Racially and ethnically diverse college students' preferences, beliefs, and self-efficacy in mental health treatment: A mixed methods analysis of therapist-client racial/ethnic concordance.

Abstract

Racially and ethnically diverse college students experience disproportionately high rates of mental health concerns yet remain among the least likely to access care. Therapist-client racial/ethnic concordance may enhance treatment engagement, but little is known about how college students perceive its importance for care. This mixed methods study examined students' preferences for racially/ethnically concordant therapists, beliefs about whether concordance is necessary for effective treatment, and confidence in finding culturally concordant therapists. Eighty-six undergraduates (Mage = 21, SD = 3.96; 87% female; 44% Asian American, 36% other racial/ethnic minorities, 20% White) completed surveys and follow-up interviews. Linear regressions tested whether race/ethnicity predicted preferences, beliefs, and self-efficacy, controlling for age, gender, and prior treatment, and qualitative data were analyzed deductively to contextualize findings. Approximately half of participants preferred a therapist who matched their race/ethnicity, with students from other racially/ethnically minoritized groups more likely than Asian American students to endorse this preference. Race/ethnicity was not associated with beliefs that effective care requires concordance or with confidence in finding culturally concordant therapists. Qualitative findings revealed five themes: intersecting identities shaping mental health needs, contextual importance of concordance for identity-based stress, benefits of working with racially/ethnically dissimilar therapists, core therapist competencies, and access to identity-affirming therapists. Preferences for concordance were often shaped by prior therapy experiences and identity-based stressors, while therapist competence and cultural humility were widely prioritized. Findings suggest concordance preferences among college students are nuanced and context-dependent, underscoring the need for culturally concordant, identity-attuned care and improved access to diverse therapists. (PsycInfo Database Record (c) 2026 APA, all rights reserved).