Mental health service use in a national sample of college students with co-occurring depression or anxiety and substance use

Introduction: Campus health systems can provide timely and accessible resources for students with co-occurring substance use and mental illness, but little is known about the degree to which students use these systems. This study examined mental health service utilization among students with symptoms of anxiety or depression, stratified by substance use. Methods: This cross-sectional study used data came from the 2017-2020 Healthy Minds Study. Mental health service use was examined among students with clinically significant anxiety or depression (N = 65,969), stratified by substance use type (no use, alcohol or tobacco use, marijuana use, other drug use). We performed a series of weighted logistic regressions to assess the adjusted association of substance use type with past year use of campus, off-campus outpatient, emergency department, and hospital mental health services. Results: Among students, 39.3% reported exclusive use of alcohol or tobacco, 22.9% reported use of marijuana, and 5.9% reported use of other drugs. Use of alcohol or tobacco was not associated with mental health service utilization, while students who use marijuana faced increased odds of campus (OR 1.10, 95% CI 1.01, 1.20) and off-campus outpatient mental health service utilization (OR 1.27, 95% CI 1.17, 1.37). Other drug use was associated with increased odds of off-campus outpatient (OR 1.28, 95% CI 1.14, 1.48), emergency department (OR 2.13, 95% CI 1.50, 3.03) and hospital service utilization (OR 1.52, 95% CI 1.13, 2.04). Conclusions: Universities should consider screening for substance use and common mental illnesses to support the health of high-risk students.