The emerging adult population, individuals between the ages of 18-29, has grown to 53.7 million in the United States (U.S. Census Bureau, 2017). College students form a significant subset of this population, with 29 percent enrolled at a college or university (National Center for Education Statistics [NCES], 2015). One in three emerging adults will experience some form of mental health disorder (Eisenberg, Hunt, Speer & Zivin, 2011; Lipson, Gaddis, Heinze, Beck & Eisenberg, 2015) and the prevalence of substance use disorders is higher than any other age group (Substance Abuse & Mental Health Services Administration [SAMHSA], 2005). Emerging adult college students with behavioral health concerns face a myriad of challenges that include negative implications for education (Arria et al., 2013; Eisenberg, Golberstein, & Hunt, 2009; Eisenberg, Hunt, Speer, & Zivin, 2011; Sontag-Padilla et al., 2014), long-term health (Eisenberg, Hunt, Speer, & Zivin, 2011), and socioeconomic status (Wang et al., 2007). Despite these challenges, few emerging adults receive help for their behavioral health concerns (Kessler et al., 2007; Lipson, Gaddis, Heinze, Beck, & Eisenberg, 2015; SAMHSA, 2012; Wang et al., 2007). Few researchers have examined this phenomenon, but some evidence shows that institutional and individual-level characteristics may play a role (Cadigan, Lee, & Larimer, 2018; Dunbar, Sontag-Padilla, Ramchand, Seelam, & Stein, 2017; Eisenberg, Hunt, Speer, & Zivin, 2011; Miller et al., 2016).
The aims of the Emerging Adult Behavioral Health (EABH) study were to (1) evaluate the association between behavioral health service use and academic outcomes among emerging adult college students; and (2) determine if emerging adult college students’ decisions to use or not use behavioral health services are associated with specific student- or institution-level characteristics. Using secondary data from the 2015-2016 Healthy Minds Study (HMS), the EABH study employed a combination analyses, including binomial logistic regression and hierarchical generalized linear modeling (HGLM), to examine the relationships between grade point average (GPA), service locations, individual- and institutional-level characteristics, and the use of behavioral health services among 22,800 emerging adult college students.
The results of the EABH study showed that 34.2 percent of students with behavioral health concerns used services. Mental health concerns were the most prevalent type experienced; students with co-occurring conditions reported the highest rate of service use. Off-campus services, from a provider in a student’s hometown or other location, were most often used. There was an inverse relationship between GPA and use of services. Several student-level characteristics were related to service use, including race and/or ethnicity, year in school, type of behavioral health diagnosis, prior diagnosis, informal help-seeking, gender identity, sexual orientation, and residential status. Three institution-level variables were related to service use: religious-affiliation, enrollment size, and graduation rate.
The EABH study confirmed both the high prevalence rates of behavioral health concerns and low rates of service use cited previously. In addition to expanding the student-level characteristics analyzed, the EABH study explored the impact of behavioral health status (e.g. type of concerns) and service use on academic outcomes; the examination of institutional characteristics in this context was the most thorough, to date. Future research should investigate other student-level predictors of service use, such as barriers to help-seeking, measures of socioeconomic status, campus climate, sense of belonging, and student stress. Exploring the same institution-level characteristics with new schools would contribute valuable information about their viability as predictors of service use.