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Table 1 Study characteristics

From: University students’ use of mental health services: a systematic review and meta-analysis

Study #

Author (year)

Study type

Country

Sample size

Population group

Sample description

Outcomes assessed

Quality rating

1

Bastos, et al. (2022) [76]

Cross-sectional

Brazil

382

Subgroup

A sample of medical students at a federal university in the South of Brazil sampled between November 2019 and February 2020

- Symptoms of anxiety

- Symptoms of depression

- Alcohol use

- Academic environment

- Current mental health service use

Low

2

Huang et al. (2020) [48]

Mixed method

USA

15

At risk

Sample of all students who had been fostered, adopted, or had experience homelessness with a mental disorder diagnosis in a Miami university in Florida in 2016

- Mental disorder diagnoses

- Academic functioning

- Current mental health service use

Moderate

3

Gebreegziabher et al. (2019) [79]

Cross-sectional

Ethiopia

444

At risk

A multistage random sample of all students attending university in Jimma, Ethiopia in November 2012. Students who were included in the analyses of mental health service use were those who were at risk of a common mental disorder

- Mental health literacy

- Substance use

- Somatic symptoms

- Common mental disorders

- Help-seeking behaviour in previous two weeks

High

4

Jennings et al. (2015) [49]

Cross-sectional

USA

246

At risk

A convenience sample of undergraduate students in a research participant pool in a university in Southeast USA. Students included in the analysis of mental health service use had major depressive disorder

- Attitudes toward treatment seeking

- Perceived stigma to treatment seeking

- Self-stigma to treatment seeking

- Self-reliance

- Self-reported current mental health problems,

- Symptoms of depression

- Alcohol use

- Mental health service use in the previous two months

Low

5

Cranford et al. (2008) [43]

Cross-sectional

USA

2843

General

A random sample of all students enrolled at a university in the Midwest of the USA in 2005

- Substance use behaviours

- Symptoms of psychological distress

- Perceived need

- Mental health service use in the past 12 months

High

6

Eisenberg et al. (2007) [67]

Cross-sectional

USA

2785

General

A random sample of students registered at university in the Midwest of the USA in 2005

- Symptoms of depression and anxiety

- Academic functioning

- Awareness of services

- Beliefs about treatment effectiveness

- Perceived need in the previous 12 months

- Receipt of treatment in the previous 12 months

High

7

Eisenberg et al. (2011) [46]

Longitudinal

USA

2822

General

A random sample of students registered at university in in the Midwest of USA in 2005, followed up in 2007

- Eating disorder symptoms

- Symptoms of depression

- Symptoms of panic disorder and anxiety

- Mental health diagnoses

- Suicidal ideation

- Mental health service use in the last 12 months in 2005 and 24 months in 2007

High

8

Jardon et al. (2022) [70]

Cross-sectional

USA

174

Subgroup

A sample of all nursing students with health insurance, eligible for campus services at a university in Los Angeles, USA in 2021

- COVID-19 experiences

- Symptoms of depression

- Symptoms of anxiety

- Traumatic stress

- Loneliness

- Resilience

- Mental health service utilisation in the last 12 months

Moderate

9

Lee et al. (2021) [50]

Cross-sectional

USA

1236

At risk

A sample of all students enrolled at a public research university in Kentucky between March and April 2020. Use of mental health services were only reported in those with moderate to severe stress, anxiety, or depression

- Symptoms of stress

- Symptoms of anxiety

- Symptoms of depression

- Mental health service use in the previous academic year on or off campus

Moderate

10

Chang et al. (2013) [51]

Cross-sectional

USA

336

Subgroup

A sample of all 1st, 2nd, and 3rd year medical students at Baylor medical school in March and April 2010

- Symptoms of burnout

- Symptoms of depression

- Mental health service use while at medical school

Moderate

11

Williams et al. (2021) [68]

