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Major Article
Mental Health Treatment Barriers Among Racial/
Ethnic Minority Versus White Young Adults 6
Months After Intake at a College Counseling
Center
Regina Miranda, PhD; Ariella Soffer, PhD; Lillian Polanco-Roman, MA;
Alyssa Wheeler, BA; Alyssa Moore, BA
Abstract. Objective: This study examined mental health treat-
ment barriers following intake at a counseling center among
racially/ethnically diverse college students. Methods: College stu-
dents (ND122) seen for intake at a college counseling center in
2012–2013 completed self-reports of depressive symptoms, sui-
cidal ideation, and mental health treatment barriers 6 months later.
Results: Racial/ethnic minority students less often reported previ-
ous mental health treatment and treatment after being seen at the
counseling center, compared with white students. They also
endorsed more treatment barriers—most commonly, financial con-
cerns and lack of time—and more often endorsed stigma-related
concerns. Treatment barriers were associated with not following
through with counseling center recommendations and with greater
depressive symptom severity but not with suicidal ideation during
follow-up. Conclusions: Improving mental health treatment seek-
ing among racial/ethnic minority college students should involve
decreasing treatment barriers, improving access to affordable
options, providing flexible scheduling or time-limited options, and
decreasing stigma.,
Keywords: college students, counseling, depression, mental
health treatment barriers, suicidal ideation
Despite a high prevalence of psychiatric disorders,
1
col-
lege-aged racial and ethnic minorities are less likely than their
white counterparts to seek mental health treatment.
2
The Sub-
stance Abuse and Mental Health Services Administration
(SAMHSA) has identified mental health service underutiliza-
tion on college campuses, coupled with increased prevalence
of depression and suicide attempts, as a national health crisis.
3
Anationwidesurveyofstudentsfrom26collegesfoundthat
only 31% of students who endorsed clinically significant
depressive symptoms and 38% of students who reported sui-
cidal ideation in the previous 12 months had received mental
health treatment during that period of time.
4
Research exam-
ining the causes of such low service use among college stu-
dents has consistently identified several barriers to care.
5–7
A
study of college students with a lifetime history of suicidal
ideation found that students who perceived that they had
insufficient mental health treatment cited a number of barriers
that kept them from obtaining treatment, including thinking
they could handle the problem without treatment (58%), lack
of time (42%), thinking treatment would not be helpful
(36%), thinking that others would have a negative opinion of
them (39%), and not knowing where to get treatment (24%).
5
Similar barriers have been identified elsewhere in the
literature.
6,7
Prior studies on treatment barriers in college populations have
relied on samples consisting primarily of white students. As a
result, they offer little information related to variations due to racial
and ethnic minority status. Consequently, the present study aimed
to identify differences in often-cited barriers to treatment between
racial/ethnic minority and white college students seen for intake at
a college counseling center and followed up 6 months later.
Dr Miranda is with the Department of Psychology at Hunter
College, City University of New York, in New York, New York,
and The Graduate Center at City University of New York in New
York, New York. Dr Soffer is with Counseling and Wellness
Services at Hunter College, City University of New York in New
York, New York. Ms Polanco-Roman is with The Graduate Center
at City University of New York in New York, New York. Ms
Wheeler and Ms Moore are with the Department of Psychology at
Hunter College, City University of New York in New York, New
York.
Copyright Ó2015 Taylor & Francis Group, LLC
291
JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 63, NO. 5
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Racial/Ethnic Disparity in Treatment Utilization
Rates of mental health service use among community
samples of racial/ethnic minorities at risk for psychiatric
symptoms are relatively low,
8,9
with similar trends among
adolescents engaging in suicidal behavior.
10,11
One study
of a community sample of teenagers who reported having
made a suicide attempt in the previous 12 months found
that white teens (31%) were more likely than black (16%)
and Hispanic teens (17%) to have used outpatient mental
health services.
11
This trend extends to college students;
recently, a national survey of over 14,000 college students
found that black, Latino, and Asian individuals were less
likely to seek mental health counseling.
4
Therefore,
although the mental health needs of college students, in
general, are not being met, the issue is more pronounced
for racial/ethnic minority students.
Factors Impacting Mental Health Treatment Utilization
Not perceiving a need for care is a well-documented bar-
rier to seeking mental health treatment in the general popu-
lation. Notably, one study of low-income women with
major depression found that US-born black women, non–
US-born black women, and non–US-born Latinas were less
likely to perceive a need for and to seek mental health treat-
ment than US-born Latinas and white women.
