TABLE OF CONTENTS

I. EXECUTIVE SUMMARY 2
II. NEEDS ASSESSMENT 3
a. Overview
b. Stakeholders
c. Target Group
d. Risk Factors
e. Summary of Key Factors Related to Health Behaviors
III. MISSION STATEMENT, GOALS, & OBJECTIVES 7
a. Mission Statement
b. Program Goals
c. Smart Process Objectives
d. Smart Learning Objectives
e. Smart Behavioral Objectives
f. Smart Outcome Objectives
IV. INTERVENTION AND IMPLEMENTATION 8
a. Theoretical Foundation
b. Logic Model
c. Intervention Summary
d. Intervention Strategies
V. PROGRAM RESOURCES 10
a. Kick-Of
b. Materials
c. Personnel
d. Timeframe/Gantt Chart
VI. MARKETING 11
a. Recruitment Marketing
b. Marketing Incentives
VII. BUDGET 12
a. Summary
b. Itemized List
VIII. EVALUATION 13
IX. REFERENCES 14

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EXECUTIVE SUMMARY

Statistics show that depression afects more than 350 million people of all
ages worldwide (World Health Organization, 2012a). According to the World
Health organization more than 800,000 people who sufer from depression
commit suicide worldwide and that is approximately 1 death every 40
seconds (World Health Organization, 2012b). According to the National
Institute of Mental Health, in the United States, adults from the ages 18-25
are more prone to clinical depression. Nationally, 1 out of 4 college student
sufers from some type of mental illness including depression (Kerr, 2012).
Young people who are diagnosed with depression are 5 times more likely to
attempt suicide than their older adult counterparts (Kerr, 2012).
Research shows that in 2012 major depressive episodes were more
prevalent among young adults aged 18-25, which is 8.9% of the United
States population (National Institute of Mental Health, 2012). This is a public
health issue because mental illness, including clinical depression, can lead to
a decrease in quality of life. Statistics show that 31% of college students
(that fall into the young adult age group) were so depressed that could not
function daily (American College Health Association, 2012). Young people
who are diagnosed with depression are five times more likely to attempt
suicide than their older adult counterparts (Kerr, 2012). Therefore, the target
population for this program is undergraduate college students, ages 18 to
24, which attend the University of South Carolina in Richland County, SC.
Our program, Cocky Conquers Depression (CCD), will focus on the primary
level of prevention for incoming college students. Because of this, students
will learn new methods to prevent depression and suicide that can result
from depression. Upon completion of the program, these students will have
gained the skills to manage stress and to create healthier social connections.
By the end of the program, students will be better equipped to deal with the
challenges, angst, and depression that sometimes accompany college life.
They will also gain a safe space to share their day-to-day activities and
feelings in a confidential online E-journal, which will be assessed by a
professional psychologist. These psychologists will serve as a support system
for students whilst they are in the program. Students that successfully
complete our program will leave with a new set of skills, a support system,
and a lowered susceptibility to depression. All of these things are items that
college students could truly benefit from.

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NEEDS ASSESSMENT

A. OVERVIEW
Clinical depression is the most severe form of depression. According to
the American Psychiatric Association, for one to be diagnosed with clinical
depression he or she must sufer from five or more symptoms for a span of
at least two weeks. One must experience these symptoms for the majority of
those two weeks. These symptoms range from issues such as decreased
interest in social activities, serious weight changes, insomnia, or even
thoughts of suicide (National Institute of Mental Health, 2011). Not only is
clinical depression severe but also abundant.
Statistics show that depression afects more than 350 million people of all
ages worldwide (World Health Organization, 2012a). According to the World
Health Organization (WHO) more than 800,000 people who sufer from
depression commit suicide; that translates to approximately 1 death every
40 seconds (World Health Organization, 2012b). According to the WHO study
(2012b), high-income countries such as the United States are more likely to
sufer from depression. The citizens of the United States are actually 19.2
percent more likely to sufer from depression than other countries (Pappas,
2011).
Geography seems to play a big role in depression. Within the United
States, adults from the ages of 18 to 25 are more prone to clinical depression
(National Institute of Mental Health, 2012). Almost 25 million Americans
sufer from a major depressive episode every year but almost half do not
receive treatment (National Alliance on Mental Illness, 2015). Also notable is
that the southeast region of the country has the highest rate of depressed
adults and the state of South Carolina has a depression rate of 9.6%
(Lohmeyer, 2010).
Depression afects young people severely. A lot of these young people
attend college that can sometimes exacerbate the problem. This is shown by
the fact that one out of four college students sufer from some type of
mental illness such as depression (Kerr, 2015) and the third leading cause of
hospitalization for Americans ages 18 to 44 are mood disorders (National
Alliance on Mental Illness, 2013). Also startling is the fact that young people
who are diagnosed with depression are five times more likely to attempt
suicide than their older counterparts (Kerr, 2012). More than 10% of college
students have been diagnosed and or treated for depression and a
staggering 31% report that they have been so depressed that they were
unable to function daily (American College Health Association, 2012).
Depression and suicide are linked. Statistics show that 15% of clinically
depressed people die by suicide. Also, depression is the second leading

