of view. That they are transient is a hypothesis that should be test by following students, like those the present project, into adult life and determining whether or not adjustment mechanisms and symptom change.

Closely related to the depression theme is one of withdrawal. Data from Yale, the University of Western Ontario, and Harvard show lack of friends, nonparticipation in activities, or living apart from college facilities are more frequent in the psychiatric group. Withdrawal and aloneness could be associated with depression, with suspiciousness, or with low self-esteem and low feelings of competency. For whatever reason, those who are uneasy about dealing with people are more likely to need psychological help.

Finally, the findings to this point in the Harvard Student Study are not clear about the meaning of noncon-S-

Closely related to the depression theme is one of withdrawal. Data from Yale, the University of Western Ontario, and Harvard show lack of friends, nonparticipation in activities, or living apart from college facilities are more frequent in the psychiatric group. Withdrawal and aloneness could be associated with depression, with suspiciousness, or with low self-esteem and low feelings of competency. For whatever reason, those who are uneasy about dealing with people are more likely to need psychological help.

Finally, the findings to this point in the Harvard Student Study are not clear about the meaning of noncon-S-