12
Similarly,
this disparity is evident among college students. Eisenberg
and colleagues found that 51% of students with a mental
health problem (ie, screened positive for major depression,
an anxiety disorder, suicidal ideation, or nonsuicidal self-
injury) who thought they needed help sought treatment,
compared with 11% of students with a mental health prob-
lem who reported that they did not need help.
4
For college
students with a history of suicidal ideation, the most com-
monly cited reasons for not seeking treatment included a
preference for dealing with problems on their own, perceiv-
ing stress as normal, receiving support from other sources,
and not having enough time to seek formal treatment.
5,6
Stigma-related concerns also deter mental health help
seeking.
8,12–15
A study of low-income women found that
non–US-born Latinas and non–US-born black women iden-
tified more stigmas for seeking mental health treatment
than US-born Latina and black women. Non–US-born
black women were also less likely to express interest in
seeking treatment than were US-born white women.
12
Another study of a sample of depressed women from com-
munity health clinics who met screening criteria for major
depression found that stigma-related concerns were nega-
tively correlated with perceived need for mental health
treatment.
14
Another possible explanation for lower utilization of tra-
ditional mental health services may involve seeking alterna-
tives to traditional mental health treatment.
16,17
Gong and
colleagues found that Filipino Americans were more likely
to seek help for mental health concerns from family,
friends, a priest or minister, a spiritualist, herbalist, or a
fortune teller than from a mental health professional.
16
An
aforementioned national survey of college students found
that 78% of students who screened positive for major
depression and 81% of students who reported suicidal idea-
tion in the previous 12 months sought help from nonclinical
sources—primarily family and friends.
4
Thus, college stu-
dents, especially racial and ethnic minorities, who do not
seek mental health treatment may, instead, seek help from
other sources.
The present study examined racial/ethnic differences in
previously identified barriers to seeking treatment among
college students seen for an intake at a college counseling
center and followed up 6 months later. It also examined
whether mental health treatment barriers would moderate
the relation between racial/ethnic minority status and risk
for depression and suicidal ideation. We expected that,
compared with white students, racial/ethnic minority stu-
dents would report more barriers to seeking treatment, as
well as lower mental health utilization rates, in the 6-month
follow-up. Additionally, we expected that the number of
reported barriers would be associated with whether or not
individuals followed through with counselor recommenda-
tions made at intake, along with reported symptoms of
depression and suicidal ideation at the follow-up.
METHODS
Participants
A sample of 122 college students (86 female), aged 17–
34 (MD21.4, SD D3.6), who completed intake assess-
ments at a college counseling center in an urban public uni-
versity in the northeastern United States between May 2012
and November 2013 were recruited to take part in an online
survey approximately 6 months following their initial
assessment. Initially, 582 students (65% female; 62%
racial/ethnic minority), aged 17–34 (MD21.9, SD D3.3)
were invited to complete the survey, selected randomly
from data available from 1,943 students who visited the
counseling center approximately 6 months earlier. Of those
invited, 124 students (21%) completed the study, and 122
students provided complete data. Racial/ethnic distribution
of the final sample was as follows: 36% white, 28% Asian,
16% Latino, 3% black, 13% multiracial, and 4% other
races. Forty-three percent (nD52) reported a lifetime his-
tory of suicidal ideation at intake, and 15% (nD18)
reported a lifetime suicide attempt history, proportions that
were representative of the rates of suicidal ideation and
attempt history among students invited to take part in the
study.
Measures
Intake Assessment
Clinicians (licensed clinical psychologist, licensed clini-
cal social worker, or MA-level social work and psychology
interns, under the supervision of a licensed clinician)
Miranda et al
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completed an Initial Assessment Form that included infor-
mation about the students’ reasons for seeking treatment,
reported areas of difficulty, treatment history, substance
use, and risk of self-harm (ie, suicide attempt history or ide-
ation). Students also completed the Standardized Dataset
(SDS), a self-report questionnaire—developed based on
information derived from more than 100 counseling cen-
ters—that collects demographic information, symptom
information, and information about treatment history. The
SDS includes questions about suicidal ideation and attempt
history (ie, students are asked to indicate if they have ever
“seriously considered attempting suicide” (ideation) and if
they ever “made a suicide attempt,” either never,before
college,after college,orboth).