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cause of death for young people (ages 15-24) and for every male attempt of
suicide there are three female attempts (Suicide Awareness Voices of
Education, n.d.). Even though females have a greater lifetime prevalence of
depression then males, the gap is closing. Studies show that the size of the
male-female diference when it comes to depression has decreased recently
(Klerman & Weissman, 1989, p.2229).

B. STAKEHOLDERS
Stakeholders will include a member of the Winningham Foundation as
they will be funding this program, several members of the USC student body,
the planning committee, a representative from the Student Afairs office at
USC, and a representative from the Campus Wellness office at USC.

C. TARGET POPULATION
All these statistics and studies show that depression is an issue. It is far-
reaching and touches many people. However, our health program cannot
target everyone with depression. Because of this, we are choosing to target
those groups which we believe are at higher risk of developing clinical
depression and attempting suicide as a result of that depression.
Our program will target undergraduate college students (both male and
female), ages 18 to 24 that attend the Columbia Campus of the University of
South Carolina (USC). We have selected this group because young people
and college students are highly afected by depression and even though
women attempt suicide more frequently, the number of men that sufer from
depression is growing. Lastly, we chose this location because it is located
within the southeast region of the United States and the State of South
Carolina has a high rate of depression.

D. RISK FACTORS ASSOCIATED WITH THE TARGET POPULATION

There are many risk factors and/or health problems that can cause or
exacerbate clinical depression in young people. These risk factors have been
divided into three sections: behaviors, environmental risk factors, and risk
factors that cannot be changed.

BEHAVIORAL RISK FACTORS

Grade point average (GPA) is a big stressor in college for many
students diagnosed with depression (Aselton, 2012).
Financial issues are a major source of stress for college students
diagnosed with depression (Aselton, 2012).

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 Future career plans are a source of stress for college students
diagnosed with depression (Aselton, 2012).
Excess cafeine can trigger anxiety for college students diagnosed
with depression (Aselton, 2012).
Large academic workload can be a source of stress for college
student diagnosed with depression (Aselton, 2012).
Irregular sleep patterns correlate with higher rates of depression
(Eisenberg, Gollust, Golberstein, & Hefner, 2010).
Fluctuations in personal relationships (friends and significant others)
can cause mental stress on students (Eisenberg et al., 2010).

Lack of religious identification correlates with higher rates of

depression (Mahmoud, Staten, Hall, & Lennie, 2012)

ENVIRONMENTAL RISK FACTORS

Roommate issues are a major stress (Aselton, 2012).
Pressure from students families to achieve is a stress factor
(Aselton, 2012).
Social disconnection leads to higher rates of depressed students.
Students that are not in a social organization are more likely to be
depressed than students that are involved (Mahmoud et al., 2012).

Undergraduate students who live at home with their parents are

more likely to be depressed (Eisenberg et al., 2010).

UNCHANGEABLE RISK FACTORS

Being raised in a household with lower socioeconomic status can
afect college students diagnosed with depression (Mahmoud et al.,
2012).

Class standing afects depression; students aged 18-19 or

sophomores tend to be more depressed (Mahmoud et al., 2012).

PRIORITIZATION MATRIX ANALYSIS

More Important Less Important

More GPA issues Roommate issues
Changeable Irregular sleep patterns Excessive cafeine
Fluctuations in personal Living at home as an
relationships undergraduate
Social disconnection student

Less Financial issues Religious affiliation

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Changeable Future stresses
Large academic
workload
Lower socioeconomic
status
Pressure from ones
family
Class standing (e.g.
freshman, sophomore)

The health program will focus on those risk factors that are both more
important and more changeable. The program will also focus on large
academic workload. The program will not attempt to change the workload
students face but give them the tools to manage the workload and keep it
from overwhelming them.

