American Journal of Health Education

ISSN: (Print) (Online) Journal homepage: www.tandfonline.com/journals/ujhe20

An Examination of Mental Health, Perceived

Barriers, and Outreach Recommendations
amongRural College Students

Kristin Reid, N. Armstrong, D. Todd, L. Ballard, C. Szczepaniak & C. Tinsley

To cite this article: Kristin Reid, N. Armstrong, D. Todd, L. Ballard, C. Szczepaniak & C. Tinsley
(2021) An Examination of Mental Health, Perceived Barriers, and Outreach Recommendations
amongRural College Students, American Journal of Health Education, 52:2, 101-110, DOI:
10.1080/19325037.2021.1877220

To link to this article: https://doi.org/10.1080/19325037.2021.1877220

Published online: 17 Feb 2021.

Submit your article to this journal

Article views: 1310

View related articles

View Crossmark data

Citing articles: 4 View citing articles

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=ujhe20
AMERICAN JOURNAL OF HEALTH EDUCATION
2021, VOL. 52, NO. 2, 101–110
https://doi.org/10.1080/19325037.2021.1877220

An Examination of Mental Health, Perceived Barriers, and Outreach

Recommendations among Rural College Students
Kristin Reid, N. Armstrong, D. Todd, L. Ballard, C. Szczepaniak, and C. Tinsley
Murray State University

ABSTRACT ARTICLE HISTORY

Background: Mental health concerns for the collegial population are noted throughout the Received 10 July 2020
literature, with a recent focus on assessment, interventions and outreach.1 Concerns regarding Accepted 9 September 2020
individual resilience, barriers to seeking care and outreach opportunity venues have led careful
consideration for further investigation of the rural college student.
Purpose: The purpose of this research study was to examine the mental health issues and concerns,
as well as the challenges related to accessing campus mental health services.
Methods: A descriptive study was conducted to examine the self-reported mental health of
currently enrolled students.
Results: A campus wide survey confirmed that many students experience stressors that negatively
impact their college experience. Study participants reported that their major sources of stress were
financial strains and academic performance pressures, along with body image and food related
issues to a lesser degree. Additionally, the students reported barriers to accessing mental health
resources.
Discussion: College students face a variety of stressors and mental health issues that threaten the
quality of their lives and their ability to perform well academically.
Translation to Health Education Practice: Institutions of higher education need to ensure that
mental health and wellness resources are not only available to students, but readily accessible.

Background
Mental health concerns for the collegial population are
noted throughout the literature with a recent focus and
attention on assessment, interventions and outreach.1
From a national perspective, suicide was the second
leading cause of death within the 10–34-year-old popu­
lation in 2016.2 In 2017, the Center for Collegiate Mental
Health (CCMH) reported that 34.2% of the collegial
population have considered suicide.3 Additionally, it
was reported in 2014 that approximately 86% of college
students that completed suicide did not previously seek
treatment from a college-based counseling service.4
Anxiety and depression have been reported as the
top two mental health concerns for this population.5,6
Other concerns reveal stressors related to academic
performance, and pressures to succeed are common.7
Gibbons et al., identified the top mental health issues
from a sample of 822 full time graduate and under­
graduate students and identified; work/school/social
balance (55.4%), stress management (52.7%), and
depression/anxiety (46.9%) as the top three concerns;
however (32.5%) of the participants reported that they
would “not likely” seek help.8 In reference to support,
the CCMH report suggested treatment sessions with
campus counseling ranges from 2–10 sessions with an
average of 4.5 sessions.4
Disparities among rural populations have long been
established. Similarly, these disparities are also common
among rural college students. These disparities include
lower family incomes, poorer health status, and limited
healthcare resources. Rural populations have higher
levels of poverty when compared to urban areas. It is
estimated that 18% of rural populations live in poverty
compared to 17% in urban populations.9
The lower family incomes experienced among rural
college students often results in these students seeking
employment while enrolled in college full-time. It is
estimated that 70% of college students work with vary­
ing degrees of hours; however, 26% of low-income stu­
dents work full-time while in college compared to 22%
of those students with high family incomes.10
Working full time while juggling college may result in
higher levels of stress which may lead to an increased
risk for mental health problems in rural college students.
It is well known that mental health problems have
increased among college students. It is reported that

