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References
Jeffries, V., & Salzer, M. S. (2022). Mental health symptoms and academic achievement factors. Journal of
American
College
Health,
70(8),
2262–2265.
https://doi-
org.libproxy.library.unt.edu/10.1080/07448481.2020.1865377
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Mental health symptoms and academic achievement factors
Objective: Assess academic habits and self-efficacy of college students with serious mental illnesses
and explore their relationship with mental health symptoms. Participants: College students with serious
mental illnesses. Methods: Baseline data from students recruited for an intervention study were
gathered using psychometrically sound instruments assessing symptom distress, procrastination, study
habits, academic self-efficacy, and campus engagement. Results were compared to reference samples
of college students without identified mental health issues and then correlational analyses were
conducted to examine their relationship with degree of mental health symptom distress. Results:
Students with serious mental illnesses scored lower on most measures associated with academic
performance. Greater symptom distress was associated with poorer academic habits and self-efficacy,
but not campus engagement. Conclusions: This study supports hypothesized mechanisms by which
mental health symptoms impact academic performance and suggests interventions aimed at addressing
these factors while treatment is in process.
Keywords: Mental health
Introduction
There are an increasing number of individuals with mental illnesses enrolled in college.[ 1],[ 2] Students
with the most serious mental illnesses now represent 24% of all students with disabilities on college
campuses[ 3] and outnumber students with registered physical, sensory-motor, and learning disabilities.[
4] While the increasing numbers of college students with mental illnesses is good news, the mental
health symptoms they experience are clearly linked to academic outcomes, such as lower GPA,[[ 5], [ 7]]
and likely account for their relatively high dropout rate[ 8] compared to the general student population.
Mental health symptoms plausibly impact a number of specific academic factors, such as academic
persistence, procrastination, study skills, academic self-efficacy, and campus engagement, that lead to
lower GPA and likelihood of dropout.[ 9],[10] For example, greater levels of depression and anxiety could
impact academic self-efficacy, which is the belief in one's abilities to succeed academically, and
perceived competence, and combined may alter their academic effort and persistence. Consistent with
this hypothesis, one study involving a general student population found that higher levels of
psychological distress was associated with lower levels of self-efficacy and greater delays in completing
coursework.[11] Mental health symptoms can also have a negative effect on academic success through
their impact on cognitive functions, such as sustained attention and memory, which can undermine study
habits and retention of information.[12],[13] Finally, engagement on college campus, including problems
establishing relationships with other students, and less participation in the classroom and in
extracurricular activities, is associated with poorer academic outcomes.[10]
The extent to which mental health symptoms impact these academic factors among those with serious
mental illnesses (SMI)—schizophrenia-spectrum disorders, bipolar disorder, and major depression, is
not clearly established. If these academic factors are more prevalent among those with serious mental
illnesses compared to general student populations, and greater symptoms are found to be associated
with these factors, then addressing them could offer an additional intervention target for enhancing their
academic success and reducing dropout. College students with serious mental illnesses in one
qualitative study reported that mental health symptoms impacted their self-confidence, class attendance,
and ability to concentrate,[14] all of which could impact academic achievement. The goals of this brief
report are to quantitatively examine these issues among students with schizophrenia-spectrum
disorders, bipolar disorder, and major depression. The specific hypotheses are: 1) Students with serious
mental illnesses will report more problems in academic self-efficacy and competence, academic skills
such as procrastination and study habits, and campus engagement, compared to published results from
general student samples; and 2) Greater levels of symptom distress among students with serious
mental illnesses will be associated with more problems in each of these areas. The results from this
study may offer novel directions for maintaining or enhancing academic success of this clinical
population.
Material and methods
Procedures
The hypotheses were tested using baseline data from 100 college students with serious mental illnesses
who were enrolled in a randomized controlled trial of a supported education intervention. Inclusion
criteria included:
Enrollment in a 2- or 4-year postsecondary educational institution in the United States and taking at
least three courses per term;
Currently receiving mental health services for a schizophrenia-spectrum disorders, bipolar disorder, and
major depression as confirmed by a clinician;
18-50 years-old;
Desired help with college related to their mental health issues.
Individuals were excluded if they expected to graduate within 1 semester, had a legal guardian, or were
in an online program. Students with serious mental illnesses were recruited from around the country
using social media ads, e-news lists and notices on the websites of campus run mental health
organizations. Individuals were screened for eligibility, and if eligible, completed the informed consent
form and measures online using Qualtrics. Participants received a $20 honorarium for completing the
baseline measures. The study received Human Subjects approval from the lead author's institution.
