Native American Students in College Counseling: Are Symptoms Related to Racial/Ethnic Diversity on Campus?

 Highlights:

• Many Native American students report elevated psychological and academic distress symptoms when they present to university counseling centers.
• Native American clients at more racially/ethnically diverse campuses report slightly lower academic distress than those at less diverse institutions.
• Increasing representation of diverse students at colleges and universities may be one part of a multi-faceted approach to help create a sense of belonging and academic self-efficacy among Native Americans. Supports to address disparities in psychological and academic distress among Native American students are also needed.

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Native American and Alaska Native individuals (hereafter referred to as Native Americans) have made profound contributions to higher education, including in the fields of medicine, public policy, education, and the arts ​(Academic Influence, 2023; American Neurological Association, n.d.)​. Because Native American students have traditionally been marginalized in the U.S. educational system (Fish & Syed, 2018), there have been efforts to increase access to college for the Native community (e.g., American Indian College Fund). However, Native Americans are still substantially under-represented at U.S. colleges and universities ​(Brayboy et al., 2015; Postsecondary National Policy Institute, 2023)​ and often report social isolation, disconnection from cultural traditions, and racial discrimination in college ​(Brayboy et al., 2015; Tachine et al., 2017)​.

The Hamas attack on Israeli civilians on 10/7/2023 and subsequent war in Gaza has had a profound regional and global impact. While the devastating effects from the events since 10/7/2023 are too vast and complex to summarize in this blog, one of the many areas of ongoing concern is the loss of safety experienced by members of religious communities, particularly those who identify as Jewish and Muslim. In fact, the Anti-Defamation League (2023) reported an increase in antisemitic incidents within the United States since 10/7/2023, which has involved assaults, property damage, harassment, and threats. Additionally, the Council on American Islamic Relations (2023) reported a substantial rise in reports against those who identify as Muslim, including assaults, threats of bodily injury, intimidation, harassment, and workplace discrimination.

First-generation college students (i.e., those who are the first in their family to attend college) make up nearly 1 in 4 clients presenting to college counseling centers in the United States (Center for Collegiate Mental Health, 2024). First-generation students often face challenges and risk factors that impede academic success, such as financial concerns, lack of familiarity with higher education systems, and complex emotional reactions to being the first in their family to receive higher education (Covarrubias et al., 2021).  Conversely, many also bring strengths that can be leveraged in academic and mental health treatment settings to foster resilience, including diverse life experiences (Ives & Castillo-Montoya, 2020). In terms of mental health, general student body surveys have produced mixed results in terms of how first-generation students compare to continuing-generation students (Rockwell & Kimle, 2023; Soria et al., 2022). However, differences in demographic and clinical characteristics between first-generation and continuing-generation students who seek treatment in college counseling have not been reported on a national level. A better understanding of first-generation students’ characteristics when they present to counseling could help clinicians and administrators better serve students within this population. As such, this blog compared the following characteristics between first-generation and continuing-generation students who sought treatment at college counseling centers nationally:

International students make up a significant proportion of the U.S. college student population. Despite a decrease in the number of total international students in 2020-2021 after the onset of the COVID-19 pandemic, the 2021 Open Door report revealed that there were 914,095 international students enrolled in a U.S. higher education institution during that year, constituting 4.63% of the total college student population in the United States (Institute of International Education, 2021).

The CCAPS-Screen is an all-in-one screening instrument that assesses eight of the most common areas of distress experienced by college students and varsity athletes....

Previous research has demonstrated that discrimination is associated with elevated mental health symptoms (e.g., Bravo et al., 2023; CCMH, 2023; Oh et al., 2018; Paradies et al., 2015).  In the CCMH 2023 Annual Report, we examined the relationship between identity-based discrimination and mental health symptoms in a large national sample of college students seeking treatment at university/college counseling centers (UCCs) between 2021 and 2023.  Discrimination was strongly related to increased general distress, social isolation, and suicidal ideation. Counseling centers were shown to effectively treat student clients with experiences of discrimination: those who reported discrimination showed similar levels of improvement in symptoms of distress, social isolation, and suicidal ideation during services as students with no discrimination. However, students who reported discrimination consistently began and ended treatment with higher average levels of distress, demonstrating a persistent outcome disparity. 

