Sexual Assault Prevalence and Access to Mental Health Services Among International and Domestic College Students

Background: Sexual assaults (SA) on US college campuses continue to be a widespread problem leading to myriad negative consequences for survivors. Accessing mental health services can help alleviate the damaging effects of SA and promote improved health and well-being. With over one million enrolled at US institutions of higher education (IHEs), international students currently make up 5.5% of the total student enrollment—a dramatic increase from previous years.  Existing research does not adequately address the SA experiences and behaviors related to help-seeking and service utilization among international college students enrolled at US IHEs. It also remains unknown whether college students who experience SA compared to their non-victimized peers are more or less likely to access mental health services during college. Therefore, the purpose of this study was to determine (1) whether students who experienced SA were more likely to receive mental health services than students who do not experience SA; and (2) whether international students, whether assaulted or not were more likely than domestic students to receive mental health services.

 Methods: The study used data from the 2016-2017 Healthy Minds Study (HMS). Data were collected from a random sample using a web-based survey, which is administered annually to colleges and universities in the US. Key independent variables included report of SA by a known or unknown perpetrator and status as an international or domestic student. The primary outcome variable was use of therapy services during college. Descriptive statistics were used to describe the prevalence of the covariates among international and domestic students. Five logistic regression models were used to determine the adjusted odds ratios and the 95% confidence intervals. All statistical significance was determined at the p<0.05 level.

 Results: The analyzed sample (n=39,976) included respondents from 54 institutions. Among international students, 1.43% reported SA by an unknown perpetrator and 1.76% by a known perpetrator. Domestic students reported slightly higher rates of assault, with 2.07% reporting a SA by an unknown perpetrator, and 2.55% reporting a known perpetrator. A larger percentage of domestic students (28.49%) received mental health counseling during college, compared to international students (17.19%).  Compared to students who did not report an experience of SA, the adjusted odds of receiving mental health services during college were 2.11 times higher for students who reported an experience of SA by an unknown perpetrator, and 1.40 times higher when the perpetrator was known. Compared to domestic students, international students were less likely to receive mental health services (AOD = 0.73); however, international student status was not a significant predictor of accessing mental health services for both assault categories (i.e. known and unknown perpetrators).

Implications: Because students who were assaulted were more likely than the general student population to access mental health services, counselors providing mental health services to college students should be equipped to address the unique mental health needs of SA survivors. Research, practice, and policy should focus on addressing barriers that affect international students’ ability to access mental health services and create strategies to promote access to mental health services.