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Students with disabilities in higher education: examining factors of mental health, psychological well-being, and resiliency
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Students with disabilities in higher education: examining factors of mental health, psychological well-being, and resiliency
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Students with Disabilities in Higher Education: Examining Factors of Mental Health,
Psychological Well-being, and Resiliency
by
Debbie Jih
Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education
August 2021
© Copyright by Debbie Jih 2021
All Rights Reserved
The Committee for Debbie Jih certifies the approval of this Dissertation
Patricia Tobey
Janice Schafrik
Ruth Chung, Committee Chair
Rossier School of Education
University of Southern California
2021
iv
Abstract
This study examined the relationships of ethnicity, gender, class standing, disability and
accommodation type and their contribution to symptoms of depression, anxiety and stress,
psychological well-being, and resiliency among college students with disabilities. A survey
containing demographic background information and three measures including the Depression
Anxiety Stress Scale (DASS-21), Flourishing Scale, and Brief Resilience Scale (BRS), was
completed by 277 student participants. Multivariate analysis of variance examined whether there
were differences by gender, ethnicity, disability type and class standing on symptoms of
depression, anxiety, stress, psychological well-being, and resilience. A separate multivariate
analysis sought to understand whether there were differences between students who have an
emotional support animal (ESA) accommodation and students who have other non-ESA
accommodations. Mental health disabilities and Attention-Deficit/Hyperactivity Disorder
(ADHD) were found to be significantly associated with higher levels of depression, anxiety and
stress, and lower psychological well-being and resiliency than students with medical and other
disability types. Both female and male students reported lower levels of depression and higher
psychological well-being than students with other non-binary or LBBTQ+ gender identities.
Sophomore and Junior students reported higher levels of anxiety than Doctoral Students. Results
did not reveal significant group differences for Ethnicity nor Accommodation Type. Results are
consistent with prior research showing that experiences of LGBTQ+ students with disabilities are
disparate to those of heterosexual and cisgender students across mental health and well-being.
Furthermore, these results add to the growing body of literature documenting a wide variety of
barriers and challenges associated with mental health and psychological disabilities. The
implications of these findings for research and practice are discussed.
vi
Acknowledgements
I would like to take this opportunity to thank all my family, friends, mentors, and
colleagues who have supported me throughout my professional and doctoral journey. First and
foremost, I would like to thank my chair, Dr. Ruth Chung, who was also my professor while I
was studying for my Master’s in Marriage and Family Therapy (MFT) at Rossier in 2009. I will
never forget the first day I shadowed your class before I was admitted to the MFT program and
the day you interviewed me for acceptance. Never had I imagined I would pursue a doctoral
degree and with you as my dissertation chair eight years later. As daunting as our Statistics
courses were in both programs, you made it so fascinating and engaging. You gave me the
courage to conduct a quantitative study for my dissertation and I am truly grateful for the
experience. I will forever remember “Correlation is not causation!” in every aspect of data and
research that I encounter. I am so thankful to have had this opportunity to work with you again
and hope that the future presents more opportunities for us to work together at USC.
I would like to thank the members of my committee, Dr. Patricia Tobey and Dr. Janice
Schafrik, whom I met while I was a graduate student working at USC’s Disability Services &
Programs (DSP) office in 2009. You were both there during my first experience working in
disability services (DS), and I loved it so much that I had second thoughts of pursuing my LMFT
career. Working with the DSP family ignited a passion in me that led me back to the DS field
and to my role today. I am so thankful for having the opportunity to learn and work with the
both of you over the years at USC. I truly appreciate your wisdom and expertise, which helped
guide me throughout my dissertation experience.
I’d like to make a special acknowledgement to my USC colleague and close friend,
Stacey Hearn. Thank you for cheering me on and motivating me when I started to get lethargic
vii
and procrastinate. If it weren’t for you, I’d still be sitting on Chapter 4! I also want to thank my
boss and mentor, Christine Street. I am so thankful that you came to DSP/OSAS and helped us
pave the way for accessibility and equal access at USC. I admire you greatly as a leader and am
thankful that I can work alongside with you, and to learn and absorb your wisdom. Thank you
for believing in me and for your constant support for the past 5 years. You are inspirational and I
would not be in my OSAS role today without your encouragement and guidance.
I would also like to thank my cohort friends (Cory Reano, Greg Akai, Jason Murillo &
Kristi Culpepper) and DSP/OSAS colleagues for their constant support and encouragement along
the way. Thank you for reminding me to go to class, eat dinner, complete my assignments and to
register and pay for classes. Thank you for saving me a seat every day and walking with me to
our cars at 10pm after class. I’d like to especially recognize everyone for experiencing an
unprecedented time together during the COVID-19 pandemic. I hope that we continue to
blossom together and value you all as great leaders in the field.
To my dearest friends. I could not have gone through all the journeys of life without my best
friends, Emily Hsu, Ting Wang, Alex Barcelo, Stephanie Cao and Claire Sun. You all have been
there at various life milestones from preschool through grad school, and I would go back and re-
experience the moments with you if I could. Our friendship and memories are everlasting and
forever in my heart. I am thankful for each of you and would not have gone through the tough
times in life without you by my side. I look forward to sharing a continued lifetime of memories
together. Thank you for being there for me.
