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Socioeconomic Disparities in Unmet Need for Student Mental Health Services in Higher Education

  • John CullinanEmail author
  • Sharon Walsh
  • Darragh Flannery
Original Research Article

Abstract

Background

Mental health problems are highly prevalent among college students in many countries. However, evidence suggests that many at-risk students do not receive professional help.

Objective

We aimed to understand which students are most likely to have unmet need for mental health services. Given increasing and widening participation in higher education, we focused attention on disparities by socioeconomic background.

Methods

We analysed data from a recent survey of over 6000 students enrolled in higher education in Ireland. Using three separate measures of mental health problems, namely stress, anxiety, and depression, we developed and modelled an indicator of unmet need.

Results

We found that students from the lowest social class and students with the greatest difficulty in making ends meet have higher rates of unmet need overall, but that these disparities disappear once we control for mental ill-health. For those with mental health problems, unmet need is shown to be independently higher for students who are younger, male, heterosexual, and studying for a Ph.D. We also found a strong independent association between unmet need and self-stigma, as well as considerable differences in unmet need across institutions.

Conclusion

Socioeconomic disparities in unmet need are driven by higher rates of mental ill-health among those from lower socioeconomic backgrounds. Our findings have implications for the targeting of services, as well as the provision of information about mental health and associated services.

Notes

Author contributions

JC conceived and designed the study, performed the analysis, and led the write-up of the manuscript. SW designed the survey questionnaire, gathered the data, performed the literature review, and helped write parts of the manuscript. DF provided input into the design of the survey questionnaire and helped develop the methodology, interpret the findings, and write the manuscript.

Compliance with Ethical Standards

Funding

This work was supported by an Irish Research Council (IRC) Research for Policy and Society award to John Cullinan for the project ‘Student Preferences for Mental Health Services in Irish Higher Education Institutions: A Discrete Choice Experiment’ (RfPS/2016/25). The funders had no role in the design of the study; the collection, analysis, and interpretation of data; the writing of the paper; or the decision to submit the paper for publication.

Conflict of interest

John Cullinan, Sharon Walsh and Darragh Flannery declare they have no conflicts of interest.

Ethical approval

Ethical approval for the study was granted by the NUI Galway Research Ethics Committee and the research was conducted in accordance with the ethical standards of the Declaration of Helsinki.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

40258_2019_529_MOESM1_ESM.docx (44 kb)
Supplementary material 1 (DOCX 44 kb)