CONTACT Kristin Reid kreid3@murraystate.edu Murray State University, SONHP, Mason Hall, Murray, KY 42071
© 2021 SHAPE America
102 K. REID ET AL.
44% of college students reported having problems with
depression.11
The American College Health Association survey
reported that almost 40% of college students had
difficulty functioning due to depression and 61%
experienced extreme anxiety.11 Unfortunately in
rural colleges and universities, there are often limited
resources on and off-campus. Access to mental health
resources is essential to dealing with the increased
mental health issues impacting rural college
students.12 Literature affirms the mental health needs
that college students experience. Chronic illnesses are
often related to mental health issues that are not
treated and/or undertreated. For example, anxiety
and depression have been linked to cardiovascular
disease, obesity and diabetes mellitus.13 Furthermore
there are often devastating mental health illnesses that
first present in the college population such as schizo­
phrenia which require intensive management for
a lifetime.13
It is well documented that medications used for com­
mon mental health illnesses may also have a negative
impact on other disease processes and induce unwanted
side effects. Many common side effects such as obesity,
metabolic syndrome and sexual side effects which may
support non adherence in medication management for
this population.14
Additionally, concerns regarding individual resili­
ence, barriers to seeking care are evidenced by the
literature. Rural college mental health perceptions
and findings are limited. Therefore, further investiga­
tion of the rural college student mental health needs
are needed.
Purpose
Mental health concerns among college students nation­
wide have most recently focused on assessment, inter­
ventions and outreach.15 After review of literature,
limited research has been completed in rural college
settings. The researchers sought to replicate the
Gibbons et al. survey in a rural population.8 The purpose
of this descriptive study was to examine the self-reported
mental health of currently enrolled students, their per­
ceptions of mental health problems on campus, and
mental health campus resources. Students were asked
to identify both recent and extended problematic mental
and emotional experiences. A sample of issues included
stress, anxiety, depression, addictions, and eating disor­
ders. Assessment of current understanding, beliefs and
coping mechanisms was essential to determine which
common college stressors, and concerns were identified
as impacting day to day life.
Methods
Participants
This descriptive study was conducted at a rural, public
university in the Southeastern part of the United States.
Demographic data consisted of enrollment status and
program of study, gender, age, relationship status, chil­
dren, and ethnicity (Table 1). Qualifications for being
part of the research included: 18 years of age or older
and a current college student. The survey was available
for approximately 30 days with one e-mail reminder sent
to all students. The sampling consisted of 547 partici­
pants with 75.69% being females (n = 414), 21.21%
males (n = 116), and 3.11% transgender/non-binary
(n = 17). The students’ ages consisted of 53.39%
(n = 291) between 18– 20 years of age, 32.84%
(n = 179) between 21–25 years of age, and 13.76%
(n = 75) over age 25. The majority of students were in
a Bachelors Program with 80.80% (n = 442), 16.27%
(n = 89) were enrolled in a Graduate Program, and
2.93% (n = 16) were taking classes, but not working
toward a degree.
The participants represented a diverse population.
The majority of participants, 48.07% (n = 262)
responded as being single and not in a significant rela­
tionship 48.07%; 40.37% (n = 220) as not married, but
in a significant relationship; 9.72% (n = 53) as married;
0.37% (n = 2) as separated; 1.28% (n = 7) as divorced;
0.18% (n = 1) as widowed; and 0.37% (n = 2) did not
respond. When asked about children, 8.61% (n = 47)
reported they have children, 91.39% (n = 499) do not
have children, and one did not respond. The majority
of participants identify as white or Caucasian, with
91.01% (n = 496) identifying as white or Caucasian.
Other ethnicities were represented, with 3.49% (n = 19)
identifying as black or African American, 1.28%
(n = 7) as Hispanic or Latino, 2.20% (n = 12) as
Asian or Asian American, 0.37% (n = 2) as American
Indian or Alaska Native, 0.55% (n = 3) preferred not to
answer, 1.10% (n = 6) as other, and two did not
Table 1. Demographic information, n= 547.
Demographics Mean or %
Age 53.39
● 18–20 years 32.84
● 21–25 year 13.76
● over 25 years
Female 75.7
Male 21.2
Transgender/Non-binary 3.1
Single 48.07
Married 9.72
Divorced 1.28
Have children 8.61
 AN EXAMINATION OF MENTAL HEALTH, PERCEIVED BARRIERS, AND OUTREACH RECOMMENDATIONS
respond. None responded as Native Hawaiian or other
Pacific Islander.
The majority of students that responded to the survey
were majoring in education with 19.96% (n = 108) of the
sample. Other majors that were represented included
18.67% (n = 101) business majors; 13.49% (n = 73)
agriculture; 17.01% (n = 92) science, engineering, and
technology; 21.07% (n = 114) humanities and fine arts;
4.44% (n = 24) nursing; 5.36% (n = 29) health profes­
sions; and 6 did not answer.
Procedures
This study was designed to examine the perceived
mental health concerns among college students, their
perceived barriers to access, and outreach recommenda­
tions. Permission was received from Gibbons et al to
adapt the original survey with minor revision which
included shortening of the survey (Appendix). The ter­
minology within the survey was modified to better fit
with a rural, public university. For example, the
researchers were not interested in first generation col­
lege students during this survey or what religious
denomination they were affiliated with currently. The
study was reviewed by the institutional review board
(IRB) and deemed exempt from IRB oversight. An
e-mail was sent to all students that included an explana­
tion of the purpose and methodology of the study with
