Most college students with psychosis lack recommended combination treatment

Although the majority of students sought and received therapy or counseling in the past 12 months, less than 40 percent received the recommended combination of therapy/counseling and antipsychotic medication, suggesting potential barriers to accessing this medication.

Despite a low overall prevalence of psychosis in the United States, affecting three percent of the population, this condition is a serious public health concern because people often delay seeking care for an average of 74 weeks from the time symptoms begin. As psychosis tends to emerge in early adulthood, it's important to understand the reasons why young adults who experience psychosis seek-or do not seek-mental health treatment. 

A new study led by a Boston University School of Public Health (BUSPH) researcher examined the perceptions, beliefs, and attitudes that influenced college students' with a diagnosis of psychosis to seek help for their mental health and found that while a majority of these students believed they needed mental health treatment, 60 percent of students did not meet current recommended guidelines for combined antipsychotic medication and therapy. 

Published in the journal Social Psychiatry and Psychiatric Epidemiology, the study found that nearly 8 in 10 surveyed college students with psychosis reported needing mental health support. While 8 in 10 students did seek therapy or counseling within the past 12 months, only 4 in 10 students reported taking antipsychotic medication. 

This high identified need for help but low utilization of services indicates potential barriers to accessing this care. Early intervention and access to services such as therapy and medication in this population are important because it improves outcomes related to overall quality of life, school involvement, employment, symptom severity, and relapse rate."

Clara Godoy-Henderson, study lead and corresponding author, PhD student in health services and policy research at BUSPH

The study is among the largest to assess the use of antipsychotic medication, therapy/counseling, and informal support among college students with psychosis. As the average age of onset of psychosis is about 20 years old, understanding college students' perceptions and behaviors around treating this condition can help identify opportunities for earlier interventions that could improve psychosis outcomes.

For the study, Godoy-Henderson and colleagues at BUSPH and the University of Minnesota analyzed national survey data from the Healthy Minds Study, the nation's largest survey of student mental health, conducted by the Healthy Minds Network. The researchers examined responses from 2,819 college students with a diagnosis of psychosis, provided between 2015-2024, about their 12-month history with therapy/counseling and antipsychotic medication, as well as whether informal support from various groups around them (friends, loved ones, roommates, campus staff, religious counselors, or support groups) motivated them to seek or utilize these services.

Overall, the majority of students-nearly 60 percent-believed that they needed help for their psychosis condition. Students who did not believe they needed mental health help-or who believed that therapy/counseling and medication would not be helpful in treating their condition-were less likely to seek and receive these services. Still, the high identified need for help, but low utilization of antipsychotic medication, may indicate that students are encountering barriers to care, such as stigma-an issue that is also the focus of this year's Mental Health Awareness Month, an awareness campaign held each May by the National Alliance on Mental Illness. 

The findings also suggested that college students who believed they needed mental health treatment were more likely to have received informal support from health professionals or friends, and were more likely to take antipsychotic medication and/or receive therapy/counseling if they were encouraged-versus being pressured or forced to seek help, as is often the case when patients can be institutionalized for their mental health.

"Support systems play a crucial role in identifying early psychosis symptoms and help navigate mental health services, which may be an important factor in treatment initiation," says Godoy-Henderson. "However, future research should examine the long-term outcomes of individuals who are encouraged by their support systems to seek help for their mental health versus being mandated to treatment."

Future research should also aim "to better understand the barriers to antipsychotic medication to improve poor outcomes, such as delayed care, and high relapse rates in individuals with psychosis," she says.

The study's senior author is Dr. Sarah Lipson, associate professor of health law, policy & management at BUSPH and a principal investigator of the Healthy Minds Network.