Risk, Protective and Associated Factors of Anxiety and Depressive Symptoms and Campus Health Services Utilization Among Black Men on a College Campus

Abstract

Objective.

Analyzed relationships among social and environmental determinants serving as risk, protective, and important covariate factors for mental health risk and help-seeking among Black men on a college campus.

Methods.

A secondary data analysis was conducted utilizing an ongoing, campus-wide survey at a large, urban, public university. Measures included depressive and anxiety symptoms; campus service utilization; risk factors (e.g. financial status); protective factors (social support/religiosity); and additional covariates (substance use/GPA). Multiple linear regressions were conducted to examine relationships between these factors, symptoms and help-seeking.

Results.

Data is included for 681 students. Findings indicated that stressful life events were associated with higher levels of anxiety symptoms (B = 0.39, p < 0.001) and depressive symptoms (B = 0.33, p = 0.013). Cannabis use (B = 1.14, p= .020) was also associated with higher levels of depressive symptoms. We found that financial status (B = 0.21, p = 0.041) was positively associated with higher levels of depressive symptoms and endorsement of religiosity was associated with lower levels anxiety (B = −0.23, p = 0.019) and depressive symptoms (B = −0.32, p = 0.035). Religiosity predicted lower utilization of campus health services.

Conclusions.

The key findings indicated that Black men’s mental health is negatively influenced by stressful live events and cannabis use. As religiosity was associated with lower levels of symptoms and utilization, it may be beneficial to assess this in future work. Further research is needed to address and improve mental health and help-seeking among these men.

Introduction

Emerging adulthood, a transitional period between adolescence and adulthood, is a critical time of development for individuals that comes with a significant amount of stress [1–3]. As emerging adults, ages 18 to 25, enroll in college, their risk for poor mental health is heightened due to disproportionate exposure to psychological distress, resulting from various stressors, such as leaving and living away from home, learning to navigate campus, social environments, and dealing with the stressors of academic life (e.g. getting good grades and/or maintaining work-life balance) [2, 4]. If unaddressed, this distress can become emotionally impairing, negatively impacting an individual’s psychological well-being and mental health [4]. Past studies have shown that, in university settings, approximately 18-30% of students will suffer from the mood disorder known as depression, [2] due to overexposure to psychological distress that results from varying college stressors. Studies also show that anxiety, a mental health disorder symptomized by feelings of worry and nervousness, is extremely prevalent on college campuses and results from these same stressors [5].

Relative to Black populations, young Black men, an especially marginalized population, represent a subgroup of emerging adults at increased risk of developing depression and anxiety [6, 7]. Such increased risk has been attributed to risk factors, such as experiences to racial discrimination [8–11]. As these men enter college, this increased risk persists. Recent studies show that as Black men enter college, risk of mental health disorders, such as depression and anxiety, increase, having daunting effects on individual health outcomes, everyday functioning, and academic success [12]. Despite high risk for experiencing poor mental health, college students, in general, do not utilize mental health services at optimal rates [13]. In particular, university-enrolled, Black men are not utilizing mental health resources at optimal rates [14–16]. Failure to seek care can lead to prolonged impairment by mental health symptoms, impacting their health behaviors, as well as their ability to succeed academically [17]. Instead, when university-enrolled, Black men experience stress and depression due to stressors, such as hostile and racist social environments, they tend to isolate themselves, [18] and resort to other, poor health behaviors, increasing their susceptibility to stress, maladaptive coping, and eventually, comorbid illnesses [16, 19–21].

There is little research examining the mental health and help-seeking behaviors of Black men in college, making this an area of critical need and development. It is important to examine risk factors increasing men’s risk of developing poor mental health, as well as their subsequent help-seeking for mental health concerns, such as anxiety and depressive symptoms. It is also important to understand how certain social and environmental factors can protect these men against the development of poor mental health [22], lessening their likelihood of developing poor mental health. The present study will not only aim to address these factors but will also provide some evidence regarding additional important covariates. The findings will offer further evidence for mental healthcare professionals and campus-based practitioners who wish to better understand, design, and implement mental health prevention programs that are relevant to Black men in college and effective in reducing racial and ethnic health and educational disparities.

Risk Factors

The role of psychological distress and stress in the development of mental health among Black men are well-documented [17, 11, 23, 8]. One major risk factor is racial discrimination in which Black men are disproportionately impacted [8], increasing their risk of adverse experiences, such as living below the poverty level and in poor, unsafe neighborhoods and disparities in health [10, 8, 24, 23]. Racial discrimination has often been linked to many stressful life events including unfair treatment from police and in school, exposure to violence [25, 26], and financial distress [27]. These factors create challenging social situations for Black men, promoting poor social behaviors, such as maladaptive coping with substances [9, 28]. According to mental health literature [29], Black men, often resort to substances to cope with this stress and stressors and is more common among men from low-income communities [30]. In addition, such experiences with maladaptive coping can lead to higher levels or stress, disproportionate exposure to psychological distress and development of mental health symptoms [31, 32].

For Black men in college, experiences with distress and stressful life events peak during the transition from adolescence to adulthood [33–35] where they are introduced to the unique demands of academic life, requiring they form a sense of independence and belongingness and search for social support [36]. This proves to be quite strenuous [2, 37], leading to depressive symptoms, poor academic performance, and increased risk of dropping out [38] among these men. This, ultimately, would perpetuate increased risk of experiencing challenging social situations [8, 39, 40]. Despite risk factors being well-documented, there is little research examining the role of social and behavioral determinants in influencing mental health risk and health behaviors among university-enrolled, Black men. This is a critical gap that must be addressed.