Lastly, the biggest thank you goes to my family. To Mama and Baba Jih who have been
my biggest support and fans since I was born. They’ve attended every graduation since
kindergarten through the most recent (and last) graduation on May 15, 2021. Thank you to my
viii
little brother, Kevin Di Di, for being you and forever little to me even though you’re 6 ft tall and
catching up with age. I love you to the moon and back and always want the very best for you
and to see you happy. Thank you to Linus, my sweet boy, German Shepherd, and emotional
support animal. It started with the two of us as I began my dissertation journey, and you have
provided me with unconditional love and comfort. My favorite moment with you while I work
on my dissertation is when I turn around and you are on the couch with all four legs in the air,
tongue out and goofy. Finally, thank you to my sweet Eric Liu, my partner and sunshine. Thank
you for your patience on days that I was tired and grumpy. Thank you for taking me to the ER
when I had anaphylaxis, while working on my dissertation, and going through that first and scary
experience with me. We’ve had many first unique experiences including being stuck at home
and surviving a pandemic! I look forward to our quality time together without any dissertation
commitment. I’m so excited to go to Canada for our first post-pandemic/dissertation trip and
look forward to many more travels and experiences as we grow old together.
ix
Table of Contents
Abstract .......................................................................................................................................... iv
Acknowledgements ........................................................................................................................ vi
List of Tables ................................................................................................................................ xii
Chapter 1: Introduction ................................................................................................................... 1
Extent of the Problem .................................................................................................................. 2
Disability Support Services in Higher Education ....................................................................... 3
Accommodations, Auxiliary Aids and Services ......................................................................... 4
Emotional Support Animal Accommodations ............................................................................ 5
Statement of the Problem ............................................................................................................ 6
Conceptual Framework ............................................................................................................... 9
Positive Psychology ................................................................................................................. 9
Positive Psychology and Students with Disabilities ................................................................. 14
Importance of Study .................................................................................................................. 14
Purpose of Study ....................................................................................................................... 15
Research Questions ................................................................................................................... 16
Organization of the Study ......................................................................................................... 16
Key Terms and Definitions ....................................................................................................... 17
Chapter Two: Literature Review .................................................................................................. 19
Defining and Conceptualizing Disability .................................................................................. 19
College Students with Disabilities ............................................................................................ 21
Depression, Anxiety & Stress ................................................................................................ 22
College Students with Psychological Disabilities ................................................................. 23
Psychology Well-being and Resilience ..................................................................................... 24
Psychological Well-being and Resilience among College Students with Disabilities .......... 26
Disability Legislation and Postsecondary Education ................................................................ 27
Americans with Disabilities Act and Section 504 of the Rehabilitation Act ........................ 27
Fair Housing Act ................................................................................................................... 28
Service Animals ..................................................................................................................... 29
Postsecondary Services for Students with Disabilities ............................................................. 30
Accommodations, Auxiliary Aids and Services ....................................................................... 32
Accommodation Outcomes and Students with Disabilities .................................................. 33
Emotional Support Animal Accommodations .......................................................................... 35
x
Recognized Benefits and Effects of Animals ........................................................................ 36
Emotional Support Animals and Mental Health .................................................................... 38
Emotional Support Animals and Psychological Well-being ................................................. 39
Summary ................................................................................................................................... 40
Purpose of the Study ................................................................................................................. 42
Chapter Three: Methodology ........................................................................................................ 44
Participants ................................................................................................................................ 44
Instruments ................................................................................................................................ 49
Depression, Anxiety and Stress ............................................................................................. 49
Psychological Well-being ...................................................................................................... 51
Resilience............................................................................................................................... 51
Procedure ................................................................................................................................... 52
Sample Selection ................................................................................................................... 52
Survey Procedure ................................................................................................................... 52
Principal Investigator Positionality ....................................................................................... 53
Chapter Four: Results ................................................................................................................... 54
Preliminary Analysis ................................................................................................................. 54
Correlations ........................................................................................................................... 54
Analyses of Research Questions ............................................................................................... 55
Research Question 1 .............................................................................................................. 55
Research Question 2 .............................................................................................................. 61
Chapter Five: Discussion .............................................................................................................. 63
Discussion of Results ................................................................................................................ 63
Group Differences by Gender................................................................................................ 63
Group Differences by Disability Type .................................................................................. 65
Group Differences by Class Standing ................................................................................... 66
Group differences by Accommodation Type ........................................................................ 67
Implications for Practice ........................................................................................................... 68
LGBTQ + College Students .................................................................................................. 68
College Students with Psychological Disabilities ................................................................. 69
Improving Practice and Policy .............................................................................................. 72
Limitations ................................................................................................................................ 74
xi
Recommendations for Future Studies ....................................................................................... 76
Conclusion ................................................................................................................................. 77
References ..................................................................................................................................... 80
Appendix A ................................................................................................................................... 96
Appendix B ................................................................................................................................... 98
Appendix C ................................................................................................................................... 99
Appendix D ................................................................................................................................. 100
Appendix E ................................................................................................................................. 101
xii
List of Tables
Table 1: Frequency Distribution for Disability and Accommodation Types of Students with
Disabilities at Study Site .......................................................................................................... 455
Table 2: Frequency Distribution for Demographics of Student Participants .............................. 46
Table 3: Frequency Distribution for Demographics of Student Participant’s Schools and
Programs of Study ....................................................................................................................... 47
Table 4: Frequency Distribution for Disability and Accommodation Types of Student
Participants .................................................................................................................................. 49
Table 5: Means, Standard Deviations, and Pearson Product Correlations for Measured Variables
of Student Participant Data .......................................................................................................... 55
Table 6: Univariate Analysis of Variance for Gender in DASS (3 subscales), Psychological
well-being and Resilience .......................................................................................................... 57
Table 7: Mean Scores and Standard Deviations of Depression and Psychological Well-being by
Gender ....................................................................................................................................... 57
Table 8: Univariate Analysis of Variance for Disability Type in DASS (3 subscales),
Psychological Well-being and Resilience .................................................................................. 59
Table 9: Univariate Analysis of Variance for Disability Type in DASS (3 subscales),
Psychological Well-being and Resilience .................................................................................. 60
Table 10: Univariate Analysis of Variance for Class Standing in DASS (3 subscales),
Psychological well-being and Resilience ................................................................................... 61
Table 11: Mean Scores and Standard Deviations of Anxiety (A) subscale by Class Standing .. 61
Table 12: Univariate Analysis of Variance for Accommodation Type in DASS (3 subscales),
Psychological well-being and Resilience .................................................................................... 62
1
Chapter 1: Introduction
Having a mental illness has significant negative impacts on an individual including,
reduced quality of life, low work productivity, unemployment, shortened lifespan, increased
health care utilization and disability status (Twinge, Cooper, Joinder, Duffy & Binau, 2019).