an invitation to participate, as well as the link to access
the survey. The students accessed the survey through
a SurveyMonkey link. Participation was voluntary and
completion of the survey implied consent. The survey
took approximately 10 minutes to complete and was
completed anonymously. There were no incentives to
complete the survey.
Study questionnaire
The survey tool used was adapted from an untitled
survey developed by Gibbons, et al and had a reported
Cronbach’s alpha score of 0.75.8 The survey consisted of
four sections that included perceptions of mental health,
self-reported mental or emotional health problems, cop­
ing and support systems, and campus resources and
recommendations. Perceptions of mental health
included questions that required the students to rank
their typical life stressors and the biggest mental and
emotional health issues on campus. Self-reported mental
or emotional health problems were assessed through
a series of questions that asked the student to self-
report mental or emotional problems that persisted for
more than two weeks, when the mental or emotional
problems began, if the mental or emotional problems
103
interfered with daily activities in the past four weeks,
and how much time physical or emotional health pro­
blems interfered with social activities in the past four
weeks. The coping and support systems assessment of
the survey consisted of questions that asked students
how likely they were to seek help, where do they seek
mental and/or emotional support, how much others care
about them, and how they cope with stress. Campus
resources and recommendation questions included
campus mental health resources students were familiar
with, what mental health topics required more informa­
tion and how the information should be shared, and
what barriers students experienced when seeking mental
health assistance.
Results
Participants ranked typical college stressors from the
most to least stressful on an individual basis using
a Likert scale from 1 (low stress) to 5 (most stress).
The stressors assessed were coping with roommates/
living conditions; living separate from family; balancing
school work with job hours; making ends meet finan­
cially; their academic load (grades, credits, exams,
papers); social needs (friends, family, etc.); health sta­
tus/health issues; food, body image, and weight issues;
transportation; parental issues/childcare issues; girl­
friend/boyfriend/other significant relationship issues;
technology problems (Facebook updates, text messages,
etc.); purpose-in-life issues/figuring out what to do for
a major or after graduation; and religion/spirituality.
The findings revealed that 28.81% (n = 157) of partici­
pants reported making ends meet as a 5 (most stressful),
with another 24.22% (n = 132) rating it as a 4. Results
also showed academic load to be stressful, with 27.66%
(n = 151) rating it as a 5, and 32.23% (n = 176) rating it
as a 4. Other factors with high stress ratings included
food/body image/weight issues, balancing school work
with job hours, and social needs.
Participants were also asked questions regarding their
mental health. Participants were asked to select their
perceptions of the most common mental and emotional
health issues on campus. The choices were: stress, anxi­
ety, depression, pornography, addictions, eating disor­
ders, perfectionism, financial stress, PTSD, transitioning
into adulthood/college, and other. The results revealed
that students perceived stress at 77.80% (n = 424) and
anxiety at 76.70% (n = 418) as the top perceived mental
health conditions on campus. Additionally, 65.87%
(n = 359) of participants felt that depression and finan­
cial stress at 42.02% (n = 229) were common among
college peers. Participants were also asked if they have
ever experienced mental or emotional problems that
104 K. REID ET AL.
persisted for more than two weeks. An overwhelming
72.71% (n = 397) responded yes followed by 18.68%
(n = 102) responding no, 8.61% (n = 47) responding
unsure, and one did not respond. When asked when
they first remember experiencing mental or emotional
problems that persisted more than two weeks, 396 par­
ticipants responded. The majority of students 63.89%
(n = 253) responded that they had experienced mental
or emotional problems before college, 32.07% (n = 127)
while at college, and 4.04% (n = 16) were unsure.
Another mental health question participants were
asked was, “During the past four weeks, have you had
any of the following mental health problems with your
work or other regular daily activities as a result of any
emotional problems (such as feeling depressed or
anxious)?” Given the options, 61.51% (n = 302) reported
cutting down the amount of time they spent on school,
work, or other activities; 80.20% (n = 393) accomplished
less than they would like; and 62.86% (n = 308) did not
do school, work, or other activities as carefully as usual
as a result of emotional problems.
The survey also questioned how their physical health
or emotional problems had interfered with social activ­
ities, such as visiting with friends or relatives, in the past
four weeks. 37.22% (n = 182) responded some of the
time; 23.31% (n = 114) a little of the time; 17.59%
(n = 86) most of the time; 14.11% (n = 69) none of the
time, 7.77% (n = 38) all of the time; and 58 did not
respond. Participants were also asked how they usually
cope with stress/psychological issues, being instructed to
check all that apply. They were given the options for
coping skills of sleep, exercise, eat, cry, spend money,
hold things in, yell at or blame others, ignore the feelings
and hope they pass, talk to friends/family, avoid friends
(social isolation), stop attending school/work, negative
self-talk, listen to music, clean their house, do nothing,
and crafting. They responded in regards to how often
they use these coping skills: never, sometimes, and
usually. The most commonly “usually” used coping
skills were holding things in at 55.69% (n = 274); listen­
ing to music at 45.82% (n = 225); ignore the feelings and
hope they will pass at 40.45% (n = 199); cry at 30.08%
