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Commentary: Implications, Themes, and Next Steps.

The author presents a commentary on a special issue of the Journal of College Counseling. The articles included in the issue describe the mental health needs and counseling center utilization patterns of the diverse population of college students. The establishment of the Center for Collegiate Mental Health has created the opportunity to study representative groups of diverse students that have previously been difficult to access. The articles in the special issue are focused on studies that offer important clues to mechanisms that will serve as a springboard for future research.

This special issue of the Journal of College Counseling is a landmark series of articles that elucidate the state of mental health in a large and diverse sample of college students. The data in these studies are from the Center for Collegiate Mental Health, a network of researchers and practitioners at approximately 150 counseling centers that have engaged in standardized data collection. Psychological symptoms assessed for all participants included depression, anxiety, eating concerns, alcohol use, hostility, family distress, social anxiety, and academic distress as assessed by the Counseling Center Assessment of Psychological Symptoms (CCAPS). Pilot data collection resulted in a sample of more than 27,000 students seeking counseling and a second sample of more than 18,000 students from the general college population, which allows the determination of the representativeness of the first sample. These large samples include relatively large subsamples of diverse groups of college students, including ethnic and sexual minorities, for whom mental health data are relatively limited.

The McAleavey, Castonguay, and Locke (2011; this issue) study is innovative because the large sample allows separate analyses of specific sexual minority groups, including those self-identified as gay, lesbian, bisexual, questioning, asexual, and queer. A major finding reported in the McAleavey et al. study was that sexual minority students were more likely than heterosexual students to report the use of college counseling center services. This finding is encouraging in that sexual minority students appear to feel as comfortable as heterosexual students in using college counseling center services, if not more so. However, relatively high service utilization also may reflect greater levels of distress among sexual minority students. Indeed, relative to heterosexuals, each sexual minority group reported greater levels of distress on at least one psychological symptom on the CCAPS.

Another important finding in the McAleavey et al. (2011) study is that sexual minority groups had significantly greater levels of family distress than did heterosexuals. As McAleavey et al. noted, lack of family support was associated with increased psychological symptoms among persons with alternative sexual orientations. How are family issues optimally addressed in counseling? Although these issues might be directly addressed in counseling centers via family therapy, interventions beyond the context of counseling centers, including education and support from organizations such as Parents, Family, and Friends of Lesbians and Gays, may be needed to facilitate parental acceptance of sexual minority children (Goldfried, 2001). Moreover, religious and cultural traditions in some communities may create particularly challenging barriers to parental or family acceptance of a sexual minority child. If family support of a sexual minority student is not possible, it may be important to help the student identify other sources of enduring social support, such as organizations for gay, lesbian, bisexual, transgender, and queer (GLBTQ) individuals or organizations that are GLBTQ friendly.

McAleavey et al. (2011) also found that lesbians had lower levels of eating concerns than did heterosexuals. This finding also was echoed by Nelson, Locke, and Castonguay (2011; this issue), whose findings are discussed in more detail later in this article. Although many areas are identified in which sexual minorities experienced greater distress than heterosexuals reported, the protective aspects of sexual minority identification merit further investigation.

The reasons that sexual minorities experience greater distress and use college counseling center services more than do heterosexual students are unknown. McAleavey et al. (2011) concluded that the possible mechanisms of the various distress profiles warrant future research. Although it might be inferred that the greater levels of distress and greater use of counseling center services are a function of sexual minority status, this issue cannot directly be answered from the McAleavey et al. data. One method of addressing this issue would be to assess strength of sexual identification and experiences of discrimination associated with sexual identification to determine if these variables are associated with distress or service utilization or both. The counseling center utilization pattern also could be a function of perceptions of services. Are the relatively high utilization levels associated with perceptions of college counseling centers as supportive of sexual minority students and as providing a safe space? Moreover, all persons have multiple, intersecting identities of which sexual identity is but one. Any identity (e.g., sexual identity, gender, ethnicity, social class) may be more or less influential depending on the person and the person's social context.

In their article, Hayes, Chun-Kennedy, Edens, and Locke (2011; this issue) addressed this issue of multiple identities among people who are both ethnic and sexual minorities. Might being a member of more than one minority group result in added psychological distress beyond that associated with being a member of a single minority group? Ethnic minority students exhibited greater levels of depression, hostility, family concerns, social anxiety, and academic distress (as measured by the CCAPS) than did European American students. Sexual minority students exhibited greater levels of distress on depression, eating, anxiety, hostility, family concerns, and social anxiety than did heterosexual students. However, there were no additive effects of sexual and ethnic minority status.