Measures
The Hopkins Symptom Checklist (HSCL-25) is a self-report instrument measuring psychological distress
with 25 mental health symptoms answered on a scale of 1 (not at all distressed) to 4 (extremely
distressed).[15] The scale has been found to be reliable and valid in multiple studies.[[15], [17]] The
scale had a Cronbach's Alpha of 0.93 in this sample.
A subscale of the Procrastination Assessment Scale – Students (PASS)[18] was used based on the
prompt "to what degree do you procrastinate on this task?" and answered about six areas: 1) writing a
term paper, 2) studying for exams, 3) keeping up with weekly reading assignments, 4) academic
administrative tasks, 5) attendance tasks, and 6) school activities in general. Each question was
answered on a scale from 1 (never procrastinate) to 5 (always procrastinate). Scores were averaged,
with higher scores indicating greater procrastination. The PASS is considered both valid and reliable.[19]
The Cronbach's alpha for this sample is 0.76.
The Perceived Competence Scale used in this study is a 4-item scale that measures a person's
motivation to engage in a certain behavior.[20],[21] The questions were modified to the education
environment (I feel confident in my ability to learn material in my courses; I am capable of learning
material in my courses; I am able to achieve my goals that I set for my courses; I feel able to meet the
challenge of performing well in my courses) and rated on a 7-point scale (1 = not at all true to 7 = very
true). The average across items was calculated with higher scores indicating higher perceived
competence. The scale was modified to a 5-point Likert scale in order to compare to the scoring used in
the reference sample.[22] The Perceived Competence Scale has been found to be reliable and valid[20],
[23] and had a Cronbach's α = 0.90 in this sample.
The Study Habits Inventory is a 32-item instrument that assesses habits and skills in the following areas:
time management, concentration, note-taking, reading comprehension, test preparation and test taking,
reading speed, writing skills and test anxiety management.[24] Examples of items include "I worry so
much about doing well on tests that it interferes with my studying", "I write my papers the night before
they are due", and "I study with the radio or TV on". Answers are rated on a 3-point scale (1 = rarely or
never, 2 = sometimes, 3 = often or always). Ratings were reversed such that higher scores indicate
better study habits. Various versions of this measure have been shown to be reliable and valid[25],[26]
and the Cronbach's alpha for the measure was 0.89 in this sample.
The College Self-Efficacy Inventory (CSEI) is a 20-item instrument created to assess college selfefficacy based on experiences common to all college and university students.[27] College self-efficacy is
defined as "a student's degree of confidence that they could successfully complete a given collegerelated task (e.g. taking notes, asking a question in class, etc.)." Responses are made using a 10-point
scale (1 = not at all confident, 10 = extremely confident) with higher average scores indicating greater
self-efficacy. The measure has four validated subscales[28]: Course Self-Efficacy, Social Self-Efficacy,
Roommate Self-Efficacy (or Coping with Others), and Social Integration Self-Efficacy. In the present
study, the CSEI had a Cronbach's α = 0.90 with subscales Cronbach's Alpha's as follows: Course SelfEfficacy, α = 0.87; Social Self-Efficacy, α = 0.87; Roommate Self-Efficacy, α = 0.82; and Social
Integration Self-Efficacy, α = 0.60.
Four scales from the College Student Experiences Questionnaire (CSEQ) were used to assess campus
engagement and experiences, relationships with others on campus, and satisfaction with their college
experience.[29] Participants were asked how often they had engaged in an activity within each area
(e.g. attended a campus event, asked a friend for feedback) using the following scale (1 = never, 2 =
occasionally, 3 = often, 4 = very often). Scores are summed within each scale, and higher scores
indicate more frequent occurrence of the activity. The CSEQ has been shown to be reliable and valid[30]
and Cronbach's alpha for each of the subscales with this sample were as follows: Campus Facilities, α =
0.72; Clubs and Organizations, α = 0.84; Personal Experiences α = 0.72; and Student Acquaintances, α
= 0.89.
Results
Participants
Participants were predominantly female (79%) and white (65%), with the remaining participants
reporting more than one race/ethnicity (11%), black (9%), Asian (8%), and Native American (1%). The
mean age was 24.5 years, with a range of 18-47 years. A majority of participants were diagnosed with
depression (54%), followed by bipolar disorder (38%), and schizophrenia-spectrum disorders (5%).