Mental illness includes mental, behavioral, or emotional conditions that vary in degree of
severity from mild to severe. It is a leading health condition in the United States (U.S.) and
nearly one in five adults (46.6 million in 2017) live with a mental illness (Substance Abuse and
Mental Health Services Administration [SAMHSA], 2017). The National Institute of Mental
Health (NIMH) utilized data from the 2017 National Survey on Drug Use and Health (NSDUH)
and reported anxiety disorders to be the most prevalent mental health condition at 19.1% (77
million) of the U.S. population followed by depression at 7.1% (million). Young adults aged 18-
25 years old (25.8%) had the highest prevalence of any mental illness (AMI) compared to adults
aged 26-49 years old (22.2%). Additionally, data from the National Comorbidity Survey (NCS)
indicated that individuals with early onset mental illness are significantly less likely to enter
college and more likely to drop out (Collins & Mowbray, 2005).
Today, college education and advanced training has become monumental to many later
life opportunities and experiences including career success, financial security and better health
and well-being (Eisenberg, Golberstein, & Hunt, 2009; Kessler, Foster, Saunders, & Stang,
1995). Even though the opportunity to attend college in the U.S. has increased dramatically due
to government financial loan programs and local community colleges, many college entrants
drop out and fail to complete all required years of college (Knapp, 2007). One contributing
factor is the national rise in prevalence of mental health illness, and many postsecondary
institutions are experiencing a mental health crisis on their college campuses.
2
The average onset and development of mental illness is between the ages of 18 and 24,
which is often during typical college years (American Psychiatric Association, 2019). A national
research survey found that in the last 12 months, 14.3% of college students reported having been
diagnosed or treated by a professional for depression and anxiety, 41.9% felt so depressed it was
difficult to function, 7.8% seriously considered suicide and 1.7% attempted suicide (American
College Health Association [ACHS], 2018). In another study, directors from 275 college
counseling centers across the nation reported that 52% of their student patients have severe
psychological problems and 8% of these students have impairments so significant they could not
remain in school or needed significant psychological and/or psychiatric help. There were 125
student suicides in the past year and 86% of these students had not sought counseling center
support (National Survey of College Counseling Centers, 2014).
This chapter begins with an overview of the challenges and barriers commonly faced by
college students who struggle with mental illness or have a mental health condition(s). It is then
followed by an examination of disability services and the types of academic support available to
college students with disabilities in higher education.
Extent of the Problem
Mental illness disorders such as anxiety and depression may often share symptoms and
co-occur and may significantly impact an individual's day to day functioning and overall, well-
being. A common anxiety disorder, generalized anxiety disorder, includes excessive anxiety and
worrying and difficulty controlling the worrying. Depression and mood disorder symptoms may
include depressed mood, loss of interest and pleasure in usual activities, sleep disturbances,
significant weight change, fatigue, feelings of worthlessness or excessive or inappropriate guilt,
difficulty concentrating and suicidal thoughts (American Psychiatric Association, 2013).
3
A particular mental health challenge is debilitating symptoms that may be cyclical and/or
episodic in nature. Consequently, if students are taking psychotropic medication to manage their
symptoms, they may experience side effects that further impact concentration, stamina, and
mood. They may experience lack of understanding, discrimination and stigma from peers, staff,
and faculty. There may be gaps in services whether it is related to loss of previous treatment
providers due to moving away to college, lack of health insurance, lack of campus based or local
mental health services and limited knowledge and information for campus resources (Collins &
Mowbray, 2005). Some students may not be aware they are experiencing signs and symptoms of
mental illness and have limited overall knowledge. One of the biggest challenges for students is
asking for help and resistance to receiving services due to stigma and stereotypes related to
mental illness and help seeking (Stanley & Manthorpe, 2001).
For college students, both the transition and experiences during postsecondary years are
challenging and require many adjustments including individuality, increased freedom and
independence and increased personal responsibility with day to day living and academic work
(Wilcox & Norstokke, 2019). These college demands may often exacerbate symptoms for
students experiencing mental illness resulting in overall lowered well-being. In addition to
typical college demands, college students with mental illness experience significant barriers and
challenges as it relates to managing their mental health, interpersonal relationships and
navigating support and resources, often in a new environment.
Disability Support Services in Higher Education
Although the impact of mental illness can be debilitating and calamitous, college students
can succeed with appropriate support. Thus, it is important to understand and identify academic
support and services that are available to students with mental health illness in postsecondary
4
programs. These may include campus counseling services, health and wellness services, career
counseling, academic coaching, tutoring and mentoring services. Particularly, disability support
services (DSS) may play a key role in supporting students with mental illness (Collins &
Mowbray, 2005). Students experiencing mental illness symptoms or who have a mental illness
condition may qualify as an individual with a psychological or mental health disability and
register with their campus DSS office to receive academic support through accommodations and
auxiliary aids and services.
