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Abstract

Objective:

College students have high rates of mental health problems and low rates of treatment. Although sociodemographic disparities in student mental health treatment seeking have been reported, findings have not been synthesized and quantified. The extent to which differences in perceived need for treatment contribute to overall disparities remains unclear.

Methods:

A systematic search of PubMed, PsycInfo, and Embase was conducted. Studies published between 2007 and 2022 were included if they reported treatment rates among college students with mental health problems, stratified by sex, gender, race-ethnicity, sexual orientation, student type, student year, or student status. Random-effects models were used to calculate pooled prevalence ratios (PRs) of having a perceived need for treatment and of receiving treatment for each sociodemographic subgroup.

Results:

Twenty-one studies qualified for inclusion. Among students experiencing mental health problems, consistent and significant sociodemographic differences were identified in perceived need for treatment and treatment receipt. Students from racial-ethnic minority groups (in particular, Asian students [PR=0.49]) and international students (PR=0.63) reported lower rates of treatment receipt than White students and domestic students, respectively. Students identifying as female (sex) or as women (gender) (combined PR=1.33) reported higher rates of treatment receipt than students identifying as male or as men. Differences in perceived need appeared to contribute to some disparities; in particular, students identifying as male or as men reported considerably lower rates of perceived need than students identifying as female or as women.

Conclusions:

Findings highlight the need for policy makers to address barriers throughout the treatment-seeking pathway and to tailor efforts to student subgroups to reduce treatment disparities.

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Supplementary Material

File (appi.ps.20230414.ds001.pdf)

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 556 - 569
PubMed: 38291886

History

Received: 17 August 2023
Revision received: 27 September 2023
Accepted: 31 October 2023
Published online: 31 January 2024
Published in print: June 01, 2024

Keywords

  1. College mental health
  2. Adolescents/adolescence
  3. Gender/sex differences
  4. Public health
  5. Racial-ethnic disparities

Authors

Affiliations

Julia Pei, M.Sc. [email protected]
Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers).
Yagmur Amanvermez, Ph.D.
Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers).
Daniel Vigo, M.D., Dr.P.H.
Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers).
Joseph Puyat, Ph.D.
Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers).
Ronald C. Kessler, Ph.D.
Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers).
Philippe Mortier, M.D., Ph.D.
Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers).
Ronny Bruffaerts, Ph.D.
Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers).
Osiris Rankin, M.A.
Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers).
Sook Ning Chua, Ph.D.
Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers).
Vania Martínez, M.D., Ph.D.
Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers).
Charlene Rapsey, Ph.D.
Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers).
Liviu A. Fodor, M.A.
Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers).
Oana A. David, Ph.D.
Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers).
Claudia Garcia, B.Sc. (Hons.)
Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers).
Pim Cuijpers, Ph.D.
Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers).

Notes

Send correspondence to Ms. Pei ([email protected]).

Competing Interests

Dr. Kessler has served as a consultant for Cambridge Health Alliance, Holmusk, Mass General Brigham, RallyPoint Networks, and Sage Therapeutics and reports having stock options in Cerebral, Mirah, PYM, Roga Sciences, and Verisense Health. The other authors report no financial relationships with commercial interests.

Funding Information

Research funding was provided by Health Canada (grant 1920-HQ-000069), by a Miguel Servet grant from the Instituto de Salud Carlos III–Fondo Social Europeo Plus (grant CP21/00078 to Dr. Mortier), and by the Romanian Ministry of Education and Research (grant PN-III-P2-2.1-PED-2021-3882 to Dr. David).

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