Participants
In total, 448 responses were recorded (completion rate = 91.5%; n = 410) from students across post-secondary institutions in Ontario, Canada. Participants who did not list their post-secondary institution or if the institution was not located in Ontario, Canada, were excluded (n = 78). On average, participants were 21.9 years of age (SD = 4.1). Most respondents did not have children (n = 437; 97.5%). Participants reporting their race or ethnicity were given the option to select all applicable identities. For demographic information, please see Table 1.
Table 1
Demographic breakdown of survey respondents.
Category | n (%) |
Gender Identity |
Woman | 267 (59.6) |
Man | 160 (35.7) |
Nonbinary | 15 (3.3) |
Prefer to self-describe | 2 (0.4) |
Prefer not to answer | 4 (0.9) |
Biological Sex |
Female | 281 (62.7) |
Male | 160 (35.7) |
Intersex | 1 (0.2) |
Prefer not to answer | 6 (1.3) |
Sexual Orientation |
Straight/Heterosexual | 321 (71.7) |
Bisexual/Polysexual | 60 (13.4) |
Gay/Lesbian | 18 (4.0) |
Asexual | 10 (2.2) |
Other | 15 (3.3) |
Prefer not to answer | 24 (5.4) |
Preferred Pronouns |
She/Her | 253 (56.5) |
He/Him | 155 (34.6) |
They/Them | 12 (2.7) |
Other | 9 (2.0) |
Prefer not to answer | 19 (4.2) |
Race/Ethnicity |
White (European descent) | 236 (52.7) |
Black (African, African Canadian, Afro-Caribbean Descent) | 63 (14.1) |
South Asian (Bangladeshi, Indian, Indo-Caribbean, Pakistani, Sri Lankan descent) | 56 (12.5) |
East Asian (Chinese, Japanese, Korean, Taiwanese Descent) | 53 (11.8) |
Middle Eastern (Arab, Persian, Afghan, Egyptian, Kurdish, Lebanese, Turkish descent) | 20 (4.5) |
Latin American (Hispanic or Latin American descent) | 13 (2.9) |
Southeast Asian (Cambodian, Filipino, Indonesian, Thai, Vietnamese descent) | 11 (2.5) |
Indigenous (First Nation, Inuk/Inuit, Métis descent) | 7 (1.6) |
Multi-ethnic | 7 (1.6) |
Other | 6 (1.3) |
Do not know | 1 (0.2) |
Prefer not to answer | 18 (4.0) |
Relationship Status |
Single, never dated | 138 (30.8) |
Exclusive romantic relationship | 109 (24.3) |
Single, in a serious relationship previously | 90 (20.1) |
Casually dating | 41 (9.2) |
Married | 17 (3.8) |
Common-law | 17 (3.8) |
Nonexclusive romantic relationship | 6 (1.3) |
Divorced | 2 (0.4) |
Other | 5 (1.1) |
Prefer not to answer | 23 (5.1) |
Post-secondary student profile
The study respondents were enrolled in 34 different institutions across Ontario. Only one participant attended a private institution. Respondents were mainly enrolled in universities (n = 406; 90.6%) compared to colleges (n = 42; 9.4%). The majority of university students attended Queen’s University (n = 80; 17.9%), followed by the University of Toronto (n = 43; 9.6%), Ontario Tech University (n = 38; 8.5%), Carleton University (n = 37; 8.4%), McMaster University (n = 37; 8.3%), University of Waterloo (n = 35; 7.8%), and York University (n = 21; 4.7%). Most of the respondents attending college were enrolled at St. Lawrence College (n = 12; 2.7%), Durham College (n = 6; 1.3%), and Centennial College (n = 4; 0.9%). Regarding degree type, 65% of respondents (n = 290) were undergraduate students, and 17.9% (n = 80) were graduate students. Further, 9.8% (n = 44) of respondents were pursuing a professional degree, diploma (n = 24, 5.4%), or other (n = 9; 2%). Most students were Ontario residents (n = 351; 90.5%) and did not relocate from another province. Work status was nearly equal among students, with 48.8% of respondents being employed (n = 217) and 51.2% (n = 228) not working. Students who indicated their weekly employment hours (n = 73) worked an average of 25.87 hours per week (SD = 11.76). Students (n = 77) also committed an average of 5.4 hours (SD = 5.24) to weekly volunteering. See Table 2 for a summary of student profiles.
