Sample Characteristics
Demographic variables showed that the study sample (N = 199,887; estimated population N = 217,552) is representative of a diverse, nationwide college population (see Table 1). Overall, about 22.43% (95% CI: [22.14, 22.71]) were SGM college students and the average age was 22.48 (standard error [SE]: 0.05).
Shifts In Pattern Of Violence During The Pandemic
As compared to the 2018–2019 cohort, SGM college students were more likely to be racial/ethnically diverse (43.51% vs. 39.31% in 2018, p < .001), U.S.-born (4.58% vs. 6.62% in 2018, p < .001), less insured (7.77% vs. 5.20% in 2018, p < .001), and living off-campus and with parents during the pandemic (33.44% vs. 19.28% in 2018, p < .001), whereas fewer were staying on-campus (26.58% vs. 44.70% in 2018) in 2020–2021. Along with the changes in living arrangements, fewer violent assaults were reported across emotional (37.47% vs. 41.99% in 2018, p < .001), physical (8.75% vs. 10.00% in 2018, p = .0169) and sexual violence categories (11.97% vs. 16.49% in 2018, p < .001) among SGM college students in 2020–2021 (Table 1).
Similarly, as compared to the 2018–2019 cohort, cisgender, heterosexual college students were more likely to be NHW (56.27% vs. 53.21%, p < 0.001), U.S.-born (94.55% vs. 92.79%, p < 0.001), less insured (7.20% vs. 4.71%, p < 0.001), and living off-campus/with parents during the pandemic (30.47% vs. 17.97% in 2018, p < .001). Along with the changes in living arrangements, fewer violent assaults were reported across emotional (25.35% vs. 30.48% in 2018, p < .001), physical (5.76% vs. 6.94% in 2018, p < .001) and sexual violence categories (5.23% vs. 7.73% in 2018, p < .001) in 2020–2021.
Additionally, both SGM and cisgender, heterosexual college students in 2020–2021 reported substantially higher rates of depression (SGM: 35.80% vs. 29.96%, p < .001; Cisgender, heterosexuals: 16.75% vs. 14.84%, p < .001) and anxiety (SGM: 44.28% vs. 40.22%, p < .001; Cisgender, heterosexuals: 26.10% vs. 23.93%, p < .001) than their counterparts in 2018–2019.
Disproportionate Risk In Minority Populations
SGM college students reported higher rates of unwanted sexual contact compared to their cisgender heterosexual peers both before and during the COVID-19 pandemic (16.49% vs. 7.73%, p < .001 in 2018–2019; 11.97% vs. 5.23%, p < .001 in 2020–2021; Supplemental table A). The percentage of SGM college students reporting ex or current partner(s) as the perpetrators of sexual violence/assaults was 4.90% in 2018–2019 and 4.55% in 2020–2021 (p = .3139). The prevalence of experiencing sexual violence/assaults at the hands of strangers and acquaintances significantly decreased between 2020–2021 and 2018–2019 for both cisgender, heterosexual and SGM college students, but this decrease was not evident for ex or current partners. Similarly, the prevalence of experiencing sexual violence/assaults from strangers and acquittances significantly decreased between 2020–2021 and 2018–2019 for both NHW and non-NHW college students, but this decrease was not evident for ex or current partners (Supplemental table B).
Associating Demographics With Adverse Mental Health Outcomes
For the adjusted logistic regression model of predicting depression in 2020–2021 (Table 2), Hispanic college students (adjusted odds ratio [aOR]: 1.09; 95%CI: [1.00, 1.20]; p = .057) were marginally more likely to report depressive symptoms whereas NHB college students (aOR: 0.84; 95%CI: [0.77, 0.92]; p < .001) reported fewer depressive symptoms compared to their NHW peers. Those racial disparities were not found in 2018–2019. In the same vein, international student status was a significant predictor of depression in 2020–2021 (aOR: 0.76. 95%CI: [0.68, 0.85]; p < .001), but not in 2018–2019. However, SOGI remained a significant predictor of depression in both 2018–2019 and 2020–2021.