(n = 148); and sleep at 34.35% (n = 169).
Participants were also asked if they have a mental/
emotional health concern, how likely they are to seek
help. 15.24% (n = 75) participants said they were very
likely, 43.29% (n = 211) were somewhat likely, 34.55%
(n = 170) were unlikely, and 6.91% (n = 34) would never
seek help. 55 participants did not respond. To assess
where participants go for help, they were asked,
“Which of the following best describes who/where you
go when in need of mental and/or emotional support?”
They were given options with answers of “I never go to,”
“I sometimes go to,” and “I usually go to.” Participants
were most likely to go to family or roommates/friends,
with 31.71% (n = 156) responding that they usually go to
family and 31.02% (n = 152) usually going to friends.
They were unlikely to go to any counseling or
a professor/staff member, with 82.89% (n = 407)
responding that they would never go to on campus
counseling, 77.64% (n = 382) would never go to off
campus counseling, and 81.26% (n = 399) would never
go to a professor/staff member.
A Likert scale was created to determine how much
they think family, friends, roommates, teachers/profes­
sors/advisers, spiritual/religious leaders, employer/boss/
supervisor at an on-campus job, and employer/boss/
supervisor at an off-campus job care about them as
a person, with 1 being low interest and 5 being high
interest. Participants rated family as having the most
interest in them with 69.11% (n = 340) rating family at
a 5 (high interest). They rated teachers/professors/advi­
sers as neutral, with 34.08% (n = 167) rating them at a 3
out of 5.
Participants were asked what mental health/potential
stressors topics they would like more information about
and allowed to choose all that apply from a list of:
balancing finances; balancing work, school, and family
life; managing stress associated with school; dating,
social, and/or romantic relationships; religion/spiritual­
ity; physical health; sexual assault prevention; how to
support a family member or friend with a mental/emo­
tional health issue; coping strategies for mental and/or
emotional health; understanding depression, stress, and/
or anxiety; how to overcome addictions; understanding
mental health problems; and other(Table 2). The top five
choices for participants were managing stress associated
with school at 56.79% (n = 230); coping strategies for
mental and/or emotional health at 56.54% (n = 229);
balancing work, school, and family life at 52.59%
(n = 213); understanding depression, stress, and/or anxi­
ety at 51.60% (n = 290); and balancing finances at
47.41% (n = 192). They were also offered to report how
they would like to receive this information, with options
of e-mailed newsletters, on campus seminars, campus
activities, a campus course, webinar or Youtube, social
media, or other. They were asked to select up to three
(Table 3). The three most popular choices were e-mail
Table 2. Top five topic students reported they would like more
information about.
Managing stress associated with school 56.79% (n = 230)
Coping strategies for mental and/or emotional health 56.54% (n = 229)
Balancing work, school, and family life 52.59% (n = 213)
Understanding depression, stress, and/or anxiety 51.60% (n = 290)
Balancing finances 47.41% (n = 192)
 AN EXAMINATION OF MENTAL HEALTH, PERCEIVED BARRIERS, AND OUTREACH RECOMMENDATIONS
Table 3. Top three outreach methods reported.
E-Mail newsletter 61.90% (n = 247)
Social media 45.11% (n = 180)
Webinar or Youtube 36.59% (n = 146)
newsletter at 61.90% (n = 247), social media at 45.11%
(n = 180), and webinar or Youtube at 36.59% (n = 146).
Finally, participants were asked about barriers which
students who are seeking help for psychological issues
face (Figure 1). The options were: not sure of available
resources, too ashamed, worried about what other people
will think, no support from friends and family to get treat­
ment, cost associated with treatment, and not enough time.
Participants were given the option of “this is not a major
barrier” or “this is a major barrier.” The top three reported
barriers were worried about what other people think at
86.91% (n = 425), too ashamed at 86.50% (n = 423), and
not enough time at 81.07% (n = 394).
Discussion
This study sought to discover the mental health and well­
ness issues affecting students at one rural university in the
United States. Study participants reported that their major
sources of stress were financial strains and academic per­
formance pressures, along with body image and food
related issues to a lesser degree. These sources of stress are
consistent with findings in other studies of college students
in the United States.16–18 The most common mental and
emotional health issues affecting the participants included
stress, anxiety, depression, and financial strain. These find­
ings are similar to those found in previous studies.7,19
Around half of the participants had experienced emo­
tional problems that had caused a reduced performance
at work or school. Past studies focused on college stu­
dent mental health found that anxiety, depression, and
Figure 1. Barriers.
105
stress often have a negative impact on academic
performance.7,20 The most common coping mechan­
isms that the participants reported that they used to
deal with stressors were “holding things in,” and “ignor­
ing feelings and hoping that they go away.”
Unfortunately, these strategies are generally considered
deleterious and may result in feeling a loss of control.20
Most of the participants reported limited awareness of
mental health resources on campus. This occurred despite
efforts by the university to make students aware of available
resources through content inclusion in new student orien­
tation and various forms of advertisement. When the par­
ticipants were given an opportunity to select mental health
and wellness education topics of which they would like
more information, the top selected items included financial
management and budgeting, maintaining a work-life-
school balance, managing stress, developing coping strate­
gies, and understanding depression and anxiety. These