Protective Factors

According to many studies, social support [41, 42, 24] and religiosity [43, 44] often serve as buffers for mental health risk among Black men. Edmond, Granberg, Simons, and Lei (2014) showed that supportive and emotionally sound relationships are positively associated with improved health, and increased ability to cope with strenuous circumstances, such as racial discrimination [45]. The social relationships Black men form can influence their health behaviors and health outcomes, mitigating negative experiences with stress and improving mental health [45]. A study conducted by McNeil, Fincham, and Beach (2014) reported that men’s perceived discrimination and depressive symptoms are positively associated with spousal support, serving as a buffer [46]. Further analysis suggested that inadequate spousal support is associated with higher levels of depression [46]. Despite its potential for mitigating stressful conditions, there is little research examining roles of social support in decreasing mental health risk among Black male college students.

Another broad protective factor, especially within the Black community, is religiosity [47] which is a valued method of coping with adverse life experiences and, even, medical conditions [48]. According to studies, among minority men, religiosity is not only a preferred method of coping [49] but has also been associated with lower levels of mental health symptoms [44]. A recent study, among approximately 400 Black individuals, found that religiosity had a negative association with depressive symptoms among men and women, particularly buffering the effects of exposure to stressors among men [50]. Importantly, there has been research examining the role of religiosity in prevention efforts for mental health [51] but not among Black men in college. Such understanding will provide direction for future research that wishes to focus on protective factors as intervention targets or research components among this population.

Additional Covariates

Research should aim to examine the role poor health behaviors play in increased risk of developing mental health symptoms among Black men in college. For example, in the literature, we see that alcohol and drug use is frequently endorsed among college students and can lead to increased risk of developing mental health symptoms associated with depression and anxiety [52]. In a recent study, researchers found that alcohol consumption was associated with mental health problems such that those consuming alcohol at higher levels were more likely to develop psychological distress and more likely to experience academic problems [53]. Recent statistical evidence also showed that not only are college students frequently using marijuana but college is the time when they first experience or engage in marijuana use [54]. Further, studies show that marijuana use has been associated with depressive symptoms among college students [55]. To date, research on college substance use and mental illness is mixed and limited, especially among Black men. As it is well-documented in the literature that substance use and menta health is associated with academic performance and achievement [56, 57], it is important to examine the role of substance use in mental health risk among Black men in college. This will also allow researchers to understand how certain social and environmental factors contribute to poor academic performance, low retention rates, and, ultimately, disparities in educational attainment and health outcomes [56, 57].

Purpose of Study

Current studies examining mental health among Black men are limited, and rarely focus on the mental health of emerging adult, Black men on a college campus. More research is needed to understand the avenues of onset and, ultimately, help-seeking for mental health symptoms and illnesses among young, Black men in this age group and social context. To aid in this effort, this study examined the relationship between risk, protective, and associated factors and mental health symptoms among university-enrolled, Black men. It is hypothesized that: a) among the risk factors being assessed, stressful life events and financial status will be positively associated with reports of symptoms; b) among protective factors, social support and religiosity will be associated with lower levels of reports of symptoms; and c) among additional covariates, there will be positive relationships between alcohol use, cannabis use and reports of symptoms and negative relationships between academic achievement (i.e. GPA) and reports of symptoms. This analysis also aims to assess how the risk and protective factors in this study relate to men’s likelihood of seeking help. The study’s finding will aid in our understanding of the mental health experiences of Black men on a college campus, allowing researchers to develop studies that aim to reduce health and educational disparities that impact this population.

Methods

A secondary data analysis was conducted utilizing data from a university-wide, longitudinal survey at a public university in the Mid-Atlantic. This survey assesses associations between genetic and environmental factors, and substance use, health behaviors and emotional health among college students [58]. Participants for this survey are incoming freshman, 18 and older, recruited via email to complete an initial survey, followed by a follow-up survey every Spring. Participants are compensated with a t-shirt and $10 after each assessment survey. Study data were collected and managed using REDCap [59]. Participants in the original dataset reflect general demographics of the university in which the data is derived. Overall, more than 12,000 students have enrolled in the project, consisting of 5 cohorts with an overall response rate above 55%. Additional details on the study can be found in the introductory article [58].

Measures

The survey includes various questionnaires assessing a number of behavioral, emotional, and mental health topics.

Mental Health Symptoms.

Abbreviated scales from The Symptom Checklist-90 [60]. were used to examine anxiety and depressive symptoms occurring within the last 30 days. Four questions measured anxiety symptoms, inquiring to what degree students experience nervousness or shakiness inside; suddenly scared for no reason; feeling fearful; and spells of terror or panic (α = 0.85) [58]. Four questions also measured depressive symptoms, inquiring to what degree students experience feeling blue; worrying too much about things; feeling no interest in things; and feeling hopeless about the future (α = 0.89) [58]. Responses were on a Likert-type scale, ranging from 0 = “not at all,” 1 = “a little bit,” 2 = “moderately,” 3 = “quite a bit,” to 4 = “extremely.” For this study, sum scores were created separately for anxiety and depressive symptoms for individuals who answered at least 50% of questions asked and missing data were prorated. Higher scores indicated higher levels of endorsement for anxiety or depressive symptoms.

Campus Service Utilization.

