The purpose of this study was to compare college student-athletes to non-athlete students for self-reported mental health symptoms, diagnoses, treatment, and impediments to academic performance. Participants were 508,672 varsity athletes and non-athletes from the 2011-2019 U.S. National College Health Assessment (NCHA). Outcomes included rates of specific mental health symptoms and untreated diagnoses, treatment rates in relation to diagnoses and symptoms, and rates at which specific mental health factors negatively affected academic performance. Logistic regression and odds ratios were used to compare outcome frequencies. Compared to non-athletes, athletes reported significantly lower rates of most mental health symptoms, diagnoses, and treatment. Among those receiving diagnosis or treatment, athletes and non-athletes were treated at similar rates. However, more athletes reported anxiety- and depression-related symptoms without corresponding diagnosis/treatment. Anxiety, depression, and sleeplessness were less often impediments to academic performance in athletes versus non-athletes. All students receiving treatment for specific mental health issues reported that they were academic impediments more frequently than untreated students. Student-athletes have overall better mental health than non-athletes, receiving treatment at similar rates following diagnosis. However, symptomatic athletes less frequently obtain diagnosis/treatment than non-athletes. Both groups may seek treatment in response to negative impacts of mental health issues on academic performance.