These findings suggest that the salience of components of students' multiple identities may vary situationally. In their model of racial identity, Sellers, Smith, Shelton, Rowley, and Chavous (1998) have contended that the salience of race is a function of a person's core identity and the immediate social context. How central race is to a person's identity and past experiences may influence how an event is interpreted. Being the sole African American in a social situation may be more or less influential based on how central being African American is to one's identity and on what experiences one has had with being a sole minority. For example, an African American lesbian may find support for her lesbian identity in a GLBTQ student organization but may find less support for her African American identity if she is the only person of color in the organization or if there are relatively few students and faculty of color on campus. The salience of her African American identity in this situation may be a function of her past involvement with other African Americans or how much discrimination she experiences. Solo status may cause psychological distress if the woman misses being with other African Americans or if she does not feel that others understand racial discrimination and are able to support her. Thus, research is needed on contexts that make sexual and ethnic identities salient and how such saliency influences psychological distress, as Hayes, Chun-Kennedy, et al. (2011) have observed. Moreover, it is possible that multiple identities may confer protective effects that are less available to persons having fewer identities. For example, for the African American woman described earlier, lesbian identity affirmation may, to some extent, buffer the effects of racial discrimination.

Just as the authors of the McAlcavey et al. (2011) study demonstrated that there was heterogeneity among sexual minority groups, there is much heterogeneity among persons of color. Hayes, Chun-Kennedy, et al. (2011) aggregated persons of color to test whether minority statuses have additive effects. However, multiple ethnic groups (African Americans, Asian Americans, Latino/a Americans, multiethnic Americans) were analyzed together as ethnic minorities. Within each of these ethnic groups, there is variability in racial, ethnic, and cultural identification that may have an impact on psychological distress. Similar to the McAleavey et al. study, it also is unknown if the discrimination experiences of ethnic minority groups in the Hayes, Chun-Kennedy, et al. study were associated with elevated levels of psychological distress.

Data for the Nelson et al. (2011) study revealed that i in 5 women reported eating concerns, which are a risk factor for eating disorders. However, the rate of caring concerns was only 11% among lesbian women. Rates of eating concerns were somewhat lower among women of color than among European American women, but at least 14% of women in all ethnic groups experienced eating concerns. Whereas only 5% of all men reported eating concerns, the rate of eating concerns among gay men was 20%, the same as the rate for all women. Thus, persons who were in sexual relationships with men experienced greater rates of eating concerns than did those who were not. Although heterosexual men were relatively unconcerned with their body weight, more than half were concerned about their body shape. Nelson et al. suggested that men's compensatory behaviors (e.g., excessive exercise, steroid use) for concerns about body shape also require attention.

The findings from the Nelson et al. (2011) study raise important considerations for counseling. Is the concern about eating among the sexual partners of men evolutionarily based, a product of gender role socialization, or both? If eating concerns are malleable, to whom should interventions be directed? Across studies, eating disorder prevention programs have been demonstrated to be effective for females (Stice & Shaw, 2004). Women from different ethnic groups had different levels of eating concerns in the Nelson et al. study. Does this warrant interventions that are culturally specific? If men contribute to their sexual partners' concerns about eating, perhaps another important component of preventing eating disorders is changing the way men are socialized concerning the value of physical appearance (cf. Hall & Barongan, 1997). Nevertheless, many women may have skewed perceptions of men's actual perceptions of thinness and attractiveness (Fallon & Rozin, 1985).

In the Hayes, Youn, et al. (2011; this issue) article, the authors reported that counseling center utilization among racial/ethnic minority students was positively associated with counseling center staff ethnicity. In other words, persons of color were more likely to seek services if the staff included therapists of their own ethnicity. This finding is consistent with the therapist-client ethnic match literature in which clients of color were more likely to stay in treatment with therapists of their own ethnicity than of another ethnicity (Sue, Fujino, Hu, Takeuchi, & Zane, 1991). Also consistent with the ethnic match literature, the effect in the Hayes, Youn, et al. study was significant but relatively small (Maramba & Hall, 2002). The limited effects of ethnic match occur because ethnic match is not necessarily a cultural match. For example, an acculturated Latina American therapist who has had limited contact with Latino/a American communities would be ethnically matched with a Latina American immigrant who grew up in a primarily Latino/a American community. However, the two Latina Americans may have very different cultural worldviews, which would be a cultural mismatch.

Although the effects of ethnic matching are small, they still may be important. Hall and Eap (2007) have compared the process by which persons of color choose a therapist to the process of choosing a Japanese restaurant in the United States. Given a choice between a restaurant with a Japanese cook and one with a non-Japanese cook, those who are familiar with authentic Japanese food would likely choose the former restaurant even though Japanese ethnicity does not guarantee cooking expertise. Similarly, a person of color may perceive a counseling center with therapists of their own ethnicity as more culturally sensitive than one without therapists of their own ethnicity. As already discussed, an ethnic match does not necessarily guarantee a cultural match. Moreover, not all persons of color seek therapists of their own ethnicity. Nevertheless, for some persons of color, ethnic matching may be the difference between seeking and not seeking help or between remaining in therapy and dropping out.

