Varsity Student Athlete Utilization of College Counseling Centers

This blog is a summary of a CCMH peer-reviewed study that examined the utilization rates, presenting concerns, and treatment outcomes of varsity athletes who seek services at college counseling centers.

Kilcullen, J.R., Scofield, B.E., Cummins, A.L. & Carr, B.M. (2022). College athlete mental health: Comparing treatment-seeking student-athletes and non-athletes on service utilization, clinical presentation, and outcomes. Sport, Exercise, and Performance Psychology. doi/10.1037/spy0000280

The college experience of varsity student-athletes can differ greatly from their nonathlete peers in many ways. Especially at the NCAA Division-I level, student-athletes may face strong expectations to represent their universities to local and national audiences and to perform consistently at a high level under a public spotlight. Student-athletes also tend to have greater demands on their time than the typical college student. Because of these differences, one might expect that the mental health experiences of student-athletes may vary from nonathletes, too. In order to explore this possibility, a recent CCMH publication – Kilcullen et al. (2022) – compared varsity student-athletes and nonathletes seeking treatment at university counseling centers (UCCs) in the following three areas:

  1. Utilization rates of services
  2. Initial clinical presentations
  3. Treatment outcomes

Utilization Rates of College Counseling Services

Using CCMH data from 2017 to 2019 and publicly available information from the U.S. Department of Education, utilization rates reflected the percentage of the total student-athlete body who received services at respective institution’s college counseling center. The same percentage was calculated for nonathletes as well.

Across all CCMH centers in 2017-2018 (N = 104), which included a combination of NCAA Division I, II, and III institutions, student-athletes utilized services at a rate of 6.42%, which was slightly underrepresented compared to nonathlete students (7.67%). When only NCAA Division I institutions (N = 63) were examined, there was essentially no difference between student-athletes (6.78%) and nonathlete students (6.97%) on utilization rates. In 2018-2019, the utilization rates of student-athletes (7.05%) and nonathletes (7.53%) for all CCMH centers (N = 110) did not differ in any meaningful way. Among NCAA Division I institutions (N = 67), results similarly showed minimal differences in utilization rates for student-athletes (7.38%) versus nonathletes (7.07%).

Initial Clinical Presentations

Differences in initial clinical presentations between student-athletes and nonathletes were examined using distress levels across the seven subscales of the Counseling Center Assessment of Psychological Symptoms (CCAPS-34) and several demographic/historical treatment experience variables from the Standardized Data Set (SDS). Data from a total of 7,730 students across 63 CCMH UCCs were analyzed. As shown in Figure 1, student-athletes reported lower levels of distress than nonathletes on all of the seven CCAPS-34 subscales. These differences were most pronounced among the depression, generalized anxiety, and social anxiety subscales with effect sizes falling in the moderate range. The smallest differences emerged on the academic distress, eating concerns, hostility, and alcohol use subscales.

Moreover, when examining historical treatment experiences (see Figure 2), results showed that student-athletes were less likely than nonathletes to present to services with prior therapy experience and psychiatric medication usage. Also, student-athletes were less likely than nonathletes to report any history of suicidal thoughts or self-injurious behaviors.

Treatment Outcomes

Treatment outcomes were compared between student-athletes and nonathletes by evaluating symptom reduction across all CCAPS-34 subscales over the course of services (defined as at least 2 attended individual counseling/psychotherapy sessions). To enhance the comparisons, student-athletes were matched with nonathlete peers of the same age and from the same CCMH institution. Data from a total of 2,563 students across 27 CCMH UCCs were analyzed.

The findings showed that both student-athletes and nonathletes experienced significant symptom reductions as effect sizes were large across all CCAPS-34 subscales These treatment effects were compared between student-athletes and nonathletes. After statistically accounting for the fact that student-athletes began treatment at lower levels of distress (thus, with less room for symptoms reduction), results showed that, in fact, student-athletes tended to end treatment reporting lower levels of distress on the depression, generalized anxiety, social anxiety, and academic distress subscales (Figure 3). Student-athletes and nonathletes did not differ in their response to treatment on the eating concerns, hostility, and alcohol use subscales.

Implications of the Findings

This study examined the differences between varsity student-athletes and nonathletes in counseling center utilization rates, initial presenting concerns, and treatment outcomes. The following takeaways were noted:

  • In terms of utilization rates, these results suggest that student-athletes may be just as likely as their nonathlete peers to pursue psychological treatment through their respective college counseling centers. These results may be unexpected and surprising, given one might anticipate that student-athletes would have a harder time seeking UCC services due to the aforementioned expectations and time constraints they face, as well as purported stigma for seeking mental health services. Considering that many student-athletes might have direct access to alternative forms of professional support through their respective athletic departments (team physicians, sport psychologists, physical therapists, etc.), especially in Division I sports, these findings demonstrate that UCC services remain in high demand, and are effective, for student athletes.
  • The results found that student-athletes entered treatment with lower distress levels and rates of prior treatment (psychological and psychiatric) than nonathletes. While it is important to consider the possibility that student-athletes may be underreporting their symptoms, these findings may also speak to protective factors associated with student-athlete status (e.g., sports as an outlet for behavioral activation, protective factors of team identity, promoting self-efficacy and self-esteem). The lower levels of reported distress at the initiation of treatment may also suggest other protective aspects of participation in collegiate athletics, such as early identification of symptoms and referral to services by coaches, teammates, trainers, and other athletic department staff (therefore presenting to services reporting lower levels of distress). Finally, the disparity of psychiatric treatment history between student-athletes and nonathletes might be influenced by the role of athletic identity and an overemphasis on sports performance, as prior research has discovered that there is a reluctance by student-athletes to take psychiatric medication due to concerns about adverse impact on performance (Reardon & Factor, 2010). These collective dynamics should be carefully considered when clinicians assess and treat student athletes.
  • The findings indicated that student-athletes compared to nonathletes experienced greater symptom reduction across numerous prevalent problem areas (depression, generalized anxiety, social anxiety, and academic distress) when they are treated at college counseling centers. In other domains, change during treatment was equivalent between athletes and nonathletes (eating concerns, hostility, and alcohol use). These results highlight that while treatment at college counseling centers nationally is very effective for both student-athletes and nonathletes, student-athletes experience greater improvement in symptoms among the most common concerns/problems experienced by students who seek services.


This blog post was written by CCMH Business Team member, Ryan Kilcullen, M.S. Ryan is in his fifth year as a Doctoral Student in Clinical Psychology at PSU and a student in the Castonguay Lab

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