Examining the Role of Predictive Factors in Mental Health Service Utilization Among African American College Students

Background & Purpose: Gender, education, employment, insurance coverage and need are common factors believed to be associated with mental health service utilization (MHSU) among African Africans (AA) and college students (CS), respectively.  However, research assessing the impact of these factors on MHSU among AACS has not been well-investigated.  AACS may be at greater risk given the potentially cumulative vulnerabilities of race and age on incidence of mental illness and the long-term consequences of untreated mental illness that disproportionately affect this population, such as lower retention and graduation rates.  Thus, it is important to explore factors that may increase utilization of MH services to offset these challenges.  Drawing from health services theoretical frameworks, this study examined the association between specific predictive factors and MHSU among AACS.   

Methods: A sample of self-identified AACS (n = 1789) was drawn from the National College Health Assessment of the American College Health Association, a nationally recognized research survey assessing various content areas, including mental health.  The original data consisted of 28,237 university students collected in Fall, 2012.  The dependent variable was MHSU, which was assessed using items that asked whether respondents had ever received psychological or MHS from various professionals (i.e., psychiatrist, counselor, physician, clergy, or their current university’s counseling/health service).  Independent variables included predisposing factors (gender, education, employment), enabling factors (whether respondent had insurance coverage), and need for services (lifetime diagnosis of depression).  Multivariate logistic regressions were employed.       

Results: The study sample was entirely AA with a mean age of 23.  Most were female (73%), freshmen (27%), working part-time (52%), and insured (90%).  Sixteen percent had been diagnosed with depression in their lifetime, while 39% had utilized at least one MHS within the same timeframe.  Gender, education, and need were positively associated with increased odds of utilizing MHS.  Females were nearly twice as likely as males to have used at least one service (OR=1.70, 95% CI=1.30, 2.24, p<.001).  As a respondents’ year in college increased, so did the likelihood for having utilized services.  Compared to freshmen, respondents who were sophomores and above were more likely to have used at least one service (sophomores: OR=1.48, 95% CI=1.05, 2.09; juniors: OR=1.76, 1.26, 2.48, p=.001; seniors: OR=1.74, 95% CI=1.22, 2.48, p=.002; graduate students: OR=3.13, 95% CI=2.01, 4.89, p<.001).  Those with a need for services were almost 11 times for likely to have utilized at least one service compared to those with no need (OR=10.90, 95% CI=7.63, 15.57, p<.001). 

Conclusions/Implications: These findings support the literature which indicates being female, later year in college, and need for services are strong predictors of MHSU, even among AACS.  However, there are implications for social work researchers and practitioners to develop and implement creative solutions for targeted outreach of AA college freshmen and those who are male, particularly as it relates to retention and increased graduation rates.  In so doing, we have the opportunity to improve social and behavioral longevity and the long-term quality of life for a population that has historically been disproportionately burdened by mental illness.