Graduate Student Mental Health: Needs Assessment and Utilization of Counseling Services

This study examined the mental health needs, knowledge, and utilization of counseling services among graduate students at a large university in the western United States. Almost half of graduate student respondents reported having had an emotional or stress-related problem over the past year, and over half reported knowing a colleague who had had an emotional or stress-related problem over the past year. Self-reported mental health needs were significantly and negatively related to confidence about one's financial status, higher functional relationship with one's advisor, regular contact with friends, and being married. Utilization of counseling services was positively associated with an index of depression symptoms, the number of semesters in school, and identifying as female. Those students who had experienced a significant mental health event in the past year and had higher functional relationships with their advisors were significantly more likely to utilize counseling services. Findings suggest a need for increased attention to graduate student mental health needs, especially the role of financial confidence in student well-being and the relationship of graduate students with their advisors.

According to the U.S. Department of Education, there were approximately 1.9 million graduate students in American universities in 2001 (U.S. Department of Education & National Center for Education Statistics, 2003). In addition to the diversity of educational programs and teaching environments, graduate students themselves possess an equal diversity of personal, professional, intellectual, and psychological traits and abilities (Committee on the College Student, Group for the Advancement of Psychiatry, 1999). Graduate students face many unique challenges. Because of demographic and social changes in recent decades, graduate students are more likely to have multiple familial and financial responsibilities entering graduate school than did students in the past. Moreover, graduate school represents a departure from the formal structure of undergraduate studies. In contrast to the experience of undergraduates, graduate students generally operate in an environment with less guidance requiring significant self-motivation in structuring progress through graduate programs (Peters, 1997).

Most of the research on mental health needs at U.S. universities has focused on undergraduate students (S. A. Benton, Robertson, Tseng, Newton, & Benton, 2003); has failed to distinguish between undergraduate and graduate student status (O'Neil, Lancee, & Freeman, 1984; Pledge, Lapan, Heppner, Kivlighan, & Roehlke, 1998; Westefeld & Furr, 1987); or has studied only small subsamples of the graduate student population, such as medical or psychology graduate students (Givens & Tjia, 2002; Nelson, Dell'Oliver, Koch, & Buckler, 2001; Nogueira-Martins, Fagnani Neto, Macedo, Citero, & Mari, 2004; Toews et al., 1997). Studies of graduate students illuminate the particular vulnerabilities and needs of this population. In comparison to medical students and residents, graduate students in the sciences had higher levels of overall stress and higher presentation of mental health problems (Toews et al.). Graduate students are particularly vulnerable to pressures related to conducting research and teaching, publishing, and finding employment, in addition to stress from the often ambiguous expectations of advisors. Multiple studies of graduate student mental health have found that financial stress was a major reason for seeking counseling (Furr, Westefeld, McConnell, & Jenkins, 2001; Nogueira-Martins et al.; Toews et al.; Westefeld & Furr). Researchers found that graduate students had significantly higher frequency of thoughts on quitting their studies than both medical students and residents (Toews et al.). Untreated mental health problems are significant contributors to graduate student dropout (Turner & Berry, 2000; Wilson, Mason, & Ewing, 1997).

Studies have also documented that graduate program characteristics are associated with students' emotional well-being and the likelihood of completing one's graduate program. These characteristics include a focus on professional versus academic degrees; a high level of administrative, social, and financial support provided by the department; a more democratic supervisory structure; mentoring; and utilization of counseling services are positive, protective factors in the psychological transition to and successful completion of graduate programs (T. Benton, 2003; Committee on the College Student, Group for the Advancement of Psychiatry, 1999; Goldberg, 1998; Johnson & Huwe, 2002).

Reports on mental health indicate that frequent mental distress among adults is on the rise across the U.S. The Centers for Disease Control reported that between 1993 and 2001, the prevalence of frequent mental distress in U.S. adults rose from 8.4% to 10.1% (Centers for Disease Control and Prevention [CDC], 2004). The conventional wisdom in the field of university counseling is that the severity of mental health problems on campus has been steadily increasing. In their landmark study, S. A. Benton et al. (2003) found that over the course of 13 years, there has been a marked increase in the percent of students seeking counseling for problems related to developmental and situational problems, depression, academic skills, grief, and medication use. The authors concluded that university counselors are seeing students with more complex problems, which may reflect changes in the prevalence of mental distress at large within the population, changes in the university environment, and increasing psychiatric medication use by students before entering college (S. A. Benton, Benton, Newton, Benton, & Robertson, 2004; Rudd, 2004; Sharkin, 2004). A significant drawback to the much-cited S. A. Benton et al. (2003) investigation is that the study design captured data only for those students who used counseling services. Although this study is helpful in ascertaining the prevalence of problems presenting at university counseling centers, other studies suggest that the majority of students who may be most at risk do not seek counseling (Furr et al., 2001; Givens & Tjia, 2002).