subjects correlated well with the most commonly reported
sources of stress and the most common mental health and
emotional issues reported by the participants. The partici­
pants reported that they preferred that this information be
shared via electronic resources, such as e-mail, webinars,
and less commonly, social media. Electronic delivery meth­
ods have been found to be effective in promoting student
mental health and wellness.21,22
One of the main limitations of this study is that it was
conducted at one university, using a convenience sample
of students. As well, the study relied on self-reported
data, which may not match the true mental health issues
and lifestyles of the students. It would be helpful to see
this study expanded to generalize the results. However,
the survey has been used in another study at a separate
university, which was not rural and in a different region
of the United States.8 The findings in the original study
were consistent with the findings in this study in many
106 K. REID ET AL.
areas. Similarities between the two studies included the
most prevalent items reported as: sources of stress,
mental health and emotional issues, and the delivery
methods in which the students would like to receive
mental health education. This strengthens the findings
of this study.
Translation to Health Education Practice
This study, in combination with the outcomes from the
original study using the survey developed by Gibbons and
colleagues, can assist mental health professionals and
health educators in focusing their resources in working
with college students.8 Many of the students in this study
reported that they were dealing with a variety of stressors
and mental health issues to varying degrees. However,
there was a general lack of unawareness of the mental
health resources available on campus. Health educators
who work within institutions of higher education, or with
the college student population, need to make every effort to
ensure that students are aware of the mental health and
wellness resources that are available to students, utilizing
effective methodologies. To reach students and assist them
in feeling more comfortable about using their services, The
College Marketing group recommends that health educa­
tors and mental health specialists use social media out­
reach, create videos with the assistance of marketing
specialists, normalize mental health struggles in their con­
tent, and utilize student ambassadors.23 Whatever the
method, health educators in the college or university set­
ting need to make sure that students are aware of the
mental health resources that are available to students.
Health Educators and Certified Health Education
Specialists who work with the college student population
can use this study as a framework for discerning the
health needs of the populations that they serve. This
study focused on the Assessment of Needs and
Capacity from the Eight Areas of Responsibility for
Health Educator Specialists from the National
Commission for Health Education Credentially
(NCHEC).24 The researchers obtained data from the
college student population about their perceived mental
health issues and social stressors. This included obtain­
ing data from sources, analyzing the health of priority
populations, and synthesizing the findings to inform the
planning process, which are all subheadings of the
Assessments of Needs and Capacity area. In addition,
the area of Advocacy was a focus of this research, as it
helped to identify current or emerging health issues that
require change within this population of students.
The researchers plan to use the data from this study
to create an intervention, in which nursing students in
a mental health course create short educational videos
discussing some of the areas of concern for this popula­
tion of college students, such as managing stress or
dealing with anxiety, and provide information about
campus and vetted outside resources that can help stu­
dents manage common mental health concerns and
other social stressors. The videos will also assist students
in finding assistance if their personal resources are insuf­
ficient to deal with stressors or mental health issues. The
plan is to complete a pilot study sharing this information
with nursing students only, eventually expanding the
release to students campus wide. Health educators and
Certified Health Education Specialists can conduct simi­
lar research with their patient populations, so that they
can create a similar advocacy program, based on the best
available evidence and the needs of the specific popula­
tion that they serve.
The students in this study stated that they would most
like to receive information about topics related to mental
health and wellness, such as financial budgeting and
managing stress, through electronic methods. Campus
health educators and mental health professionals should
consider providing information on a routine basis about
maintaining mental health and wellness through elec­
tronic resources, such as electronic newsletters, e-mails,
or webinars. Electronic mental health education videos
that are readily accessible to students as needed, such as
through a cell phone app, have been found to be useful
in reaching students and assisting them in reducing
stress, as well as responding to other common mental
health issues.25 In addition, health educators who work
within universities or colleges might consider conduct­
ing their own yearly mental health surveys with stu­
dents, in order to tailor their health education to best
meet the needs of their student population. Finally,
health educators might find it helpful to provide educa­
tion to professors and staff about common mental health
issues and stressors in college students to increase aware­
ness, as well as to ensure that faculty and staff are aware of
resources that are available to help students develop skills
to respond to these stressors and issues. As previously
discussed, rates of depression and anxiety, as well as
suicide rates in college students have been increasing at
alarming rates in the United States. It is imperative that