18
History of suicidal idea-
tion and attempts were determined by the clinician inter-
view and SDS. Responses of before college,after college,
or both to SDS questions about suicidal ideation or
attempts, respectively, were considered an endorsement of
lifetime suicidal ideation or attempt history.
Counseling Center Assessment of Psychological
Symptoms-62
Depressive symptoms were assessed using the 13-item
depression subscale (aD.91) of the Counseling Center
Assessment of Psychological Symptoms-62
19
(CCAPS-62),
administered at intake and follow-up. The CCAPS is a 62-
item self-report questionnaire designed to assess college-
student mental health. Items are rated on a Likert scale
ranging from 0 (not at all like me)to4(extremely like me)
and are averaged to obtain raw scores. Scores above 1.70
on the depression subscale indicate clinically significant
symptoms above the 56% percentile, based on norms devel-
oped using a sample of 59,606 treatment-seeking students
from 97 college counseling centers in the United States.
19
In the present sample, internal consistency reliability of the
CCAPS depression subscale was .91 at follow-up.
Suicidal Ideation and Suicide Attempts (Lifetime and at
6-Month Follow-Up)
Lifetime suicidal ideation and attempts were reassessed
at follow-up using the SDS (see above), and suicidal idea-
tion and attempts made during the 6-month follow-up
period were assessed using modified questions from the
Youth Risk Behavior Survey.
20
Suicidal ideation was
assessed using the question, “During the past 6 months, did
you ever seriously consider attempting suicide?” Suicide
attempt in the previous 6 months was examined using the
question, “During the past 6 months, how many times did
you actually attempt suicide?”
Experiences With Mental Health Treatment
Questionnaire (EMHT)
The EMHT, a new measure developed for the present
study, inquires about individuals’ experience with and cur-
rent interest in mental health treatment (excluding the
treatment they received at the counseling center), along
with reasons that kept them from seeking mental health
treatment in the previous 6 months and reasons that might
keep them from seeking treatment in the future—including
the following: fear of reactions from family or friends, not
knowing if a problem warrants treatment, too little time to
dedicate to treatment, preferring to deal with problems on
their own, preferring to seek help from other sources, and
financial concerns (eg, not having insurance). The EMHT
assesses a total of 11 possible barriers to treatment. Internal
consistency reliability for the 11 options comprising the
past barriers scale was .67, and reliability for the 11 options
constituting the anticipated barriers scale was .68. An
“other” option allowed students to fill in any additional rea-
sons for not seeking treatment.
Additionally, the measure inquired about students’ his-
tory of mental health treatment since they were seen at the
counseling center and whether they remembered the recom-
mendations given to them by the counseling center (if so,
they were asked to write them down). The EMHT also
assessed whether students agreed with the treatment recom-
mendations provided by the counseling center (“Did you
agree with the recommendations provided to you by your
counselor at [the counseling center]”), whether they fol-
lowed through with them (“Did you follow through with
the recommendations from your counselor at [the counsel-
ing center]”), and whether they received adequate assis-
tance in following through (“Were you provided with
adequate assistance in following through with the treatment
recommendations?”).
Procedure
Students seen for intake at a college counseling center
were contacted by electronic mail by an administrator at
the counseling center approximately 6 months after their
intake to complete a 30-minute online survey for $20 in
compensation (Amazon gift card or cash).
*
The e-mail sent
to each participant contained a link and a code that was
assigned to the participant. The participant was instructed
to use that code when completing the survey. This code
*The process at the counseling center from which participants
were recruited typically involves seeing each client for a
comprehensive assessment, during which a decision is made as to
whether the client would benefit from short-term therapy at the
counseling center, or would be better served by a referral to a
community agency that either offers more comprehensive
services, more specialized services, or less-time-limited therapy.
Each client is assigned to work with a counselor following the
initial assessment, and this counselor begins working with the
student approximately 1 week following the initial assessment,
either to begin short-term therapy or to assist the client with the
referral recommendation. Depending on the needs of the client,
the counselor either helps the student make an appointment during
a counseling session, or plans a follow-up with the client over the
phone after the referral recommendation is made to assess
progress towards pursuing the referral and whether additional help
from the counselor is indicated.
