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

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



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.


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.


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.


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.


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.


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


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)


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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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