Racial/ethnic differences in the association between suicidal ideation and mental health service utilization: a national study of U.S college students

Abstract

Objectives: Suicidal ideation (SI) is common among U.S. college students, yet mental health service utilization (MHSU) remains incomplete and may differ across race and ethnicity groups. We examined whether the SI-MHSU association varies by race and ethnicity among U.S. college students. Design: We analyzed pooled repeated cross-sectional data from the American College Health Association-National College Health Assessment III (ACHA-NCHA III), Fall 2019–Fall 2022. We fit multivariable logistic regression models including a SI × race and ethnicity interaction and covariates guided by Andersen’s Behavioral Model of Health Services Use. We report race and ethnicity-specific adjusted odds ratios (aORs) for SI (Yes vs No) and ratios of odds ratios (RORs) comparing each group’s SI-MHSU association to non-Hispanic (NH) White students. Results: Among 330,436 students, 31.4% reported SI in the past 12 months; among those with SI, 47.4% reported MHSU. Effect modification by race and ethnicity was observed (global SI × race and ethnicity Wald χ2 = 48.81, df = 6, p < 0.0001). SI was associated with higher odds of MHSU within each race and ethnicity group (aORs ranged from 1.59–2.02). Relative to NH White students, the SI-MHSU association was weaker among Hispanic or Latino/a/x students (ROR = 0.86; 95% CI: 0.81, 0.91) and NH Biracial or Multiracial students (ROR = 0.89; 95% CI: 0.82, 0.97), and stronger among NH Asian or Asian American students (ROR = 1.09; 95% CI: 1.02, 1.16). Differences relative to NH White were not statistically significant for AI/AN, NH Black or African American, or NH Other students. Conclusion: The association between SI and MHSU varies by race and ethnicity among U.S. college students. Campus mental health strategies may benefit from tailored approaches to equitably reduce barriers to care in groups where the SI-MHSU association appears weaker relative to NH White students. Future research should identify mechanisms underlying these differences in utilization.