For the logistic regression model of predicting anxiety in 2020–2021, after adjusting for socio-demographic covariates, NHB college students (aOR: 0.71; 95%CI: [0.65, 0.77]; p < .001) and Hispanic college students (aOR: 0.88; 95%CI: [0.81, 0.96]; p = .004) reported less anxiety compared to their NHW peers; however, those racial disparities were not found in 2018–2019. Similarly, international student status was a significant predictor of anxiety in 2020–2021 (aOR: 0.80. 95%CI: [0.72, 0.89]; p < .001), but not in 2018–2019. SOGI remained a significant predictor of anxiety in both 2018–2019 and 2020–2021.
Associating Patterns Of Sexual Violence With Adverse Mental Health Outcomes
As shown in Table 3, over 21% of the college students in 2020–2021 had depressive symptoms − 1.18 times as many as in 2018–2019 (Risk Ratio [RR]: 1.18; 95%CI: [1.13, 1.24]). Also, more than 30% of the college students in 2020–2021 had anxiety symptoms in the last year − 1.11 times as many as in 2018–2019 (RR: 1.11; 95%CI: [1.07, 1.15]). Thus, symptoms of poor mental health were considerably more prevalent during the COVID-19 pandemic compared to two years prior.
The mental health disparities between the 2018–2019 and 2020–2021 samples appear across various minority groups, including SGM, race/ethnicity, and international student status. In regard to depression, more than one in three SGM college students in 2020–2021 (35.80%) had depressive symptoms − 1.19 times as many as in 2018 (RR: 1.19; 95%CI: [1.12, 1.28]; compared to 29.96% in 2018–2019). Over 21% of NHW participants reported depressive symptoms in 2020-2021- 1.24 times as many as in 2018–2019 (95%CI: [1.17, 1.22]; compared to 16.98% in 2018). Almost 19% of Asians reported depressive symptoms in 2020–2021–1.19 times as many as in 2018–2019 (95%CI: [1.02, 1.38]; compared to 15.96% in 2018–2019). Also, the relationship between depressive symptoms and any type of violence/assault was significantly greater in 2020–2021 compared to 2018–2019. Particularly, almost 45% of college students who experienced sexual assault in the past 12 months reported depressive symptoms − 1.23 times as many as in 2018–2019 (95%CI: [1.12, 1.36]; compared to 35.76% in 2018–2019). Among them, 44.16% and 49.55% who experienced sexual assault committed by strangers and ex or current partners reported depressive symptoms in 2020–2021, compared to 32.12% (RR: 1.37; 95%CI: [1.12, 1.69]) and 39.03% (RR: 1.27; 95%CI: [1.09, 1.49]) in 2018–2019, respectively.
In regard to anxiety, more than one in four cisgender heterosexual students in 2020–2021 (26.10%) reported anxiety symptoms − 1.09 times as many as in 2018 (95%CI: [1.04, 1.14]; compared to 23.93% in 2018–2019). Almost 45% of SGM college students in 2020–2021 reported anxiety − 1.10 times as many as in 2018–2019 (95%CI: 1.04–1.16; compared to 40.22% in 2018–2019). Over 31.77% of NHW participants reported anxiety in 2020–2021–1.17 times as many as in 2018–2019 (95%CI: [1.12, 1.22]; compared to 27.16% in 2018). Almost 24.72% of Asians reported anxiety in 2020–2021–1.16 times as many as in 2018–2019 (95%CI: [1.03, 1.32]; compared to 21.23% in 2018–2019). Additionally, anxiety reported by those who experienced any type of violence/assault was significantly greater in 2020–2021 compared to 2018–2019. For instance, more than half of the college students who experienced sexual assault in the past 12 months (55.57%) reported anxiety − 1.14 times as many as in 2018–2019 (95%CI: [1.05, 1.23]; compared to 48.80% in 2018–2019). Among them, 55.47% who experienced sexual assault committed by a stranger reported anxiety in 2020–2021, compared to 47.21% in 2018–2019 (RR: 1.17; 95%CI: [1.01, 1.37]).