Relationships between counselor statements and student connection to mental health care: A cross-sectional analysis of digital screening platform conversations

Objective: To examine the relationship between counselor communication techniques and students seeking referrals to care within the American Foundation for Suicide Prevention’s (AFSP’s) Interactive Screening Program’s (ISP’s) text-based chats. Participants: Data included 14,931 text-based chats between students and counselors from 58 U.S. colleges that used the ISP between 2009 and 2024. Methods: Natural Language Processing was used to analyze ISP counselor communication techniques within the online chats. Results: Counselor informing statements (aOR: 1.98, 95% CI: 1.78–2.21), emotional reactions (aOR: 1.11, 95% CI: 1.02–1.20), and longer dialogue length (aOR: 1.30, 95% CI: 1.28–1.32) were positively associated with seeking a referral. Counselor interpretations (aOR: 0.32, 95% CI: 0.29–0.35), explorations (aOR: 0.32, 95% CI: 0.28–0.36), and normalizing statements (aOR: 0.69, 95% CI: 0.61–0.78) were negatively associated with seeking a referral. Conclusions: Findings advance understanding of how counselors might prioritize using specific language in text-based chats to support students seeking a referral to care.