University counseling centers serve students from diverse linguistic and cultural backgrounds; however, institutional materials often assume linguistic neutrality, which may unintentionally disadvantage multilingual, international, and domestic bidialectal students. Despite attention to cultural competence in counseling services, limited research has explored how the language used in institutional materials influences students' perceptions of accessibility and support. Using critical discourse analysis informed by sociolinguistic, raciolinguistic, and psychological safety frameworks, this study examined available counseling center materials - websites, intake forms, crisis protocols, and outreach documents - from ten Midwestern universities. Results show that counseling center communications focus on procedural clarity and individual responsibility while subtly expecting standardized emotional expressions. Crisis messaging further reinforces these expectations, increasing stress for students whose communication styles differ from institutional norms. Although these discourse patterns do not limit access, they can influence students' perceptions of counseling center responsiveness, belonging, and psychological safety. The findings highlight opportunities for counseling centers to improve access by explicitly acknowledging language differences, supporting multiple modes of emotional expression, and addressing structural barriers in institutional communication. Practical recommendations include revising intake materials, offering multimodal communication options, training staff in linguistically responsive practices, and collaborating with campus partners to enhance student engagement with counseling services.
College campuses are increasingly relying on threat assessment (TA) teams to identify and intervene with students exhibiting behaviors of concern (e.g. stalking, harassment, and targeted violence). Many of these students also present with suicidal ideation embedded within broader mental health concerns, yet the intersection of suicidality and targeted violence risk remains underexplored in college mental health literature. This study analyzes 494 cases managed by a university TA team to better understand how suicidality influences clinical risk indicators and behavioral escalation. Individuals presenting with suicidal ideation were more likely to have diagnosed mental illness, particularly symptoms of psychosis and emotional dysregulation, and often voiced grievances rooted in perceived victimization. Their communication patterns were more frequent, multimodal, and threatening, with several including specific plans to harm themselves or others. Although these individuals were not more likely to perpetrate violence, their cases reflected greater psychological complexity and more intense clinical presentations. These findings support the importance of integrating campus mental health professionals into behavioral intervention teams, and the need for Structured Professional Judgment (SPJ) models that account for co-occurring risks to self and others. Implications for assessment, clinical management, and suicide prevention efforts in college settings are discussed.
Mental health stigma is associated with suicide-related outcomes, yet its mechanisms may differ across racial and ethnic groups. Using nationally representative data from the 2023-2024 Healthy Minds Study (N = 88,014; ages 18-29), this study examined whether personal stigma mediates the relationship between perceived stigma and suicide-related outcomes, and whether this pathway varies by race and ethnicity. Moderated mediation analyses (PROCESS Model 7) controlled for sex at birth, education, LGBTQ+ identity, and depressive symptoms. Perceived stigma significantly predicted higher personal stigma (B = 0.22, 95% CI [0.22, 0.23], p < .001). In turn, personal stigma was positively associated with suicidal ideation (logit B = 0.07, p < .001) but negatively associated with suicide attempts (logit B =-0.07, p = .02); no significant effect was found for suicide planning. Race and ethnicity moderated the association between perceived stigma and personal stigma, with stronger associations observed among Asian and Hispanic/Latinx participants than among White participants. Conditional indirect effects for suicidal ideation were significant across racial and ethnic groups, but the index of moderated mediation reached significance only for Asian participants. No moderated mediation was observed for suicide planning or suicide attempts. These findings contribute to the literature by clarifying the stage-specific and culturally contingent pathways through which stigma may shape suicidality among U.S. college students.
The exam session is one of the most intense stressors for university students. Its effects and intensity depend on mental resources and coping styles. Trait anxiety increases susceptibility to the destructive impact of stress and is linked to maladaptive coping strategies. Internal dialogues play a key role in self-regulation; among them, identity and perspective-changing dialogues are the most adaptive and positively related to well-being. This study aimed to examine whether these two types of internal dialogue moderate the relationship between trait anxiety and maladaptive coping strategies among university students during the exam session. Participants were 230 Polish students from 57 universities. The following instruments were used: the State-Trait Anxiety Inventory, Brief-COPE Inventory, and Internal Dialogical Activity Scale - Revised. Moderation analyses showed that identity dialogue did not moderate the examined relationships. In contrast, perspective-changing dialogue weakened the relationship between trait anxiety and the self-distraction strategy but simultaneously strengthened the association between anxiety and venting. This implies that training in constructive perspective-changing dialogue may attenuate the propensity for stressor-avoidance strategies, thereby promoting more adaptive coping in exam-related contexts. However, the risk of impulsive emotional expression in anxious students imposes an obligation on practitioners to integrate this form of intervention with emotion-regulation techniques.