universities develop tools to evaluate and respond to
stressors and mental health issues in a manner that is
effective and ensures that college students in need of
help are aware of how to access those resources.
Disclosure statement
No potential conflict of interest was reported by the authors.
 AN EXAMINATION OF MENTAL HEALTH, PERCEIVED BARRIERS, AND OUTREACH RECOMMENDATIONS
References
1. National Council on Disability. Mental health on col­
lege campuses: investments, accommodations needed to
address student needs. National Council on Disability
website. https://ncd.gov/sites/default/files/NCD_
Mental_Health_Report_508_0.pdf. Published July 21,
2017. Accessed June 30, 2020.
2. National Center for Health Statistics. Suicide mortality
in the United States, 1999-2017. The Centers for Disease
Control website. https://www.cdc.gov/nchs/data/datab
riefs/db330-h.pdf. Published November, 2018.
Accessed June 30, 2020.
3. Penn State Center for Collegiate Mental Health. Center
for Collegiate Mental Health (CCMH) 2014 annual
report. https://files.eric.ed.gov/fulltext/ED572852.pdf.
Published January, 2015. Accessed June 20, 2020.
4. Penn State Center for Collegiate Mental Health. Center
for Collegiate Mental Health (CCMH) 2017 annual
report. https://files.eric.ed.gov/fulltext/ED586224.pdf.
Published January, 2018. Accessed June 20, 2020.
5. Penn State Center for Collegiate Mental Health. Center
for Collegiate Mental Health (CCMH) 2016 annual
report. https://ccmh.psu.edu/files/2017/01/2016-
Annual-Report-FINAL_2016_01_09-1gc2hj6.pdf.
Published January, 2017. Accessed June 30, 2020.
6. de Sá Junior AR, de Andrade AG, Andrade LH,
Gorenstein C, Wang YP. Response pattern of depressive
symptoms among college students: what lies behind
items of the beck depression inventory-II? J Affect
Disord. 2018;234:124–130. doi:10.1016/j.jad.2018.02.064.
7. Beiter R, Nash R, McCrady M, et al. The prevalence and
correlates of depression, anxiety, and stress in a sample
of college students. J Affect Disord. 2015;173:90–96.
doi:10.1016/j.jad.2014.10.054.
8. Gibbons S, Trette-McLean T, Crandall A, Bingham J, Garn C,
Cox J. Undergraduate students survey their peers on mental
health: perspectives and strategies for improving college coun­
selling center outreach. J Am Coll Health. 2019;67(6):580–591.
doi:10.1080/07448481.2018.1499652.
9. Pew Research Center. Social and demographic trends.
Pew Research Center Website. https://www.pewsocial
trends.org/2018/05/22/demographic-and-economic-
trends-in-urban-suburban-and-rural-communities/.
Published May, 2018. Accessed August 23, 2020.
10. Armour M. Working college students. Inside Higher Ed
website. https://www.insidehighered.com/news/2019/
11/18/most-college-students-work-and-thats-both-
good-and-bad. Published November, 2019. Accessed
August 23, 2020.
11. Mental health guide for college students. College stats
website. https://collegestats.org/resources/mental-health-
guide/. Published 2020. Accessed August 23, 2020.
12. Reilly K. Record numbers of college students are seeking
treatment for depression and anxiety, but schools cannot
keep up. Time. https://time.com/collection/davos-2020-
mental-%20health/5190291/anxiety-depression-college-
university-students/. Published March 19, 2018. Accessed
August 23, 2020.
107
13. Sadock BJ, Sadock VA, Ruiz P. Synopsis of Psychiatry:
Behavioral Sciences/Clinical Psychiatry. 11th ed. Alphen
aan den Rijn, NL: Wolters Kluwer; 2015.
14. Stahl SM. Stahl’s Essential Psychopharmacology:
Prescriber’s Guide. 6th ed. Cambridge, UK: Cambridge
University Press; 2018.
15. American College Health Association. National college health
assessment. https://www.acha.org/documents/ncha/NCHA-
II_SPRING_2017_REFERENCE_GROUP_EXECUTIVE_
SUMMARY.pdf. Published Spring 2017. Accessed August 23,
2020.
16. Han M, Pong H. Mental health help-seeking behaviors
among Asian American community college students:
the effect of stigma, cultural barriers and acculturation.
J Coll Stud Dev. 2015;56(1):1–14. https://dio.org/10.
1353/csd.2015.0001.
17. Pitt A, Oprescu F, Tapia G, Gray M. An exploratory
study of students’ weekly stress levels and sources of
stress during the semester. Act Learn High Educ.
2017;36(4):61–75. doi:10.1177/146978741773119.
18. Britt SL, Mendiola MR, Schink GH, Tibbetts RH,
Jones SH. Financial stress, coping strategy, and aca­
demic achievement of college students. J Fin Counsel
Plan. 2016;27(2):172–183. doi:10.1891/1052-
3073.27.2.172.
19. England BJ, Brigati JR, Schussler EE, Chen MM. Student
anxiety and perception of difficulty impact performance
and persistence in introductory biology courses. CBE Life
Sci Educ. 2019;18(2):ar21. doi:10.1187/cbe.17-12-0284.
20. Dijkstra MT, Homan AC. Engaging in rather than dis­
engaging from stress: effective coping and perceived
control. Front Psychol. 2016;7:1415. doi:10.3389/
fpsyg.2016.01415.
21. Nguyen-Feng VN, Greer CS, Frazier P. Using online inter­
ventions to deliver college student mental health resources:
evidence from randomized clinical trials. Psychol Serv.
2017;14(4):481–489. doi:10.1037/ser0000154.
22. Lyzwinski LN, Caffery L, Bambling M, Edirippulige S.
University students’ perspectives on mindfulness and
mHealth: a qualitative exploratory study. Am J Health Educ.
2018;49(6):341–353. doi:10.1080/19325037.2018.1502701.
23. How to get more students to seek help for mental health.
College Marketing Group website. https://collegemarke
tinggroup.com/blog/how-to-get-more-students-to-seek-
help-for-mental-health/. Updated January 6, 2020. Accessed
May 29, 2020.
24. National Commission for Health Education
Credentialing. Areas of responsibility, competencies,
and sub-competencies for health education specialist
practice analysis II 2020. https://assets.speakcdn.com/
assets/2251/hespa_competencies_and_sub-
competencies_052020.pdf. Published January, 2020.
Accessed August 12, 2020.
25. McKenzie L. Colleges use technology to help students
manage mental health. Inside Higher Ed website.
https://www.insidehighered.com/news/2018/10/05/col
leges-turn-wellness-app-address-student-mental-
health. Published October 5, 2018. Accessed May 29,
2020.
108 K. REID ET AL.

