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

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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.

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Data Availability Statement

The data used in this paper were collected as part of a confidential survey of college students and are therefore not publicly available. However, independent researchers can be given access to the data at the National University of Ireland Galway subject to signing a data usage agreement. The agreement allows independent researchers to access and analyse the data, but not to take the data away from the National University of Ireland Galway.

Notes

  1. Perceived unmet need occurs when an individual perceives/reports they had a need for mental health treatment or counselling but did not get it.

  2. Outside of the higher education setting, students can access mental health services for free through the public health system. However, long waiting times are also common in this case [31]. Alternatively, students can pay out-of-pocket in order to engage private mental health professionals.

  3. For the academic year 2017/18, examination periods in most institutions were in December 2017 and/or April/ May 2018. Therefore, our data collection did not occur during an examination period, which can be stressful for many students.

  4. To address potential sample selection bias, we stressed in the invitation email to students that we were interested in the views of all students—those who have experienced a mental health issue and those who have not. In addition, all students were incentivised to partake as they were told that those who participated would be entered into a draw to win a 128 GB iPad.

  5. According to Wong et al. [37], “it is worth noting the rates of depression, anxiety and stress symptoms of moderate severity or above as such symptom levels are likely to lead to some functional impairment and may require attention from health-care professionals”, while Larcombe et al. [38] state that “results in the moderate and higher ranges indicate that the respondent is likely to be experiencing difficulties with some daily activities such as sleeping, concentrating, processing information and interacting with others”.

  6. The distinction between the two definitions is important since a student with a need for care may not be looking for many reasons, e.g. they don’t realise that they have a need, associated stigma with help seeking, or have a preference for self-reliance.

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Author information

Authors and Affiliations

  1. Discipline of Economics, J.E. Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland

    John Cullinan & Sharon Walsh

  2. Department of Economics, Kemmy Business School, University of Limerick, Limerick, Ireland

    Darragh Flannery

Authors
  1. John Cullinan
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  2. Sharon Walsh
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  3. Darragh Flannery
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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.

Corresponding author

Correspondence to John Cullinan.

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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.

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Cullinan, J., Walsh, S. & Flannery, D. Socioeconomic Disparities in Unmet Need for Student Mental Health Services in Higher Education. Appl Health Econ Health Policy 18, 223–235 (2020). https://doi.org/10.1007/s40258-019-00529-9

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