Barriers to Mental Health Care Among College Students

This week we will be discussing an article written by authors Horwitz, McGuire, Busby, Eisenberg, Zheng, Pistorello, Albucher, Coryell, and King. This article, titled “Sociodemographic differences in barriers to mental health care among college students at elevated suicide risk” was published in the Journal of Affective Disorders earlier this month. In this article, the authors examine college student mental health experiences, and explore the barriers to mental health care service utilization, as well as how these barriers differ among sociodemographic subgroups of students.

What did they do?

Using data collected from college students (n = 3,358) at four US universities during the Fall semesters of 2015-2018, the authors aimed to build upon the existing literature examining barriers that college students face to seeking mental health services, and how these barriers differ across sociodemographic variables.

Why did they do it?          

As we have discussed before, attending college, while often incredibly exciting, can be particularly stressful for many students. Accordingly, college-aged students are a vulnerable population with regard to developing difficulties with mental health. Given this vulnerability, in conjunction with research suggesting that suicide is a leading cause of death among college students in the US, there is a clear need to better understand the experiences of college students and the barriers to treatment that they face. 

The primary aim of this study was to directly compare the ways in which specific barriers to mental health service utilization differ as a function of various sociodemographic factors.  

How did they do it?

The sample included in this study was a collection of college students from four US universities who screened positive for elevated suicide risk and who were not receiving any mental health treatment at the time of recruitment. Elevated suicide risk was indicated by participants endorsing at least two of four suicide risk factors (in this study the four factors were: depression, alcohol use, suicidal ideation, suicide attempt) which were assessed using four different questionnaires. Participants were also asked about barriers to mental health service use. The authors conducted a series of logistic regressions to obtain adjusted odds ratios.

What did they find?

Overall, a majority of participants screened positive for depression (75%) and suicidal ideation (87%). 39% of participants screened positive for heavy alcohol use and 26% reported attempting suicide at some point in their life. With regard to treatment barriers, the most commonly endorsed barriers included: lack of time (66.7%), questioning seriousness of needs (65.0%), and feelings of stress being a normal aspect of being a college/graduate student (57.5%). In their direct comparisons across sociodemographic variables, the authors broke down their discussion into four groups of barriers and how those barriers differed across sociodemographic groups. 

1. Age/School-related Barriers: The authors found that compared to graduate and professional students, younger undergraduate students were less likely to report barriers related to logistics such as time and finances, but were more likely to report barriers related to concerns about privacy and stigma. Graduate students were also more than two times as likely to report cultural sensitivity issues as a barrier to mental health service utilization.
2. Gender-related Barriers: Overall, transgender and genderqueer participants reported more overall barriers compared to cisgender participants. Transgender and queergender students also identified financial and cultural concerns as primary barriers. Cisgender women were more likely than cisgender men to report all barriers except for privacy and stigma concerns. 
3. Race/Ethnicity-related Barriers: White participants were less likely to report barriers to mental health service utilization compared to minority groups across almost every domain. The likelihood of reporting barriers related to logistical concerns, cultural sensitivity, and financial concerns were greater among all racial/ethnic minority groups relative to White students.
4. Sexual Orientation Barriers: Generally, heterosexual students were less likely to report barriers across numerous domains. Relative to heterosexual students, the odds of gay/lesbian and bisexual/pansexual students reporting financial concerns was 47% greater and 62% greater, respectively. It was demonstrated that cultural sensitivity was a significantly stronger barrier for all sexual orientation groups, compared to heterosexual students.

What does it all mean (our take)?

College can be both an exciting time and a stressful time in an individual’s life. The transition into college is challenging for most students and it has become clear that college students are an at-risk population with regard to developing mental health difficulties. But, it still seems that amidst an elevation in mental health concerns, college students experience barriers that prevent them from engaging in treatment.

The authors of this study creatively evaluate this at a level that is critically important. They not only assessed barriers to treatment broadly, but they dug in and examined how barriers vary across subgroups of college students. In doing this, they uncovered the conclusion that barriers clearly vary across several sociodemographic groups of students. 

We thank the authors for conducting this well thought out study, as their hard work demonstrates that if we want to reach college students effectively, we need to develop treatment programs that meet their specific needs. This type of system should include a way to evaluate students accurately and efficiently, as well as treat students. Over time, we believe a system like this will be most impactful in successfully treating college students with mental health difficulties, and we are looking forward to being part of the solution in this endeavor.