Cross-sectional

USA

152

At risk

A sample of Black men and women, and White men attending at Mid-Atlantic university in the USA who reported depressive symptoms above the 75th quintile on the Symptom Checklist-90

- Symptoms of anxiety and depression

- Campus service utilization

Moderate

12

Nilsson et al. (2004) [52]

Secondary data analysis

USA

2050

Subgroup

A sample of international students who had used the university counselling centre at a University in the East of the USA

- Overall functioning

- Assessment at end of treatment

- Use of the university counselling centre while at university

Low

13

Ryan et al. (2017) [73]

Cross-sectional

Australia

176

At risk

A sample of all 4th, 5th, and 6th year medical students reporting a mental health problem at a medical school in Western Australia

- Self-reported psychological wellbeing, mental health, and stress

- Perceived usefulness of health service

- Barriers to service use

- Use of health services in previous 12 months

Moderate

14

Smith et al. (2021) [53]

Cross-sectional

USA

292

General

A random sample of English-speaking students with an email address aged between 18 to 40 attending a university in the Midwest of the USA

- Loneliness

- Social support

- Basic psychological needs

- Mental health service use while at university

- Barriers to help seeking

Moderate

15

Yorgason et al. (2008) [54]

Cross-sectional

USA

266

General

A random sample of students registered at a university in the East of the USA

- Mental health functioning

- Knowledge of and use of the university’s mental health service

Low

16

Liu et al. (2017) [77]

Cohort

China

13,085

General

A sample of all freshman university students followed up for four years noting episodes of use of the university counselling centre using linked medical records at a University in Beijing

- Symptoms of mental health problems

- Help-seeking behaviours while at university

Moderate

17

Leao et al. (2011) [75]

Cross-sectional

Brazil

156

Subgroup

A sample of final year medical students attending a final year practical exam at a medical school in Sao Paulo

- Depression and anxiety symptoms

- Perceived need for help

- Knowledge of university mental health service

- Use of university mental health service

Moderate

18

Giusti et al. (2020) [80]

Mixed methods

Italy

103

At risk

A random of all students who used an online mental health service at a university in the Abruzzo region

- Traumatic distress

- Anxiety and depression symptoms

- Current treatment

- Lifetime mental health service use

Moderate

19

Bourdon et al. (2020) [55]

Cross-sectional

USA

674

General

A random sample of undergraduates attending Virginia Commonwealth University in 2018

- Mental health concerns

- Treatment received for mental health concerns

- Lifetime mental health service use

Moderate

Multiple institution samples

20

Dyrbye et al. (2015) [56]

Cross-sectional

USA

154

At risk

A sample of all 2nd,3rd, and 4th year medical students with burnout attending Mayo Medical School; University of Washington School of Medicine; University of Alabama School of Medicine; University of California, San Diego School of Medicine; Rutgers New Jersey Medical School; and Uniformed Services University of Health Sciences in 2012

- Symptoms of burnout

- Symptoms of Depression

- Quality of life

- Help-seeking behaviours in the 12 months

High

21

Eisenberg et al. (2011) [45]

Cross-sectional

USA

14,175

General

A convenience sample of 13 universities in 2007 and then 15 universities in 2009 the USA. A random sample of students registered in each institution were sampled in 2007 and 2009

- Symptoms of depression

- Symptoms of panic and anxiety

- Suicidal ideation

- Self-injurious behaviours

- Mental health service use in the last 12 months

High

22

Eisenberg et al. (2012) [20]

Cross-sectional

USA

8488

General

A convenience sample of 15 universities in the USA. A random sample of students registered in each institution were sampled in 2009

- Symptoms of depression

- Suicidal thoughts and behaviours

- Symptoms of anxiety

- Substance use

- Minimally adequate care

- Mental health service use in the last 12 months

Moderate

23

Fischbein et al. (2019) [44]

Cross-sectional

USA

482

Subgroup

A convenience sample of 23 universities in the USA. A random sample of medical and pharmacy students registered in each institution were sampled between 2015–2016

