Objective: This study aimed to document population-level trends in mental health service utilization by college students. Methods: The study drew on 10 years of data from the Healthy Minds Study, an annual web-based survey, with a sample comprised of 155,026 students from 196 campuses. Analyses focused on past-year mental health treatment and lifetime diagnoses of a mental disorder. Changes in symptoms of depression and suicidal ideation and levels of stigma were hypothesized as potential explanatory factors. Results: Rates of treatment and diagnosis increased significantly. The rate of treatment increased from 19% in 2007 to 34% by 2017, while the percentage of students with lifetime diagnoses increased from 22% to 36%. The prevalence of depression and suicidality also increased, while stigma decreased. Conclusions: This study provides the most comprehensive evidence to date regarding upward trends in mental health service utilization on U.S. campuses over the past 10 years. Increasing prevalence of mental health problems and decreasing stigma help to explain this trend.

hysical distancing has been the primary strategy to limit the spread of COVID-19 in the United States. Physical distancing (also called 'social distancing') entails reducing contacts between non-household members to reduce opportunities for transmission from infected to susceptible individuals. To promote physical distancing, most US states closed schools, mandated business closures, and issued 'stay-at-home' orders directing residents to avoid unnecessary trips. These measures have been essential to prevent worst-case scenarios involving millions of deaths 1-3. Although there is evidence that new cases of COVID-19 declined as people stayed home 2 , evidence suggests unequal declines in the burden of COVID-19. While case data disaggregated by income are not available, COVID-19 case and death rates have risen fastest in low-income communities 4,5. An association between lower neighbourhood income and COVID-19 risk is also consistent with data showing higher COVID-19 mortality among racial and ethnic minorities 6 , whose socioeconomic position is systematically lower, on average, than that of white Americans and who disproportionately reside in low-income neighbourhoods due to a long history of discriminatory housing policy 7,8. Financial constraints to physical distancing may have been an important factor contributing to higher COVID-19 burden among economically marginalized populations 4. At businesses that have remained open during the pandemic, low-income workers have reported less ability to work from home relative to higher wage earners 9. At these workplaces, most workers were not eligible for unemployment insurance unless they could document a COVID-19 diagnosis or exposure 10. Although many states began closing businesses and ordering residents to stay home in the second half of March, businesses deemed essential remained open, and staffed predominantly by low-wage workers 11,12. It was not until mid-April that some states began requiring people to wear masks in public spaces to reduce COVID-19 transmission, and some states still have not done so 10. In this context, low-income workers have had to choose between staying home and losing their income or going to work and risking exposure to COVID-19 for themselves and their households and neighbours. Given that those in low-income households typically have little savings 13 , losing income could bring other health and safety risks, including homelessness and food insecurity. Previous work 14 has found that residents of low-income neighbourhoods were less likely than residents of higher-income neighbourhoods to stay home in response to COVID-19. In this article, we test two main hypotheses. First, we proposed that this gap in physical distancing was explained by work-related demands (hypothesis 1a) and not by visits to places other than work (hypothesis 1b). Second, we proposed that state policies that ordered non-essential businesses to close, and for residents to stay at home, increased the gap in physical distancing between low-and high-income neighbourhoo...

U.S. college students are a distinct population facing major challenges due to the COVID-19 pandemic. Before the pandemic, students were already experiencing substantial mental health concerns, putting both their health and academic success in jeopardy. College students now face increasing housing and food insecurity, financial hardships, a lack of social connectedness and sense of belonging, uncertainty about the future, and access issues that impede their academic performance and well-being. There is also reason to believe that COVID-19 is exacerbating inequalities for students of color and low-income students. We provide several recommendations for institutions of higher education to mitigate these obstacles, including engaging in data-driven decision making, delivering clear and informative messaging to students, prioritizing and expanding student support services, and using an equity framework to guide all processes.

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