Barriers of mental health treatment utilization among first‐year college students: First cross‐national results from the WHO World Mental Health International College Student Initiative
Open accessAbstract
Background: Although mental disorders and suicidal thoughts‐behaviors (suicidal thoughts and behaviors) are common among university students, the majority of students with these problems remain untreated. It is unclear what the barriers are to these students seeking treatment. Aims: The aim of this study is to examine the barriers to future help‐seeking and the associations of clinical characteristics with these barriers in a cross‐national sample of first‐year college students. Method: As part of the World Mental Health International College Student (WMH‐ICS) initiative, web‐based self‐report surveys were obtained from 13,984 first‐year students in eight countries across the world. Clinical characteristics examined included screens for common mental disorders and reports about suicidal thoughts and behaviors. Multivariate regression models adjusted for socio‐demographic, college‐, and treatment‐related variables were used to examine correlates of help‐seeking intention and barriers to seeking treatment. Results: Only 24.6% of students reported that they would definitely seek treatment if they had a future emotional problem. The most commonly reported reasons not to seek treatment among students who failed to report that they would definitely seek help were the preference to handle the problem alone (56.4%) and wanting to talk with friends or relatives instead (48.0%). Preference to handle the problem alone and feeling too embarrassed were also associated with significantly reduced odds of having at least some intention to seek help among students who failed to report that they would definitely seek help. Having 12‐month major depression, alcohol use disorder, and suicidal thoughts and behaviors were also associated with significantly reduced reported odds of the latter outcome. Conclusions: The majority of first‐year college students in the WMH‐ICS surveys report that they would be hesitant to seek help in case of future emotional problems. Attitudinal barriers and not structural barriers were found to be the most important reported reasons for this hesitation. Experimental research is needed to determine whether intention to seek help and, more importantly, actual help‐seeking behavior could be increased with the extent to which intervention strategies need to be tailored to particular student characteristics. Given that the preference to handle problems alone and stigma and appear to be critical, there could be value in determining if internet‐based psychological treatments, which can be accessed privately and are often build as self‐help approaches, would be more acceptable than other types of treatments to student who report hesitation about seeking treatment.
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Barriers to help-seeking in adolescence include lack of confidence in mental health professionals, preference for self-reliance, difficulties with physical and financial access to care, and feelings of embarrassment and stigma.
“Barriers to help-seeking in adolescence include a lack of confidence in mental health professionals, a preference for self-reliance, difficulties with physical and financial access to care, and feelings of embarrassment and stigma [34–37].”
From Efficacy of a transdiagnostic Internet prevention approach in adolescents (EMPATIA study): study protocol of a randomized controlled trial (2024) · cites this paper as [35]
The Introduction reports a review of adolescent samples identifying self-reliance, embarrassment, and stigma as barriers. The Methods and Results address cost, transportation, and doubts about treatment effectiveness, but in first-year college students, not adolescents generally. Doubts about effectiveness are not the same as lack of confidence in mental health professionals. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMobile health technology has been growing in popularity to minimize some barriers to traditional mental healthcare.
“Mobile health (mHealth) technology has been growing in popularity to minimize some barriers to traditional mental healthcare [8,9].”
From Analysis of Mobile App-Based Mental Health Solutions for College Students: A Rapid Review (2023) · cites this paper as [8]
The Discussion suggests that digital self-help approaches might help first-year college students overcome embarrassment and a preference to handle problems alone when seeking treatment. It does not say that mHealth is growing in popularity, and it presents barrier reduction as a possibility rather than an established effect. (LLM, conf=0.85)
Experimental — accuracy not yet measuredStudents can be reluctant to seek professional mental health treatment because of unwillingness to define themselves as having a mental disorder and fear of stigma.
“In addition, students can be reluctant to seek professional mental health treatment because of unwillingness to define themselves as having a mental disorder and fear of stigma (Ebert et al., 2019; Marsh and Wilcoxon, 2015).”