DSS offices are available in most postsecondary institutions and exist because of the
Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA) of
1990 and amended in 2008 (ADA Amendments Act [ADAA]). Both legislations are disability
civil rights laws and prohibit discrimination against individuals with disabilities in the United
States. Section 504 states that any private and public entity, program, or activity that receives
federal financial assistance must provide equal access to individuals with disabilities. The ADA
prohibits discrimination in all public and private places and services that are open to the public,
including jobs, schools, telecommunications, and transportation. Section 504 and the ADA work
together to protect children and adults with disabilities from exclusion, unequal treatment in
schools, jobs, and the community. DSS offices are usually designated by their postsecondary
institution as the unit responsible for ensuring equal access for students in compliance with the
Section 504 and ADA.
Accommodations, Auxiliary Aids and Services
At the postsecondary level, responsibilities to comply with the mandates of disability
legislation are often charged to the DSS office. The DSS office considers the provision of
services on an individualized basis through determining reasonable and appropriate
5
accommodations (Shaw & Dukes, 2005). Accommodations are any necessary means of
assistance designed to provide equal access to students with disabilities in meeting course
requirements without fundamentally altering the academic standards of the course or program
(Miller, Zayac, Paulk & Lee, 2019). Colleges often have various types of educational support
for students with disabilities including classroom accommodations, assistive technology,
learning centers, and support with transition to employment. Equal access is typically provided
via approved accommodations and auxiliary aids for use in classrooms, course-related testing,
housing, dining, events and activities, fieldwork/clinical placements, and physical/architectural
settings. Testing accommodations are often the accommodation offered most frequently
(Stodden, Whelley, Chang & Harding, 2001). Accommodations and auxiliary aids allow
students with disabilities to access, learn, and benefit from the postsecondary institution’s
programs and services equally with their college peers without disabilities (Upton, 2000).
Emotional Support Animal Accommodations
Accommodations for students with mental health disabilities are often like what students
with other disabilities receive. Common accommodations may include extended time on exams,
separate space for testing, note-taking, and flexibility with attendance (Stein, 2013) and
assignment deadlines. Recently, college campuses are seeing a rise with presence and requests
for emotional support animal (ESA) accommodations. ESAs are sometimes called therapy
animals or emotional support animals and are typically cats or dogs. However, there may be
other animal species that may provide comfort or aid in well-being (Von Bergen, 2015). Due to
the stress of college, students with mental health disabilities often experience exacerbated mental
health symptoms and are requesting and seeking approval for bringing an ESA to live with them
in their university housing. Students assert that having an ESA will provide therapeutic benefit
6
and help with alleviation of mental health symptoms. The accommodation would require
modification of common rules and practices related to no pets’ policies that postsecondary
institutions uphold.
ESAs may contribute to campus accessibility by addressing a broad range of functional
limitations experienced by students with mental health disabilities such as anxiety or mood
disorders. For example, ESAs may alleviate mental health symptoms through providing a sense
of comfort and enable students to engage in daily activities such as maintaining hygiene, getting
out of bed, and getting ready, and increased social and physical activities. By increasing
socialization, ESAs can help alleviate stress and decrease low mood or agitated behaviors
(Hammill, Phattaphone, Anderson, & Brandt, 2018). Research has found that there are health
and mental health benefits of pet ownership which include overall benefits to the body including
lowered blood pressure, increased activities, better mood, and fewer medical and health
problems (Polking, Cornelius-White, & Stout, 2017; Sachs-Ericsson, Hansen, & Fitzgerald,
2002).
Statement of the Problem
The dramatic rise of college students with mental health challenges has been described as
a campus mental health crisis nationwide. According to the 2014 National Survey of College
Counseling Centers, 94% of college and university counseling center directors reported that there
is a continued growing trend of students with serious psychological problems on their campuses.
Directors reported that 52% of their center clients have serious psychological problems, an
increase from 44% in 2013 (National Survey of College Counseling Centers, 2014). The
American College Health Association found in 2019 that over the past year, 13% of college
students seriously considered suicide compared to 7.8% in 2018 (ACHS, 2018).
7
For college students, both the transition and experiences during college years are
challenging and require many adjustments including individuality, increased freedom and
independence and increased personal responsibility with day to day living and academic work
(Wilcox & Norstokke, 2019). These college demands may often exacerbate symptoms for
students with disabilities particularly those experiencing mental illness. In addition to typical
college demands, these students experience significant barriers and challenges as it relates to
managing their disability, mental health, interpersonal relationships and navigating support and
resources, often in a new postsecondary environment. Those with chronic medical or mental
health conditions often experience increased stress due to threats to well-being, independence,
interpersonal relationships, and lowered quality of life (Marni & Stebnicki, 2012). These
additional stressors may make common college goals related to learning, social engagements,
graduation, and employment attainment much more challenging.
Although the rapid increase in students with mental health challenges is accompanied by
the rise of increased academic support such as various types of DSS accommodations, the
provision and use are rarely supported by empirical data. As a result, little is known about the
effectiveness of accommodations and auxiliary services particularly as we consider various types
of disabilities. If available, past studies have been limited by the populations selected and the
type of information gathered. Most studies have assessed what educational supports or services
are available to students with disabilities (SWDs) (Collins & Mowbray, 2005; Stodden et al.,
2001), or have focused on different student populations with learning disabilities (Lindstrom,
2007; Trammell, 2014). Even with different disability populations such as learning disabilities,
the literature on the efficacy of accommodations is sparse, particularly for ESA accommodations.