Mental Health Treatment Barriers and Racial/Ethnic Minority
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was the only identifier attached to the participant’s
responses, so that the research team would not have access
to the student’s name. Participants provided informed con-
sent online prior to study participation. Students with
CCAPS-Depression scores above the 70th percentile or
who reported that they had seriously considered making a
suicide attempt in the previous 6 months or had made a sui-
cide attempt were contacted by counseling center staff to
return for an intake. When such students were identified by
the research team as being in need of follow-up, their codes
were provided to the counseling center, so that counseling
center staff could match the codes to the participants’
names and make contact. However, only the research team
(and not the counseling center staff) had access to the
student’s de-identified survey responses.
Forty-seven students (39%) received follow-up calls by
counseling center staff after completing the study. Of these
47 individuals, 34 students responded to follow-up attempts
either by telephone, e-mail, or by returning to the counsel-
ing center for an evaluation, and 13 students did not
respond to follow-up attempts. The procedures used in this
study received institutional review board approval.
Data Analyses
Chi-square analyses were conducted to examine whether
endorsement of suicidal ideation, mental health treatment
history, follow-through with treatment recommendations,
and treatment barriers varied by racial/ethnic minority sta-
tus. Differences between racial/ethnic minority versus
white college students in average depressive symptoms and
total number of reasons reported for not seeking treatment
were examined via independent-samples ttests (note that
these variables were approximately normally distributed).
Predictors of depressive symptoms at follow-up were exam-
ined via multiple linear regression, and predictors of fol-
low-through with counseling center treatment
recommendations and of suicidal ideation at follow-up
were examined via logistic regression.
RESULTS
Symptoms, Treatment, and Barriers by Racial/Ethnic
Minority Status
There were no statistically significant differences in
depressive symptoms (at baseline and follow-up), life-
time suicide attempt, and suicidal ideation history and
in suicidal ideation during the follow-up period between
racial/ethnic minority and white college students (see
Table 1). However, racial/ethnic minority students less
often reported having sought treatment in the past (53%
vs 89%), x
2
(1) D16.22, pD.000, and also treatment
after they were seen at the counseling center (31% vs
52%), compared with white students, x
2
(1) D5.49, pD
.02. In addition, they endorsed a greater number of bar-
riers to treatment in the previous 6 months (MD4.06,
SD D2.34 vs MD3.14, SD D1.97), t(120) D2.22,
TABLE 1. Sample Characteristics
All (ND122) Minority (ND78) White (ND44)
Characteristic n%MSDn %MSDn%MSD
Gender
Male 34 28 23 29 11 26
Female 86 71 55 71 31 72
Transgender 1 1 0 0 1 2
Age 21.5 3.6 21.4 3.6 24.7 3.7
Past mental health treatment (besides counseling center)
b
80 66 41
**
53 39 89
Mental health treatment during follow-up
b
47 39 24
*
31 23 52
Agree with recommendations 105 86 67 88 38 86
Follow-through with recommendations 54 44 32 41 22 50
Adequate assistance in following through with recommendations 90 74 59 76 31 71
Suicide attempt, lifetime
CCC
18 15 12 15 6 14
Suicidal ideation, lifetime
a
52 42 30 40 22 50
Suicidal ideation, past 6 months
b
22 18 14 18 8 18
CCAPS Depression
Baseline
a
2.04 0.82 2.00 0.75 2.13 0.95
6-month follow-up
b
1.78 0.91 1.78 0.86 1.79 0.99
Total barriers to mental health treatment
b
3.73 2.25 4.06
*
2.34 3.14 1.97
Total anticipated barriers to mental health treatment
b
3.17 2.22 3.50
*
2.33 2.59 1.90
Note: CCAPS DCounseling Center Assessment of Psychological Symptoms-62.
a
Assessed at baseline.
b
Assessed at 6-month follow-up.
CCC
Based on combined information from clinician intake interview at baseline and Standardized Dataset at follow-up.
*
p<.05;
**
p<.01
294 JOURNAL OF AMERICAN COLLEGE HEALTH
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pD.03, and anticipated future barriers (MD3.50,
SD D2.33 vs MD2.59, SD D1.90) than did white
students, t(120) D2.21, pD.03.
Most students agreed with the recommendations pro-
vided by counseling center staff (86%) and reported that
they were provided with adequate assistance in following
through with them (74%). However, less than half of stu-
dents actually followed through with recommendations
(44%), regardless of race.