Effrig, Bieschke, and Locke (2011; this issue) provided much-needed data on the understudied population of transgender students. Transgender students experienced very high levels of victimization, suicidal ideation, and self-harm relative to male and female students in a clinical sample. More than half of transgender students experienced harassing, controlling, or abusive behavior versus 35% of male and female students. More than 1 in 3 transgender students had an unwanted sexual experience versus approximately 1 in 5 male and female students. More than half of the transgender students had seriously considered suicide versus one fourth of the male and female students. More than one fourth of transgender students had attempted suicide versus 8% of male and female students. Effrig et al. noted that it is unclear if suicidal ideation and self-harm are associated with victimization. It is also unknown if the victimization, suicidal ideation, and self-harm were directly a result of" the students' transgender status.

Effrig et al. (2011) also reported that transgender college students in treatment did not significantly differ from those who were not currently in treatment in terms of their psychological distress and experiences of victimization. Contrary to previous findings on the reluctance of transgender students to seek counseling service s (McKinney, 2005), more than half of those who were not currently in treatment had received treatment in the past. However, it is unclear why some transgender students sought treatment and others did not. Perhaps the sensitivity of counseling centers to transgender students influences treatment utilization. Clearly, transgender students are in need of attention from counseling centers.

In summary, these articles provide a critical first step in describing the mental health needs and counseling center utilization patterns of diverse college students. The establishment of the Center for Collegiate Mental Health has created the opportunity to study representative groups of diverse students that have previously been difficult to access. As several of the authors have observed, the mechanisms of the findings are largely unknown and warrant further investigation. Nevertheless, these studies offer important clues to these mechanisms that will serve as a springboard for future research.


Effrig, J. C., Bieschke, K. l., & Locke, B. D. (2011). Examining victimization and psychological distress in transgender college students. Journal of College Counseling, 14, 143-157.

Fallon, A. E., & Rozin, P. (1985). Sex differences in perceptions of desirable body shape. Journal of Abnormal Psychology, 94, 102-105.

Goldfried, M. R. (2001). Integrating gay, lesbian, and bisexual issues into mainstream psychology. American Psychologist, 56, 977-988.

Hall, G. C. N., & Barongan, C. (1997). Prevention of sexual aggression: Sociocultural risk and protective factors. American Psychologist, 52, 5-14.

Hall, G. C. N., & Eap, S. (2007). Empirically-supported therapies for Asian Americans. In F. T. L. Leong, A. Inman, A. Ebreo, L. Yang, L. Kinoshita, & M. Fu (Eds.), Handbook of Asian American psychology (2nd ed., pp. 449-467). Thousand Oaks, CA: Sage.

Hayes, J. A., Chun-Kermedy, C., Edens, A., & Locke, B. D. (2011). Do double minority students face double jeopardy? Testing minority stress theory. Journal of College Counseling, 14, 117-126.

Hayes, J. A, Youn, S. J., Castonguay, L. G., Locke, B. D., McAleavey, A. A., & Nordberg, S. (2011). Rates and predictors of counseling center use among college students of color. Journal of College Counseling, 14, 105-116.

Maramba, G. G., & Hall, G. C. N. (2002). Meta-analysis of ethnic match as a predictor of dropout, utilization, and level of functioning. Cultural Diversity & Ethnic Minority Psychology, 8, 290-297.

McAleavey, A. A., Castonguay, L. G., & Locke, B. D. (2011). Sexual orientation minorities in college counseling: Prevalence, distress, and symptom profiles. Journal of College Counseling, 14, 127-142.

McKinney, J. S. (2005). On the margins: A study of the experiences of transgender college students. Journal of Gay & Lesbian Issues in Education, 3, 63-75.

Nelson, D. L., Castonguay, L. G., & Locke, B. D. (2011). Challenging stereotypes of eating and body image concerns among college students: Implications for diagnosis and treatment of diverse populations. Journal of College Counseling, 14, 158-172.

Sellers, R. M., Smith, M. A., Shelton, J. N., Rowley, S. A. J., & Chavous, T. M. (1998). Multidimensional model of racial identity: A reconceptualization of African American racial identity. Personality and Social Psychology Review, 2, 18-39.

Stice, E., & Shaw, H. (2004). Eating disorder prevention programs: A meta-analytic review. Psychological Bulletin, 130, 206-227.

Sue, S., Fujino, D. C., Hu, L., Takeuchi, D. T., & Zane, N. W. S. (1991). Community mental health services for ethnic minority groups: A test of the cultural responsiveness hypothesis. Journal of Consulting and Clinical Psychology, 59, 533-540.

Gordon C. Nagayama Hall, Department of Psychology and Center on Diversity and Community, University of Oregon. Work on this article was supported by the Asian American Center on Disparities Research (National Institute of Mental Health Grant I P50MH0 73511-01A2). Correspondence concerning this article should be addressed to Gordon C. Nagayama Hall, Department of Psychology and Center on Diversity and Community, University of Oregon, Eugene, OR 97405 (e-mail:
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Title Annotation:Research
Author:Hall, Gordon C. Nagayama
Publication:Journal of College Counseling
Article Type:Author abstract
Geographic Code:1USA
Date:Sep 22, 2011
Previous Article:Challenging stereotypes of eating and body image concerns among college students: implications for diagnosis and treatment of diverse populations.

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