8
While there may be anecdotal support for the benefit of ESAs and assistance animals, the
use of animals for supportive service is not widely understood and there is limited scientific
research. Many postsecondary institutions and administrators are facing challenges regarding
their obligations and are unsure how to navigate situations related to ESA requests. There are
concerns of students misusing the system and acquiring an ESA when they do not have a need
related to a disability and/or violating the accommodation process by bringing animals to campus
without approval through the campus DSS office. One of the biggest concerns for post-
secondary institutions is setting a precedent with ESAs on campuses (Von Bergen, 2015).
Moreover, few studies have defined and measured successful outcomes of DSS and
accommodations. Despite the growth towards positive psychology research, most research on
students with disabilities, specifically those with mental health or psychological disabilities, in
higher education have been problem focused. Postsecondary institutions need to explore ways to
increase access and retention for this student population and gain awareness and understanding
of protective factors that may contribute to a student's academic and developmental success.
There is little research on emotional and affective constructs such as resilience and overall well-
being as possible outcomes. As we address postsecondary challenges experienced by SWDs, the
understanding of their resilience to their struggles is vital to guiding university practices and
processes to promote student well-being. Currently, it is unclear how DSS and accommodations
contribute to their overall psychological well-being and resilience, particularly those with mental
health disabilities.
Without a strong foundation of empirical evidence to support or refute the use of various
accommodations, professional DSS staff are left to make subjective decisions about which
accommodations to provide to students (Lindstrom, 2007). It is not known how well DSS
9
accommodations meet the needs of SWDs and what can be done to improve services. Staff need
to know if specific accommodations address limitations related to certain disabilities. There
needs to be more attention to the emotional facets of SWDs on college campuses and how
accommodations may impact their resilience and promote well-being. Finally, more empirical
studies that investigate the statistical validity of DSS accommodations at the postsecondary level
are necessary.
Conceptual Framework
Positive Psychology
This study focuses on positive psychology as a conceptual framework by specifically
investigating the theoretical constructs of psychological well-being and resilience. Despite the
increased popularity of positive psychology, a limited number of studies have been conducted on
its relationship with college students with disabilities, particularly those with mental health
disabilities.
Social perspectives of mental health are changing with increased awareness and
education, but mental health research tends to be negative and problem-focused on distress,
pathology, and unhealthy functioning, rather than on strengths and abilities. Consequently,
research focuses on prevention of negative outcomes such as academic probation, drop out and
behavioral problems instead of focusing on promoting positive outcomes such as life
satisfaction, resilience, and motivation (Shogren, Lopez, Wehmeyer, Little & Pressgrove, 2006).
The term positive psychology was first used in 1954 by Abraham Maslow where he noted
that the science of psychology has been one-sided and only focused on negative human
experiences and one’s shortcomings. He stated, “It is as if psychology has voluntarily restricted
itself to only half its rightful jurisdiction, and that, the darker meander half” (p. 354). More than
10
40 years later, in 1999, Martin Seligman, psychologist, past president of the American
Psychological Association (APA) and leading researcher of positive psychology, stated in his
President’s Address to the APA, “psychology has moved too far away from its original roots,
which were to make the lives of all people more fulfilling and productive” (p. 559). Seligman’s
message redirects attention to positive psychology research. Research on postsecondary students
and mental health needs to focus on awareness and understanding of protective factors that may
contribute to a student's overall well-being and to focus on promoting positive outcomes.
Positive psychology may be beneficial and used as a conceptual framework for
maximizing learning and development for college students with disabilities. Positive psychology
studies have shown that intrapersonal and interpersonal resilience factors such as tenacity,
commitment and social support contributes to academic achievement (Hartley, 2013).
Additionally, factors such as self-efficacy, grit, and positive mental health are critical and
contribute to overall life satisfaction and well-being.
Psychological Well-being
One of the oldest definitions of happiness is related to Aristotle’s concept of eudaimonia,
which has also been interpreted as flourishing and sometimes well-being or psychological well-
being (PWB). Well-being may be defined as a feeling of satisfaction with life in general or a
subjective quality of life (Reinschmiedt, Sprong, Dallas, Buono & Upton 2013) and flourishing
is described as functioning positively in life with emotional vitality (Keyes & Haidt, 2003).
Seligman (2011) describes happiness as having three elements: positive emotion, engagement
and meaning. Engagement is about flow, the merging and loss of self-consciousness during an
activity. Seligman believes that the happiest life is one that prioritizes meaning which consists of
belonging to and serving something larger than oneself. According to positive psychology,
11
happiness is often multidimensional, a blending experience of sense of well-being,
meaningfulness, and purpose.
PWB or subjective well-being (SWB) has been studied extensively by social
psychologists and recently emerged as scholars shifted their focus to positive psychology
(Diener, Wirtz, Biswas-Diener, Tov, Kim-Prieto, Choi & Oishi, 2009). An individual’s PWB
plays an important role in optimal psychological functioning and emotional and social stability
(Springer & Hauser, 2006). Theorists have assessed well-being by looking at ranges of positive
and negative emotions and moods related to an individual’s personal life experiences. Other
components of well-being have included individual behavior and demographics, social support
networks, employment, and access to health care (Heiman & Shemesh, 2012). In one study,
Diener and Lucas (2000) found that well-being was strongly correlated with higher self-esteem,
lower stress, and positive and pleasant experiences.
Additional research suggests that positive emotions such as optimism can promote more
accurate insight of the self, such as self-perceptions and awareness of personal strengths and
weaknesses. Optimism can help individuals identify and accept ownership and responsibility for
making changes in controllable situations (Scheier, Weintraub, & Carver, 1986). In another
study, Carnevale and Isen (1986) found that boosting positive emotions during negotiation
enhanced the negotiator’s ability to be integrative and creative and to develop new solutions.