Most Commonly Endorsed Barriers to Mental Health
Treatment
The most commonly cited barriers to mental treatment
during the follow-up period, across racial group, included
financial concerns (61%), too little time (51%), preference
for dealing with problems on their own (48%), and not
knowing if a problem warranted treatment (47%). Most of
these barriers were distributed in approximately equal pro-
portions across racial category (see Table 2). However,
racial/ethnic minority students more often cited lack of
time as a barrier to past mental health treatment (62%), rel-
ative to white students (32%). Although only about one-
fifth of students cited fear of stigma from family, friends, or
other people as a barrier, racial/ethnic minority students
more often cited fear of what others (besides family and
friends) would think of them (28%) as a barrier than did
white students (9%).
Follow-Through With Treatment Recommendations,
Depressive Symptoms, and Suicidal Ideation at
Follow-Up
To examine predictors of follow-through with treatment
recommendations, racial/ethnic minority status, baseline
depressive symptoms, and number of past treatment bar-
riers endorsed were entered into a logistic regression,
adjusting for agreement with recommendations and
whether students received assistance in following through.
Total treatment barriers were associated with lower odds
(odds ratio [OR] D0.78, 95% confidence interval [CI]
[0.65, 0.95], pD.01) of following through with recommen-
dations, whereas being provided with adequate assistance
was statistically associated with over 5 times higher odds
of following through with recommendations (OR D5.14,
95% CI [1.75, 15.11], pD.003). Racial/ethnic minority sta-
tus (OR D0.78, 95% CI [0.33, 1.82], pD.56), depressive
symptoms (OR D1.40, 95% CI [0.84, 2.34], pD.19), and
agreeing with recommendations (OR D4.45, 95% CI
[0.87, 22.87], pD.07) were not statistically associated with
following through with recommendations (overall model
Cox and Snell R
2
D.19; Nagelkerke R
2
D.26).
We also examined predictors of depressive symptoms at
6-month follow-up. A multiple linear regression examining
score on the CCAPS-Depression subscale at follow-up
revealed that total number of barriers to mental health treat-
ment predicted CCAPS score at follow-up (bD0.35, pD
.01), adjusting for baseline CCAPS-Depression score
(which also predicted follow-up scores). Neither racial/
TABLE 2. Reasons That Kept Participants From Seeking Help From a Mental Health Practitioner in the Previous
6 Months and That Would Keep Them From Seeking Help in the Future
Past barriers Anticipated barriers
Minority White Total Minority White Total
Reasons n%n%n%x
2
pn%n%n%x
2
p
Too little time to dedicate to seeking a mental
health professional
48 62 14 32 62 51 9.94 <.01 41 53 18 41 59 48 1.53 .22
Fear of what parents or other family members
would think
22 28 6 14 28 23 3.38 .07 21 27 4 9 25 21 5.49 .02
Fear of what others (besides family) would
think
22 28 4 9 26 21 6.13 .01 17 22 2 5 19 16 6.37 .01
Not knowing if problem important enough 38 45 19 43 57 47 0.35 .56 26 33 13 30 39 32 0.19 .67
Not knowing how to get in touch with a
mental health professional
17 22 8 18 25 21 0.23 .64 13 17 7 16 20 16 0.01 .91
Preferring to deal with problems on own 38 49 20 46 58 48 012 .73 28 36 11 25 39 32 1.54 .22
Preferring to seek help from family or friends 11 14 3 7 14 12 1.47 .23 10 13 3 7 13 11 1.07 .30
Not believing that a mental health professional
would be able to help
23 30 13 30 36 30 0.00 1.00 21 27 11 25 32 26 0.05 .82
Had a bad experience with a mental health
professional in the past
10 13 8 18 18 15 0.64 .42 9 12 11 25 20 16 3.72 .05
Not comfortable sharing problems with a
mental health professional
27 35 12 27 39 32 0.70 .40 28 36 9 21 37 30 3.18 .08
Financial concerns (eg, no insurance, not
enough money to pay for it)
50 64 24 55 74 61 1.08 .30 52 67 22 50 74 61 3.27 .07
Note. Percentages may not add to 100% due to rounding.
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ethnic minority status nor treatment received in the previ-
ous 6 months predicted depressive symptoms at follow-up.
