Context: Recently the athletic training community has paid increased attention to college student-athlete mental health, treatment-seeking, and impacts on athletic and academic performance. Ongoing efforts to better-educate and equip athletic trainers to help student-athletes in this regard should result in improved mental health-related outcomes.

Objective: Examine changes in student-athlete mental health over the past decade compared to non-athlete students.

Design: Cross-sectional study.

Setting: United States colleges and universities.

Patients or other participants: Varsity athletes (n=54,479) and non-athlete students (n=448,301) who completed the National College Health Assessment (NCHA) between 2011 and 2019.

Main outcome measures: Survey responses (self-report) to questions in five mental health-related domains: symptoms, diagnoses, treatment-seeking, institutional information distribution, and academic impacts.

Results: Student-athletes consistently reported significantly lower symptom and diagnose rates than non-athletes, except for attempted suicide, substance abuse, and eating disorders. Diagnoses increased over time in both groups, but remained lower in athletes. Treatment-seeking and openness to future treatment increased over time in both groups, but remained lower in athletes. Student-athletes received more information on stress reduction, substance abuse, eating disorders, and handling distress/violence than non-athletes. Both groups received information more frequently over time. Athletes reported lower academic impacts, especially for depression and anxiety, but impacts grew over time in both groups. Impacts of injuries and extracurricular activities on academic performance were higher in athletes than in non-athletes.

Conclusions: Athletes reported overall lower levels of symptoms, diagnoses, and academic impacts than non-athletes. While non-athlete rates climbed over the past decade, athletes' rates broadly remained flat or climbed less rapidly. Increasingly positive attitudes toward treatment are encouraging, but the deficit relative to non-athletes remains. Ongoing efforts of athletic trainers to educate athletes and guide them to mental health resources are needed in order to continue (or, better yet, accelerate) the observed positive trends in information dissemination and treatment-seeking.