Table 2. Participant student profiles
Category
|
n (%)
|
Degree Type
|
Undergraduate
|
291 (65.0)
|
Graduate
|
80 (17.9)
|
Professional
|
44 (9.8)
|
Diploma
|
24 (5.4)
|
Other
|
9 (2.0)
|
Enrolment Status
|
Full-time
|
396 (88.4)
|
Part-time
|
36 (8.0)
|
On leave
|
8 (1.8)
|
Other
|
8 (1.8)
|
Student Status
|
Domestic (Canada)
|
389 (86.8)
|
International
|
59 (13.2)
|
Housing Arrangement
|
Living with family/parents
|
161 (36.2)
|
Living with housemates
|
127 (28.5)
|
Living on campus residence
|
75 (16.9)
|
Living with significant other
|
38 (8.5)
|
Living alone
|
35 (7.9)
|
Other
|
9 (2.0)
|
Mental Health Disorders And Symptoms
Most participants reported not being diagnosed with a mental health disorder (n = 270; 61.4%; Fig. 1). Amongst those diagnosed, depression (n = 85; 19.3%) and generalized anxiety disorder (n = 80; 18.2%) were the most prevalent, followed by social anxiety disorder (n = 51; 11.6%), panic disorder (n = 40; 9.1%), and attention deficit hyperactivity disorder (n = 34; 7.7%). The most frequently reported mental health disorders not listed was obsessive-compulsive disorder (n = 9). Most participants (n = 351; 80.7%) reported not having a disability. The most frequently reported disability was neurodevelopmental (n = 36; 8.6%). Since starting their post-secondary education, 66.5% of respondents (n = 290) reported a decline in their mental health, 23.4% (n = 102) did not see a difference in their mental health, and 10.1% (n = 44) were unsure. Specifically, 66.1% of students (n = 288) reported problems concentrating, 59.6% (n = 260) experienced signs of depression, 58% (n = 253) experienced daily general anxiety, 51.4% (n = 244) experienced anxiety in social situations, 42.2% (n = 184) had mood swings, 33.7% (n = 147) experienced panic attacks, and 13.5% (n = 59) engaged in problematic use of alcohol or other substances including cannabis. Other symptoms expressed by students (n = 13) predominately comprised insomnia and other sleep disturbances (n = 5).
Mental Health Needs
Although most students indicated that their mental health knowledge was good (n = 283; 67.7%), many did not believe that post-secondary students have good mental health (n = 253; 60.5%). Furthermore, most students (n = 261; 62.4%) thought they did not have enough coping strategies and tools when starting their post-secondary studies. Not having enough time to focus on mental health during post-secondary studies was also expressed as a concern by participants (n = 198; 47.3%). Most respondents (n = 278; 66.5%) also believed that the majority of students keep their mental health problems a secret. With respect to high school education, most (n = 209; 50%) did not believe that the awareness and education on mental health were adequate, and others were neutral about this sentiment (n = 71; 17%). On the other hand, many participants (n = 307; 73.5%) believed that improving high school students’ mental health could enhance their overall functioning and well-being during their post-secondary studies.
Treatment-seeking Behaviours
Concerning treatment, 70.5% (n = 182) of respondents indicated that they were not taking medication, and 71.5% (n = 318) were not receiving counselling or psychotherapy for their mental health. Amongst those receiving counselling or psychotherapy, the majority (52.0%; n = 66) received their sessions over online video platforms and 33.9% (n = 43) engaged in in-person sessions. Many participants believed that digital mental health care delivery was good but not as good as in-person delivery (n = 132; 31.1%), and 18.6% (n = 79) were unsure.
When asked about the campus environment and resources, most participants (n = 321; 73.6%) indicated that they had not experienced any form of harassment on campus. However, 17.9% (n = 78) of participants experienced verbal harassment, followed by cyber harassment (n = 27; 6.2%), sexual harassment (n = 25; 5.7%), and physical harassment (n = 22; 5.0%). Most students (n = 267; 61.7%) did not have accommodations such as extra test time or separate exam rooms. Some students (n = 151; 34.9%) reported not using mental health services during their post-secondary studies. However, 34.6% (n = 150) of students used the student wellness services offered by their institutions, and 25.4% (n = 110) used mental health services provided outside their post-secondary institution. Participants also indicated several strategies to cope with stress (Fig. 2). The most frequently used approach was distractive behaviours such as hobbies (n = 305; 70.4%), followed by connecting with friends (n = 258; 59.6%), food (n = 209; 48.3%), and physical activity (n = 208; 48.0%).
The most frequently reported barriers to mental health care were financial (n = 214; 16.88%), long wait lists (n = 202; 15.93%), lack of resources to address needs (n = 165; 13.01%), inability to receive care due to school commitments (n = 148; 11.67%), stigma (n = 133; 10.49%), cultural barriers (n = 108; 8.52%), and past negative experiences with mental health care (n = 86; 6.78%). Only 2.76% (n = 35) of respondents indicated no barriers to receiving care. Respondents who indicated “other” (1.66%, n = 21) listed accessibility issues (n = 4), anxiety or social anxiety preventing treatment-seeking (n = 2), work commitments (n = 2), and apathy (n = 2; Fig. 3).
Mental Health Care
A sizeable proportion of participants were unsure about the helpfulness of different forms of mental health care (Fig. 4). Although in-person services were frequently rated as helpful (n = 271; 63.9%), the perceptions of accessibility were nearly equally divided, with 42.9% finding this delivery type accessible and 37.3% finding it inaccessible (Fig. 5). By contrast, the fewest participants rated online psychotherapy with no therapist involved as helpful (n = 100; 23.6%), and 36.8% (n = 156) found it accessible. Similar to perceptions of helpfulness, most respondents were unsure about the accessibility of the different care deliveries, particularly those in online or group therapy formats.