Numerous services on a college campus are available and accessible by students, offering resources for mental health needs, comorbid conditions, and, even, other ways to cope. Therefore, a range of services are included in this analysis to gain insight into various methods for help-seeking. For this study, utilization of campus services and resources, include the following three services (see Appendix A): University Counseling Services, University Health Services, and The Wellness Resource Center (The Well). The survey examines utilization of these services for every spring semester to ensure students have had sufficient opportunity to use each service (or not). Response categories were “yes” and “no.” A response of “yes” suggested that individuals have used that particular service since they have been enrolled.

Risk Factors.

Certain stressors were examined in two categories--potential non-traumatic stressful life events [61] and financial status (demographic questions about parents’ educational level and perceived financial status). SLEs included 14 items and consisted of various topics or questions asking experiences within the last 12 months related to a broken engagement, someone close passing away, serious illness, experiencing burglary, trouble with the police, etc. A sum score was created for each individual based on their endorsement of total exposure to the events. To assess financial status, two separate demographic questions are included, asking about education level (high school, college, GED) of the student’s guardian who functioned as their mother or father figure. The items (see Appendix A) asked, “for the woman who functioned as the student’s mother, how far in school did she go.” The same question was asked for the father. Response options ranged from “There was no one who functioned as a mother in my household” to “graduated college or university.” Items were recoded to ensure lowest level of education started at 0 and highest level ended at 12. In addition, perceived financial status is assessed from three items assessing whether students felt they were able to afford the opportunity to engage in leisure activities of their liking, if they felt they were able to afford the clothing they need and food they felt they should have (see Appendix A). This self-report measure is included to account for data that speaks to perceived financial status and how students feel this is impacting their mental health symptoms. This is often missing in current mental health literature. Response options included 0 = “Never”, 1 = “Seldom”, 2 = “Sometimes” and 3 = “Often.” A sum score was created for those who answered at least two of these items.

Protective Factors.

Social support and religiosity were examined as protective factors. Social Support is assessed by the Survey of the RAND Medical Outcomes Study [62]. Three items measured to what degree students felt they had someone: to give advice when experiencing a crisis; to get together with for relaxation; and, to love them when needed within the past 12 months [61]. Participants were given the response options of 0 = “none of the time,” 1 = “some of the time,” 2 = “most of the time,” or 3 = “all of the time” [61]. A sum score was calculated for individuals who answered at least two of the three items with lower scores indicating less support. Two items were included and summed to asses religiosity [63]. One question asked “how important are your religious or spiritual beliefs in your daily life” with responses including 1 = “not at all important, 2 = “not very important”, 3 = “somewhat important”, 4= “very important.” [63] Another question asked “how often do you seek spiritual comfort” when you have problems with responses including: 0 = “never”, 2 = “sometimes”, 3 = “almost always.”

Additional Important Covariates.

To assess alcohol consumption, a scale consisting of items from the Alcohol Use Disorder Identification Test [64] was used. This scale measured frequency and quantity items associated with alcohol consumption within the past 30 days [65]. Calculations included: data to compute grams of ethanol consumed per month; number of days a student drank alcohol in the past 30 days; and, if those who had a drink in the past 30 days, was it 1 to 10 or more drinks on a typical day. Students were asked to specify number of drinks with responses ranging from “1 or 2,” “3 or 4,” “5 or 6,” “7, 8, or 9,” and “10 or more” which was converted to midpoint ranges. This had the following options (recoded options are in parentheses): never (0); monthly or less (0.5); 2 to 4 times a month (3); 2 to 3 times a week (10.7); and 4 or more times a week (23.54). The responses to the number of drinks per drinking occasion were also converted: 1 or 2 drinks (1.5); 3 or 4 (3.5); 5 or 6 (5.5); 7, 8, or 9 (8); and 10 or more (15.5). Number of days participants drank was multiplied by the number of drinks per occasion, and this was multiplied by 14 (rough amount of grams in a standard drink) [65]. Cannabis use [66] was assessed on a three-point scale: “none,” “at least once,” and “six or more times,” asking students how often they used non-medical cannabis within the past 12 months. For academic achievement, participants consented to having their University cumulative GPA data (university student ID numbers) matched to Spit for Science survey data (participant ID numbers). This information is not self-reported.

Statistical Analyses

All data were analyzed using SPSS 26.0. This analysis included data from Black male students from their freshman and sophomore years. Data for depressive, anxiety symptoms, and help-seeking behavior were summarized for Black male students. Basic descriptives were analyzed separately for freshman year (Y1S) and sophomore spring semester (Y2S). Bivariate correlations were conducted to determine multicollinearity issues or concerns between variables and outcomes of interest. Multiple linear regression analyses were conducted to test the study’s hypotheses, including three regression models per mental health symptom category (anxiety and depression) and by year (freshman and sophomore year). Model 1 represents the risk and protective factors and their relationship with anxiety and depressive symptoms among men. To assess the impact of additional covariates on mental health risk, Model 2 included alcohol consumption and cannabis use, allowing us to examine the associations of risk and protective factors on mental health outcomes while controlling for other important covariates (i.e., alcohol consumption, cannabis use). Similarly, Model 3 included GPA, allowing us to ascertain how GPA might impact mental health risk. Finally, a logistic regression was conducted, for each service, to see if the likelihood of individuals using a service is impacted by these same risk and protective factors. Bonferroni corrections [67] were conducted to correct for multiple testing, adjusted p-values are reported.

Results

Sample Characteristics.

In Table 1, sample characteristics are presented showing a sample including overall count of 681 black male students. Sample sizes are also presented for each variable of interest (varies based on survey completion by each participant). Median age for this sample was greater than 18 years of age.