Furthermore, there was no statistically significant interac-
tion between racial/ethnic minority status and total number
of treatment barriers endorsed (see Table 3).
y
A binary logistic regression analysis examining racial/
ethnic minority status, baseline depressive symptoms, life-
time suicide attempt history, lifetime suicidal ideation, and
total treatment barriers, along with the interaction between
treatment barriers and racial/ethnic minority status, as pre-
dictors of whether participants reported having experienced
suicidal ideation during the 6-month follow-up period
revealed that only baseline depressive symptoms and life-
time suicide attempt history predicted suicidal ideation at
follow-up (see Table 4).
COMMENT
The present study aimed to identify racial/ethnic dif-
ferences in mental health treatment utilization and in
self-reported mental health treatment barriers among
college students seen for intake at a counseling center.
At 6-month follow-up, 39% of students had sought treat-
ment since their intake, with racial/ethnic minority stu-
dents having lower rates of past mental health treatment
seeking (53% vs 89%, respectively) and also lower rates
of mental health service use during the follow-up (31%
vs 52%, respectively), relative to white students, despite
having equal levels of depressive symptoms and rates of
suicidal ideation and attempt history. Results of this
study support findings that racial/ethnic minorities are
less likely to receive mental health treatment than white
individuals,
2,10,11
and that these trends extend to college
populations.
4
The most-often cited barrier to treatment seeking,
across race, was financial concerns (eg, not being able
to afford treatment), with 61% of respondents endorsing
this as both a past barrier and an anticipated future bar-
rier. Among racial/ethnic minority students, the next
most-often cited barrier was lack of time, and they more
TABLE 3. Predictors of Depressive Symptoms at 6-Month Follow-Up
Predictor bSE95% CI btp
Racial/ethnic minority ¡0.01 0.13 ¡0.27, 0.24 ¡0.01 ¡0.11 .91
Depressive symptoms
a
0.65 0.08 0.50, 0.80 0.59 8.69 .000
Treatment in past 6 months
b
0.18 0.13 ¡0.08, 0.43 0.10 1.37 .17
Past treatment barriers
b
0.14 0.05 0.04, 0.24 0.35 2.75 .01
Treatment Barriers £Minority ¡0.03 0.06 ¡0.11, 0.09 ¡0.05 ¡0.41 .68
Note. Adjusted R
2
D.49; F(5,116) D24.38, p<.01. CI Dconfidence interval.
a
Assessed at baseline.
b
Assessed at 6-month follow-up.
TABLE 4. Predictors of Suicidal Ideation at 6-Month Follow-Up
Predictor OR 95% CI p
Racial/ethnic minority 1.76 0.53, 5.76 .35
Depressive symptoms
a
2.87 1.12, 7.33 .03
Lifetime suicide attempt
CCC
4.07 1.18, 14.04 .03
Lifetime suicidal ideation
a
3.14 0.80, 12.29 .10
Treatment in past 6 months
b
1.58 0.52, 4.78 .42
Past treatment barriers
b
1.03 0.68, 1.59 .88
Treatment Barriers £Minority 0.88 0.52, 1.48 .63
Note. Cox and Snell R
2
D.21; Nagelkerke R
2
D.34. OR Dodds ratio; CI Dconfidence interval.
a
Assessed at baseline.
b
Assessed at 6-month follow-up.
CCC
Based on combined information from clinician intake interview at baseline and Standardized Dataset at follow-up.
yWe also conducted an exploratory regression analysis to
examine which specific treatment barriers were associated with
depressive symptoms at follow-up. Thus, endorsement of each of
the 11 possible treatment barriers was entered as a predictor of
depressive symptoms at follow-up, adjusting for baseline
depressive symptoms. “Not [being] comfortable sharing problems
with a mental health professional” was the only barrier
significantly associated with depressive symptoms at follow-up, b
D0.30, bD0.16, pD.04.
296 JOURNAL OF AMERICAN COLLEGE HEALTH
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often endorsed this barrier than did white respondents
(62% vs 32%). Close to half of students—across race—
also endorsed a preference for dealing with problems on
their own and not knowing if a problem they were
experiencing was important enough to warrant treatment
as other reasons they did not seek treatment in the past.