They found that positive affect enables productive and more constructive negotiation. These
findings suggest that positive emotions such as happiness, well-being and optimism may
contribute to learning, development, and life satisfaction, all which are important for college
students throughout their academic career.
12
Extensive research in neuroscience has also found that happiness levels can change over
the lifespan and has been attributed to neuroplasticity; the ability of the brain’s architecture to
change in response to intrinsic and extrinsic influences. One of the world’s prominent
neuroscientists, Richard Davidson, led some of the early research on meditation and intrinsic
neuroplasticity. In his study with the Dalai Lama and Buddhist monks, Davidson found that long
term meditation resulted in anatomical changes in the prefrontal cortex which is associated with
positive emotions (Davidson et al., 2003). Moreover, certain meditation practices such as
mindfulness-based stress reduction therapy (MBSR) may alter brain functions and strengthen the
ability to sustain attention (Lutz, et al.,2009). MBSR has also been associated with reducing
distress associated with chronic pain and decreased risk of relapse for depression (Kerr, Sacchet,
Lazar, Moore, & Jones, 2013). These findings affirm the possibility for reprogramming of the
brain and the ability to modify overall well-being through positive psychology and focusing on
positive emotions.
Resilience
Another concept often associated with well-being is resilience and is especially critical in
our demanding society. Emerging from the positive psychology movement, resilience has been
defined as the capability to adapt to stress and to maintain and recover well-being despite
experiencing adversity (Ryff, Singer, Dienberg Love, & Essex, 1998). Resilience is a construct
that has been studied since the 1800s and rooted in the fields of psychology and physiology
(Tusaie & Dyer, 2004). In psychology, researchers are examining the psychological aspects of
coping with stress and in physiology, the physiological aspects of stress. Research on resilience
has been particularly focused on its relation to the most stressful transitions throughout the
lifespan. Transitions may be developmental, going off to school, detachment from parents
13
during adolescence, new careers, childbearing, and childrearing. They may be unexpected such
as natural disasters, family disruption, unemployment, or any other trauma. Stressful transitions
place individuals at risk for developing psychosocial or physical symptoms. However, those
who experience a disruption in well-being due to stress but utilize personal strengths to
overcome adversity are considered resilient.
Earlier studies focused on interpersonal, environmental factors and characteristics that
assist an individual in overcoming adversities. Interpersonal factors include cognitive factors
such as optimism, intelligence, creativity, and humor. Intraindividual factors may include having
good coping strategies and a meaningful value and belief system. Lastly, environmental factors
may include perceived social support and connectedness with others and the environment
(Schweizer, Beck-Seyffer & Schneider, 1999). Current studies have been more focused on the
process of an individual’s resilience, particularly their positive adaptation and growth in response
to stress and adversity. This approach is described as positive psychology, a perspective focused
on strengths that allow individuals to persevere and survive rather than problem-oriented and
disease-focused medical perspectives (Campball-Sills, Cohan & Stein, 2006).
Mental health research has been focused on pathology and eliminating negative
symptoms and behavior. Ryff and Singer (1996) suggest that while alleviating symptoms is
important, interventions also need to enhance wellness and positive functioning. The focus on
well-being helps create meaning and purpose in life and allows for personal growth and the
capacity to manage one’s life with self-determination. The outcome is a dynamic process of
flourishing that fosters resilience and PWB.
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Positive Psychology and Students with Disabilities
The growing body of research in positive psychology can be practical tools for educators
when supporting college students with disabilities. Many students with disabilities have
difficulty adjusting to college life and report higher levels of psychological stress, depression
symptoms and lower self-esteem (Smedema et al., 2015).
Although postsecondary DSS exist in accordance with disability laws and provide
programs, services, and resources to remove barriers and facilitate equal learning opportunities,
DSS offices typically do not provide programming and services related to wellness and health.
However, through nurturing positive emotions and providing encouragement, DSS staff can
build positive relationships with students with disabilities, which may promote their sense of
well-being and resilience. Unknowingly, DSS staff often foster positive psychology with
students through praxis when encouraging health and mental health support, promoting social
events and connections, engaging strengths, and providing collaborative support with other
campus partners.
It is important for researchers to identify contributors to well-being in college students
with disabilities so that effective interventions can be developed to influence positive
psychosocial and academic outcomes. Therefore, in addition to investigating the impact of
disability and accommodation type on students' mental health, the present study will also
examine the relationship between accommodations and positive psychology constructs of student
PWB and resilience.
Importance of Study
Earning a postsecondary degree is often an important and significant steppingstone for
later life achievement, fostering independence and future employment. Although access to
15
higher education and employment has significantly increased for individuals with disabilities
because of Section 504 and ADA, students with disabilities and mental health challenges
continue to face barriers and struggles throughout their college career (Eisenberg, Goldstein &
Hunt, 2009; Hysengebashi, 2005). Is apparent from existing literature that students with
disabilities experience lower quality of life and overall well-being than their counterparts without
disabilities. However, there is a gap in literature on DSS and accommodation outcomes and how
it impacts and addresses the needs of students with disabilities in higher education.
This study may help fill the gap in literature by helping postsecondary institutions
understand the impact of having a disability among college students and the relationship between
DSS and student well-being. Campus administrators may better address policies and practices to
reduce barriers and can shape the lives, experiences and learning of students using positive
psychology in programming, counseling, advising, and directing resources. Literature on
positive psychology and neuroscience allows for a better understanding of the role positive
emotions might play in postsecondary student development and achievement. Through positive
psychology scholarship, there is an opportunity to nurture positive emotions and foster
potentialities instead of using traditional, deficiency and problem focused approaches with
students (Maher, 2010). Interventions that promote student well-being and resilience can lead to
overall positive self-evaluation, a sense of growth and achievement, and a sense of having a
purposeful and meaningful life.