From Effects of self-guided stress management interventions in college students: A systematic review and meta-analysis (2022) · cites this paper as Ebert et al., 2019
The Introduction names perceived stigma as a barrier, and the Discussion reports that embarrassment was associated with reduced intention to seek treatment. The paper does not establish unwillingness to define oneself as having a mental disorder as a reason for reluctance; searches for that idea found no matching passage. (LLM, conf=0.87)
Experimental — accuracy not yet measuredMany students prefer to manage mental health issues alone due to concerns about confidentiality, feeling the problem is too personal, and fear that no person or service could help.
“Research has shown that many students prefer to manage mental health issues alone, due to concerns on confidentiality, a feeling that the problem is too personal, and the fear that no person or service could help”
From Meta-analytic review of online guided self-help interventions for depressive symptoms among college students (2021) · cites this paper as Ebert et al., 2019
The Results (Barriers to mental health treatment, Table 1) show that many first-year students preferred to handle a future emotional problem on their own, and the Discussion identifies embarrassment as another common barrier. The paper does not report confidentiality concerns, feeling a problem is too personal, or fear that no person or service could help as reasons students gave; uncertainty about treatment effectiveness is narrower than that last claim. (LLM, conf=0.88)
Experimental — accuracy not yet measuredA considerable proportion of students do not seek help for mood and anxiety symptoms.
“A treatment gap exists, where a considerable proportion of students do not seek help for mood and anxiety symptoms.”
Reasons that prevent students from seeking help are mostly attitudinal (internal) rather than structural (external).
“Reasons that prevent students from seeking help are mostly attitudinal (internal, e.g., the desire to solve problems independently) rather than structural (external, e.g., temporal or financial costs of treatment) (11, 12).”
From Mental health services for German university students: acceptance of intervention targets and preference for delivery modes (2024) · cites this paper as [12]
Ebert et al. found internet-based personalized feedback on symptom severity and information on available services to be effective in increasing help-seeking intentions.
“Ebert et al. (11, 12) found internet-based personalized feedback on symptom severity and information on available services, which was integrated in our survey, to be effective in increasing help-seeking intentions.”
From Mental health services for German university students: acceptance of intervention targets and preference for delivery modes (2024) · cites this paper as [12]
The Discussion (page unavailable) speculates that digital self-help approaches might help students who hesitate to seek treatment; it does not report an effective intervention. Searches for personalized symptom-severity feedback and information on available services found no passage showing that these increased help-seeking intentions. The References list a separate Ebert et al. pilot trial, but its results cannot establish what this paper says. (LLM, conf=0.76)
Experimental — accuracy not yet measuredA rapid review speeds up the systematic review process by omitting stages, making it less rigorous and precise.
“A rapid review speeds up the systematic review process by omitting stages of the systematic review making it less rigorous and precise [8,9].”
From Analysis of Mobile App-Based Mental Health Solutions for College Students: A Rapid Review (2023) · cites this paper as [8]
The Introduction discusses barriers to mental health treatment and mentions a systematic review of those barriers, but does not describe rapid-review methods. Searches for omitted review stages and reduced rigor or precision found no relevant passage in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredThe rapid review approach is best suited for capturing timely information about fast-growing topics.
“This approach is best suited for capturing timely information about fast-growing topics [8].”
From Analysis of Mobile App-Based Mental Health Solutions for College Students: A Rapid Review (2023) · cites this paper as [8]
The Methods describe a cross-national student survey, and the Discussion addresses limitations of its findings; neither evaluates rapid reviews. Searches for “rapid review,” “timely,” and “fast-growing topics” found no passage supporting the claimed suitability of that approach. (LLM, conf=0.77)
Experimental — accuracy not yet measuredSynthesizing a standard systematic review typically takes significant time and fails to capture emerging issues.
“Synthesizing a standard systematic review, which is best suited to assess well-established topics, typically takes significant time to evaluate and analyze at least ten years of literature; therefore, fails to capture emerging issues.”