Table 1:

Sample characteristics and descriptive analyses for variables included in analysis

	N	Median	Std. Deviation	Range
Year 1
Demographics
Age	355	18.92	0.46	6.36
Gender (Black Men)	681	1	0	0
Variables
Mental Health
Depression	490	4	3.60	16
Anxiety	493	1	2.70	16
Risk Factors
Stressful Life Events	501	1	1.80	10
Mother’s Educational Level*	657	8	2.03	9
Father’s Educational Level*	611	8	2.14	8
Perceived Financial Status*	226	4	2.55	9
Protective Factors
Religiosity*	490	6	1.92311	6
Social Support	437	6	2.40314	9
Additional Important Covariates
Alcohol Consumption	7998	38.5	490.07	5108
Cannabis Use	466	0	0.822	2
Grade Point Average (GPA)	9468	3.06	0.73	4
Utilization
University Counseling Services	191	0	0.42	1
University Health Services	191	0	0.50	1
The Wellness Resource Center	191	0	0.41	1
Year 2
Age	283	19.88	0.44	4.19
Depression	267	3	3.61	16
Anxiety	267	0	2.30	12
Stressful Life Events	271	1	1.83	11
Social Support	157	6	2.44	9
Alcohol Consumption	4169	63	487.42	5108
Cannabis Use	266	0	0.90	2
GPA	8067	3.08	0.58	3.87
University Counseling Services	102	0	0.39	1
University Health Services	102	1	0.50	1
The Wellness Resource Center	102	0	0.42	1

^*Some variables were only assessed at baseline under the assumption that data does not change over the years.

In Year 1, freshman (see Table 2) year, stressful life events (B = 0.39, SE = 0.09, p < 0.001) was positively associated with anxiety symptoms. When combining important covariates, religiosity (B = −0.23, SE = 0.10, p = 0.019), as a protective factor, became associated with lower levels of anxiety symptoms and stressful life events (B = 0.32, SE = 0.10, p = 0.002) remained associated with higher levels of anxiety symptoms. Cumulative GPA was then added. The regression established that stressful life events (B = 0.31, SE = 0.10, p = .002) remained associated with higher levels of anxiety and religiosity (B = 0.25, SE = 0.10, p = .013) remained associated with lower levels of anxiety symptoms. In Year 2, analyses showed that stressful life events (B = 0.48, SE = 0.11, p < 0.001) were associated with higher levels of anxiety. When adding covariates, mother’s educational level (B = −0.23, SE = 0.12, p = 0.055) was associated with lower levels of anxiety symptoms and stressful life events (B = 0.35, SE = 0.12, p = 0.007) were associated with higher levels of anxiety symptoms. Once GPA was added, stressful life events (B = 0.37, SE = 0.14, p = 0.013) remained significantly associated with higher levels of anxiety. Overall, social support was not significantly associated with levels of anxiety symptoms in year 1 (B = −0.02, SE = 0.07, p = 0.76) or year 2 (B = 0.007, SE = 0.09, p = 0.94).

Table 2:

Relationship between risk factors, protective factors, covariate factors and mental health symptoms

	Model 1 B, SE, p-value	Model 2 B, SE, p-value	Model 3 B, SE, p-value
Outcome: Anxiety Symptoms
Year 1
N	181	150	144
Risk Factors
Stressful Life Events	0.39, 0.09, p< 0.000	0.32, 0.1, p = 0.002	0.31, 0.1, p = 0.002
Mother’s Educational Level	−0.02, 0.08, p = 0.81	−0.13, 0.86, p = 0.11	−0.14, 0.08, p = 0.11
Father’s Educational Level	0.04, 0.08, p = 0.62	0.11, 0.085, p = 0.19	0.12, 0.08, p = 0.16
Perceived Financial Status	0.06, 0.07, p = 0.41	−0.02, 0.07, p = 0.76	−0.04, 0.08, p = 0.56
Protective Factors
Religiosity	−0.1, 0.09, p = 0.27	−0.23, 0.1, p = 0.01	−0.25, 0.24, p = 0.32
Social Support	−0.02, 0.07, p = 0.76	−0.09, 0.078, p = 0.23	−0.09, 0.08, p = 0.23
Additional Important Covariates
Alcohol Consumption		0, 0.001, p = 0.45	0, 0.001, p = 0.39
Cannabis Use		0.2, 0.23, p = 0.36	0.23, 0.24, p = 0.32
GPA			0.17, 0.26, p = 0.51
Year 2
N	97	82	72
Stressful Life Events	0.48, 0.11, p = 0	0.35, 0.12, p = 0.007	0.375, 0.14, p = 0.013
Mother’s Educational Level	−0.17, 0.11, p = 0.14	−0.23, 0.12, p = 0.055	−0.254, 0.13, p = 0.056
Father’s Educational Level	−0.06, 0.1, p = 0.58	−0.1, 0.11, p = 0.337	−0.116, 0.12, p = 0.355
Perceived Financial Status	−0.12, 0.08, p = 0.15	−0.16, 0.1, p = 0.104	−0.209, 0.11, p = 0.062
Religiosity	−0.13, 0.12, p = 0.26	−0.12, 0.12, p = 0.32	−0.166, 0.13, p = 0.231
Social Support	0.007, 0.09, p = 0.94	−0.02, 0.1, p = 0.833	−0.01, 0.11, p = 0.929
Alcohol Consumption		0, 0, p = 0.699	0, 0.001, p = 0.844
Cannabis Use		0.25, 0.29, p = 0.392	0.407, 0.31, p = 0.206
GPA			0.387, 0.43, p = 0.374
Outcome: Depression Symptoms
Year 1
N	181	150	144
Stressful Life Events	0.33, 0.13, p = 0.013	0.33, 0.15, p = 0.031	0.31, 0.14, p = 0.039
Mother’s Educational Level	0.05, 0.12, p = 0.661	0, 0.13, p = 0.988	−0.01, 0.12, p = 0.906
Father’s Educational Level	0.03, 0.11, p = 0.799	0.02, 0.12, p = 0.828	0.06, 0.13, p = 0.631
Perceived Financial Status	0.21, 0.1, p = 0.041	0.25, 0.11, p = 0.036	0.2, 0.12, p = 0.094
Religiosity	−0.25, 0.13, p = 0.065	−0.32, 0.15, p = 0.035	−0.36, 0.15, p = 0.017
Social Support	−0.1, 0.11, p = 0.362	−0.1, 0.11, p = 0.397	−0.11, 0.11, p = 0.319
Alcohol Consumption		−0.1, 0.11, p = 0.397	3.41E-05, 0.001, p = 0.967
Cannabis Use		0.35, 0.34, p = 0.307	0.41, 0.35, p = 0.251
GPA			0.14, 0.38, p = 0.715
Year 2
N	97	82	72
Stressful Life Events	0.63, 0.19, p = 0.001	0.56, 0.2, p = 0.009	0.47, 0.24, p = 0.055
Mother’s Educational Level	0.04, 0.19, p = 0.806	−0.06, 0.19, p = 0.738	−0.009, 0.21, p = 0.968
Father’s Educational Level	−0.14, 0.17, p = 0.408	−0.28, 0.18, p = 0.127	−0.36, 0.2, p = 0.079
Perceived Financial Status	−0.17, 0.14, p = 0.229	−0.21, 0.16, p = 0.195	−0.27, 0.18, p = 0.136
Religiosity	−0.04, 0.2, p = 0.843	0.07, 0.21, p = 0.719	0.14, 0.22, p = 0.521
Social Support	−0.18, 0.15, p = 0.225	−0.19, 0.16, p = 0.243	−0.31, 0.19, p = 0.105
Alcohol Consumption		0, 0.001, p = 0.543	0, 0.001, p = 0.585
Cannabis Use		1.14, 0.47, p = 0.02	1.08, 0.52, p = 0.045
GPA			−0.35, 0.71, p = 0.621

