A Meta-Analysis of Indicated Mental Health Prevention Programs for At-Risk Higher Education Students Colleen S. Conley, Jenna B. Shapiro, Alexandra C. Kirsch, and Joseph A. Durlak Loyola University Chicago This meta-analysis found empirical support for the effectiveness of indicated prevention programs for higher education students at risk for subsequent mental health difficulties based on their current subclinical levels of various presenting problems, such as depression, anxiety, or interpersonal difficul- ties. A systematic literature search identified 79 controlled published and unpublished interventions involving 4,470 college, graduate, or professional students. Programs were effective at post-intervention overall (ES  0.49, CI [0.43, 0.55]), and for both targeted outcomes (ES  0.58, CI [0.51, 0.64]) as well as additional nontargeted outcomes assessed in the studies (ES  0.32, CI [0.25, 0.39]). Interventions compared with a no-intervention or a wait-list control (ES  0.64, CI [0.57, 0.71], k  68) demonstrated significantly larger effects overall than did interventions compared with an attention-placebo control (ES  0.27, CI [0.11, 0.43], k  11), although both were significant. Among the former group, modality and presenting problem emerged as significant moderators of intervention effectiveness, and among the 43 of these that assessed effectiveness at an average follow-up period of 35 weeks, the positive effects from intervention remained strong (ES  0.59, CI [0.50, 0.68]). Overall, programs were fairly brief, attracted and retained students, were positively rated by students, and effective when administered by paraprofessionals as well as professionals. Current findings are promising and stimulate recommenda- tions for improving future research, such as expanding the range of outcomes assessed, and clarifying moderators and mediators of intervention impact. Public Significance Statement This meta-analysis found empirical support for the effectiveness of indicated prevention programs for higher education students at risk for subsequent mental health difficulties based on their current subclinical levels of various presenting problems, such as depression, anxiety, or interpersonal difficulties. Several features of these interventions, such as their brevity and positive ratings offered by students, indicate the feasibility of helping students who are having difficulties before they become more serious. Keywords: mental health, meta-analysis, indicated prevention, higher education, students Mental health problems are common among higher education students. For example, epidemiological evidence suggests that up to 40% of higher education students have a diagnosable mental disorder (Blanco et al., 2008), and many college students struggle with various subclinical-level psychological symptoms (Bewick, Gill, Mulhern, Barkham, & Hill, 2008). One large national survey of over 95,761 respondents found that over the past year, 36.7% of students reported experiencing levels of depression so severe that it was difficult for them to function, 58.4% had overwhelming anxiety, and 39.6% had experienced overwhelming anger (American College Health Association [ACHA], 2016). A significant portion of students also reported recent interpersonal stresses such as loneliness (59.3%), family difficulties (28.8%), problems in intimate relation- ships (30.1%), and other interpersonal concerns (26.1%). Mental health problems in college students deserve attention, not only be- cause of their psychological and social impact on students and the broader campus community, but also because adjustment difficulties have an impact on academic functioning and enrollment. Students with mental health problems are at risk for lower academic perfor- mance and for dropping out of school (Eisenberg, Golberstein, & Hunt, 2009; National Alliance on Mental Illness, 2012), which pres- ents a loss to students and to institutions. Additional data suggest that the typical ways to offer mental health services on campuses—through appointments with counsel- ing or health centers— have significant limitations. Counseling center usage data suggests that only 35.6% of students who need mental health services for clinical or subclinical problems seek assistance through traditional campus resources (Eisenberg, Hunt, Colleen S. Conley, Jenna B. Shapiro, Alexandra C. Kirsch, and Joseph A. Durlak, Department of Psychology, Loyola University Chicago. This research was supported by the American College Health Founda- tion Stephen D. Weiss Award. An early version of these results was presented at the American College Health Association annual meeting in 2015. Special thanks go to Evan Zahniser and the many research assistants who provided valuable contributions to this project. Correspondence concerning this article should be addressed to Colleen S. Conley, Department of Psychology, Loyola University Chicago, 1032 West Sheridan Road, Chicago, IL 60660. E-mail: cconley@luc.edu This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Journal of Counseling Psychology © 2017 American Psychological Association 2017, Vol. 64, No. 2, 121–140 0022-0167/17/$12.00 http://dx.doi.org/10.1037/cou0000190 121