The Healthy Minds Study is a non-probability online survey administered to students in higher education in the United States (19). The survey was administered at 140 institutions between September 2020 and June 2021. We limited the sample to emerging adults (aged 18–29) and used complete-case analysis. The final analytic sample was 110,203. The response rate for the survey was 14%. To account for non-response, we used sample probability weights [based on administrative data at each institution (19)]. HMS data were collected with the approval of Advarra and all participating colleges/universities (IRB number: Pro00028565). The secondary analysis presented in this study was deemed exempt under the approval of USC (UP-22-00068).

We examined several mental health outcomes. Depression was measured using the Patient Health Questionnaire-9 [PHQ-9; (20)], which captures the frequency of depression symptoms over the past 2 weeks. The items were summed into a scale (range: 0–27), which was dichotomized (cutoff: 10) to reflect moderately severe or severe depression (21). Anxiety was measured using the Generalized Anxiety Disorder-7 [GAD-7; (22)], which captures the frequency of anxiety symptoms over the past 2 weeks. The items were summed into a scale (range: 0–21), which we then dichotomized (cutoff: 10) to reflect moderately severe or severe anxiety in accordance with prior studies (23). Psychotic experiences were measured using an abbreviated version of the World Health Organization Composite International Diagnostic Interview Psychosis Screen, assessing the lifetime prevalence of subthreshold hallucinations and delusions (strange feeling, persecutory delusion, and thought control) (24). Suicidal thoughts and behaviors were measured by the dichotomous items (yes/no) eliciting past year suicidal ideation, suicide plan, and suicide attempt. Perceived need for help was measured using a single ordinal item about needing help for emotional/mental health problems (feeling sad, blue, anxious, or nervous), which was dichotomized to reflect general agreement or disagreement. Loneliness was measured using the 3-item UCLA loneliness scale (range: 3–9) (25). The scale was then dichotomized such that those who had scores of 6 or higher were deemed significantly lonely. Flourishing/Languishing was assessed using a scale (range: 8–56) that elicits the respondent’s level of agreement with eight statements about flourishing (26, 27). The flourishing scale was dichotomized such that a score of 47 or lower was considered languishing (28).

Respondents reported gender (man, woman, non-binary/transgender/self-described), age (continuous), and race/ethnicity (White, Black, Latinx/Hispanic, Asian American/Pacific Islander, Multiracial, and Other).

We used multivariable logistic regression models to examine associations between perceptions of anti-racism (categorical) and the mental health outcomes of interest (depression, anxiety, psychotic experiences, suicidal ideation, suicide plan, suicide attempt, perceived need for help, loneliness, and flourishing). We tested for dose–response associations by re-running all models while treating anti-racism as continuous. We also conducted exploratory sensitivity analyses to determine whether race/ethnicity moderated the associations between perceptions of anti-racism and mental health outcomes, using interaction terms. We presented findings as odds ratios (ORs) with 95% confidence intervals (95% CIs). We used Stata SE 15 to perform all analyses.

Racism is a pervasive force that adversely impacts the mental health of people of color, making anti-racism efforts imperative. However, anti-racist efforts are often lacking across institutions. We found that among students in higher education, perceiving the absence of anti-racism efforts within the campus community was associated with greater odds of endorsing a wide range of mental health problems in a dose-dependent fashion. The more strongly students disagreed with the statement that their schools actively combatted racism, the more likely they were to endorse mental health problems such as depression, anxiety, psychotic experiences, suicidal thoughts and behaviors, perceived need for help, and loneliness. We found that perceiving the absence of anti-racism programs on campus was associated with lower odds of flourishing. We also found that perceiving the absence of anti-racism efforts was associated with poorer mental health across all racial/ethnic groups, including White students, even though White students are not directly affected by systemic racism. This association may be a positive externality where the benefits of anti-racism ‘spill over’ to White students. Moreover, existing within more diverse, inclusive, and equitable spaces may be beneficial for mental health regardless of whether one is directly affected by racism.

Racism is a multi-faceted construct that impacts mental health through multiple pathways (29, 30). Racism in its many forms is pervasive on campuses. Since racism is deleterious to mental health, it stands to reason that actively combatting racism would result in the improvement of mental health. We cautiously interpret findings given the cross-sectional nature of the data and the absence of experimental conditions. There is some question as to whether perceptions of anti-racism are adequate proxies for the actual presence of anti-racism programs (or at least the visibility of anti-racism programs) on campuses. We acknowledge that perceptions do not always accurately reflect reality. Still, it is possible that colleges and universities that actively combat racism on campus are more diverse, equitable, and inclusive, such that students experience less discrimination, oppression, and exclusion, which are strongly linked to mental health.

To our knowledge, this study is among the first to examine perceptions of anti-racism efforts on campuses and their associations with mental health among emerging adults in higher education. However, there were several limitations of this study. First, in terms of measurement, we relied on a single self-report item to measure perceptions of anti-racism efforts on campus. It is not clear how students interpreted ‘anti-racism’, as it refers to a range of actions, including measures to change individual attitudes and behaviors, but also policies to improve racial equity. The single item did not allow students to specify what aspects of anti-racism they were able to observe. Future studies can use more extensive subjective and objective measures of anti-racism efforts (e.g., counting the number of anti-racist associations, anti-racist policies, and anti-racist trainings). The combination of these measures would be important in reducing bias. Second, in terms of sampling, the data were collected using a non-probability sampling strategy that yielded a relatively low response rate (14%). We used survey weights to attempt to account for non-response; however, future studies should use probability sampling strategies with incentives to increase participation and reduce sampling bias. Third, in terms of design, the cross-sectional nature of the study did not allow us to make any causal claims. While perceiving the absence of anti-racism efforts may reflect hostile and invalidating socioenvironmental conditions that lead to mental health problems, it is also possible that people with mental health problems are either more likely to perceive their environments negatively or less likely to be able to detect anti-racism on their campuses due to their symptoms (e.g., social isolation). More experimental designs are needed to test the effects of various anti-racism efforts on mental health across multiple settings. Finally, the data were collected in 2020 during the COVID-19 pandemic and during the Black Lives Matter (BLM) movement to protest anti-Black racism. The BLM movement raised awareness of racism and brought anti-racism to the foreground of many campuses. Moreover, hate crimes against Asian Americans surged across the country, impacting mental health on campuses (31). The HMS data collection coincided with these historical events, which may have resulted in a period effect. Future research can examine the moderating effects of the location of the school, the ethno-racial composition of the student body, the size of the student body, and the political orientation of the student. It is possible that what constitutes significant anti-racism programming in one department may seem inadequate in another department. For instance, students in the field of social work may be more attuned to issues of racism and may feel more discontent with the amount of anti-racist programming when compared with students in other professional degree programs.

Perceptions of anti-racism on campuses were inversely associated with mental health problems. It is worth noting that sometimes anti-racism efforts can potentially generate ‘backlash’ that stokes more racism (2). Anti-racist strategies can include programs to empower and educate, but can also include programs to build alliances for advocacy and social justice/activism (4). Future experimental studies should explore the effects of anti-racism on mental health toward reducing mental health and service disparities affecting students of color, and which specific strategies prove to be most effective.