• The effects of sense of belonging on student mental health outcomes

    Nambi Ndugga is a Policy Analyst with Boston University’s School of Public Health. She tweets at @joerianatalie

    Content warning: mentions of sexual assault and suicide

    Feelings of depression, suicidal ideation, and attempted suicide among college students have dramatically increased in recent years. Researchers have found that 20 percent of college students have experienced suicidal ideation and 9 percent have attempted suicide. The numbers are even more striking for students who identify as sexual minorities; for example, over 50 percent of bisexual students experience suicidal ideation and self-harm and over 25 percent have attempted suicide.

    Numerous studies support these findings, showcasing that mental health conditions are common among college students, especially among students who do not identify as heterosexual. Further, these studies show that students who struggle with mental health conditions, including depression, also experience diminished energy levels and difficulty concentrating. This adversely affects their sense of wellbeing, academic performance, and the probability of college completion.

    New Research

    An international group of researchers recently studied the effects of varying levels of sense of belonging and the experience of sexual assault on predicting suicidality and depression among LGBQ and heterosexual college students. The team included Insa Backhaus, Sarah K. Lipson, Lauren B. Fisher, Ichiro Kawachi, and Paola Pedrelli – from Sapienza University of Rome, Harvard T.H. Chan School of Public Health, Department of Health, Law, Policy & Management at Boston University School of Public Health, Massachusetts General Hospital, and Harvard Medical School.

    The researchers used a subset of data from the 2017-2018 Healthy Mind Study (HMS) – an annual, web-based survey that examines mental health, service utilization, and other related factors among over 60,000 graduate and undergraduate students from 60 US campuses. Most of the participants included were white (61.2 percent) and female (61.5 percent). LGBQ students made up 21 percent of the sample, with 5 percent identifying as gay or lesbian, 7 percent as bisexual, and 7 percent as queer or questioning.

    Backhaus et al. assessed the relationships among sexual orientation, sexual assault, sense of belonging, and depression and suicidal ideation. They hypothesized that a high sense of belonging would be associated with overall lower depressive symptoms and suicidal ideation and that it would play a protective role in the presence of sexual assault.

    Key Measures

    The researchers defined key concepts and variables in the following ways:

    Sexual orientation: The sex of the person whom an individual is sexually and emotionally attracted to, including, lesbian, gay, bisexual, queer, and questioning individuals.

    Sexual assault: Any unwanted, unconsented sexual contact, regardless of where it happened.

    Sense of belonging: An individual’s experience of feeling valued, needed, and accepted by a social system (college campus). This was based on how much students’ agreed or disagreed with the following statements: (a) I see myself as part of the campus community, (b) I fit in well at my school, (c) I feel isolated from campus life, (d) Other people understand more than I do about campus life.

    Depression and suicidal ideation: Depressive symptoms were identified and measured using the Patient Health Questionnaire (PHQ-9) – a multipurpose instrument for screening, diagnosing, monitoring, and measuring the severity of depression. They used item #9 of the questionnaire to measure self-harm and suicidal ideation.

    Results

    Significantly more LGBQ students reported depressive symptoms, suicidal ideation, and experiences of sexual assault within a twelve-month period than heterosexual students. Depression and suicidal ideation had a significantly strong positive correlation to each other among both groups of students, while sexual assault and depression had a smaller positive correlation.

    Sexual orientation, sexual assault, and sense of belonging were significant predictors of depressive symptoms. Sexual orientation and sexual assault were significant predictors of suicidal ideation for students with a low sense of belonging, but not for those with a high sense of belonging. Sense of belonging provided a protective effect against depression and suicidal ideation in the presence of sexual assault in both LGBQ and heterosexual students but the effect was much greater among LGBQ students.

    Conclusions

    The work of Backhaus et al. identifies pathways that can be used to improve mental health outcomes and reduce the mental health disparities between LGBQ and heterosexual students within the college context. In particular, the results emphasize the need for a greater focus on students’ sense of belonging within the college context by adequately addressing the prevalence of sexual assault on college campuses and increasing the availability of mental health resources for students.

    Though more could be done, in recent years numerous schools have implemented mental health information sessions during orientation week to reduce the stigma surrounding mental illness and introduce students to the available services. Some, such as UCLA, have implemented comprehensive programs that offer screening, tracking, and treatment of anxiety, depression, and suicidality to all students.

    With the understanding that LGBQ students are more likely to experience adverse mental health outcomes, most college campuses have versions of a LGBTQ alliance (including transgender students as well) which have been shown to reduce the severity of adverse mental health outcomes among LGBTQ students. Further, schools are using data from HMS, Columbia’s Sexual Health Initiative to Foster Transformation, and other comprehensive datasets to inform sexual assault prevention strategies and increase feelings of safety and belonging on campus.

    These steps help students in multiple ways. Improved mental health outcomes and sense of belonging clearly foster wellbeing. They are also strongly associated with increased student retention and student academic and personal success.

     
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