Mental health help for college students

Telemental health (TH) resources – technology used to provide assessment and treatment for mental health conditions – are plentiful. But while we know college students can likely benefit from such services, we know little about their opinions on this particular type of resource. Tammy Toscos, Ph.D., Informatics Research Manager, Parkview Research Center, and team set out to examine students’ previous use of and willingness to use several types of TH. Here, she tells us more about their findings, and what they could mean for the future of mental health care in higher education.

Approximately 50,000 college students sought treatment at counseling centers in more than 400 U.S. universities during 2015-16.1 This represents a substantial uptick – 30% on average – in counseling center usage.1 During the same period, average enrollment increased only 5%, which has left many counseling centers challenged with balancing a stagnated budget with increased student needs.1

What our students are struggling with.
The top concerns of students who visited student counseling in 2015-16 were anxiety (61%), depression (49%) and stress (45.3%).1 Despite increases in counseling service utilization across campuses, substantial numbers of college students don’t seek treatment for their psychological distress.4-7 An oft-cited study on mental health help-seeking (MHHS) behaviors among college-age individuals found that fewer than 25% of those with any type of mental disorder had sought treatment within the past year.4 Moreover, only 36% of college students with depression only and 52% with anxiety only received treatment in the past year.6

Why aren’t they getting treatment?
Consistently across the literature, stigma has been cited as a significant barrier.9-14 Barriers also include distrust in mental health service providers, hesitance in self-disclosure, and perceived devaluation11,14  as well as lack of knowledge/familiarity with treatment14 and lack of clarity/urgency about whether one needs help.8,9,11 This may explain why college students with serious distress often choose to deal with their issue(s) themselves.11,15 Gender might also be a barrier to treatment. Women exhibit more depression, anxiety, and stress symptoms than men;16,17 however, women with mental health problems and suicidal ideation are more likely than men with these issues to seek treatment.7,8  

Changing the model of care.
With both increased demand for care and low prevalence of MHHS, counseling centers must make tough budgeting decisions. Urgent and continual care for students at risk for suicide are constant areas of need.18 However, with high rates of mental health issues among the general college population,4 it is critical to reach those not already seeking treatment. As Eisenberg et al.5 proposed, “New strategies may prove to be especially important for changing the behavior of the large number of students who are not using services despite reporting positive attitudes and beliefs about treatment (p. 229).” These novel approaches could include web-based treatments and interactive software,19 which may be perceived as more confidential and less stigmatized methods of therapeutic support.20-22 As few college students engage with university resources23 and the majority prefer informal over formal resources9, these modern mechanisms might serve as a conduit for counseling centers to expand their reach and provide pathways to formal care.22

In recent years, there has been a surge in TH applications and websites24, many relying on traditional therapeutic approaches, like Cognitive Behavioral Therapy, to help with stress, mental health problems and/or suicidal behavior.19,25-31 College-age adults, who are prolific users of technology, the Internet, and social media,32,33 appear to be open to these online treatments.20,21,34 In fact, a recent study with 572 university students showed that students facing emotional problems were more likely to seek help online than face-to-face.34 As technology and TH resources become more accessible, it is important for counseling centers to continually reassess college students’ use of and willingness to engage with TH.



Goal of study.
Our aims were to assess college students’ preferences for, previous experience with, and willingness to use TH (including anonymous chat with a trained non-professional, online therapy, and self-help resources).


The population.
We worked with 662 students from two U.S. midwestern colleges.


We used an online survey in spring 2017, where we measured students’ depression, anxiety, stress and suicidal thoughts, preferences for care options during distress, and use and interest in anonymous chat with trained non-professionals, online therapy and self-help resources.

Overall, 10.1%-13.8% had experience with these TH resources; however, 24.6%-40.1% expressed willingness to try them. At-risk students, especially those higher in depression/anxiety scores, showed greater use of and willingness to use some applications.

Counseling centers might consider endorsing TH resources as potential pathways to care. TH resources might help broaden reach with minimal cost, reduce mental-health help seeking barriers, and provide support to at-risk populations.

Consistent with previous research,4 mental health problems were common in our sample of college students: 31% reported depressive symptoms and 9% had contemplated suicide in the past year. Additionally, 33% had seen a mental health provider. Although women reported significantly higher levels of depression, anxiety, and stress than men—a common finding across studies16,17— women and men were equally likely to have contemplated suicide. Thus, as other researchers have suggested, gender needs to be a consideration in delivering solutions for stress and/or mental health;17 however, suicide prevention strategies in college should target men and women equally.

Decisions about where to invest resources for the treatment of college students’ mental health problems must be driven by cost, need and potential reach. TH resources, such as self-help resources, online anonymous chat and online therapy, may provide pathways to care that fill current gaps in treatment and overcome major barriers in MHHS among college students. These technologies, especially self-help resources, might be particularly appealing to those in high-risk groups, such as those with moderate to high depression/anxiety scores, high stress levels and women.




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