Associations between discrimination and adverse mental health symptoms and disorder diagnoses among college students in the United States

Background: Mental health disorders are prevalent among college students in the US. Perceived discrimination is a known risk factor for adverse mental health and is widespread on college campuses. Methods: We estimated the association between perceived discrimination and mental health among US college students using the American College Health Association–National College Health Assessment (ACHA-NCHA), a large national cross-sectional survey of college students. Results: 7.9% of students reported experiences of discrimination, and that discrimination was more common among minority students. Perceived discrimination was associated with 86 excess cases of students reporting being too depressed to function per 1000 students, and 27 excess cases of students reporting seriously considering suicide per 1000 students. Students who experienced discrimination had a 37% increase in the number of mental health symptoms (IRR 1.37 [95% CI 1.35, 1.39], P < .0001) compared to non-discriminated students, and a 94% increase in the number of mental health diagnoses (IRR 1.94 [95% CI 1.89, 1.99], P < .0001). Discrimination was positively associated with all mental health symptoms and diagnoses. This pattern was largely held across sub-analyses by race/ethnicity, gender, and sexual orientation, but with varying magnitudes. Limitations: Inability to distinguish between the forms of discrimination experienced, whether involving gender, sexual orientation, or race/ethnicity. Conclusions: Consequences of perceived discrimination are of clinical relevance for healthcare providers in general and mental health providers in particular. This study confirms the association between perceived discrimination and adverse mental health in college students. Efforts to reduce discrimination and bias in college campuses may improve the mental health of students.