Identifying Correlates and Predictors of Help-Seeking and Treatment Engagement among Undergraduates at Elevated Suicide Risk

Suicide is a leading cause of death among young adults. Despite the relative affordability and accessibility of mental health care services for college students, rates of treatment utilization remain relatively low among undergraduates reporting serious thoughts of suicide. Thus, efforts are needed to improve connection to mental health care services among undergraduates at elevated suicide risk. This study aimed to identify correlates and predictors of help-seeking behaviors (e.g., researching treatment options) and treatment engagement (e.g., attending therapy sessions) among a sample of undergraduates not currently engaged in mental health treatment who had experienced suicidal ideation since beginning their college careers. At baseline, participants (N = 237) completed explicit (i.e., self-report) and implicit (i.e., implicit association tests) measures of attitudes toward suicide and mental health service use, as well as self-report measures of structural barriers to care, suicide literacy, prior mental health treatment experiences, suicidal symptom severity, and readiness to change. Two months later, participants completed a self-report survey assessing help-seeking behaviors and treatment that had occurred during the study period. One-way ANOVAs, ANCOVAs, logistic regression analyses, and zero-inflated Poisson regression models were utilized to identify correlates and predictors of help-seeking and treatment engagement. At baseline, 66% and 28% of participants reported having engaged in help-seeking behaviors and mental health service use, respectively, since beginning their college careers. At two-month follow-up, 59% of participants reported having engaged in helping-seeking behaviors and 25% reported having initiated mental health service use during the study period. Cross-sectional analyses revealed that a lower degree of stigma concerns was significantly correlated with both help-seeking and mental health service use. Longitudinal analyses identified greater readiness to change as the only significant predictor of help-seeking during the study period. No factors significantly predicted whether or not participants initiated mental health service use during the two-month study period; however, those reporting greater structural barriers to care at baseline attended fewer treatment visits over the study period. Findings suggest that enhancing readiness to change might serve to encourage help-seeking among at-risk undergraduates. Our results also suggest that addressing structural barriers to care might facilitate greater treatment retention among at-risk undergraduates who have initiated mental health treatment. Additional research is needed to replicate these findings and to identify predictors of mental health service use among at-risk undergraduates over longer periods of time.