Appendix Q8 How do these typical college student stressors rank in

your life (1 being low stress and 5 being high stress)?
Survey Instrument
Q1 Are you currently enrolled in a Bachelors or Graduate (Low) 2 (High)
degree program? 1(0) (1) 3(2) 4(3) 5(4)
Coping with roommates, living ● ● ● ● ●
● Bachelors program (1) conditions (1)
● Graduate program (2) Living separate from family. (2) ● ● ● ● ●
Balancing schoolwork with job hours (3) ● ● ● ● ●
● I am taking classes, but not seeking a degree (3) Making ends meet financially (4) ● ● ● ● ●
Academic load (grades, credits, exams, ● ● ● ● ●
Q2 What is your gender? papers) (5)
Social needs (friends, family, etc) (6) ● ● ● ● ●
Health status, health issues (7) ● ● ● ● ●
● Male (1)
Food, body image, and weight issues (8) ● ● ● ● ●
● Female (2) Transportation (9) ● ● ● ● ●
● Transgender/Non-binary (3) Parental issues, child care issues (10) ● ● ● ● ●
Girlfriend, boyfriend issues (or other ● ● ● ● ●
Q3 What is your age range? significant relationships) (11)
Technology problems (Facebook ● ● ● ● ●
updates, text messages, etc) (12)
● 17–20 (1) Purpose-in-life issues/Figuring out what ● ● ● ● ●
● 21–25 (2) to do for a major or after graduation
● > 25 (3) (13)
Religion/Spirituality (14) ● ● ● ● ●
Q4 Your major’s program or track is achieved through
which of the following MSU college or school?
Q9 What do you think are the biggest mental and emotional
● Arthur J. Bauernfeind College of Business (1) health issues on campus? (Select the top three (3).
● Hutson School of Agriculture (2)
● Jesse D. Jones College of Science, Engineering and ● Stress (1)
Technology (3) ● Anxiety (2)
● College of Humanities and Fine Arts (4) ● Depression (3)
● School of Nursing and Health Professions (5) ● Pornography (4)
○ Nursing (5a) ● Addictions (5)
○ Health Professions (5b) ● Eating disorders (6)
● College of Education and Human Services (6) ● Perfectionism (7)
● Financial stress (8)
Q5 What is your relationship status? ● PTSD (9)
● Transitioning into adulthood/college (10)
● Single and not in a significant relationship (1) ● Other (11) ____________________
● Not married, but in a significant relationship (2)
● Married (3) Q10 Have you ever experienced mental or emotional
● Separated (4) problems that persisted for more than 2 weeks?
● Divorced (5)
● Widowed (6) ● Yes (1)
● No (2)
Q6 Do you have children? ● Unsure (3)