B Beta, SE Standard Error

Model 1: Includes just risk and protective factors. Model 2: Includes additional covariates alcohol and cannabis use. Model 3 Includes additional covariate GPA.

Analyses showed that higher levels of depression were associated with stressful life events (B = 0.33, SE = 0.13, p = 0.013) and financial self-report status (B = 0.21, SE = 0,10, p = 0.041) in Year 1 (see Table 2.). Financial self-report status (B = 0.25, SE = 0.11, p = 0.036) and stressful life events (B = 0.33, SE = 0.15, p = 0.031) remained associated with higher levels of depressive symptoms when covariates were added. In addition, religiosity (B = −0.32, SE = 0.15, p = 0.035) became associated with lower levels of depression. When GPA was added, stressful life events (B = 0.311, SE = 0.14, p = .039) remained associated with higher levels of depression and religiosity (B = −0.36, SE = 0.15, p = 0.17) showed a negative relationship with depressive symptoms. During Sophomore year, we saw that stressful life events (B = 0.63, SE = 0.19, p = 0.001) were associated with higher levels of depression. When covariates were added, the regression established stressful life events (B = .56, SE = 0.20, p = .009) and cannabis use (B = 1.14, SE = 0.47, p = .020) became associated with higher levels of depressive symptoms. The addition of GPA showed that stressful life events (B = 0.47, SE = 0.24, p = 0.055) and cannabis use (B = 1.08, SE = 0.52, p = 0.045) remained associated with higher levels of depressive symptoms. In Model 3, stressful life events (B = 0.47, SE = 0.24, p = 0.055) and cannabis use (B = 1.08, SE = 0.52, p = 0.045) were associated with higher levels of depressive symptoms. Overall, social support was not significantly associated with levels of depressive symptoms in year 1 (B = −0.1, SE = 0.11, p = 0.36) or year 2 (B = −0.18, SE = 0.15, p = 0.22).

A logistic regression was conducted to assess the relationship between the likelihood that students would utilize services based on risk and protective factors. For Year 1, results showed that religiosity (B = −.478, SE = .179, p = 0.048) was significantly associated with utilization of health services such that religiosity predicted lower odds of individuals utilizing health services (OR: 0.62, 95% CI: 0.436 - 0.881). For Year 2, results showed that religiosity (B = −.296, SE = .163, p = 0.069) trended towards significance but did remain significantly associated with the utilization of health services. Importantly, as mentioned, social support was assessed as a protective factor; however, social support did not seem to have an impact on utilization. Further analyses showed that no other factors had a statistically significant impact on utilization of campus services utilization (see Table 3).