Despite the professional and social benefits associated with higher educational attainment, this period of growth can also introduce a range of stressors that can negatively impact students' mental health. Young adults are at a higher risk for developing mental health conditions during this transitionary period, particularly anxiety and depression. Personal, circumstantial, and societal barriers can negatively impact students' experience. Connection and sense of belonging have been widely recognized as essential mitigating factors, promoted by peer relationships, faculty mentorship, and campus supports. The current qualitative study gathered student perspectives through focus group discussions about challenges, institutional supports, belongingness, and well-being at a post-secondary institution in Canada. The findings from this project were used by those in student support services at the institution to guide campus Mental Health Strategy moving forward. Thematic analysis by two independent coders revealed four overarching themes: (1) financial challenges and frustrations, (2) accessing supports, (3) faculty and program; and (4) connection/campus climate. Implications of these findings are discussed along with possible steps for better supporting student success and well-being.
Understanding group differences in psychotherapy outcomes can help mental health practitioners develop effective treatment plans based on knowledge of specific populations. This study examined differences in psychological symptoms during therapy for military veteran and civilian students using latent growth curve models (LGCMs). Samples of 1,822 military veteran and 1,822 civilian students who attended therapy during the 2016-2018 and 2021-2023 academic years and completed the Counseling Center Assessment of Psychological Symptoms-34 (CCAPS-34) during two or more sessions were used. There were no differences in LGCM parameters across military veteran and civilian students for Depression and Academic Distress scales. There were minor differences across groups on the Generalized Anxiety, Social Anxiety, and Eating Concerns scales, where civilian students had higher initial levels of distress than military veteran students. The largest differences were for the Hostility and Alcohol Use scales, where military veteran students had higher initial levels of distress, faster rates of change across sessions, and greater variability in initial levels and rates of change compared to civilian students. Practitioners providing services to military veteran students may need to carefully consider hostility and alcohol use with this population and consider treatments studied with military veterans.
Climate change poses a psychological burden on young people's health and mental health. Yet limited research explores how climate-related anxiety intersects with mental health and eco-behavioral engagement in university settings. This study examined the relationship between climate change anxiety, mental health symptoms, and eco-activism among undergraduate and graduate students (n = 126) at a large western U.S. university. Participants completed validated measures of climate anxiety, depression, generalized anxiety, and eco-activism through an online survey. Results indicated moderate levels of climate change anxiety across the sample. Students identifying as female or non-binary reported significantly higher cognitive-emotional impairment and greater ecological behavioral engagement compared to male students. Political affiliation and household income were also significantly associated with climate anxiety dimensions. Climate anxiety positively correlated with symptoms of depression and generalized anxiety, as well as with engagement in eco-activism such as environmental leadership and participation. However, no significant differences emerged in climate anxiety functional impairment across demographic variables. Findings suggest that climate anxiety is a mental health concern and a motivator for ecological action. Higher education institutions should consider expanding support systems that address students' climate-related anxiety and equip them with resources to process ecological concern while also engaging in pro-environmental behavior.
Eating disorder (ED) symptoms are prevalent among university students, with perfectionism identified as a significant psychological risk factor. However, the cognitive mechanisms that mediate this relationship remain insufficiently understood. The current study examined how upward counterfactual thinking (UCT; the "what-if" consideration of how past events might have been better) mediates the link between perfectionism and eating disorder symptoms among Iranian university students. A cross-sectional design was employed with 320 Iranian university students (M = 21.26, SD = 3.43). Participants completed the Frost Multidimensional Perfectionism Scale, Counterfactual Thinking for Negative Events Scale, and the Eating Attitudes Test-26. Structural equation modeling (SEM) revealed that perfectionism predicted dieting (beta = 0.142, z = 2.029, p = .042) and oral control (beta = 0.138, z = 1.999, p = .046). Additionally, UCT partially mediated the relationship between perfectionism and oral control (beta = 0.097, z = 2.471, p = .013), but not with other ED symptoms. The final model showed an adequate fit (chi 2 /df = 1.97, RMSEA = .05, CFI = .97). Findings highlight the role of overutilization of what-if thoughts in amplifying restrictive ED symptomatology and suggest interventions targeting counterfactual rumination in those with high perfectionism.