Although fear of what family, friends, and others would
think was not among the most commonly endorsed
treatment barriers, it was more often endorsed as a
potential future barrier by racial/ethnic minority college
students than it was by white students. Finally, total
number of treatment barriers endorsed was associated
with not following through with treatment recommenda-
tions and with higher depressive symptoms at follow-up,
even after taking into account depressive symptoms at
intake. More comprehensively and directly addressing
total barriers to treatment may improve mental health
outcomes among college students who are seen at
counseling centers. At the same time, further research is
necessary to establish the clinical significance of the
findings, given that an increase in 1 treatment barrier
was only associated with a small increase in average
depressive symptoms.
Although, as stated, stigma was not the primary bar-
rier to treatment, it warrants attention. Some reasonable
suggestions for decreasing mental health treatment
stigma can be found in the literature. This includes pro-
viding universal messages about mental health problems
in order to minimize “us/them” thinking, disseminating
accurate information about the relatively low levels of
public stigma towards treatment on college campuses,
and using school- and Internet-based initiatives to pro-
mote treatment initiation.
6,21
In order to address the
higher stigma perceived by racial/ethnic minority stu-
dents, these interventions must actively engage this pop-
ulation. One way to achievethisisbyincreasingthe
visibility of racial/ethnic minorities in the process
through the appropriate incorporation of these popula-
tions in any informational or educational initiatives as
well as the use of racial/ethnic minority mental health
workers and representatives.
To address time concerns, interventions that work
well on a time-limited basis should be utilized and flexi-
ble-scheduling options should be offered. For example,
online or at-home skills-based interventions may be
effective for particular mental health issues and offer
the added benefit of affordability. As college counseling
centers are simultaneously faced with addressing
increased severity of students’ psychiatric needs and an
emphasis on short-term treatment, with oftentimes lim-
ited staffing, appreciating ways to proactively engage at-
risk students is also vital.
21
These results can also
inform feedback sessions with racial and ethnic minority
students, to ensure that they not only understand and
appreciate the rationale for the treatment recommenda-
tions, but that they also receive adequate assistance in
following through with recommendations.
Limitations
Several study limitations are noteworthy. First, the sam-
ple was primarily female and may not be reflective of men-
tal health care use for male college students. Second,
although suicidal ideation was assessed at both baseline
and follow-up, we relied on a single-item measure of sui-
cidal ideation as an outcome and did not confirm ideation at
6-month follow-up via interview. Thus, caution is war-
ranted in interpreting findings that examine suicidal idea-
tion as an outcome. Third, separate analyses by different
racial/ethnic minority groups were not conducted due to
insufficient participants of each racial/ethnic group in the
sample. Finally, within-group heterogeneity (eg, country of
origin, socioeconomic status, language proficiency, accul-
turation) was not taken into account. Future studies should
examine within-group differences that may also account for
mental health treatment disparities.
Conclusions
This research points to the importance of examining
racial/ethnic differences in possible reasons behind treat-
ment-seeking disparities among college students who are
seen for intake at a college counseling center. Identifying
factors such as lack of time, financial concerns, and fear of
stigma is a first step in designing interventions to increase
mental health treatment utilization among at-risk college
students from diverse backgrounds. Efforts to increase
mental health treatment seeking among college students
might include offering access to time-limited treatments
with flexible scheduling options. In addition, outreach
efforts should focus on decreasing the fear of stigma, spe-
cifically incorporating racial and ethnic minority students
in the process. Such efforts may increase treatment out-
comes among racial and ethnic minority students and per-
haps decrease risk for depression and future suicidal
behavior.
ACKNOWLEDGMENTS
We thank Cecilia Teye-Ampomah and Justyna Jurska for
their assistance with data collection.
FUNDING
This study was funded by a grant from the Shuster Fac-
ulty Fellowship Fund.
CONFLICT OF INTEREST DISCLOSURE
The authors have no conflicts of interest to report. The
authors confirm that the research presented in this article
met the ethical guidelines, including adherence to the legal
requirements, of the United States and received approval
from the Institutional Review Board of City University of
New York.
VOL 63, JULY 2015 297
Mental Health Treatment Barriers and Racial/Ethnic Minority
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NOTE
For comments and further information, address correspon-
dence to Regina Miranda, Department of Psychology, Hunter
College, CUNY, 695 Park Avenue, Room 611HN, New York,
NY 10065, USA (e-mail: regina.miranda@hunter.cuny.edu).
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Received: 14 May 2014
Revised: 3 November 2014
Accepted: 30 December 2014
298 JOURNAL OF AMERICAN COLLEGE HEALTH
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