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Peer-reviewedCC BY-NC-NDJournal of American college health : J of ACH

Relationships between Counselor Statements and Student Connection to Mental Health Care: A Cross-sectional Analysis of Digital Screening Platform Conversations

  • Susanna Lewis1
  • Ashley M. Witmer2
  • Susan Han1
  • Mark Dredze3
  • Holly C. Wilcox2,4
  • James Aluri1,4
4 affiliations
  1. 1Student Health and Well-Being – Mental Health Services, Johns Hopkins University, Baltimore, MD, USA.
  2. 2Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  3. 3Department of Computer Science, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA.
  4. 4Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Abstract

Objective: To examine the relationship between counselor communication techniques and students seeking referrals to care within the American Foundation for Suicide Prevention’s (AFSP’s) Interactive Screening Program’s (ISP’s) text-based chats. Participants: Data included 14,931 text-based chats between students and counselors from 58 U.S. colleges that used the ISP between 2009 and 2024. Methods: Natural Language Processing was used to analyze ISP counselor communication techniques within the online chats. Results: Counselor informing statements (aOR: 1.98, 95% CI: 1.78–2.21), emotional reactions (aOR: 1.11, 95% CI: 1.02–1.20), and longer dialogue length (aOR: 1.30, 95% CI: 1.28–1.32) were positively associated with seeking a referral. Counselor interpretations (aOR: 0.32, 95% CI: 0.29–0.35), explorations (aOR: 0.32, 95% CI: 0.28–0.36), and normalizing statements (aOR: 0.69, 95% CI: 0.61–0.78) were negatively associated with seeking a referral. Conclusions: Findings advance understanding of how counselors might prioritize using specific language in text-based chats to support students seeking a referral to care.

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Cite

BibTeXRIS
BibTeX
@article{lewis2026relationships,
  title = {{Relationships between Counselor Statements and Student Connection to Mental Health Care: A Cross-sectional Analysis of Digital Screening Platform Conversations}},
  author = {Susanna Lewis and Ashley M. Witmer and Susan Han and Mark Dredze and Holly C. Wilcox and James Aluri},
  journal = {Journal of American college health : J of ACH},
  year = {2026},
  month = aug,
  doi = {10.1080/07448481.2026.2717318},
  url = {https://doi.org/10.1080/07448481.2026.2717318},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Relationships between Counselor Statements and Student Connection to Mental Health Care: A Cross-sectional Analysis of Digital Screening Platform Conversations
AU  - Susanna Lewis
AU  - Ashley M. Witmer
AU  - Susan Han
AU  - Mark Dredze
AU  - Holly C. Wilcox
AU  - James Aluri
PY  - 2026
DA  - 2026/08/27
JO  - Journal of American college health : J of ACH
DO  - 10.1080/07448481.2026.2717318
UR  - https://doi.org/10.1080/07448481.2026.2717318
AB  - Objective: To examine the relationship between counselor communication techniques and students seeking referrals to care within the American Foundation for Suicide Prevention’s (AFSP’s) Interactive Screening Program’s (ISP’s) text-based chats. Participants: Data included 14,931 text-based chats between students and counselors from 58 U.S. colleges that used the ISP between 2009 and 2024. Methods: Natural Language Processing was used to analyze ISP counselor communication techniques within the online chats. Results: Counselor informing statements (aOR: 1.98, 95% CI: 1.78–2.21), emotional reactions (aOR: 1.11, 95% CI: 1.02–1.20), and longer dialogue length (aOR: 1.30, 95% CI: 1.28–1.32) were positively associated with seeking a referral. Counselor interpretations (aOR: 0.32, 95% CI: 0.29–0.35), explorations (aOR: 0.32, 95% CI: 0.28–0.36), and normalizing statements (aOR: 0.69, 95% CI: 0.61–0.78) were negatively associated with seeking a referral. Conclusions: Findings advance understanding of how counselors might prioritize using specific language in text-based chats to support students seeking a referral to care.
SN  - 0744-8481
SN  - 1940-3208
ER  -