E. SUMMARY OF KEY FACTORS RELATING TO BEHAVIORS

Type of Factor Factor Relationship to Behavior

Predisposing I. Lack of knowledge I. Being unaware of
about various campus options for connecting
clubs and activities. with peers and
becoming more
involved on campus
could lead to students
feeling socially
disconnected.
Enabling I. Competition for I. Competition forces
graduate school and many students to
post-graduate overwork themselves,
employment which can lead to
irregular sleep
patterns.
II. Lack of time II. An inability to manage
management skills time well can keep
students up late at
night finishing
assignments. This
irregularity in sleep
patterns causes
students to feel over-
worked, stressed, and

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Reinforcing I. Poor test, project, and
paper grades
II. Loss of close friend or II. Losing contact with
significant other
unhappy.
I. Students that receive
poor grades may
become discouraged
and apathetic towards
future assignments
and classes in general.
close friends or
significant others can
lead to a student
feeling upset and
alone.

MISSION STATEMENT, GOALS, AND OBJECTIVES

A. MISSION STATEMENT
We are going to strive to provide primary preventative care regarding
social, mental, and physical health for undergraduate students at USC
Columbia so that the prevalence of clinical depression and the number of
suicide attempts resulting from clinical depression on campus decline.

B. PROGRAM GOALS
I. Improve students support networks on campus by increasing their
knowledge on how to become more connected socially.
II. Provide students with various time and stress management techniques
to improve their quality of life and grade point averages (GPAs).
III. Students will learn about resources on campus that can increase their
knowledge and management skills for their heavy workload.

C. SMART PROCESS OBJECTIVES

I. By August 1, 2015, the program planners will have contacted all
University 101 (U101) professors and set up dates (and times) to

7
 present to the professors classes for the upcoming (2016-2017) school
year.
II. By August 2016, the program planners will have designed four
presentations to present to all University 101 classes at the University
of South Carolina. One presentation will focus on stress management,
one on social health, one on clinical depression and suicide, and one on
how to use an e-journal.

D. SMART LEARNING OBJECTIVES

I. Upon completion of the stress management presentation, 80% of
University 101 students will be able to list two ways to manage stress
factors.
II. Upon completion of the social health presentation, 70% of University
101 students will be able to list three organizations and/or events on
campus that they are interested in and can get involved in.

E. SMART BEHAVIORAL OBJECTIVES

I. Two weeks after the stress management presentation, at the first
check-in, at least 70% of students will have begun writing down class
assignments in an agenda or an electronic calendar.
II. Two weeks after the social health presentation, at the first check-in,
80% of students will report that they have spoken to one or more
parent/guardian (on the phone or in person) at least four times since
the presentation.

G. SMART OUTCOME OBJECTIVES

I. By 2025, the prevalence of clinical depression among young adults,
ages 18-24, at the University of South Carolina - Columbia will have
decreased by 15%.

INTERVENTION AND IMPLENTATION

A. THEORETICAL FOUNDATION
Cocky Conquers Depression (CCD) will utilize the Social Cognitive Theory.
One of the constructs in the Social Cognitive Theory proposes that self-
efficacy beliefs are the determinants in regulating behavior. These self-
efficacy beliefs are needed to enact change and can be developed in four
diferent ways. The four ways to enhance self-efficacy are mastery
experiences, vicarious experiences, social persuasion, and reducing stress
reactions.
Using social persuasion, students will be encouraged to help themselves if
they are feeling depressed or even reach out and help a friend that is feeling
depressed. Students will also be taught how to manage stress reactions and
their diferent emotions through cognitive restructuring, problem solving, and
relaxation techniques. Lastly, vicarious experiences allow people to use their

8
own stories of overcoming depression and/or changing their risk factors so
that they are no longer at risk, to inspire people currently dealing with
depression and/or its risk factors (Strunk, King, Vidourek, & Sorter, 2014). We
have decided that all of these techniques will work well with our intervention.

B. LOGIC MODEL

C. INTERVENTION SUMMARY
CCD will be implemented in 40 randomly selected University 101
curriculums in the fall of 2016 as a primary prevention intervention for
depression. Each curriculum will consist of 4 presentations that are given by
hired professional speakers in the first two weeks of the University 101
program. The four presentations will be; What is Clinical Depression?,
Stress Management Techniques, Why be Socially Active?, and How to
Utilize the E-journal?. These four presentations will be the base of the
program so; the students have the skills/knowledge to know how to
completely embrace the idea of the E-journal throughout the semester. The
presentation How to utilize the E-journal will be a presentation where the
two hired psychologists will introduce themselves and get comfortable with
the students. The psychologists that have been hired will monitor the e-
journals and be there to give students positive and helpful advice. The E-

9
journal is a confidential domain for students to express their thoughts and
feelings with a medical professional. It will be a mentoring and helpful
experience for their first semester of college where they may face many
challenges and dilemmas.