Purpose of Study
The purpose of this study is to provide a deeper understanding of how postsecondary
disability support services meet the needs and impacts students with disabilities by examining
variables that may contribute to students’ mental health and well-being. Specifically, this study
16
will investigate the relationship between demographics of ethnicity, gender, class standing,
disability and accommodation type, particularly emotional support animal accommodations, on
symptoms of depression, anxiety, and stress and on psychological well-being and resiliency in
college students with disabilities.
Research Questions
This study aims to investigate the following research questions:
Research Question 1: Are there differences by gender, ethnicity, class standing and
disability type on symptoms of depression, anxiety, stress, psychological well-being, and
resilience, in college students with disabilities?
Research Question 2: Is there a difference in symptoms of depression, anxiety, stress,
psychological well-being, and resilience between college students with disabilities who have an
emotional support animal (ESA) accommodation and students who have other non-ESA
accommodations?
Organization of the Study
Chapter One of this dissertation provides an overview of the study, including the
background, theoretical framework, and importance of the study. The remaining chapters have
been organized as follows:
Chapter Two provides a review of the relevant literature pertaining to this study,
including
analyses of the study variables of mental health, psychological well-being, and resilience.
Chapter Three describes the population of focus, survey instrument, data collection
method, research design, and planned analyses for this study.
17
Chapter Four provides the main results of this study, including preliminary analyses,
research questions and post hoc analyses.
Chapter Five summarizes the results of the study, it’s limitations, implications for
practice and directions for future research.
Key Terms and Definitions
The following definitions are provided to ensure understanding of these terms throughout
this paper and study. The researcher developed all definitions not accompanied by a citation.
Accommodations. Any necessary means of assistance designed to provide equal access
to students with disabilities in meeting course requirements without fundamentally altering the
academic standards of the course or program (Miller, Zayac, Paulk & Lee, 2019). Common
accommodation types include testing, note taking, flexible deadlines, flexible attendance, and
assistive technology.
Auxiliary Aids and Services. Items, equipment, or services that assist in effective
communication between a person who has a hearing, vision or speech disability and a person
who does not (Americans with Disabilities Act, 1990).
College. May be used interchangeably with postsecondary education, which includes
various types of institutions, private and public, two-year, and four-year, with undergraduate and
graduate students.
Disability. A person who has a physical or mental impairment that substantially limits
one or more major life activities, has a record of such an impairment, or is regarded as having
such an impairment (U.S. Equal Employment Opportunity Commission, 2015).
Disability Support Services (DSS). Services in postsecondary settings which include
accommodations and auxiliary aids which allow students with disabilities to access, learn, and
18
benefit from the postsecondary institution’s programs and services equally with their college
peers without disabilities (Upton, 2000).
Emotional Support Animals (ESAs). May also be known as assistance animals,
companion or comfort animals and are different from service animals (Von Bergen, 2015).
Mental Health. Includes emotional, psychological, and social well-being. Can result in
mental health problems when thoughts, mood and behaviors are affected. The specific factors
examined in this study are depression, anxiety, and stress.
Mental Illness. May be used interchangeably with psychological, psychiatric, or mental
health problems and used to describe a disability type or mental health condition.
Psychological Disability. May be used interchangeably with mental health disability and
is a disability group type. May consist of mental health conditions related to depression, anxiety,
bipolar disorder, post-traumatic stress disorder (PTSD) and other mood disorders.
Psychological Well-being (PWB). May be used interchangeably with well-being and
defined as a state achieved through optimal psychological functioning and emotional and social
stability (Springer & Hauser, 2006)
Psychotropic Medication. Medicine or drug that affects behavior, mood, thoughts, or
perception. Used to treat psychiatric conditions, which may include antidepressants, anxiolytics,
antipsychotics, stimulants, and mood stabilizers (National Institute of Mental Health, 2016).
Service animals. Defined as either a dog or, in some circumstances, a mini horse, that
has been individually trained to do work or perform tasks for an individual with a disability.
Unlike ESA’s, service animals are protected under the ADA and students may bring their service
dogs on all areas of college campuses (ADA) (Americans with Disabilities Act, 1990; Von
Bergen, 2015).
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Chapter Two: Literature Review
The purpose of this study is to provide a deeper understanding of how postsecondary
disability support services meet the needs and impacts college students with disabilities by
examining variables that may contribute to their mental health and psychological well-being.
This literature review provides an overview of how disability is defined and conceptualized and
of psychological well-being and resilience as it relates to students with disabilities in higher
education. The review further presents literature on the history of disability litigation and on
postsecondary services for students with disabilities, specifically on emotional support animal
accommodations. This chapter will conclude with proposed research questions and
corresponding hypotheses to contribute to best practices in the field of disabilities services in
higher education.
Defining and Conceptualizing Disability
In the United States, the definition and criteria of disability often varies depending on the
context in which it is being referenced. In the field of disability studies, researchers use different
models of disability to conceptualize and examine the social, political, cultural, and economic
factors. According to Olkin (2007), there are three predominant ways of conceptualizing
disability including the moral, medical, and social models. In the moral model, having a
disability has a symbolic and/or religious meaning. Disability may be viewed as a character
defect caused by moral lapse or sins. In the medical model, disability is a medical problem that
resides in the individual. The individual is viewed as having a defect or failure of their bodily
system. The medical model is most prevalent in the United States with a focus on rehabilitation.
The social model views disability as a social construct. It is non pathological and posits that the
problems are not individuals with disabilities, but due to the environment that is not accessible.
