College Student Mental Health: An Investigation of How Stigma Shapes Beliefs, Attitudes, and Communication Intentions and Preferences

Background and Purpose: Increasingly, social work practice is focused on meeting rising demands for mental and behavioral health services on college campuses for students who have pre-existing psychiatric conditions as well as those who are coping with traumatic life issues, mental health distress, and emerging mental and behavioral health illnesses. First-generation, international, and racial-ethnic minority students may be particularly vulnerable to experiencing mental health distress and less likely to seek mental health treatment; such inequities may be attributable, in part, to the pervasive stigma surrounding mental illness. Stigma can manifest in myriad ways, including the use of derogatory labels, social distancing, and discriminatory behavior, and may also influence willingness to communication about mental health. Thus, it is especially critical to consider the impact of stigma on college students’ mental health communication motivations and preferences. The purpose of this exploratory study was to investigate: 1) how college students conceptualize communication about mental health; and 2) the presence and influence of stigma on college students’ beliefs and attitudes about mental health communication.

Methods: A cross-sectional online survey was administered to college students (N = 200) at a large Northeastern University. The survey questionnaire contained validated scales to measure mental health beliefs, attitudes, and behavioral intentions, and a thought-listing procedure designed to generate participants’ beliefs and attitudes about mental health communication. A content analytic procedure was used to explore thought-listing data for the presence of stigma characteristics in college students’ beliefs about mental illness (e.g., stereotypes about the nature and consequences of mental illness) and to identify mental health communication preferences (e.g., specific words/phrases that students would use/avoid in mental health communication scenarios). Statistical analyses were performed to explore associations between constructs of interest.

Results: Even as the results revealed an awareness about the negative effects of stigmatizing language in mental health communication, thematic analysis of participants’ conceptions about mental health distress revealed an emphasis on extreme and stereotypical symptomatology associated with mental illness. The results revealed an association between stigmatizing beliefs and attitudes about mental illness and decisions about whether to communicate about mental health. Imagined stigma reactions have a particularly negative effect on beliefs, attitudes, and behavioral intentions related to communicating about mental health. Results also showed the moderating effect of identity characteristics, including personal or familial experiences with mental illness, college student status (e.g., first-generation), and racial/ethnic identity.

Conclusions and Implications: Findings from this study have important implications for mental health promotion on college campuses as well as mental health practice and intervention. This study offers suggestions for improving mental health education (e.g., providing targeted educational messages to strengthen identification and understanding of the signs and effects of mental illness and distress) and addressing mental health communication strategies at both the micro and mezzo level (e.g., providing suggestions for communicative and linguistic strategies between college students, mental health treatment providers, and college staff and faculty to motivate mental health communication and mitigate impact of stigma) in order to address inequities in college student mental health and treatment.