From Analysis of Mobile App-Based Mental Health Solutions for College Students: A Rapid Review (2023) · cites this paper as [8]
The Discussion addresses barriers to mental health treatment among first-year college students, not how long systematic reviews take or whether they miss emerging issues. Searches for those terms and for the claimed ten-year literature period found no supporting passage in our copy; the References section merely lists reviews. (LLM, conf=0.76)
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Self-citation
- Authors
- Ebert, D. D., Mortier, P., Kaehlke, F., Bruffaerts, R., Baumeister, H., Auerbach, R. P., Alonso, J., Vilagut, G., Martínez, K. U., Lochner, C., Cuijpers, P., Kuechler, A., Green, J., Hasking, P., Lapsley, C., Sampson, N. A., Kessler, R. C., & On behalf of the WHO World Mental Health—International College Student Initiative collaborators
- Affiliations
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- KU Leuven (BE)
- Clinical Psychology and Psychotherapy, Department of Psychology Friedrich‐Alexander‐University Erlangen‐Nürnberg Erlangen Germany
- Universität Ulm (DE)
- Columbia University (US)
- Municipal Institute for Medical Research (ES)
- Department of Psychology Universidad Autónoma de Aguascalientes Aguascalientes City Mexico
- MRC Unit on Anxiety & Stress Disorders, Department of Psychiatry University of Stellenbosch Stellenbosch South Africa
- Amsterdam Public Health (NL)
- Clinical Psychology and Psychotherapy University of Ulm Ulm Germany
- Boston University (US)
- Curtin University (AU)
- University of Ulster (GB)
- Harvard University (US)
- Corresponding author
- Ebert, David Daniel
- ORCID
- Venue
- International Journal of Methods in Psychiatric Research
- Publisher
- Wiley
- Published
- 2019-05-09
- Volume
- 28
- Issue
- 2
- Pages
- e1782-e1782
- ISSN
- 1049-8931 (ISSN-L)
- 1557-0657
- PMC
- PMC6522323
- OpenAlex
- W2943939821
- Cited by
- 407
- References
- 47
- Citations by year
- 2026: 62 · 2025: 71 · 2024: 71 · 2023: 77 · 2022: 60 · 2021: 40 · 2020: 21 · 2019: 4 · 2018: 1
- FWCI
- 38.99
- Type
- journal article
- Language
- en
- Update notices
- correction (2019-12-29)
- Open access
- hybrid
- doi.org
- Licence
- Locations
- International Journal of Methods in Psychiatric Research (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by-nc)
- Lirias (submittedVersion, other-oa)
- Docusalut (Conselleria de Salut i Consum del Govern de les Illes Balears) (submittedVersion, cc-by-nc)
- Hispana (submittedVersion, cc-by-nc)
- Ulster University Research Portal (Ulster University) (submittedVersion, cc-by-nc-sa)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion, cc-by-nc)
- SUNScholar (Stellenbosch University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Instituto de Salud Carlos III (CD12/00440, CM14/00125)
- Bristol-Myers Squibb
- GlaxoSmithKline
- Pan American Health Organization
- Fogarty International Center (FIRCA R03‐TW006481)
- U.S. Public Health Service (R01 DA016558, R01‐MH069864, R13‐MH066849)
- Pfizer Foundation
- John D. and Catherine T. MacArthur Foundation
- Consejo Nacional de Ciencia y Tecnología (CB‐2016‐01‐285548)
- Ulster University
- Departament d'Innovació, Universitats i Empresa, Generalitat de Catalunya (2017 SGR 452)
- South African Medical Research Council
- ZonMw (636110005)
- Eli Lilly and Company (IIT‐H6U‐BX‐I002)
- King Baudouin Foundation United States (2014‐J2140150‐102905)
- Fonds De La Recherche Scientifique - FNRS (1114717N, 11N0514N, 11N0516N)
- National Institute of Mental Health (R56MH109566, R01MH070884)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Developmental and Educational Psychology › Student Stress and Coping
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Keywords
- help-seeking barriers, help-seeking intentions, first-year college students, mental health treatment utilization, common mental disorders, suicidal thoughts and behaviors, major depressive disorder, alcoholism, stigma, self-help, internet-based psychological treatment, cross-national comparison
- MeSH terms
- Adolescent, Female, Health Services Accessibility, Humans, Male, Mental Health Services, Patient Acceptance of Health Care, Surveys and Questionnaires, Students, Suicide, Attempted, Universities, Young Adult, Suicidal Ideation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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