- Symptoms of depression

- Symptoms of anxiety

- Use of alcohol and other substance

- Perception of treatment efficacy

- Stigma

- Receipt of medication in the last 12 months

- Formal and informal help-seeking in the last 12 months

High

24

Han et al. (2016) [57]

Cross-sectional study

USA

9400

At risk

A nationally representative sample of all adults with a household address in the USA sampled between 2008 and 2016. Students those who reported suicidal thoughts and behaviour

- Suicidal thoughts and behaviour

- Mental and physical health status

- Mental health treatment in the last 12 months

Moderate

25

Lipson et al. (2019) [9]

Cross-sectional

USA

155,026

General

A convenience samples of universities across the main regions of the USA with random sample of students attending these universities between 2007 and 2017

- Symptoms of depression

- Suicidal ideation

- Stigma

- Mental health service use in the last 12 months

Moderate

26

Lipson et al. (2021) [23]

Cross-sectional

USA

58,063

At risk

A convenience sample of universities and community colleges across the main census regions of the USA with a random sample of students attending these institutions between 2016 and 2019

- Symptoms of depression in the last 2 months

- Symptoms of anxiety in the last 2 months

- Eating disorder behaviours

- Non-suicidal self-injurious behaviours

- Suicide ideation

- Academic performance

- Mental health service use in the last 12 months

Moderate

27

Lu et al. (2014) [74]

Cross-sectional

Australia

144

Subgroup

A convenience sample of students recruited from Chinese student associations in universities across Australia

- Symptoms of psychological distress

- Barriers to help-seeking

- Willingness to seek help

- Help-seeking behaviours in last 12 months

Moderate

28

Nash et al. (2017) [58]

Cross-sectional

USA

7992

General

Convenience sample of major public research state sponsored universities across the USA. All undergraduate students enrolled at these universities were sampled

- Academic status

- Socioeconomic status

- Psychological and physical conditions

- Stereotypical views

-Understand of others

- Mental health service use in the last 12 months

Moderate

29

Sifat et al. (2022) [28]

Cross-sectional

Bangladesh

350

General

A sample of students from 27 universities in Bangladesh, mostly (62.8%) from Jahangimagar University sampled in 2020

- Perceived need for intervention

- Positive feeling towards services

- Relatedness

- Autonomy

- Competency

- Current non-clinical mental health practice

- Perceived stress

- Symptoms of depression

- Mental health service use in the last 12 months

Moderate

30

Romano et al. (2022) [72]

Cross-sectional

USA

22,171

At risk

A convenience samples of universities across the main regions of the USA with random sample of students with a positive screen for eating disorder symptoms attending these universities in the 2019–2020 wave

- Eating disorder symptoms

- Eating disorder diagnosis

- Mental health service use in the last 12 months

High

31

Connor et al. (2022) [71]

Cross-sectional

USA

1892

Subgroup

A convenience sample of universities in Oregon with a sample of sexual and gender minority students

- Mental health symptoms

- Helpfulness of service utilization

- Barriers to on campus service utilisation

- Awareness of services

- Mental health service use while at university

Moderate

32

Dunbar et al. (2017) [41]

Cross-sectional

USA

33,220

Subgroup

A sample of all University of California (UC), California State University (CSU), California Community Colleges (CCC) receiving mental health funding and a random sample of CCCs not receiving funding. All enrolled students and staff in these universities were sampled in 2013. Students identifying as lesbian, gay, bisexual, queer or questioning (LGBQQ) were compared with non-LGBQQ students

- Psychological health

- Mental health related academic impairment

- Awareness of campus mental health services

- Campus mental health climate

- Mental health service use while at university

Moderate

33

Sontag-Padilla et al. (2016) [47]

Cross-sectional

USA

33,943

General

A sample of all UC, CSU, CCCs receiving mental health funding and a random sample of CCCs not receiving funding. All enrolled students and staff in these universities were sampled in 2013