D.INTERVENTION STRATEGIES
CCD will employ health intervention strategies of health communication,
health education, incentives, and behavioral modification activities. The
health communication and health education will come in the form of the
presentations and the pamphlets to the students. In these presentations and
pamphlets they will learn what depression is and how it is linked to suicide.
They will also learn the risk factors that can lead to depression and ways to
minimize these factors. These presentations will also serve as a chance for
students to ask questions and openly communicate with presenters. Health
communication will also come in the form of contact with the psychologist
through the e-journals. The psychologist will be able to communicate with all
students through the e-journals but especially the at-risk students. The e-
journals will serve as the behavioral modification activities. Students will take
notes on their feelings and actions and will be able to see where they can
improve. Lastly, students will receive a grade or extra credit for completing
these journals. This will serve as an incentive to really invest in the program.

PROGRAM RESOURCES

A. KICK-OFF
CCDs kick-of event will be tabling that takes place on Greene Street
during welcome week. At the event program planners will be there to pass
out free goods to promote CCD and to inform freshman that the program will
be coming to their Fall U101 classes. Goods passed out will be t-shirts with
the CCD logo on the front, stress balls shaped like the school mascot, Cocky,
and popsicles that have funny or cheery statements on the sticks so that
students may lick their blues away.

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B. MATERIALS
See Budget section B page # for complete list and cost.

C. PERSONNEL
See Budget section B page # for complete list and cost.

D.TIMEFRAME /GANTT CHART

MARKETING

A. RECRUITMENT MARKETING
I. Mass emails will be sent to all U101 professors informing them of
the program and what exactly it entails.
II. Forty professors will be randomly selected and then emailed or
called and asked to participate in the pilot program.
III. Professors will be informed of the incentives they will be eligible to
receive upon completion of the program.

11
 IV. When enrolling in U101 classes, students will have the option to
select the U101 class that incorporates CCD curriculum. Emails will
then be sent to students enrolled in classes that include CCD
curriculum to give them more information about the program.
V. Emails will also be sent to professors and students informing them
to come to our kickof event during welcome week.

B. MARKETING INCENTIVES
I. Incentives will be provided for the U101 professors whos classes
participate in the program. The incentives will function as a thank-
you for the extra time they will spend implementing the program in
their classes (because they will not be paid a salary or hourly wage
with the programs budget). Each professor will get to choose one
office item or gift card they would like to receive (up to a $100
value). If professors do not inform program planners which incentive
they would prefer they would simply receive a small gift basket of
assorted office supplies (valued at $30).
II. Gift baskets will include one cofee mug, one stapler, one tape
dispenser, a three-pack of black pens, a five-pack of whiteboard
markers, a stack of multi-colored post it notes, and one Cocky stress
ball.
III. Incentives provided for the students participating in the program
will be that professors have the option to make the e-journals
graded assignments or worth extra credit.
IV. Classes that successfully complete the program will receive a free
pizza party at the end of the semester. This will benefit both
professors and students.

BUDGET

A. SUMMARY
CCDs budget will total $72,935. However, CCD is asking the Winningham
Foundation for $62,935. Student Health and Wellness Center at the
University of South Carolina will provide $10,000.

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B. ITEMIZED LIST

CATEGORY ITEM COST

Personnel Program Planners (5) $10,000
Staf members for
Personnel $10,000
management (4)
Staf members for
Personnel development & $5,000
presentation (5)
Personnel Psychologists (4) $40,000
Materials/Supplies/Equipm
Classrooms No cost
ent
Materials/Supplies/Equipm
PowerPoint No cost
ent
Materials/Supplies/Equipm
Computers No cost
ent
Materials/Supplies/Equipm
Flash drives $250
ent
Materials/Supplies/Equipm
Writing Utensils $50
ent
Materials/Supplies/Equipm
Ink $250
ent
Materials/Supplies/Equipm
Paper $100
ent
Materials/Supplies/Equipm
E-journals $50
ent
Materials/Supplies/Equipm
Stress balls In-kind*
ent
Materials/Supplies/Equipm
Banners $100
ent
Materials/Supplies/Equipm
Posters $25
ent
Materials/Supplies/Equipm
Paint $25
ent
Materials/Supplies/Equipm
Markers $10
ent
Materials/Supplies/Equipm
T-shirts $1000
ent
Materials/Supplies/Equipm
Popsicles $75
ent
Materials/Supplies/Equipm
Table on Greene Street No cost
ent
Materials/Supplies/Equipm Pizza party for all
$2,000
ent classes

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Materials/Supplies/Equipm Incentives for all
$4,000
ent professors
Womens Quad Sims,
Office Space/Rent In-kind**
Room 119

*Stress balls are in-kind from the Student Health and Wellness Center at
the University of South Carolina.
**Womens Quad Sims, Room 119 is in-kind from the Student Success
Center at the University of South Carolina.

