Sociodemographic Differences in Barriers and Facilitators of Mental Health Service Utilization Among College Students at Risk for Suicide: A Systematic Review

Background. A lot of college students who experienced suicidal ideation did not seek any formal mental health services. Previous reviews synthesized barriers and facilitators of mental health service utilization among all-aged suicidal people. However, there is no literature review focusing specifically on college students at risk for suicide. Especially, sociodemographic differences in treatment barriers were rarely explored and synthesized. The present literature review aims to answer two questions: a) What are facilitators and barriers to mental health service utilization among college students at elevated suicide risk? b) Do these facilitators/barriers differ by demographic characteristics?

Method. This systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Three groups of key terms indicating suicide risk, college student, and mental health service utilization were combined with “AND” to search in the title or abstract among four databases, i.e., PsycInfo, CINAHL, ERIC, and PubMed. Inclusion criteria were: empirical peer-reviewed articles; published in English; the population was college students at risk for suicide; the outcome or topic was formal mental health service utilization. Eight articles were included, extracted, and analyzed. The quality of each study was assessed using Appraisal tool for cross-sectional studies (AXIS tool) for seven quantitative studies and the critical appraisal skills program (CASP) tool for one qualitative study.

Findings. Perceived low need for service, preference for self-management, lack of time were the most common barriers to service, followed by financial reasons, and fear of stigma, belief in/questioning on treatment effectiveness. Several social network factors were found to be facilitators, including encouragement from others, disclosure of suicidal ideation to others, and receiving advice on seeking professional help. Gender differences in barriers were noted in several studies. First, women are more likely to report barriers such as lack of time, financial issues, fear of hospitalization, and parental notification (S03, S05, S07). Stigma, low perceived need, and preference for self-management are more significant among men (S05, S07). In terms of racial difference, Asian students report more language barriers, low perceived need than White Americans (S01, S07, S08). Financial barriers were prominent among Hispanic and Black students (S05, S07). White students are more likely to normalize stress status (S07). Gender minority and all racial-ethnic minority groups are more likely to report cultural sensitivity concerns (S05).

Conclusions. Understanding the barriers that are prominent for certain racial and ethnic groups is important to close the service utilization gap for college students at risk for suicide. The findings from this review underscore the importance of providing more culturally sensitive mental health services for all students of minority status. Besides, institutional support can be provided to help students overcome structural barriers, such as financial burden and lack of time. The findings also found that almost all subgroups face some unique attitudinal barriers to service utilization (such as self-reliance for men, family responsibilities for women, and normalizing stress for White students). This review underscored the importance of shifting harmful social norms or helping students become aware of the influence of social norms.