- Coping

- Mental health related academic impairment

- Awareness of campus mental health services

- Campus mental health climate

- Mental health service use while at university

Moderate

34

Turner et al. (2015) [59]

Secondary data analysis

USA

730,785

Subgroup

A sample of all students up to age 50 who had interacted with university health centres at a convenience sample of universities across the country between January 2011 and May 2014

- Type of health service visits

- Diagnoses

Moderate

35

Xiao et al. (2017) [60]

Secondary data analysis

USA

473,338

General

All universities part of the Center for Collegiate Mental Health Practice Research Network in the USA between 2010 and 2015

- Assessment of treatment history, history of events and symptoms, current problems

- Symptoms of mental disorder

- Mental health service use of university counselling service

Moderate

36

Albright et al. (2019) [69]

Cross-sectional

USA

2289

Subgroup

A convenience sample of universities across the USA. Random sample of students within those universities. Only students who identified as American Indian, Alaskan Native, or Native Hawaiian with and without army deployment between 2011–2014

- Discrimination

- Army deployment

- Financial stress

- Health insurance coverage

- Substance use

- Diabetes diagnosis or treatment in the previous 12 months

- Suicidal ideation in lifetime

- Lifetime mental health service utilization

Low

37

Artime et al. (2019) [62]

Cross-sectional

USA

19,861

At risk

A convenience sample of universities across the USA. Within these universities a random sample of students who had experienced trauma related to interpersonal violence or a history of army deployment in 2015

- Trauma exposure

- Symptoms of mental disorder

- Lifetime mental health service use

Moderate

38

Baams et al. (2018) [63]

Cross-sectional

USA

25,844

Subgroup

A random sample of four-year universities participating in the National Research Consortium of Counselling Centers in High Education. Students who were lesbian, gay, bisexual, or questioning attending these universities were sampled

- Future resource use

- Ability to cope during times of stress

- Suicidal ideation in lifetime

- Lifetime mental health history

- Relationship status

- Lifetime mental health service use

Moderate

39

Bonar et al. (2015) [64]

Cross-sectional

USA

1439

At risk

Students who were returning members of the army with experience in combat were sampled using a total design method between October 2011 and July 2013

- Symptoms of depressive

- Anxiety symptoms

- Symptoms of Post-Traumatic Stress

- Alcohol use

- Physical and mental health functioning

- Perceived stigma and barriers to care

- Lifetime mental health service use

Moderate

40

Kerr et al. (2013) [65]

Cross-sectional

USA

6689

Subgroup

A convenience sample of universities across the USA and a random sample of undergraduate female students aged 18–25 years old attending those institutions between 2008–2009

- Symptoms of mental disorder

- Lifetime mental health service use

Low

42

Karaffa et al. (2019) [61]

Cross-sectional

USA

573

Subgroup

A convenience sample of American Veterinary Medical Association on Education colleges in the USA. All students enrolled in these colleges were sampled

- Symptoms of depression

- Symptoms of anxiety

- Alcohol use

- Non suicidal self-injurious behaviours

- Suicidal thoughts

- Lifetime mental health service use

Low

43

Linden et al. (2021) [78]

Cross-sectional

Canada

137,235

General

A convenience sample of 32 universities in 2013, 41 universities in 2016 and 58 universities 2019. Within these universities a random sample of students were chosen

- Symptoms of stress and psychological distress

- Mental illness diagnosis

- Help-seeking behaviours

Moderate

44

Rice (2015) [66]

Cross-sectional

USA

26,451

At risk

A stratified random sample of university counselling centres that were part of National Research Consortium of Counselling Centers in Higher Education across the main four regions of the USA in 2003. Those reporting use were those who had experienced suicidal thoughts or behaviour

- Suicidal ideation

- Severity of suicidal ideation

- Primary care service use

- Mental health service use in lifetime, previous 12 months and while at university

Moderate