Mental health disparities among Black, Hispanic, and Asian college students remain a critical concern, particularly in relation to culturally stressful experiences and identity processes. In the present study, we examined the interplay of cultural stress, ethnic identity, and national identity with mental health concerns and well-being among Black, Hispanic, and Asian college students. Participants included 1,130 Black, Hispanic, and Asian students from seven ethnically diverse universities across the United States. We used latent profile analysis to model subtypes of cultural stress (i.e. discrimination, microaggressions) and identities (i.e. ethnic, national). We identified three distinct profiles characterized by varying levels of cultural stress, identity development, and negative affect. These profiles differed meaningfully in mental health concerns and well-being. Specifically, students experiencing high cultural stress reported the most severe mental health concerns, whereas those with low cultural stress and well-resolved identities reported the most favorable well-being. Notably, although a resolved bicultural identity was associated with higher well-being, students with resolved identities coupled with high negative affect appeared more vulnerable to mental health concerns under conditions of high cultural stress. Findings highlight the importance of considering the joint roles of cultural stress and identity processes in understanding mental health among college students of color.
First-generation college students, a significant subset of college students in the United States, are at heightened risk of poorer academic outcomes and lower psychological well-being when compared with continuing-generation college students. The mechanisms underlying these associations, however, remain largely unknown. Students' sense of belonging within different college contexts may help explain the relationship between generational status, academic satisfaction, and flourishing. Participants in the current study were 329 college students who completed a series of self-report questionnaires assessing generational status, academic satisfaction, flourishing, and four belonging factors. Findings revealed that after controlling for participant ethnicity, first-generation student status was indirectly associated with both lower academic satisfaction and lower flourishing through two belonging factors: classroom comfort and faculty support. These results suggest that fostering first-generation students' sense of belonging in academic settings, specifically, may play an important role in bolstering students' academic success and psychological health.
The increasing enrollment in post-secondary education has highlighted the need for effective university policies to support students facing mental health challenges. This study explores the impacts of involuntary university leaves of absence on students with mental health issues, focusing on their experiences, the effectiveness of these policies, and recommendations for improvement. Using a qualitative methodology involving framework analysis, 22 emerging adult undergraduate students from across Canada were interviewed to understand their journeys before, during, and after taking an involuntary leave of absence. The study identifies three primary themes: (a) the health and well-being journey in the context of the leave of absence; (b) the interactions between mental health and university structures, supports, and policies; and (c) other influences on mental health and well-being. Academic pressure, interpersonal stressors, and the COVID-19 pandemic significantly contributed to the need for a leave of absence. Student outcomes, however, differ markedly: some students report relief and personal growth, whereas others contend with disrupted identities and difficulties reengaging with university life. The study underscores the importance of tailored support systems and policies that address the unique needs of students with mental health issues, advocating for a balance between institutional requirements and student well-being.
This study investigated the daily mediating role of core self-evaluation (CSE) in the relationship between academic social comparison (upward and downward) and college students' mental health. A 15-day daily diary design was employed with 116 college students who reported their academic social comparisons, CSE, perceived stress, and state anxiety. Data were analyzed using multilevel mediation modeling in Mplus 8.3. Findings indicated that, at the between-person level, a "contrast effect" emerged, with students who habitually engaged in more upward comparison reported higher CSE and lower psychological distress, while those prone to downward comparison showed the opposite pattern. Conversely, at the within-person level, daily increases in both upward and downward comparison were associated with diminished CSE and heightened stress and anxiety. Crucially, CSE consistently mediated the impact of social comparison on mental health fluctuations at both levels of analysis. These findings highlight a divergence between trait-like tendencies and state-level experiences in academic evaluation. While upward striving may characterize high-functioning students, the act of comparison itself appears to be a daily stressor that taxes self-worth. Future research should utilize experimental designs to develop interventions aimed at mitigating the negative psychological impacts of frequent academic comparison.