Table 3:

Logistic regression showing relationship between risk factors, protective factors and each category of campus health services utilization

	B	SE	Wald	df	p-value	OR	95% CI
Year 1
N	57
Outcome: Counseling Services
Stressful Life Events	−0.218	0.274	0.635	1	0.426	0.804	0.47 - 1.375
Mother’s Educational Level	0.009	0.174	0.003	1	0.957	1.01	0.718 - 1.42
Father’s Educational Level	−0.075	0.158	0.225	1	0.635	0.928	0.68 - 1.265
Perceived Financial Status	−0.043	0.156	0.078	1	0.78	0.958	0.706 - 1.299
Social Support	−0.005	0.166	0.001	1	0.978	0.995	0.718 - 1.379
Religiosity	0.121	0.203	0.353	1	0.553	1.128	0.757 - 1.681
Constant	−1.348	2.082	0.419	1	0.517	0.26
Outcome: Student Health Services
Stressful Life Events	0.335	0.231	2.09	1	0.148	1.397	0.888 - 2.2
Mother’s Educational Level	−0.176	0.152	1.349	1	0.246	0.838	0.623 - 1.129
Father’s Educational Level	0.009	0.147	0.004	1	0.95	1.009	0.757 - 1.345
Perceived Financial Status	0.07	0.132	0.281	1	0.596	1.073	0.828 - 1.39
Social Support	0.219	0.157	1.946	1	0.163	1.245	0.915 - 1.693
Religiosity	−0.478	0.179	7.107	1	0.048*	0.62	0.436 - 0.881
Constant	1.768	1.759	1.01	1	0.315	5.856
Outcome: Wellness Center
Stressful Life Events	0.445	0.239	3.482	1	0.062	1.561	0.978 - 2.491
Mother’s Educational Level	0.065	0.153	0.18	1	0.671	1.067	0.791 - 1.44
Father’s Educational Level	−0.061	0.148	0.168	1	0.682	0.941	0.704 - 1.258
Perceived Financial Status	0.084	0.132	0.404	1	0.525	1.088	0.839 - 1.409
Social Support	0.138	0.157	0.77	1	0.38	1.148	0.843 - 1.563
Religiosity	−0.282	0.174	2.615	1	0.106	0.755	0.536 - 1.062
Constant	−1.323	1.818	0.529	1	0.467	0.266
Year 2
N	61
Outcome: Counseling Services
Stressful Life Events	−0.119	0.205	0.338	1	0.561	0.888	0.594 - 1.326
Mother’s Educational Level	−0.057	0.198	0.083	1	0.773	0.945	0.641 - 1.392
Father’s Educational Level	−0.134	0.16	0.705	1	0.401	0.874	0.639 - 1.196
Perceived Financial Status	−0.248	0.162	2.331	1	0.127	0.781	0.568 - 1.073
Social Support	−0.062	0.153	0.165	1	0.685	0.94	0.697 - 1.268
Religiosity	0.278	0.242	1.317	1	0.251	1.32	0.821 - 2.122
Constant	−0.737	2.385	0.095	1	0.757	0.479
Outcome: Student Health Services
Stressful Life Events	0.17	0.154	1.229	1	0.268	1.186	0.877 - 1.602
Mother’s Educational Level	0.287	0.188	2.324	1	0.127	1.332	0.921 - 1.927
Father’s Educational Level	−0.285	0.152	3.537	1	0.36*	0.752	0.558 - 1.012
Perceived Financial Status	−0.062	0.115	0.289	1	0.591	0.94	0.751 - 1.177
Social Support	−0.037	0.119	0.094	1	0.759	0.964	0.763 - 1.218
Religiosity	−0.296	0.163	3.306	1	0.069	0.744	0.541 - 1.023
Constant	1.851	1.802	1.055	1	0.304	6.366
Outcome: Wellness Center
Stressful Life Events	−0.171	0.22	0.599	1	0.439	0.843	0.547 - 1.299
Mother’s Educational Level	0.164	0.196	0.698	1	0.403	1.178	0.803 - 1.728
Father’s Educational Level	−0.261	0.15	3.049	1	0.081	0.77	0.574 - 1.033
Perceived Financial Status	0.05	0.124	0.164	1	0.686	1.052	0.824 - 1.342
Social Support	0.159	0.135	1.399	1	0.237	1.173	0.901 - 1.527
Religiosity	−0.159	0.172	0.86	1	0.354	0.853	0.609- 1.194
Constant	−0.564	2.018	0.078	1	0.78	0.569

B Beta, SE Standard Error, OR Odds Ratio, Ci, Confidence Interval (Lower, Upper)

^*Adjusted p-value.

Discussion

The current study analyzed relationships between mental health symptoms, risk factors, protective factors and important covariates (i.e. substance use and GPA) among university-enrolled, Black men, as well as whether or not these risk and protective factors predict campus health services utilization. Overall, stressful life events appeared to be a robust predictor of anxiety and depressive symptoms, which is consistent with current mental health literature in which many studies [68, 30, 31] suggest that higher levels of stress are associated with more mental health challenges and poorer health outcomes [69–71]. Within this study, as stressful events are associated with anxiety and depressive symptoms, it seems Black men are exposed to various stressors, putting them under high levels of stress during their freshman and sophomore year. According to literature, this stress, especially if ignored or untreated, will eventually lead to psychological distress which increases risk of developing mental health issues [72]. For future work, it would be beneficial for researchers to examine what kinds of stressors these men may be dealing with and how they vary by grade level, as well as which of these stressors are more likely to lead to experiences with psychological distress.