Academic measures and comparisons to published college student samples
Mean scores on the measures from general college student samples were obtained from the available
published literature and presented in Table 1 alongside the means for the SMI sample obtained for this
study. The mean score on the Perceived Competence Scale was significantly lower than a reference
sample of undergraduate chemistry students.[22] The mean score on the CSEI was significantly lower
than a sample of first-year college students.[31] A greater percentage of students in our sample reported
greater procrastination in writing term papers, studying for exams, and doing weekly readings on the
PASS, which are viewed as the most impactful academic areas in terms of overall performance,
compared to a college student sample.[18] Finally, our SMI sample had lower engagement on two of the
four subscales (Campus Facilities and Student Acquaintances) compared to a nationally normed
sample.[29] The mean score on the Study Habits Inventory was 64.62 ± 11.26. No comparison sample
was found in the literature.
Table 1. Descriptive statistics comparing academic factors between study and reference samples.
Measure
Study sampleReference sample
M or %
Perceived Competence Scale 3.63*
Pass
CSEI
SD
M or %SD
0.78
3.94
0.72
Writing term papers
62%*
46%
Studying for exams
54%**
27.6%
Doing weekly readings
59%**
30.1%
Total Score
6.11**
1.49
6.78
1.07
Course Self-Efficacy
6.23**
1.76
5.61
1.16
Social Self-Efficacy
6.36**
1.98
7.92
1.49
Measure
Study sampleReference sample
M or %
SD
M or %SD
6.45**
1.80
7.5
1.00
Social Integration Self-Efficacy4.4**
2.13
6.34
1.76
Campus Facilities
14.86**
4.34
17.7
4.80
Clubs and Organizations
8.96
3.99
9.2
4.10
Personal Experiences
19.19
4.49
19.9
5.20
Student Acquaintances
22.71**
6.06
26.3
6.90
Roommate Self-Efficacy
CSEQ
1 Note: For p < 0.01*; p < 0.001**.
Symptom severity correlations with academic measures
The mean score on the HSCL-25 was 2.44 ± 0.56. A total of 89% of the sample met or exceeded 1.75
that is commonly used to reliably differentiate between people who meet diagnostic criteria and those
who do not.[15],[16] The HSCL-25 was negatively correlated with the Perceived Competence Scale (r =
–0.538, p = 0.001), CSEI (r = –0.397, p = 0.001), and the Study Habits Inventory (r = –0.358, p < 0.001),
and positively associated with the Procrastination Assessment Scale (r = 0.333, p < 0.001). The HSCL25 was not correlated with any of the CSEQ subscales.
Discussion
This is the first study to quantitatively examine the relationship between symptom severity and specific
academic factors known to be associated with academic success among college students with SMI.
First, as hypothesized, our results suggest that college students with SMI experience lower levels of
self-efficacy compared to other college samples and greater levels of procrastination in important
academic areas. They also use campus resources less, and have poorer student relationships,
compared to other students. All of these are areas related to poorer academic performance. Second,
students with SMI who are experiencing greater psychological distress also report less perceived
competence, lower self-efficacy, and poorer study habits, and greater procrastination. The one
unanticipated finding was that symptom distress was not associated with campus engagement.
This study does have some limitations. For example, the general student samples that we compared our
mean scores to may have differed in significant ways, such as demographics, that may explain some of
the differences that were found. The other findings are correlational, which clearly limits causal
inferences about the weather symptoms cause academic problems or vice versa.
Nonetheless, the findings shed some light on possible mechanisms by which the psychological distress
experienced by students with serious mental illnesses may impact their academic performance. One
implication is that these students might benefit from interventions that focus on these academic factors,
such as targeting efforts to maintain or enhance study skills and combat procrastination, and address
perceived academic competence and self-efficacy, to prevent academic failure. Given the correlational
nature of these results, such approaches may even result in some symptom amelioration. Supported
education is one such program model that identifies student strengths, interests, and needs, and
provides individualized supports to maximize student success,[32] and has promising results in
achieving these goals.[33] These programs may be an important complement to medications, mental
health counseling, and other symptom-focused interventions to counter the likely academic problems
that these students also are experiencing.
Disclosure statement
The authors have no disclosures to report.
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~~~~~~~~
By Victoria Jeffries and Mark S. Salzer
Reported by Author; Author
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