Community college students have higher rates of mental health problems compared to same age peers at 4-year institutions, according to a new national study. It also found that community college students from traditionally marginalized backgrounds were more likely to have mental health problems and less likely to get treatment. The study appears online this week in Psychiatric Services, a journal of the American Psychiatric Association.

Community college students make up about a third of all undergraduate college students in the U.S. In addition, about half of all students completing a degree at four-year institutions attended community college at some point in the previous 10 years. On average, community college students are older and more likely to be students of color or come from low-income backgrounds compared to students at 4-year colleges. For all students, mental health challenges increase the likelihood of dropping out of college.

Data for this study, led by Sarah Ketchen Lipson, Ph.D., Ed.M, with Boston University, came from the national Healthy Minds Study, a large annual survey examining mental health in college students. It involved more than 10,000 students from 23 community colleges and more than 95,000 students from 133 4-year institutions from the fall of 2016 through the spring of 2019.

Overall, the rates of mental health problems were similar at the community colleges and four-year schools, with just over half of students screening positive for one or more mental health problems. However, when the researchers compared that rates among similar age students, those 18 to 22 years, the rate was significantly higher among community college students than students at 4-year institutions. Financial concerns played a large role—financial stress was a strong predictor of mental health problems.

While the data for the study is from prior to the pandemic, more recent information has found that rates of mental health problems during the pandemic have increased more among young adults than among any other age group. In the latest Centers for Disease Control and Prevention Household Pulse survey from Feb. 3 to 15, 2021, 56% of young adults (ages 18-29) reported symptoms of depression or anxiety, the highest of any age group. In this ongoing survey, young adults have consistently had the highest rates of mental health concerns throughout the pandemic.

Use of Mental Health Services

Community college students were significantly less likely to have used mental health services, either psychotherapy or medication, compared to students on four-year campuses. Among college students ages 18-22 with at least one mental health condition, 25% of community college students used therapy and 26% used psychotropic medication, while 40% of four-year students used therapy and 32% used psychotropic mediations.

Community college students are also less likely to have access to services on campus. Among students receiving mental health services, 23% of students at four-year colleges used services on campus compared to only 5% of community college students.

Students from traditionally marginalized backgrounds were less likely to use mental health services and service use varied by race and ethnicity. For example, among community college students with at least one identified mental health problem, 18% of Latinx students used psychotropic medication, compared to 38% of white students. The authors note that it is unclear if the difference was due to cultural preferences or lack of access.

Barriers to Treatment

Financial concerns were the most common barrier to treatment among community college students who screened positively for at least one mental health disorder. Other reasons cited include wanting to deal with it on their own, not having enough time, and no need for service. (See figure.) Almost one in five community college students indicated they didn’t know where to go for treatment.

The authors suggest that increasing community college student access to psychotherapy is particularly important, both because it is often preferred over medication and because younger students could especially benefit from the cognitive tools and coping skills built through therapy as they are experiencing their first symptoms of a mental disorder.

Lipson and colleagues conclude that collectively, the findings “point to a need to assess financial stress as part of the full picture of student well-being and academic persistence and to consider high levels of financial stress as a risk factor not only for retention but also for mental health.” They also note the findings have important implications for campus policies and programs and for future research to advance equity in mental health and other key outcomes.