Racial/Ethnic Trends in Virtual Mental Health Care Utilization among Undergraduate Students: An Observational Study (Preprint)

BACKGROUND Undergraduate students are a population particularly in need of mental health support, but demand has far surpassed campus resources. Many students with a diagnosis do not access any form of mental health care. This gap between mental health diagnoses and access to support is particularly large among Asian, Hispanic, and Black students. Supplementing on-campus care with a virtual-only behavioral health partner may shift these trends by addressing some of the common barriers to receiving mental health care among these groups. OBJECTIVE This study aimed to compare the number of undergraduate students engaging in virtual mental health visits as part of a partnership with a company providing virtual-only care, with the total enrolled undergraduate students at the same 113 institutions. We aimed specifically to compare the number of patients engaging in visits among different racial/ethnic groups (White, Asian, Islander, Hispanic, Black, Native, and Multiracial) with total enrollment of the students identifying in that group at the universities. METHODS We used de-identified visit data and self-reported race/ethnicity to define the “patient” population of undergraduates accessing care. We compared that to the full “student” population of undergraduates among the same schools, defined by enrollment numbers and admissions-reported race/ethnicity publicly available as part of the Integrated Postsecondary Education Data System (IPEDS). We utilized a chi-square goodness of fit test to compare patient population race/ethnicity with student population race/ethnicity. RESULTS Patient population race/ethnicity (N=14,870) differed significantly from student population race/ethnicity (N=619,459). A significant effect (Chi-Square = 2258, P < .001) indicated that patient population demographics were not aligned with student population demographics. Exploratory analyses revealed a complex pattern of results: We found more Asian, Black, and Multiracial patients than expected based on enrollment, in contrast to prior findings indicating these groups are less likely to access traditional mental health care models. At the same time, we found fewer Hispanic patients than expected, aligning with prior results. We also found fewer White patients than expected, in contrast to prior results. There was not a significant difference in the proportion of patients and students who identified as Native or Islander. CONCLUSIONS We conclude that, in contrast to prior literature on traditional mental health care settings, some racial/ethnic minority undergraduates (Asian, Black, and Multiracial) may actually access care at a disproportionately high rate under a fully virtual support model. On the other hand, White and Hispanic students may access care less frequently.