Mental Health and the DPT Student: Retention Strategies for Successful Outcomes
The purpose of this session is to discuss the issues and prevalence of mental health conditions among Doctor of Physical Therapy (DPT) students and to address strategies for recruitment, admission, retention and success, both in the classroom and in the clinic.
Methods and/or Description of Project
Anecdotally faculty and staff are identifying an increasing number of students in their DPT cohorts that exhibit signs of high stress and anxiety. The literature identifies a significant prevalence of mental health conditions among undergraduate and graduate students, which impact their ability to be successful in their chosen areas of study. This session will review the available literature, with particular emphasis on students in physical therapy programs, including both domestic and international students. Lecture and small group discussions will address prevalence of mental health conditions and the need to implement strategies for identifying these students and interventions for addressing their challenges in the classroom, laboratory settings and during clinical experiences.
The 2016 American College Health Association-National College Health Assessment data report indicates that high numbers of graduate and professional students suffer from a variety of mental health conditions. Survey questions regarding the previous 12 months indicated prevalence of overwhelming anxiety (55%), overwhelming anger (33%), depression that limited function (33%), and thoughts of suicide (6%).1 Survey data from health professional graduate students from 7 colleges in the Midwest United States identified that 41% reported elevated depressive symptoms and 28% had elevated anxiety.2 More than a quarter of surveyed Physical Therapy students in Ireland scored above the General Health Questionnaire Survey threshold for probable psychological morbidity and indicated that academic, personal and financial issues were the greatest sources of stress.3 Similar findings were reported for DPT students in Pakistan with higher stress levels related to future job, family expectations, coursework, and financial issues. 4 Several investigators in the United States have found that DPT student academic and clinical performance is related to measures of stress and anxiety. 5,6
Many DPT programs admit a significant number of international students and several authors have identified higher stress levels in international graduate and undergraduate populations. Shenoy studied graduate students in Virginia from America, China and India and found that Americans and Indians reported fewer adjustment problems than Chinese students.7 Oyeniyi found that 97% of international undergraduate and graduate students suffer from stresses from environmental and cultural changes which impact their emotional stability.8
The physical therapy literature is limited regarding the impact of mental health conditions on retention of students or strategies for decreasing the impact of mental health issues on classroom management and clinical education. Previous authors found that meditation sessions decreased measures of stress and anxiety in PT students and resilience based coping strategies built self-efficacy and cognitive control.5,6 Other disciplines have investigated intervention strategies for students with emotional distress including counseling programs to identify personal stress reactions and employing adapted coping strategies increased self-esteem, decreased depression and anxiety and improved grades.9,10 Oswalt and Riddock recommend incorporation of stress management into graduate student orientation and coordination of efforts with Student Affairs departments. They encourage faculty and administration to consider the impact of curriculum and program changes on student mental health as well as factors such as health insurance, funding and the overall academic climate.11 Hyun et al. found that graduate students with higher functional relationships with their advisors had fewer mental health needs and recommend that faculty increase their attention to graduate student mental health in their role as advisor.12
Conclusions/Relevance to the conference theme: Through the Looking Glass: Transforming Physical Therapy Education
DPT programs include undergraduates with conditional admission as well as graduates and many programs admit both domestic and international students. CAPTE sets baselines for graduation rates of 80% for DPT and 60% for PTA programs. An apparently increasing number of students in DPT programs are being identified as having mental health conditions that can adversely impact the ability to be successful in the program. In addition, addressing these students’ specific needs necessitates the willingness on the part of academic and clinical faculty to relook at how we orient, how we teach, how we assess and how we manage the current and future student cohorts.
1. American College Health Association National College Health Assessment: http://www.acha-ncha.org/ Graduate/Professional Reference Group Executive Summary, Spring 2016 (pdf)
2. Mazurk MB, et al. Physical health, lifestyle beliefs and behaviors, and mental health of entering graduate health professional students: Evidence to support screening and early intervention. J Am Assoc Nurse Pract. 2016 Apr;28(4):204-11.
3. Walsh JM, et al: Sources of stress and psychological morbidity among undergraduate physiotherapy students. Physiotherapy. 2010;96(3):206-212.
4. R Noor, MS Bashir, S Nayab: Sources of stress among Doctor of Physical Therapy Students. Journal of Riphah College of Rehabilitaion Sciences, 2017: 4(2)81-85.
5. Frank L, Cassady S. Chambers J, et al: Effects of meditation on stress levels of Physical Therapist Students. JPTE 30(3):33-39.
6. Delany C, et al: Replacing stressful challenges with positive coping strategies: a resilience program for clinical placement learning. Adv Health Sci Educ Theory Pract 2015 Dec:20(5)1303-24.
7. Shenoy UA: College-Stress and Symptom-expression in International Students: a comparative study. Virginia Polytechnic Institute and State University, Disseration. Theses.lib.vt.edu
8. Oyeniyi OF, Bain SF, Furgerson KL: Stress factors experienced by international students while attending a South Texas University. www.aabri.com/SA2016Manuscripts/SA16031.pdf
9. Godbey KL, Courage MM: Stress-management program: intervention in nursing student performance anxiety. Archives of Psychiatric Nursing 1994, Vol 8(3)190-199.
10. Lo K, et al: Group interventions to promote mental health in health professional education: a systematic review and meta-analysis of randomized controlled trials. Adv Health Sci Educ Theory Pract 2017 Mar 15. Doi: 10.1007/s10459-9770-5. Epb ahead of print.
11. Oswalt SB, Riddock CC: What to do about being overwhelmed: Graduate students, stress and university services. The College Student Affairs Journal. 27.1, Fall 2007:24-44.
12. Hyun JK, Quinn BC, Madon T, Lustig S: Graduate Student Mental Health: Nees assessment and Utilization of Counseling Services. Journal of College Student Development. 47(3) May/June 2006: 247-266.
Define and discuss the most prevalent mental health conditions among graduate students.
Discuss DPT program admission challenges related to mental health issues and identify strategies for recruitment and orientation.
Discuss DPT student retention challenges and strategies for university student support services, DPT faculty, and DPT students.
Lecture; small group discussion with group reports
0-20 min: Counselor report on prevalence of mental health conditions in graduate students; role of university student support services. Information on both domestic and international students and the causes of stress that could initiate or exacerbate signs and symptoms.
21-30 min: small group questions
What is your reaction to the high incidence reported?
What does your school or facility do to support mental health?
30-50 min: Admission chair outlines strategies for recruitment and admission; classroom & curricular strategies for retention
51-60 min: small group questions
What does your school do address mental health issues during recruitment, admission, and orientation?
What classroom or curricular strategies does your program incorporate for promoting mental health?
60-80 min: DCE outlines strategies for clinical education for students with mental health conditions
80-85 min: small group question
What other clinical strategies come to mind?
85-90: General Q&A