When focusing on post-secondary mental health services, 46.9% (n = 196) of respondents believed they had a good understanding of the mental health resources offered by their institution. The exact number of participants (n = 167; 40%) were either neutral or agreed that their institution's mental health programs and services were adequate. At the same time, 73.2% (n = 306) of students believed that post-secondary mental health resources need to be increased. Most students (n = 186; 44.5%) did not feel comfortable reaching out to faculty members or staff to access support for their mental health, although most were either neutral (n = 137; 30.4%) or agreed (n = 181; 43.3%) that institutional staff promoted mental health resources. Most individuals were also neutral (n = 160; 38.3%) when asked if they prefer using services outside their institutions. This may be because most participants (n = 187; 45.6%) did not believe they could afford private mental health care, despite 61.2% (n = 251) being aware of resources outside their institutions. Most participants were neutral (n = 172; 42%) or agreed (n = 157; 38.3%) that mental health services outside their campuses were more accessible. Most individuals (n = 186; 45.4%) also preferred using services outside of their institution, even though most were neutral (n = 210; 51.2%) about whether the quality of the service was superior to those on campus.
Many students (n = 231; 56.5%) believed that greater awareness about mental health is necessary and that increasing awareness in the region could prevent mental health disorders (n = 265; 64.6%; Fig. 6). Students also believed that current psychotherapy resources were insufficient and that more resources were needed (n = 225; 54.9%).
Finally, when exploring the perception of online mental health care, students were relatively divided about their preference for online and in-person care, with most being neutral (n = 178; 43.4%; Fig. 7). At the same time, most had or were willing to use online mental health care services (n = 251; 61.2%). Although online mental health care was believed to make it easier for students to get the help they need (n = 261; 63.7%), many thought it was easier to connect with therapists in-person than online (n = 233; 56.8%). A large number of participants also expressed that they had privacy concerns accessing online mental health care (n = 183; 44.6%).
Qualitative Data
Initially, 155 participants responded when asked in the survey whether they had any additional feedback to share. After removing irrelevant content (i.e., responses with “no” or “not applicable” without follow-up statements), a final set of n = 110 feedback responses were coded. Agreement between the coders was moderate, κ = 0.53, (95% CI, 0.64 to 0.42), p < 0.001. After resolving discrepancies, seven categories and 24 subcategories emerged from the data (Table 3). Personal strategies (n = 35; 31.82%) and the need for mental health education (n = 29; 26.36%) were the most frequently expressed categories. Personal strategies mostly stressed interpersonal skills (n = 9), methods to enhance self-awareness (n = 7) and self-regulation (n = 5), and lifestyle changes (n = 5). Concerning mental health education, most feedback centred on developing a formal course (n = 16) with content focused on personal strategies (n = 7). The most frequently discussed service and support were related to the need for guidance and counselling (n = 6). Three respondents also highlighted the institution’s role, particularly the need for support from faculty and staff. The feedback about awareness mostly centred around highlighting its importance (n = 10). The few environmental risk factors described digital online technology (n = 2), systemic factors (n = 2), and COVID-19 (n = 1). Further, changes to the post-secondary learning environment were related to improving time management by extending the years needed to complete a degree and spreading out the course workload (n = 2). One person also suggested improvements to institutional hardware and software. Lastly, participants who provided survey feedback (n = 11; 10%) thanked the researchers for the survey (n = 6) and offered suggestions to improve the survey (n = 4). Changes pertained to a question using the term “prevention” rather than “treatment,” including an “I don’t know” option in some parts of the survey, a technical error where a blank question was visible, and the consideration of student diversity in mental health status.
Table 3
Content analysis of open-ended feedback provided by post-secondary students (n = 110) at the end of the Post-Secondary Student Mental Health Experience Survey
Category | n (%) |
Personal strategies | 35 (31.82) |
Interpersonal skills | 9 |
Self-awareness | 7 |
Lifestyle changes | 5 |
Self-regulation | 5 |
Problem-solving | 3 |
Avoidance behaviours | 2 |
Crisis management | 2 |
Positive mindset | 2 |
Mental health education | 29 (26.36) |
Formal course | 16 |
Educational content | 7 |
Expert team | 3 |
Importance of education | 2 |
Inclusivity | 1 |
Services and support | 14 (12.73) |
Counselling and guidance | 6 |
Institutional role | 3 |
Resource information | 3 |
Inadequacy of services | 2 |
Awareness | 13 (11.82) |
Importance of awareness | 10 |
Proactive measures | 2 |
Peer support | 1 |
Survey feedback | 11 (10) |
Thanking for survey | 6 |
Suggested changes | 5 |
Environmental risk factors | 5 (4.55) |
Digital and online technology | 2 |
Systemic | 2 |
COVID-19 | 1 |
Curriculum restructuring | 3 (2.73) |
Time management | 2 |
Hardware and software | 1 |