The present RCT investigated the short-term effectiveness of a voice-based conversational Artificial Intelligence (AI) agent (Maya and Miles) compared to a traditional psychoeducational video in reducing state anxiety among undergraduate students during exam periods. Sixty participants (aged 18-22) who reported elevated levels of state anxiety on the State-Trait Anxiety Inventory (STAI-S) were randomly assigned to one of the two conditions: the experimental group (n = 30) engaged in a 12-15-min interaction with a conversational AI agent (Maya or Miles), while the control group (n = 30) viewed a 15-min TED Talk on anxiety management. Pre- and post-intervention anxiety scores were recorded. A two-way mixed ANOVA revealed a significant main effect of time and group (F = 73.17, & 28.28 p < .001), respectively, indicating a reduction in anxiety across both groups. The group & times; time interaction was not significant, indicating no statistical evidence that one intervention was more effective than the other. However, effect size analysis revealed large within-group reductions in anxiety for both the conversational AI group (d = -1.12) and the video group (d = -1.10), underscoring the strong impact of both interventions. These findings suggest that both interactive and non-interactive digital interventions may serve as viable short-term tools for managing state anxiety in academic contexts. Future studies should explore longer-term effects and the role of user expectations and engagement styles in shaping outcomes.
Mood disorders are commonly reported by student-athletes but are often untreated, compromising academic and athletic performances. Sociodemographic, institutional, and individual factors modify mood disorder symptom risk and treatment-seeking/avoidance, but studies of combined effects in student-athletes are rare. The present non-experimental, epidemiological study uses multivariable logistic regression and relative risk to evaluate these effects on mood disorder symptoms, diagnoses, and treatment in a sample of n = 51,882 student-athletes responding to the U.S. National College Health Assessment. Data spanned 2011-2019, collected at different points during those years. Over 75% of student-athlete respondents reported mood disorder symptoms, 27.4% reported depression-related functional barriers, and similar to 6% reported intentional self-harm/considering/attempting suicide. Of those experiencing functional barriers, just 21.1% reported treatment. Gender, sexuality, race/ethnicity, international status, year in school, school type, and treatment history significantly affected symptom risk. Diagnosis/treatment was significantly influenced by gender, sexuality, race/ethnicity, treatment history, and academic impacts. Among those reporting diagnoses, 80.5% received treatment, with gender, sexuality, race/ethnicity, year in school, treatment history, and academics predictive of untreated diagnoses. Sociodemographic, institutional, and individual factors significantly affected mood disorder symptoms and treatment-seeking propensity. This impact potentially aids athletic trainers and other providers in early screening for at-risk individuals, encouraging treatment, and improving student-athlete mental health.
Suicide is the second leading cause of death among college students. The recent transition of the National Suicide Prevention Lifeline to the 3-digit 988 Suicide and Crisis Lifeline offers new opportunities for students at elevated risk of suicide to receive free, 24/7 crisis support; however, little is known about college students' help-seeking intentions and behavior related to the service. We therefore sought to examine reported levels of knowledge and use of the 988 Suicide and Crisis Lifeline and factors associated with intentions to use the Lifeline among college students at elevated risk of suicide (N = 379). Only 12 participants reported use of the 988 Suicide and Crisis Lifeline, whereas over half of the participants were unaware of the service. Identifying as Latinx was significantly associated with lower odds of intentions to use the Lifeline. Furthermore, students identified mental health crises and life stressors, concerns about the Lifeline, and personal beliefs as factors that would influence their use of the Lifeline. Further efforts are needed to increase tailored public messaging about the Lifeline to increase help-seeking among students.
Embedded programs in college counseling centers have emerged across campuses in response to growing demands for mental health support for college students. Though the benefits of embedded programs for students have been well established, less is known about the impact these programs have on the providers. Preliminary discussions suggest that this work can be burdensome, given the nuances of working outside of the counseling center, navigating the cultures of different colleges, and coordinating with campus partners. To better understand the inherent impacts on the providers, a survey was sent to embedded providers across the country to learn more about how to engage and retain embedded counselors on college campuses. Data for this study consisted of a 17 question Qualtrics survey. The survey utilized a mixed-method approach, incorporating multiple choice options for structured data, open-ended questions for qualitative insights, and a 1-10 rating scale to assess levels of stressors. It was completed by 94 embedded therapists across North America (United States and Canada). This study serves as an essential first step in understanding the challenges of college and university counseling centers' embedded therapists. The data is reviewed, and suggestions are made for optimizing the sustainability of the embedded role.
