(PS8-88) Stigma May Drive Engagement with Self-Guided Internet-based Therapy While Impeding Formal Therapy Use in Diverse U.S. College Students

Background

Stigma remains a barrier to mental health treatment, particularly among college students, who experience high rates of mental health concerns. According to the WHO World Mental Health International College Student project, nearly one-third of college students worldwide experience mental health disorders, yet many do not seek treatment. Self-guided internet-based therapy offers accessible, private support through digital platforms, providing alternatives for individuals facing high stigma against formal therapy. However, it is unclear how perceived (i.e., perceived negative views of others) versus personal (i.e., one’s own negative views) stigma against mental health treatment may influence self-guided versus formal therapy use among students with severe symptoms. Using data from the Healthy Minds Study (HMS) 2022–2023, a nationwide study with over 70,000 responses, this study examines how perceived and personal stigma relate to engagement in self-guided and formal therapy among students with clinically elevated psychiatric symptoms. We further explore whether stigma affects different clinical presentations (e.g., depression, anxiety, suicidality) differently when seeking self-guided versus formal therapy.

Methods

We analyzed survey responses from 21,380 college students (Mage=22.43; 71.28% cisgender female) who reported clinically elevated depressive symptoms, anxiety symptoms, and/or suicidal ideation in the past 12 months. Logistic regression analyses by clinical group examined the associations between stigma and self-guided versus formal therapy use. 

Results

Analysis demonstrated that students with depressive symptoms who held personal stigma were 57.5% (99% CI [16.6%, 110.0%], p< .001) more likely to use self-guided therapy; personal but not perceived stigma led them to be 44.4% (p< .001, 99% CI [29.3%, 56.5%]) less likely to use formal therapy. For students with anxiety symptoms, stigma is not significantly associated with usage of self-guided therapy, but students with anxiety symptoms who held personal stigma were 42.7% (p< .001, 99%CI [24.5%, 56.6%]) less likely to use formal therapy. Students with suicidal ideation who held personal stigma were 89.0% (p< .001, 99% CI [32.4%, 165.4%]) more likely to use self-guided therapy; personal but not perceived stigma led them to be 50.9% (p<.001, 99%CI[34.1%, 63.6%]) less likely to use formal therapy.

Conclusions

Our findings suggest that for college students with elevated mental health symptoms, self-guided therapy may be an option to improve the accessibility of mental health support. To ensure students receive appropriate care, efforts should focus on reducing personal stigma to increase access to formal therapy. While self-guided therapy may provide a solitary and accessible option, universities and mental health organizations should prioritize stigma-reduction strategies through campus outreach and mental health campaigns. These efforts should particularly target personal stigma among students with depression and suicidal ideation, helping them feel more comfortable seeking evidence-based, professional treatment.