BACKGROUND/RATIONALE:
Mental health symptoms are highly prevalent among Veterans returning from the conflicts in Afghanistan and Iraq and many of these veterans are enrolling in college or other secondary educational institutions. Studies using convenience samples of veteran college students have reported startlingly high rates of mental health issues and suicidal ideation among these students, exceeding those observed among OEF/OIF Veterans seeking VA care. Several studies or non-veteran students have reported links between non-Veteran student mental health, poor college performance, and failure to graduate.

OBJECTIVE(S):
Aim1: Assess the prevalence of mental health symptoms, hazardous alcohol use, and levels of wellbeing among a representative sample of Veteran and comparison college students.
Aim 2: Assess mental health treatment use, treatment preferences, and perceived barriers to treatment.
Secondary Aim: Assess the relationships between mental health, treatment use, and academic performance, including "stop outs" (lack of enrollment for terms in an educational institution without achieving a degree).
Exploratory Aim: Assess employment status between Veterans and comparison college students and the relationship to academic performance, including "stop outs."

METHODS:
Data for this study come from surveys of a representative sample of Veteran students and comparison non-Veteran students, supplemented by surveys of college administrators; and academic administrative data. A stratified cluster sample design was used to select Veteran and comparison college students for the student survey. Sixty colleges and 5,451 Veteran and comparison students within these institutions were selected. Baseline and one and two year follow up surveys assessed well-being, mental health symptoms, alcohol use, social and academic integration, and treatment use. Data on GPA and stop out from enrollment were also assessed. Univariate, bivariate, and multivariate analyses of quantitative data were used to address study aims.

FINDINGS/RESULTS:
Aim 1: Veteran students, compared to non-Veteran students, were more likely to report mental health symptoms such as depression (37% vs. 24%; p<.001), anxiety (30% vs. 19% p=.0.027), PTSD (36% vs. 21%; p=0.007) and hazardous alcohol use (43% vs. 31%; p=.001). Veteran students also reported a lower overall quality of life. There were no significant differences in reported suicidal ideation or suicide attempts in the past year.

Aim 2: Among Veteran students, 26% reported receiving mental health treatment in the past 12 months (comprising 41% of the Veteran students who had positive screens for depression, anxiety, PTSD, or suicide variables). Among Veterans who received mental health treatment in the past 12 months, only 3% received treatment from services offered on campus; 18% received treatment in the community; and 84% received treatment from the VA or a military facility.

When Veterans' were asked which mental health facilities they would be likely to use in the future should they need or want services, 17% indicated they would use campus services, 26% indicated they would likely use community services, and 72% indicated they would likely use VA or military facility services.

Barriers to mental health treatment reported by at least 10% of Veterans were: prefers to deal with the issues on their own (40%); not having enough time (24%); receives support from other sources, such as friends and family (21%); the problem will get better by itself (16%); does not want it to appear on medical records (14%); costs too much money (11%); would be seen as weak (10%).

Secondary Aim: There were no significant differences in self-reported school performance between Veteran and non-Veteran students overall or among those with or without mental health symptoms. Veteran students were less likely to be continually enrolled during the year compared to non-Veteran students overall (77% vs. 83%; p=.014), though among students without mental health symptoms there was not a significant difference between Veterans and non-Veterans (79% vs. 81%; p = 0.47).

Exploratory Aim: Veteran students were less likely to be working full or part-time (40%) compared to non-Veterans (59%); however, Veteran students who were working full- or part-time were less likely to be recently enrolled in school compared to non-Veteran students (70% vs. 80%; p=.0185); and among student who were not working, Veterans rated their school performance lower than non-Veterans.

IMPACT:
This study found high levels of mental health symptoms among Veteran college students, with Veteran students being more likely than comparison college students to have mental health symptoms and hazardous alcohol use. These findings indicate a need for continued VA outreach to Veteran students and continued efforts to engage them in mental health care to reduce symptoms and improve quality of life.

Only a minority (41%) of Veterans students with symptoms engaged in mental health treatment. The two top barriers to treatment were that Veteran students preferred to deal with symptoms "on their own" or did not have time to seek care. Veteran students preferentially use VA mental health care when they do seek treatment. Thus, the VA remains the major resource for care for Veteran students and must make continued efforts to educate Veteran students about treatment efficacy and availability, and develop approaches to working with symptomatic students who do not perceive a need for care. The VA also must make its services accessible and efficient for students who have many demands on their time.

Surprisingly, despite higher rates of mental health symptoms, overall Veterans did not assess their school performance differently than non-Veteran students. However, Veteran students were less likely to be continuously enrolled in school than non-Veterans students indicating more difficulty in maintaining continuity in studies, though this difference disappeared when comparing students without mental health symptoms. Additional work is needed to determine whether greater outreach and treatment engagement of student Veterans can reduce disparities in enrollment between Veteran and non-Veteran students.

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External Links for this Project

NIH Reporter

Grant Number: I01HX000916-01A1
Link: https://reporter.nih.gov/project-details/8486551

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PUBLICATIONS:

Journal Articles

1. Valenstein M, Clive R, Ganoczy D, Garlick J, Walters HM, West BT, Kim HM, Eisenberg D, Bohnert KM, DesJardins SL, Zivin K, Lepkowski J, Pfeiffer PN. A nationally representative sample of veteran and matched non-veteran college students: Mental health symptoms, suicidal ideation, and mental health treatment. Journal of American College Health : J of Ach. 2022 Feb 1; 70(2):436-445. [view]
2. Pfeiffer PN, Pope B, Houck M, Benn-Burton W, Zivin K, Ganoczy D, Kim HM, Walters H, Emerson L, Nelson CB, Abraham KM, Valenstein M. Effectiveness of Peer-Supported Computer-Based CBT for Depression Among Veterans in Primary Care. Psychiatric services (Washington, D.C.). 2020 Mar 1; 71(3):256-262. [view]
3. Fortney JC, Curran GM, Hunt JB, Cheney AM, Lu L, Valenstein M, Eisenberg D. Prevalence of probable mental disorders and help-seeking behaviors among veteran and non-veteran community college students. General hospital psychiatry. 2016 Jan 1; 38:99-104. [view]

DRA: Mental, Cognitive and Behavioral Disorders
DRE: Epidemiology
Keywords: none
MeSH Terms: none