To assess the role of financial status and its relationship with anxiety and depressive symptoms, we included items assessing parental education level and individual’s perceived financial status. In the literature, financial status is a significant contributor to men’s poor psychological well-being [10, 21]. From the results in this study, perceived financial status (see Table 2), specifically, was only associated with higher levels of depressive symptoms in Year 1. This supports the hypotheses and mirrors current literature which shows that financial stress is a major risk factor [21] for the onset of psychological distress and increases individual risk of experiencing poor mental health. Studies suggest that financial instability or low socioeconomic status is associated with higher levels of poor mental health [21, 73]. However, perceived financial status did not remain significant when GPA was added to the model. This is unexpected and contradicts literature but can be due to other factors. It may be that perceived financial status, among this population, is not the most prevalent stressor compared to other stressors accounted for within the stressful life events category. Additionally, it can mean that symptoms associated with depression are not impacted by perceived financial status. Interestingly, as men ascribe to masculine norms (being the provider) [74, 75], men, in this sample, may not be willing to report or answer survey questions associated with their financial status as a stressor worth ascribing to in light of other stressors accounted for in this study. This may be a factor future work can investigate further, examining which factors related to masculine norms might impact Black [76] men’s willingness or endorsement of symptoms and stress and the role it plays in development of mental health symptoms.

Focusing on mother’s educational level, analyses showed that lower levels of anxiety symptoms in Year 2 were associated with higher levels of mother’s education level which aligns with current mental health literature [56]. Recent studies show that higher levels of parental education is associated with not only better health outcomes [77] among minority populations, but also lower levels of mental health symptoms [10, 21] . More research is needed to understand and examine the relationships between parental education and mental health among Black college men and should aim to assess this individually for both parents. This will offer insight into how certain types of financial status affects these men, their mental health risk, and their help-seeking. It is interesting that mother’s education level is associated with lower levels of anxiety, but father’s educational level is not significantly associated with any outcome. This finding could be due to a number of factors. For example, there is evidence to suggest that single-parent households in the US are more likely to be headed by women [78]. Further, there is literature to suggest that Black men are less likely to be gainfully employed [79] and more likely to be socioeconomically disadvantaged [27]. From this, it can be considered that, among this sample, either the man who functioned as the student’s father is more likely to have lower educational attainment, a significant predictor of poor health outcomes [39], or that the student does not have someone who functions as a father in their household. However, as this is not certain, further research is needed such that researchers should not only aim to examine relationships between parental education and mental health risk among Black men in college but also in particular to father’s educational level.

During students’ freshman year, religiosity was associated with lower levels of anxiety and depressive symptoms. This is only seen when additional covariates (i.e. alcohol use and cannabis use) were included in the model. The negative relationship observed is consistent with current literature, however, and supports the hypothesis that religiosity might serve as a protective factor, buffering the association between life stressors and poor mental health outcomes. Studies have reported that protective factors, including religiosity [43], would help buffer negative impacts of stressors, such as racial discrimination, that increase mental health risk [80, 81]. Not explicated in the literature is how conformity to religiosity is impacted by endorsement of other factors, such as alcohol and cannabis use. Among this sample, it could be that as Black men’s endorsement of religiosity increases, their need to engage in substance use decreases. There is evidence to suggest that Black men and those from Black communities often turn to religiosity in times of need and as a form of coping [49, 63]. It is important to understand the role of religiosity in attenuating mental health risk and its role in coping. As mentioned, as literature shows that social support buffers the negative impacts associated with mental health risk and onset of symptoms [70, 80] it was hypothesized that social support would be associated with lower levels of symptoms. Surprisingly in this study, social support was not significantly associated with anxiety or depressive symptoms. Among this sample, it could be that social support in the form of significant others (i.e. romantic) is not prevalent among this population. These men may not have someone to confide in, get advice from, or relax with when dealing with mental health issues as was assessed by the items.

Black men often resort to poor coping mechanisms for dealing with high levels of stress [82]. When examining the effects of additional covariate factors, it is seen that cannabis use was associated with higher levels of depressive symptoms in Year 2. This may suggest that men dealing with depression are more likely to use cannabis which, overall, aligns with current literature. According to literature, substance use has been reported to predict mental health symptoms among many populations [83, 12]. Particularly for cannabis use, among a sample of Black adolescents, males marijuana use was predictive of their depressive symptoms but not amongst their peers [84]. In this study, endorsement of cannabis only appeared during Year 2 and only for depressive symptoms. This offers direction for future research. First, it may benefit researchers to examine differences in endorsement of alcohol and cannabis use among this population. From this, researchers can determine whether cannabis use may be a better route of intervention and reducing mental health risk among men, as well as creating opportunity to attenuate unhealthy behaviors among Black men. Further, as mentioned, cannabis use is only predictive of depression during their sophomore year. Future research should aim to examine what about a student’s sophomore year is more stressful and increases one’s risk of developing mental health symptoms.

Another aim of this study was to determine if risk and protective factors could predict utilization. Results showed that religiosity was significantly associated utilization such that it predicts lower levels of utilization of student health services. This finding further speaks to the role of religiosity as a means for coping among Black men. It could be that, among this sample, Black men who endorse religiosity and/or are spiritual are less likely to use formal services for concerns. Researchers should aim to further analyze this, focusing on types of utilization that may be more relevant for this population as well as factors that may impact these relationships. However, religiosity did not predict utilization of counseling services. This is an important finding to consider as the literature contains studies that show religion (i.e. prayer and going to church) to be preferred coping methods for health and mental health issues among Black populations [85, 86]. It would be important to further examine this and for researchers to conduct work that ascertains if religiosity can be a viable avenue for mental health prevention and what aspects of religiosity are relevant and appropriate to promote among this population.

