Methods: A mixed methods design was used. The SF-36v2 uses normative data from the 1998 and 2009 general U.S. population sample to compare test subjects. The T- score based scores have a mean of 50 and a standard deviation of 10. Higher numbers indicate better health. (QualityMetric Health Outcomes Scoring Software 5.0 Users’ Guide, 2016).
Results: A nonrandom sample consisted of 39 first year undergraduates. Every other participant was placed in an EW intervention group who wrote about their deepest thoughts and feelings related to a stressful or traumatic event or a control group who wrote about neutral topics. Of the 39 initially enrolled students, 32 (18: intervention, 14: control) completed the study. The participants completed four 20 minute writing sessions on four consecutive days between the hours of 5 pm and 9 pm. Pre-test data were collected using the SF-36v2 health survey immediately prior to the initial writing session along with the collection of a salivary sample using the drool method. Three weeks following the final writing session participants provided post-test data using the SF-36v2 health survey and a salivary sample using the drool method. A 16 item exit survey using Qualtrics was sent via email to participants at one year. Pre and three - week post-intervention data in the form of saliva samples and SF-36 Version 2 Health Survey results were analyzed along with an exit survey given at one year.
At all time points the total sample, experimental and control groups scored above the national norm in physical health. On the contrary, at all time points the total sample, experimental and control groups scored below the national norm in mental health. From pre to posttest, there was an increase, although not statistically significant, in the SF-36v2 Mental Health Component Summary Score of the experimental group compared to the control group. The Physical Health Component Summary Score showed little change from pre to posttest in either group. Cortisol levels for the entire group showed a decrease, although not statistically significant, from pre to posttest. One explanation for the lack of statistical significance is that during the time of the study there were two student suicides on the small private college campus. As expected, the counseling center was inundated with visits related to the suicides. An alternative explanation is the study participants were concurrently engaged in other health promotion and disease prevention strategies targeting first year undergraduates. Despite lack of statistical significance, data from the exit survey validated the effectiveness of the EW intervention. For instance, respondents wrote in the exit survey that the EW intervention was “definitely therapeutic,” and “helped us to move on” [from past trauma]. In response to the item, “Writing about my deepest thoughts and feelings related to a stressful or traumatic event was helpful” 71% of respondents answered affirmatively. No participant requested to see a counselor in conjunction with the study.
Conclusion: First year undergraduates in particular find the transition to college stressful, and many, despite access to mental health services, come with concerns about the stigma, privacy and anonymity in seeking counseling (Hussain et. al., 2013). In healthy educational environments, available resources promote learning to address life challenges; vulnerability opens opportunities for developing resilience with toolkits of strategies to combat stressful and traumatic experiences. This analyses suggest that EW is a feasible, low-cost, accessible self-help intervention that may augment a comprehensive toolkit of strategies for vulnerable first year undergraduates.