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  • The Mental Distress Response Scale and Promoting Peer-to-Peer Mental Health Support: Implications for College Counselors and Student Affairs Officials
  • Michael T. Kalkbrenner (bio) and Ryan E. Flinn (bio)

Enrollment in postsecondary institutions of higher education increased 33% between 2000 and 2014 and is projected to grow another 13% between 2014 and 2025 (Hussar & Bailey, 2017). This new wave of college students is presenting with increased mental health concerns; Auerbach et al. (2016) found that approximately one fifth of college students reported clinically significant symptoms of mental health disorders (MHDs) in a 12-month period, with 16.4% not receiving any kind of treatment. If left untreated, the consequences of mental health disorders, including poor academic performance, higher attrition rates, lower retention rates, self-harm, and suicide or homicide in the most severe cases, can be severe and wide-ranging for students and for the larger campus community (Kalkbrenner & Carlisle, 2019). In response, college counselors, student affairs officials, wellness coordinators, and administrators across the United States are engaging in outreach, education, and consultation by training students to recognize and refer peers in mental distress (Kalkbrenner & Carlisle, 2019); however, in a recent national survey (N = 51,294), Albright and Schwartz (2017) found that the majority of college students (72%) did not refer a peer in psychological distress to mental health support services.

The literature is lacking a psychometrically validated measure to help college counselors and student affairs officials identify how likely a student is to respond when encountering a peer in mental distress and which responses are more likely. The purpose of this study was to design, validate, and cross-validate scores on such a measure, the Mental Distress Response Scale (MDRS). The following research questions were addressed: (a) What is the underlying dimensionality of the MDRS with a large sample of undergraduate students? (b) Is the emergent factor structure of the MDRS confirmed with a new sample of undergraduate students?


Because college counselors and student affairs officials are likely to have more opportunities to administer a shorter measure (e.g., during new student orientations or in classes), we sought to develop a brief screening tool of approximately 8 to 15 items. We initially generated 25 items based on the guidelines of DeVellis (2016), approximately three times as many as the final scale. The MDRS items were sent to 3 expert reviewers who had more than 70 years of combined experience in counselor education, clinical supervision, student affairs, and college counseling. Based on the reviewers’ feedback 12 items were removed. The remaining 13 items were then administered as a pilot test with a sample of 34 undergraduate students. Participants responded to a prompt asking what they would do if they encountered a [End Page 246] student who was struggling with a mental health issue. A Likert-type scale was used, based on the recommendations of DeVellis, for attitudinal measures with the following anchors: 1 (I would not do this), 2 (I would probably not do this), 3 (I’m not sure if this is something I would do), 4 (I would probably do this), or 5 (I would do this).

Participants and Procedures

Data from this study were purposefully collected from 2 separate universities, in different geographic locations and with diverse groups of students, both to increase the generalizability of the data set and to ensure a sufficient sample size for psychometric testing. The first university was a large, public, research-intensive university in a metropolitan area. The second university was a large, public, land-grant, Hispanic-serving institution in a rural area. They are both nationally ranked for ethnic diversity. An identical nonprobability sampling procedure, using paper copies of the questionnaire, was used to collect data from participants in the student union at both universities.

For the exploratory factor analysis (EFA), data were collected from 569 respondents, 3 of whom were removed from the data set due to missing data, resulting in a total sample of 566. The demographic profile is as follows: for gender, 57.4% (n = 325) of participants identified as female, 41.9% (n = 237) male, 0.5% (n = 3) nonbinary or third gender, and 0.2% (n = 1) did not specify their gender. For...