Limitations

The present results should be considered in the context of several limitations. This study aimed to examine certain factors as risk and protective factors and there is a possibility that there may be measures more appropriate for assessing risk and protective factors among this population. Some measures were only collected at baseline, which can speak to why we only see an association between parental education and depressive symptoms in year 1; however, this does not allow us to ascertain any changes in these measures outside of this scope. Despite these limitations, this is one of the first studies to examine risk, protective and associated factors among this vulnerable population and, therefore, offers unique insight into their experiences. Importantly, this study did not sum across all services used and allowed for a deeper look into utilization of each different service. This can provide evidence for the services that are most relevant to these men and which might be most appropriate to investigate further in future work.

Generalizability of these findings may be limited to the scope of this sample—Black male students on a college campus in Southern region of US. Hence, there are numerous populations that are left out. For example, other minority men who may not face the same issues, but similar in race or gender, may not necessarily fully benefit from the findings. However, this does not take away from the significance of this work. Black men, in general, are a severely marginalized population whose mental health issues are steadily climbing and yet despite prevention efforts. Black men’s help-seeking remains low and they continue to face significant disparities in health that are tied to mental health concerns. Therefore, this study provides valuable information, lending itself to avenues for future research. From the mental health measures, we are able to look at anxiety and depression separately in regard to increased risk and factors that minimize its onset. Some studies may suggest combining since these mental health conditions are common and often co-morbid; however, that is not certain among this population. Therefore, it is a strength of this study to look at these symptoms separately. The results should be considered in research moving forward and should aim to collect primary data, using mixed methods and developing measures that are suitable and comprehensive for examining mental health and utilization among Black men in college.

Implications for Future Research

The current study has implications for future research, intervention work, and prevention practices. Primarily, we see that stressful life events are a robust predictor of mental health symptoms. This is congruent with literature, for many populations, however, for Black men in college, research still lacks in this area. For future research, it would be important to continue in this effort and conduct research that examines stressful life events—traumatic and non-traumatic—among Black men during emerging adulthood. Understanding what kinds of stressful life events impact their health as well as how it shapes their social and behavioral environments will provide direction for campus professionals who wish to reduce mental health risk among these men by changing health behaviors [87]. In addition, it would allow public health professionals to gain a more comprehensive understanding of Black men’s willingness to seek help for mental health concerns.

Particular to protective factors, religiosity was associated with lower levels of anxiety and depressive symptoms and service utilization. It may benefit researchers to consider partnering with religious organizations on campuses or otherwise, finding ways to incorporate religiosity into their prevention efforts. Further, as mentioned, analysis of social support in this study did not show association with any symptoms though being highly regarded in the literature as a board protective factor. Primarily, for future work, it could be with this group that social support may not be primary intervention targets for future programming efforts geared towards help-seeking improvement. However, future research should also aim to further analyze the effects and impacts of religion and social support on mental health risk and help-seeking. For example, there may be certain types of religious activities and forms of social support that have positive effects on mental health for Black men and their communities [88], some of which are not captured in this study.

This study only includes data from freshman and sophomore years; therefore, researchers should aim to either expand on this by including data for these men during all college years. Further, as we see from the results, there are factors that are more predictive of depression and anxiety during the sophomore year. It may be worthwhile to consider focusing on the sophomore year in college and the stressors that may come with entering this year. Such data can help determine whether the impact of risk, protective, or associated factors shift between years of schooling or whether change in predictive relationships are due to accumulated stress. Nonetheless, both avenues would offer valuable insight.

In conclusion, we saw that Black men on this college campus are experiencing mental health symptoms associated with anxiety and depression due to stressors, such as financial status, and that religiosity and endorsement of spirituality is associated with lower levels of anxiety and depressive symptoms. Additionally, we learned that cannabis use is associated with depressive symptoms. Public health practitioners should consider expanding on these findings and emphasize religiosity among this population in regard to prevention. This will be particularly relevant for college professionals who wish to improve mental health among minority men and reduce educational disparities that continue to persist. Importantly, as this study is one of the first to assess the role of social and environmental factors in mental health risk among Black men in college, further research is needed on a larger scale.

Appendix

Appendix A: Non-standard Survey Measures Only

Table 1:

Raw Questions and Survey Items¹

Item Variable Name or Category	Survey Question:	Response Options
Campus Service Utilization (was assessed via three questions individually)	Since coming to college, have you used University Counseling Services? Since coming to college, have you used University Student Health services? Since coming to college, have you used The Well?	Yes No
Financial Stress: Parents’ Education (was assessed via two questions)	This question is about the woman who functioned as a mother in your household when you were growing up; she could be your biological mother, stepmother, foster mother, adoptive mother or, perhaps, a grandmother or aunt. How far in school did she go? This question is about the man who functioned as a father in your household when you were growing up. How far in school did he go?	Eighth grade or less More than eighth grade, but did not graduate from high school Went to a business, trade, or vocational school instead of high school High school graduate Completed a GED Went to a business, trade, or vocational school after high school Went to college, but did not graduate Graduated from a college or university Professional training beyond a four-year college or university She never went to school She went to school, but I don’t know what level There was no one who functioned as a mother in my household I don’t know if she went to school I choose not to answer
Financial Status: Perceived Financial Status (assessed via three questions)	How often do you have trouble affording the kind of leisure activities you want to have? How often do you have trouble affording the kind of clothing you need? How often do you have trouble affording the kind of food you should have?	Never Seldom Sometimes Often Skip I choose not to answer
Cannabis use (Timeframe: Since attending college…)	Have you ever used cannabis (marijuana, hashish, THC, ganja, other) for non-medical use? Non-medical use means on your own, without a doctor’s prescription, in greater amounts than prescribed, or for reasons other than your doctor recommended. Remember that all your responses are completely confidential.	Yes No

¹All of these items were assessed for Year 1 and 2