The COVID-19 pandemic had a substantial long-term impact on how mental health services were delivered across the country.  College counseling centers, similar to most other mental health facilities, were forced to abruptly transition to remote services in March of 2020.  To better understand this unprecedented systemic migration to remote care, CCMH began collecting data on the service modalities (in-person, video, audio, and text) offered at centers during the early phases of the pandemic.  At the time, there were ongoing questions regarding the staying power of telehealth services once students resumed a more typical academic instruction environment, which eventually occurred in 2021-2022. Now, approximately four years after the onset of the COVID-19 pandemic, CCMH completed an initial investigation evaluating in-person, video, and hybrid (combined) services, answering the following questions:

The demography of higher education institutions in the United States has notably changed over the last two decades.  For example, the proportion of college students who identify as racially/ethnically diverse has shifted nationally, rising from 45.3% of the general student population in 2010 to 52.1% in 2022 (National Center for Education Statistics, NCES, 2010; 2022).  Notably, in the same time period, the percentage of college students who identify as Hispanic/Latino/a/x increased from 11.8% to 18.9%, and the representation of Asian American/Asian students rose from 5.5% to 6.6%.  Additionally, there has been movement in the percentage of students from other traditionally marginalized groups, such as the LGBQQ+ (Lesbian, Gay, Bisexual, Queer, Questioning, plus others) and TGNB+ communities (e.g., Transgender, Non-binary, plus others).  The proportion of students identifying as TGNB+ in the general student body increased from 1% in 2014 to 4% in 2023 (Healthy Minds Study, HMS, 2014; 2023).  Likewise, the American College Health Association (ACHA) noted changes in the proportion of college students who identify as LGBQQ+, rising from 6.6% in 2008 to 19.6% in 2019.

After the murder of George Floyd on May 25, 2020, and the national reckoning that ensued, CCMH immediately began to explore ways students could share recent experiences of discrimination when they seek services at college counseling centers. This initiative was deemed critical by the collective collegiate mental health community given the CCMH measures at the time did not adequately capture experiences of discrimination from the student’s perspective, and there was cautious optimism this awareness raising effort would help clinicians more effectively comprehend the contextual environments of students and enhance the support services they provide. Moreover, research emphasizing that discrimination is connected to increased mental health distress, social isolation, and suicidality (Oh et al., 2018; Paradies et al., 2015) further highlighted the need for this endeavor.

The CCMH 2023 Annual Report describes 185,114 unique college students seeking mental health treatment, 4,817 clinicians and more than 1.2 million appointments from the 2022-23 academic year. This is the 15th year the report has been produced.

College fraternities and sororities (referred to collectively as Greek life) are a long-standing component of higher education in the United States. Greek life can frequently intersect with treatment and outreach at university counseling centers (UCCs), as certain concerns such as alcohol abuse and sexual assault are reported at higher rates among students in Greek life than students in the general student body (e.g., Zimmerman, 2022). However, less is known about how Greek-affiliated students seeking college counseling services compare with non-affiliated students.  For example, while non-clinical Greek-affiliated students report lower depression and anxiety symptoms than non-affiliated students in the general student body (Grace et al., 2022), it is unclear whether this is true among treatment-seeking students as well. A better understanding of Greek-affiliated clients’ symptoms and presenting concerns when they begin counseling could help colleges/universities and UCCs identify intervention, outreach, and general support needs for these students. As such, this blog explored four questions about Greek-affiliated students seeking counseling at UCCs:

College counseling centers serve the needs of diverse student populations, including students at both the undergraduate and graduate levels. The demands faced by students at these various stages of their academic careers vary, which may result in differences in symptoms and presenting concerns between graduate and undergraduate students. It is also possible that graduate and undergraduate students systematically differ on other demographic identity variables that could lend insight to their presenting concerns. An understanding of potential differences between these groups could help inform the support services provided by academic institutions and college counseling centers. As such, this blog examined the following questions:

International students in the United States consistently report higher rates of social isolation than their domestic peers (Prieto-Welch, 2016; Smith & Khawaja, 2011). Some research suggests that this disparity has grown during the COVID-19 pandemic due to the transition to online learning, fewer opportunities for in-person social activities, and increased discrimination faced by international students (Al-Oraibi et al., 2022; Koo & Jiang, 2022; Maleku et al., 2022). As colleges and universities transition to more sustained post-pandemic operations, understanding recent changes in social isolation among international students could help institutions provide them with appropriate support. Additionally, examining changes in social isolation among international students at college counseling centers could inform recommendations for students who are struggling the most and clarify impacts of social isolation on mental health symptoms. In this blog, we explore three questions about social isolation among international students attending colleges and universities within the United States:

The Association for University and College Counseling Center Directors (AUCCCD) and the Center for Collegiate Mental Health (CCMH) share and collaborate on data regarding counseling center trends. This blog, the first featuring our partnership, focuses on counseling center staff turnover. As part of the annual renewal process, CCMH requested turnover data from its member centers in Summer 2022 while AUCCCD requested turnover and recruitment data from its membership during the Fall of 2022. The data reflects information from the 2021-2022 academic year.

The Center for Collegiate Mental Health (CCMH) 2022 Annual Report highlighted that Social Anxiety is the area of distress that demonstrated the largest 12-year increase among students seeking services at college counseling centers nationally. Social anxiety has been found to be prominent among college students and linked to mental health problems later in life (Purdon et al., 2001; Schry et al., 2012). Clients with higher social anxiety symptoms utilize more UCC services (Kilcullen et al., 2021; Janis, 2017) and experience stigmatization (Anderson et al., 2015). Thus, it is important to better understand current trends in social anxiety for students seeking college counseling services to provide clinicians and institutions with nuanced information that may inform care and programs. In the current blog, we further explored the trends in social anxiety, including information from clinicians’ assessments, as well as co-occurring problems that are associated with social anxiety. Specifically, the following questions were answered:

In recent years, there has been increased attention on discrimination and its negative effects on well-being, including both physical and mental health. Students on university and college campuses are not immune from experiencing discrimination. According to data from the National College Health Assessment (NCHA), 7.9% of students experienced discrimination, and this rate is even higher in students who identify with minority identities.

2022 Annual Report

The Center for Collegiate Mental Health (CCMH) is the largest practice-research- network of its kind in the world, focusing on the research of college student mental health. More details about CCMH history and our mission is described here in a prior blog. This particular blog zooms in to focus on the benefits of CCMH membership, as membership with CCMH gives a counseling center access to various tools and resources. Whether you are a current member, or someone interested in membership, this blog is designed to review each of the membership tools/benefits available and expand a bit to share how members use them in their centers.

This blog post is dedicated in loving memory of Nora Maginnis (1963 to 2022). Nora, who served as a Psychiatric Nurse Practitioner at Penn State Counseling and Psychological Services, was a beloved colleague and trailblazer in providing affirming care for individuals who identify as transgender and non-binary. Nora, your tremendous work and impact will always be remembered.

CCMH Membership Growth

CCMH operates and exists thanks to our membership of over 750 colleges and universities! Since 2013, membership has grown substantially, which has allowed us to offer new tools and conduct more research that, in turn, supports college counseling centers and the clients served. All of our members contribute to research by providing center level characteristics and Clinical Load Index (CLI) information. This vital data contribution from members supported the development of the Clinical Load Index (CLI) and three years of subsequent national CLI distributions.