Higher-risk psychiatric and sociodemographic characteristics predicting referral-seeking among college students using...

This study examined whether sociodemographic and higher-risk psychiatric characteristics predicted whether college students sought a referral to mental health care through the American Foundation for Suicide Prevention's Interactive Screening Program (ISP). Using data from 63,407 college students across 58 institutions of higher education from 2009 to 2024, natural language processing (NLP) methods were used to classify student-counselor online message exchanges to determine whether students sought a referral to care, with robust agreement between human coders and the NLP model. Logistic regression models were used to examine the relationships between seeking a referral and higher-risk psychiatric and sociodemographic characteristics of ISP participants. Students were more likely to seek a referral if they had a PHQ-9 score ≥ 10 (aOR: 1.55, 95% CI: 1.44-1.66), were not currently in therapy (aOR: 2.02, 95% CI: 1.80-2.28), reported recent self-harm (aOR: 1.13, 95% CI: 1.00-1.26), recent suicidal ideation (aOR: 1.22, 95% CI: 1.12-1.33), a lifetime suicide attempt (aOR: 1.10, 95% CI: 1.00-1.22), and were aged 25+ (aOR: 1.38, 95% CI: 1.29-1.47). Participants identifying as genderqueer (aOR: 0.70, 95% CI: 0.53-0.91), Hispanic/Latin(x) (aOR: 0.86, 95% CI: 0.78-0.96), and "other" race and ethnicity (aOR: 0.79, 95% CI: 0.63-0.97) were less likely to seek referrals. Findings underscore the ISP's effectiveness in connecting students with significant mental health challenges to care and ability to bridge gaps in care by facilitating connections to appropriate resources. However, disparities in referral-seeking among genderqueer, Hispanic/Latin(x), and participants of "other" races and ethnicities highlight the need for further work to address factors that might discourage help-seeking.