College Student Medical Care

Aka: College Student Medical Care, Healthcare of the College Student, Health Maintenance for College Students, Preventive Health Care of College Students

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II. Epidemiology

  1. U.S. college students: 19-20 Million (12 million under age 24 years)
  2. Uninsured college students: 9% (1.6 Million)
  3. Special health needs in college students: 20%
  4. Mental health condition in 33% of college students (esp. Anxiety Disorder and Major Depression)

III. Management

  1. Attention Deficit Disorder (ADHD)
    1. See Attention Deficit Disorder in Adults
    2. Screen with Adult ADHD Self-Report Scale Symptom Checklist (ASRS)
      1. http://webdoc.nyumc.org/nyumc/files/psych/attachments/psych_adhd_checklist.pdf
    3. IncidenceADHD: 2-8% among college students
    4. Consider allowing additional time for classroom tests (however minimal evidence of benefit)
    5. Consider Cognitive Behavioral Therapy for adults with ADHD
    6. Stimulant misuse or diversion in up to 35% of college students receiving these prescriptions
  2. Learning Disorders
    1. Consider neuropsychological evaluation
    2. Consider Assistive Technology (e.g. Text to speech)
    3. Consider tutoring
    4. Consider course or testing modifications
    5. Consider learning and testing strategy instruction
  3. Alcohol Abuse
    1. Screen with AUDIT-C (Alcohol Use Disorders Identification Test - Consumption Items)
    2. Increased risk of binge drinking (especially among Fraternities and similar groups)
      1. Up to 24% of college students report binge drinking (5 drinks or more) in prior 2 weeks
    3. Increased risk in women who self-treat distress with Alcohol
      1. Associated with increased Sexual Assault risk
  4. Tobacco Abuse or Vaping
    1. Up to one third of college students have used Tobacco or Vaping
    2. Two thirds of those who have used Tobacco or Vaping, have done so recently (last 3 months)
  5. Chemical abuse
    1. See Adolescent Drug Abuse
    2. See CRAFFT Questionanaire
    3. Cocaine Abuse
    4. Flunitrazepam (Rohypnol)
    5. Gamma-Hydroxybutyrate (GHB)
    6. Ketamine
    7. Marijuana
    8. Methamphetamine
    9. Methylenedioxy-Methamphetamine (MDMA or Ecstasy)
  6. Eating Disorder
    1. See Eating Disorder
    2. See SCOFF Questionnaire
    3. Incidence: 1% of college students
    4. Anorexia Nervosa
    5. Bulimia Nervosa
    6. Binge Eating Disorder
  7. Major Depression
    1. See Adolescent Depression
    2. See Patient Health Questionaire 9 (PHQ-9)
    3. Incidence: 30% with depressed mood episode interfering with function in prior year
    4. Suicidal Ideation in 7-13%, plan in 2%, attempt in 0.5 to 3%
      1. War Veteran students have Suicidal Ideation in 46%, plan in 20%, attempt in 4%
    5. Resources: Suicide Prevention
      1. http://www.sprc.org/collegesanduniversities
  8. Anxiety Disorder
    1. See Anxiety Disorder
    2. See Generalized Anxiety Disorder Scale (GAD-7)
    3. Incidence: 24% with Anxiety Disorder
    4. Up to 48% of college students report episode of overwhelming anxiety episode in prior year
  9. Post-Traumatic Stress Disorder
    1. Commonly associated with Sexual Assault, returning war Veterans
    2. Screen with Primary Care PTSD Screen (PC-PTSD)
  10. Sleep Disorder or Insomnia
    1. See Insomnia
    2. Incidence: 20% with poor sleep that interferes with academic performance

IV. Prevention: Immunizations

  1. Influenza Vaccine annually
  2. Human Papilloma Virus Vaccine (HPV Vaccine) prior to college
  3. Meningococcal Vaccine (second booster after 16 year birthday)
  4. Pertussis Vaccine as part of Tdap Vaccine (e.g. Adacel)
    1. Booster dose typically due at age 21 years

V. Prevention: Anticipatory Guidance

  1. See Young Adult Health Maintenance
  2. Medical Coverage
    1. Age <26 years old in U.S. can remain on parent's insurance plan
    2. Other options include school health plan, marketplace, Medicaid
    3. Counseling services are mandated to be covered in U.S. under all but school health plans
  3. General Health
    1. Access to adequate food resources
    2. Regular Exercise or sports participation
    3. Substance avoidance
    4. Regular follow-up for chronic health conditions
  4. Sexual Health
    1. Counseling
      1. Contraception
      2. Prevention of Sexually Transmitted Infection
    2. Sexuality
      1. See Preventive Health Care of Men Who Have Sex With Men
      2. See Preventive Health Care of Women Who Have Sex With Women
      3. See Transgender Person
    3. Sexual Violence Screening
      1. See HITS Screen for Intimate Partner Violence
    4. Sexually Transmitted Infection
      1. Gonorrhea and Chlamydia Screening annually for age under 25 years
      2. Consider HIV Screening
      3. Pap Smear after age 21 years

VI. References

  1. Unwin (2013) Am Fam Physician 88(9): 596-604 [PubMed]
  2. Unwin (2021) Am Fam Physician 104(2): 141-51 [PubMed]

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