References

  1. 1.
    WHO. Mental health action plan 2013–2020. Geneva: World Health Organisation; 2013.Google Scholar
  2. 2.
    Department of Children and Youth Affairs. Better outcomes, brighter futures: a national policy framework for children and young people 2014–2020. In: Department of Children and Youth Affairs, editor. Dublin: Stationery Office; 2014.Google Scholar
  3. 3.
    Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602.  https://doi.org/10.1001/archpsyc.62.6.593.CrossRefPubMedGoogle Scholar
  4. 4.
    Insel T. The global cost of mental illness. National Institute of Mental Health. 2011. https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2011/the-global-cost-of-mental-illness.shtml. Accessed 28 Jan 2019.
  5. 5.
    McGorry PD, Purcell R, Hickie IB, Jorm AF. Investing in youth mental health is a best buy. Med J Aust. 2007;187(7 Suppl):S5–7.Google Scholar
  6. 6.
    Reavley N, Jorm AF. Prevention and early intervention to improve mental health in higher education students: a review. Early Interv Psychiatry. 2010;4(2):132–42.  https://doi.org/10.1111/j.1751-7893.2010.00167.x.CrossRefPubMedGoogle Scholar
  7. 7.
    Ryan ML, Shochet IM, Stallman HM. Universal online interventions might engage psychologically distressed university students who are unlikely to seek formal help. Adv Ment Health. 2010;9(1):73–83.  https://doi.org/10.5172/jamh.9.1.73.CrossRefGoogle Scholar
  8. 8.
    Eisenberg D, Hunt J, Speer N. Help seeking for mental health on college campuses: review of evidence and next steps for research and practice. Harv Rev Psychiatry. 2012;20(4):222–32.  https://doi.org/10.3109/10673229.2012.712839.CrossRefPubMedGoogle Scholar
  9. 9.
    Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry. 2010;10(113):1–9.Google Scholar
  10. 10.
    Laidlaw A, McLellan J, Ozakinci G. Understanding undergraduate student perceptions of mental health, mental well-being and help-seeking behaviour. Stud High Educ. 2016;41(12):2156–68.  https://doi.org/10.1080/03075079.2015.1026890.CrossRefGoogle Scholar
  11. 11.
    Eisenberg D, Hunt J, Speer N, Zivin K. Mental health service utilization among college students in the United States. J Nerv Ment Dis. 2011;199(5):301–8.CrossRefGoogle Scholar
  12. 12.
    Eisenberg D, Gollust SE, Golberstein E, Hefner JL. Prevalence and correlates of depression, anxiety, and suicidality among university students. New York: Educational Publishing Foundation; 2007. p. 534–42.Google Scholar
  13. 13.
    Lipson SK, Eisenberg D. Mental health and academic attitudes and expectations in university populations: results from the healthy minds study. J Ment Health. 2018;27(3):205–13.  https://doi.org/10.1080/09638237.2017.1417567.CrossRefPubMedGoogle Scholar
  14. 14.
    Hunt J, Eisenberg D. Mental health problems and help-seeking behavior among college students. J Adolesc Health. 2010;46(1):3–10.  https://doi.org/10.1016/j.jadohealth.2009.08.008.CrossRefPubMedGoogle Scholar
  15. 15.
    Brown P. The invisible problem? Improving students’ mental health. Oxford: Higher Education Policy Institute; 2016.Google Scholar
  16. 16.
    Eisenberg D, Hunt J, Speer N. Mental health in American colleges and universities: Variation across student subgroups and across campuses. J Nerv Ment Dis. 2013;201(1):60–7.CrossRefGoogle Scholar
  17. 17.
    Corscadden L, Callander EJ, Topp SM. Who experiences unmet need for mental health services and what other barriers to accessing health care do they face? Findings from Australia and Canada. Int J Health Plan Manag. 2019.  https://doi.org/10.1002/hpm.2733.CrossRefGoogle Scholar
  18. 18.
    Alang SM. Sociodemographic disparities associated with perceived causes of unmet need for mental health care. Psychiatr Rehabil J. 2015;38(4):293–9.CrossRefGoogle Scholar
  19. 19.
    Cadigan JM, Lee CM, Larimer ME. Young adult mental health: a prospective examination of service utilization, perceived unmet service needs, attitudes, and barriers to service use. Prev Sci. 2018.  https://doi.org/10.1007/s11121-018-0875-8.CrossRefGoogle Scholar
  20. 20.
    Flisher AJ, Kramer RA, Grosser RC, Alegria M, Bird HR, Bourdon KH, et al. Correlates of unmet need for mental health services by children and adolescents. Psychol Med. 1997;27(5):1145–54.  https://doi.org/10.1017/S0033291797005412.CrossRefPubMedGoogle Scholar
  21. 21.
    McLafferty M, Lapsley CR, Ennis E, Armour C, Murphy S, Bunting BP, et al. Mental health, behavioural problems and treatment seeking among students commencing university in Northern Ireland. PLoS One. 2017;12(12):e0188785.  https://doi.org/10.1371/journal.pone.0188785.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Deasy C, Coughlan B, Pironom J, Jourdan D, Mannix-McNamara P. Psychological distress and help seeking amongst higher education students: findings from a mixed method study of undergraduate nursing/midwifery and teacher education students in Ireland. Ir Educ Stud. 2016;35(2):175–94.  https://doi.org/10.1080/03323315.2016.1146157.CrossRefGoogle Scholar
