Last year, I supervised Honors Thesis research by Morgan Rondinelli related to mental health in two introductory science courses at Michigan (Bio 171 and Physics 140). Morgan’s survey included two common screeners, one focused on symptoms of depression (the PHQ-8*) and one focused on anxiety symptoms (the GAD-7). The survey also asked about previous diagnoses, stress mindset, resource usage and knowledge, barriers to seeking help, and demographic information. Here, I will briefly summarize some of our findings, but I will especially focus in on the area that seemed the most novel: student views on stigma associated with seeking mental health care.
The tl;dr answer to the question in the post title is: it seems possible.
Before getting to the findings related to stigma, I’ll highlight a few other findings. But, before doing that, I want to emphasize that the response rate was low (5% of students across the two courses). That’s not surprising: survey fatigue is real and students didn’t receive any incentives for taking the survey (due to IRB concerns about coercion). There are some indications in the survey responses that the respondents were not a random sample of students**, which influences how we should interpret the results (a topic I’ve written about before in the context of grad student mental health). As one example, if X% of survey respondents indicate they have diagnosis Y, that does not mean that X% of all students in the classes have that diagnosis.
With that caveat, here are some of our most interesting findings:
- ~23% of students reported a previous diagnosis of a depressive disorder and ~25% reported a previous diagnosis of an anxiety disorder. While our response rate was low and potentially biased, those are very similar to findings of a larger survey of UMich students (which found the following stats for previous diagnoses: 25% depression, 18% generalized anxiety disorder, 8% social anxiety, 7% ADHD, and 3% OCD).
- First generation and LGBTQ+ students had significantly higher scores on the PHQ-8 (depression) and GAD-7 (anxiety) screeners.
- Most students were aware of at least some on campus mental health resources.
Focusing on barriers to seeking treatment:
- The most common barrier to seeking treatment was fear of how disclosing would affect student and faculty/staff perceptions. 37.7% of survey respondents identified this as a past barrier and 32.8% as a current barrier.
- Something we didn’t think to ask about but that multiple students wrote in as a free response was that their mental health condition prevented them from seeking help (e.g., due to a lack of motivation associated with depression). In retrospect, we probably should have thought to include that as an option. It would be really interesting to know what percentage of students experience that as a barrier to seeking care.
The main motivation for me writing this post, though, was to discuss the results of two questions that we asked related to stigma. We asked the students:
- I would think less of a person who has received mental health treatment, and
- Most people think less of a person who has received mental health treatment
The difference in the responses to those questions was striking. There are a few ways of visualizing the data, and I think they each have different advantages, so I’ll include three different plots of the same data.
First, in the figure below, you can see that most students strongly disagreed with the statement that they themselves would think less of a person who has received mental health treatment (blue bars). In contrast, the most common response to the question about views of others (shown with black bars) was to “somewhat agree” that most people think less of a person who received mental health treatment:
We can use the very neat Likert package in R to plot those same data somewhat differently. Here’s that plot:
Note: on this figure “self” indicates the responses to the question “I would think less of a person who has received mental health treatment” and “others” indicates the responses to the question “Most people think less of a person who has received mental health treatment”. 61 students answered both questions; the percentages on the right indicate the percentage of students who chose one of the “agree” options for a question and the percentages on the left indicate the percentage of students who chose one of the “disagree” options.
The take home message that stood out to me was: students view others as more judgmental than they say they are themselves. I’ll discuss that more below, but first want to show one last plot of the same data. Perhaps because I am an evolutionary ecologist, it seemed like I should create a reaction norm-style plot that connects individual answers to the two questions:
Note: On the y-axis, 1 = strongly disagree whereas 6 = strongly agree. The lines are partially transparent and jittered, so that more common response combinations appear darker and thicker.
That paired response figure makes it really clear that no students viewed themselves as more judgmental of students who seek mental health care (as compared to how they think most people view people who seek mental health treatment).
Why is this?
At first, I thought “This is wonderful! Now we just need to tell students that their peers are much less judgmental than they think and then people will feel okay seeking care!” But there are (at least) two important caveats that warrant consideration. First, people do not always admit to holding unpopular views; our survey was anonymous which should reduce the impact of this social desirability bias, but it’s possible some students didn’t trust that we really wouldn’t be able to link their answers to them. Second, I wouldn’t want a student who has experienced negative reactions when someone found out they had received mental health care to feel like we were saying their real, lived experience of stigma had not really happened.
In the end, I find these results really interesting, but am not sure what to do next. I have a lot of ideas for projects related to student mental health and am moving ahead with several of them. But none of them directly involve exploring this issue of stigma. I think that would be really interesting to do, but also need to spend more time thinking about it and reading about it. (I also need more hours in the day so I can actually get that done!)
In the meantime, as the project wraps up and the nears its end, I thought it would be useful to share these results more broadly, in the hopes that they inspire discussion (and maybe even follow up research). I’d love to hear thoughts from others!
- 36% of our respondents identified as members of the LGBTQ+ community; we don’t know of a survey of Michigan students that asked the exact same question, but in the UMAY survey of the campus community, 14% of students identified their sexual orientation as something other than heterosexual. That’s not a direct comparison, but the difference is sufficiently large that it seems likely that LGBTQ+ students may have been more likely to respond to our survey.
- 20% of our respondents identified as first generation students; in 2013, ~10% of students reported having parents who did not attend college or who attended some college.