EVALUATION

Evaluation will take place after the first semester of the program. At the
end of the Fall 2016 semester, results from all of the U101 classes will be
collected. These results will include pre-tests and post-tests taken by U101
students about their knowledge of clinical depression, suicide, risk factors,
and methods to limit those risk factors. Students will also be asked to fill out
evaluations about how useful they thought the program was, how much they
believe they learned, and how helpful they thought the presenters and
psychologists were.
The e-journals that all students wrote in would not actually be collected
however, the psychologists that managed these e-journals will provide notes
on them. These notes will include how many students used methods to
combat risk factors of clinical depression, which methods they used, how
often they used these methods, how many students exhibited symptoms of
depression, the number of symptoms they exhibited, what symptoms the
exhibited, and how many could be diagnosed as clinically depressed at the
beginning and end of the program.
CCD will be evaluated by quantitative and qualitative measures. The
psychologists notes will be used to collect quantitative data (e.g. the
number of students helped, the number of students still depressed) and the
end of program evaluations will provide qualitative data about how efective
the program and staf members were.

PROCESS OBJECTIVE
By August 2016, the program planners will have designed four
presentations to present to all University 101 classes at the University of
South Carolina. One presentation will focus on stress management, one on
social health, one on clinical depression and suicide, and one on how to use
an e-journal.

EVALUATION

14
 The final evaluation will be used to evaluate the quality of the
presentations. Students will provide their opinion on how useful the
presentations were.

IMPACT OBJECTIVE
Upon completion of the stress management presentation, 80% of
University 101 students will be able to list two ways to manage stress
factors.

EVALUATION
The pre and post-tests will be used to assess how many students can list
at least two stress management skills and the psychologists notes will be
used to measure how many students actually utilized the diferent stress
management skills.

REFERENCES

American College Health Association (2012). American College Health Association-National

College Health Assessment II: Reference Group Executive Summary Spring 2012.
Retrieved from http://www.acha-ncha.org/docs/ACHA-NCHA-
II_ReferenceGroup_ExecutiveSummary_Spring2012.pdf.
Kerr, M. (2012, March 29). Depression and the college student. Healthline. Retrieved from
http://www.healthline.com/health/depression/college-students#1.
Klerman, G.L., Weissman, M.M. (1989). Increasing rates of depression. Journal of the
American Medical Association. 261(15). 2229-2235.
http://dx.doi.org/10.1001/jama.1989.03420150079041.
Lohmeyer, S. (2010, October 1). Depression rates vary widely by state, demographics. The State
of the USA. Retrieved from http://www.stateoftheusa.org/content/states-people-with-
highest-dep.php.
National Institute of Mental Health. (2011). Depression. Retrieved from
http://www.nimh.nih.gov/health/publications/depression/index.shtml#pub.
National Institute of Mental Health. (2012). Major depression among adults. Retrieved from
http://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-
adults.shtml/index.shtml.
National Institute of Mental Health. (2013). Leading causes of death ages 18-65 in the U.S.
Retrieved from http://www.nimh.nih.gov/health/statistics/suicide/leading-causes-of-
death-ages-18-65-in-the-us.shtml.
National Institute of Mental Health. (2015). What is depression. Retrieved from
http://www.nami.org/template.cfm?section=Depression.
Pappas, S. (2011, July 25). US and France more depressed than poor countries. Live Science.
Retrieved from http://www.livescience.com/15225-global-depression-poor-rich-
countries.html

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Suicide Awareness Voices of Education. (n.d.). Suicide facts. Retrieved from
http://www.save.org/index.cfm?fuseaction=home.viewPage&page_id=705D5DF4-055B-
F1EC-3F66462866FCB4E6
World Health Organization. (2012a). Depression. Retrieved from
http://www.who.int/mediacentre/factsheets/fs369/en/.
World Health Organization. (2012b). Mental Health. Retrieved from
http://www.who.int/gho/mental_health/en/.

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