  23. 23.
    Goodwin J, Behan L, Kelly P, McCarthy K, Horgan A. Help-seeking behaviors and mental well-being of first year undergraduate university students. Psychiatry Res. 2016;246:129–35.  https://doi.org/10.1016/j.psychres.2016.09.015.CrossRefPubMedGoogle Scholar
  24. 24.
    Flannery D, Cullinan J. Economics and higher education policy. In: Cullinan J, Flannery D, editors. Economic insights on higher education policy in ireland: evidence from a public system. London: Palgrave Macmillan; 2017.Google Scholar
  25. 25.
    Flannery D, Doris A, Chapman B. Student financing of higher education. In: Cullinan J, Flannery D, editors. Economic insights on higher education policy in Ireland: Evidence from a public system. London: Palgrave MacMillan; 2017.Google Scholar
  26. 26.
    HEA. Student grant recipients from a first year full-time undergraduate new entrant cohort for the academic year 2013/14 in HEA funded institutions. Dublin: HEA; 2015.Google Scholar
  27. 27.
    HEA. National plan for equity of access to higher education 2015–2019. Dublin: Higher Education Authority; 2015.Google Scholar
  28. 28.
    OECD. Education at a glance: OECD indicators. Paris: OECD; 2018. p. 2018.Google Scholar
  29. 29.
    Karwig G, Chambers D, Murphy F. Reaching out in college: help-seeking at third level in Ireland. Dublin: ReachOut Ireland; 2015.Google Scholar
  30. 30.
    AHEAD. Mental health matters: mapping best practice in higher education. Dublin: Association of Higher Education Access & Disability; 2016.Google Scholar
  31. 31.
    Mental Health Reform. Mental health reform pre-budget submission 2019. Dublin: Mental Health Reform; 2018.Google Scholar
  32. 32.
    Walsh S, Cullinan J, Flannery D, Kennelly B. Modelling student preference heterogeneity for the design of campus counselling services. NUI Galway Discipline of Economics Working Paper Series. 2019.Google Scholar
  33. 33.
    Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales. 2nd ed. Sydney: Psychology Foundation of Australia; 1995.Google Scholar
  34. 34.
    Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol Assess. 1998;10(2):176–81.  https://doi.org/10.1037/1040-3590.10.2.176.CrossRefGoogle Scholar
  35. 35.
    Brown TA, Chorpita BF, Korotitsch W, Barlow DH. Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behav Res Ther. 1997;35(1):79–89.  https://doi.org/10.1016/S0005-7967(96)00068-X.CrossRefPubMedGoogle Scholar
  36. 36.
    Crawford JR, Henry JD. The Depression Anxiety Stress Scales (DASS): normative data and latent structure in a large non-clinical sample. Br J Clin Psychol. 2010;42(2):111–31.  https://doi.org/10.1348/014466503321903544.CrossRefGoogle Scholar
  37. 37.
    Wong J, et al. Web-based survey of depression, anxiety and stress in first-year tertiary education students in Hong Kong. Aust N Z J Psychiatry. 2006;40(9):777–82.CrossRefGoogle Scholar
  38. 38.
    Larcombe W, et al. Prevalence and socio-demographic correlates of psychological distress among students at an Australian university. Stud High Educ. 2016;41(6):1074–91.CrossRefGoogle Scholar
  39. 39.
    Rose D, Harrison E. The European Socio-Economic Classification: A new social class schema for comparative European research. Eur Soc. 2007;9(3):459–90.  https://doi.org/10.1080/14616690701336518.CrossRefGoogle Scholar
  40. 40.
    Jang Y, Yoon H, Park NS, Rhee M-K, Chiriboga DA. Mental health service use and perceived unmet needs for mental health care in Asian Americans. Community Mental Health J. 2019;55(2):241–8.  https://doi.org/10.1007/s10597-018-0348-3.CrossRefGoogle Scholar
  41. 41.
    Denny K. The effect of abolishing university tuition costs: evidence from Ireland. Labour Econ. 2014;26:26–33.CrossRefGoogle Scholar
  42. 42.
    Force National Youth Mental Health Task. National Youth Mental Health Task Force report. Dublin: Department of Health; 2017.Google Scholar
  43. 43.
    HEA. Age of all full-time enrolments undergraduate and postgraduate at 1 in all HEA-funded institutions. Dublin: HEA; 2017. p. 2017.Google Scholar
  44. 44.
    HEA. Domiciliary of origin of full-time students in all HEA-funded institutions, 2016/2017. Dublin: HEA; 2017.Google Scholar
  45. 45.
    HEA. Full-time, part-time and remote enrolments in all HEA-funded institutions in the academic year 2016/2017. Dublin: HEA; 2017.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Discipline of Economics, J.E. Cairnes School of Business and EconomicsNational University of Ireland GalwayGalwayIreland
  2. 2.Department of Economics, Kemmy Business SchoolUniversity of LimerickLimerickIreland

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