Prevalence of probable mental disorders and help-seeking behaviors among veteran and non-veteran community college students☆,☆☆,★
Introduction
The onset of mental illness typically occurs before age 24 years [1] and these disorders account for about half of the overall burden of illness for adolescents and young adults [2]. Early detection and treatment is critical because, if left untreated, mental illness has significant negative consequences for academic achievement [3], employment [4], substance misuse [5] and social relationships [6]. The college years in particular represent a developmentally challenging transition period to adulthood. Sixty-eight percent of high school graduates attend college [7] and, like their same-aged non-students peers, about a third of college students meet diagnostic criteria for a psychiatric disorder [8]. However, only about a third of college students with a mood disorder report taking psychotropic medications or going to counseling in the previous year [8], [9]. Therefore, campus-wide efforts to engage college students in mental health treatment may be warranted.
In recent years, the growing number of two-year community colleges has given disadvantaged students increased access to postsecondary education. In fact, nearly half (42%) of all college students are enrolled in two-year community colleges [7]. In 2014, there were 1132 two-year community colleges with 12.8 million enrolled students [10]. Community colleges, also called junior colleges or technical colleges, are two-year institutions that grant certificates and associate's degrees. Community colleges enroll mostly students from the local community and are primarily funded by state and local governments. The vast majority (88%) of two-year community colleges have open enrollment policies [7]. The average age of community college students is 28 years, 49% are racial and/or ethnic minorities and 60% are part-time students. Annual household incomes are substantially lower among two-year college students compared to four-year college students [11]. In addition, two-year college students have substantially lower high school grade point averages and college admission test scores (e.g., SAT, ACT) than four-year college students [11]. Only 16% of two-year community college students receive a degree within three years of enrollment [11]. In addition, community college students are significantly more likely to have experienced traumatic events compared to four-year college students [12]. Because lower socioeconomic status and trauma are risk factors for poor mental health among students [12], [13], the prevalence of mental disorders may be higher at community colleges than four-year colleges. However, there has been virtually no research investigating the prevalence of mental disorders and help-seeking behaviors on community college campuses. While college campuses potentially represent an ideal setting to detect and treat mental disorders, most (58%) two-year community colleges lack student health centers [14], and even fewer appear to provide mental health services [15], [16].
Another important reason to better understand mental illness on community college campuses is that a substantial number of veterans from Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF) and Operation New Dawn (OND) have been entering community colleges on the new Post-9/11 GI Bill. A majority of returning service members successfully reintegrate into family life, educational activities and vocational pursuits [17]. While attaining further postsecondary education is an extremely important reintegration goal for many veterans, it is difficult to make the transition from a highly structured and hierarchical military setting to the less structured and more self-directed campus environment [18]. These student veterans must contend with the traditional pressures of college life while also dealing with the stress of reintegration. Moreover, a substantial percentage of veterans experience mental disorders, but most do not seek treatment because of stigma [17]. Since the Post-9/11 GI Bill was implemented in August 2009, the Department of Veterans Affairs has provided educational benefits to one million veterans and their family members, amounting to over US$30 billion [19]. A third (34.6%) of those using the Post-9/11 GI Bill have enrolled in a community college [20].
To determine the prevalence of probable mental disorders and help-seeking behaviors, we fielded a survey to population-based samples of veterans and non-veterans attending community colleges. We hypothesized that veterans would have a higher prevalence of probable mental disorders than non-veterans. We also compared student veterans and non-veterans with regard to their perceived need for treatment, perceived stigma associated with receiving treatment and perceived effectiveness of treatment. We also compared the utilization of mental health services between student veterans and non-veterans. We hypothesized that student veterans would perceive a greater need for treatment but would also perceive greater stigma and use fewer services.
Section snippets
Methods
A total of 11 two-year community colleges were recruited from across the state of Arkansas. The registrar's office of each community college provided us with the list of students enrolled in the 2012 Spring semester, which served as the sampling frame. For purposes of sampling, all students using the Post-9/11 GI Bill were preliminarily classified as veterans. Using a stratified sampling scheme, we sampled 100% of veterans at each community college and randomly sampled 2.8–18.5% of non-veterans
Results
There were substantial and significant modifiable and non-modifiable sociodemographic differences between veteran and non-veteran community college students (Table 1). Compared to non-veteran students, veterans were significantly older, more likely to be male, more likely to be married, more likely to be employed more than 30 hours per week, more likely to have health insurance and less likely to be very religious. Three quarters of the student veterans had been deployed during their military
Discussion
There is a small, but growing, literature on community college students' risky health behaviors, including alcohol and tobacco use [30]. However, to the best of our knowledge, this is the first study to report the prevalence of probable mental health disorders and help-seeking behaviors among community college students. The proportion of students screening positive for depression, GAD and PTSD appear to be similar at community colleges compared to four-year colleges and universities despite the
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Disclosures and Acknowledgments: There are no conflicts of interest for any authors.
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This work was supported by grant number MH092641 from the National Institute of Mental Health and by grant number DM090465 from the Department of Defense.
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The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the Department of Defense.