● Yes (1) If Yes Is Not Selected, Skip to Q12 “During the past
● No (2) 4 weeks, have you had . . . ”
Q11 When do you first remember experiencing mental
Q7 What ethnicity do you identify with most? or emotional problems that persisted for more than
2 weeks?
● White/Caucasian (1)
● Black/African American (2) ● Before college (1)
● Asian (3) ● At college (2)
● Hispanic/Latino (4) ● Unsure (3)
● Pacific Islander (5)
● Native American (6) Q12 During the past 4 weeks, have you had any of the
● Multiracial (7) following mental health problems with your work or
● Other (8) ____________________ other regular daily activities as a result of any emotional
● Prefer not to answer (9) problems (such as feeling depressed or anxious)?
 AN EXAMINATION OF MENTAL HEALTH, PERCEIVED BARRIERS, AND OUTREACH RECOMMENDATIONS 109

Q15 How aware are you of the following services on Murray

Yes No
(1) (2) State University campus?
a. Cut down the amount of time you spent on school, work ● ● Not Very
or other activities (1) Aware Somewhat Aware
b. Accomplished less than you would like (2) ● ● (1) Aware (2) (3)
c. Didn’t do school, work or other activities as carefully as ● ● response options anonymized for peer ● ● ●
usual (3) review
University Counseling Services, Oakley ● ● ●
Applied Science Building
Murray State Psychological Center ● ● ●
Q13 During the past 4 weeks, how much of the time has 401 Wells Hall
your physical health or emotional problems interfered with Murray State Counseling and ● ● ●
your social activities (like visiting with friends, relatives, etc.)? Assessment Center
3rd Floor Alexander Hall
● All of the time (1)
● Most of the time (2)
● Some of the time (3) Q16 If you have or develop a mental/emotional health
● A little of the time (4) concern, how likely are you to seek help?
● None of the time (5)
● Very likely (1)
Q14 How do you usually cope with stress/psychological ● Somewhat likely (2)
issues? (check all that apply) ● Not likely (3)
● Never (4)

I sometimes use Q17 Which of the following best describes who/where you
I never use this this method to I usually use this go when in need of mental and/or emotional support?
method to cope cope with stress method to cope
with stress (1) (2) with stress (3)
Sleep (1) ● ● ● I never go I sometimes go I usually go
to (1) to (2) to (3)
Exercise (2) ● ● ●
Eat (3) ● ● ● Spiritual/religious leader ● ● ●
(1)
Cry (4) ● ● ●
Family (2) ● ● ●
Spend money ● ● ●
(5) Roommates/friends (3) ● ● ●
Hold things in ● ● ● On campus counseling (4) ● ● ●
(6) Off campus counseling (5) ● ● ●
Yell at or blame ● ● ● Professor or other staff ● ● ●
others (7) member (6)
Ignore the ● ● ● Other (7) ● ● ●
feelings and
hope they
will pass (8)
Talk to friends/ ● ● ●
family (9)
Avoid friends ● ● ●
(social Q18 How much do you think the following individuals
isolation) (10) or groups care about you as a person (1 being low interest
Stop attending ● ● ● in you as a person and 5 being high interest in you as
school/work a person)
(11)
Negative self- ● ● ● Not
talk (12) (Low) 2 3 4 (High) Applicable
Listen to music ● ● ● 1 (1) (2) (3) (4) 5 (5) (6)
(13) Family (1) ● ● ● ● ● ●
Clean my house ● ● ● Roommates (2) ● ● ● ● ● ●
(14) Friends (3) ● ● ● ● ● ●
Do nothing (15) ● ● ● Teachers/professors/advisors ● ● ● ● ● ●
Crafting (16) ● ● ● (4)
Other (17) ● ● ● Spiritual/religious leader (5) ● ● ● ● ● ●
Please Define Employer/boss/supervisor of ● ● ● ● ● ●
Other, list up an on-campus job (6)
to 3 items Employer/boss/supervisor of ● ● ● ● ● ●
(18) an off-campus job (7)
110 K. REID ET AL.

Q19 What mental health (or potential stressors) topics do ● Campus activities (3)
you want more information about? (Choose all that apply.) ● Campus course (4)
● Webinar or YouTube video (5)
● Balancing finances (1) ● Social media (6)
● Balancing work, school, and family life (2) ● Other (7) ____________________
● Managing stress associated with school (3)
● Dating, social, and/or romantic relationships (4) Q21 What are some barriers that students who are seeking
● Religion/spirituality (5) help for psychological issues face?
● Physical health (6)
● Sexual assault prevention (7)
● How to support a family member or friend with a mental/ This is NOT This IS a major
emotional health issue (8) a major barrier (1) barrier (2)
● Coping strategies for mental and/or emotional health (9) Not sure of available resources (1) ● ●
● Understanding depression, stress, and/or anxiety (10) Too ashamed (2) ● ●
● How to overcome addictions (11) Worried about what other people ● ●
will think (3)
● Understanding mental health problems (12)
● Other (13) ____________________ No support from friends and ● ●
family to get treatment (4)
Cost associated with treatment (5) ● ●
Q20 How would you like to hear about these topics?
Not enough time (6) ● ●
Check up to three (3) responses.
Other (7) ● ●
● E-Mail newsletters (1)
● On campus seminars (2) Survey modified with permission from Gibbons et al.8