Mental health concerns among college students have increased in recent years—rates of depression, anxiety, substance use and suicidal behaviors have all increased. One in four college students had a psychiatric diagnosis in the past year, and racial-ethnic minority students maybe at high risk of undetected mental illnesses, according to new research published in Psychiatric Services.

Mirroring the overall U.S. population, the college student population is increasingly diverse. Minority high school students (non-white) are expected to become the majority of high school graduates by the mid-2030s. The number of Americans who identify as multiracial or multiethnic is also growing rapidly. In 2015, one in seven U.S. infants (14 percent) were multiracial or multiethnic.

Researchers, led by Justin A. Chen, M.D., M.P.H., with Massachusetts General Hospital and Harvard Medical School, sought to develop a large-scale analysis of the mental health experience of college students, particularly racial and ethnic minority students. The study used data from the 2015 American College Health Association – National College Health Assessment and involved information on more than 67,000 undergraduates from more than 100 colleges.

The study found high rates of psychiatric symptoms and psychiatric diagnosis for students of all races/ethnicities, 25.9 percent reported having a psychiatric diagnosis in the past year. Responding to questions about a range of mental health symptoms, more than four in five students said they felt overwhelmed by all they had to do at some point. About half of all college students said they have at some point “felt things were hopeless;” more than 60 percent have felt very lonely; and 35 percent said they felt so depressed that it was difficult to function. About 7 percent of college students said they had intentionally injured themselves, nearly one in 10 (9.8 percent) said they had seriously considered suicide and 1.5 percent said they had attempted suicide.

Multi-racial students were less likely than whites to have a psychiatric diagnosis, but they had significantly greater likelihood of experiencing eight of the 11 mental health symptoms compared with white students. Multiracial students also had higher rates of considering or attempting suicide.

Asian/Pacific Islander students were more likely to have considered or attempted suicide than whites, “strongly suggesting under detection of psychiatric problems in this group,” the authors note. Black and Hispanic students were less likely than whites to have a psychiatric diagnosis and less likely to experience most of the mental health symptoms or indicators, but their rates of past year attempted suicides were virtually the same as whites.

According to Chen and colleagues, while these differences may reflect an actual difference in prevalence, other factors may contribute to the lower rates of diagnosis among some groups. For example, a lack of access to care or stigma of mental illness could contribute. In addition, students from racial-ethnic minority groups may conceptualize or express symptoms differently than their white peers, potentially contributing to providers minimizing or misinterpreting students’ description of symptoms, the authors suggest.

To help address these disparities, the authors recommend that universities consider early, proactive, culturally informed education and prevention programs designed to increase mental health awareness and engagement, particularly among racially and ethnically diverse students.

“Simply providing care for those already aware of their diagnosis is likely not enough,” Chen and colleagues conclude.