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With the social model, individuals with disabilities were viewed as a minority group,
denied equal access, civil rights, and protection. Not only may the definition of disability vary
depending on context, but the way disability is also measured may vary depending on the overall
context of the measurement. There may be variance in the definition of disability used to
construct the measures and in the methods of measurement resulting in different estimates of
disability prevalence. Although data is collected through various government agencies,
institutions, and national surveys, it is difficult to obtain a precise number on individuals with
disabilities because it is based on self-report which can be unreliable (Belch, 2011).
The Social Security Administration (SSA) Supplement, a national survey conducted by
the U.S. Census Bureau (2014), reported that 85 million people in the United States (U.S.) had a
disability in 2014 which is equivalent to about 27% of the total US population. Those living with
a disability may face challenges and barriers at any time of their lives as they relate to education,
relationships, and employment. The Bureau of Labor Statistics (BLS) found that individuals with
disabilities (16%) have lower high school completion rates compared to individuals without
disabilities (11%). They also reported lower employment rates with an employment rate of 27%
for 25- to 64-year-olds with disabilities compared to 77% of those without disabilities.
Despite the barriers of living with a disability, the number of students with disabilities
(SWDs) attending higher education has been increasing. In 1991, full time freshmen college
students with disabilities were reported at 8.8% (Henderson, 1995). According to the National
Center for Education Statistics (NCES) (2017), the number of postsecondary undergraduate
students identified as having disabilities in the United States is now estimated to represent 19%
of the student body. Particularly, the number of postsecondary students with psychological
disabilities have been increasing. Students with psychological disabilities are reported at 15-
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20% of the subpopulation of postsecondary students with disabilities (Belch, 2011). The rise of
prevalence rate may be attributed to the advancement of psychiatric medications that alleviate
symptoms and disability legislation that offers civil rights protection to individuals with
disabilities including those with psychological disabilities (Rickerson, Souma, & Burgstahler,
2004).
College Students with Disabilities
Due to increased access and equal opportunities paved by Section 504 and the ADA,
postsecondary institutions have been experiencing a steady increase in the number of SWDs.
However, even though they constitute a substantial campus population, the statistics of total
SWDs in higher education are often underestimated since they do not capture students who
choose not to disclose their disability. Additionally, SWDs are frequently underrepresented in
campus discussions and initiatives on diversity, equity, and inclusion (Bryan & Meyers, 2006;
Kimball, Well, Ostiguy, Manly & Lauterbach, 2016; McCune, 2001). The experiences of SWDs
are further complicated by stigma and challenges associated with having a disability. A common
stereotype regarding students with learning disabilities is the assumption that they have low
ability, low potential for learning and that they were less intelligent (May & Stone; 2010). Some
students have disabilities that are hidden and invisible. Due to the less apparent nature of their
disability, these students experience different challenges related to disability identity including
rejecting the notion of having a disability (Kimball, Well, Ostiguy, Manly & Lauterbach, 2016).
Alternatively, others may be dismissive and not acknowledge the student has a disability because
they have no visible impairments. More recently with the national rise in prevalence of mental
illness, there has been a particular increase of students with mental health and psychological
disabilities.
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Depression, Anxiety & Stress
The average age of onset for an individual to develop a psychological disability or
serious mental illness, is between 17-25 years old, which is often during the years when a student
is pursuing their postsecondary education (Collins & Mowbray, 2005). Depression and anxiety
are one of the most common psychological disorders that negatively affect an individual’s
thoughts, feelings, and behaviors. There is no objective, medical and laboratory tests that can
establish a diagnosis for the two conditions. In the United States, the Diagnostic and Statistical
Manual of Mental Disorders (DSM) serves as the principal authority for psychiatric diagnoses
(American Psychiatric Association [APA], 2013). Professionals who may diagnose may include
psychiatrists, family practitioners, pediatricians, internists, neurologists, psychologists, and
mental health and behavioral medicine specialists. To diagnose and determine a diagnosis of
depression or anxiety, they may utilize the DSM’s symptom descriptions as diagnostic criteria,
psychological and medical assessments, and/or assessment instruments developed by experts in
the field of psychiatry (Beck, Epstein, Brown & Steer, 1988).
Depression may cause feelings of sadness and loss of interest in activities that were
previously enjoyed. Anxiety disorders involve feelings of significant nervousness, fear and
worry that is beyond a typical stress response of anxiety. Both depression and anxiety can
impact an individual's daily functioning and may lead to a multitude of physical, emotional, and
behavioral problems (APA, 2013). They may affect physical health, cognitive functioning
including concentration and emotional regulation and interpersonal relationships, all which are
essential for a college student. Depending on the severity of symptoms, there may be significant
impact on productivity as it relates to academic tasks such as attending class, paying attention to
lectures, completing assignments, and taking exams resulting in lowered grade point average
23
(GPA) and dropping out (Eisenberg, Goldstein & Hunt, 2009; Hysengebashi, 2005).
Additionally, mental illness is often associated with an increased risk for substance abuse such as
alcohol consumption (Weitzman, 2004) and increased levels of smoking impacting academic
productivity, negatively impacting graduation rates and future career success (Buchanan, 2012).
College Students with Psychological Disabilities
Despite disability services and other campus support, there are many barriers and
challenges for students with psychological disabilities when navigating their college campuses.
Beiter, Nash, McCrady, Rhoades, Linscomb, Clarahan & Sammut (2015) sought to investigate
main behaviors and factors that may contribute to depression, anxiety, and stress among college
students. The participants of the study were undergraduate students between the ages of 18 and
24 attending Franciscan University in Steubenville Ohio. A two-part survey was utilized and
included a demographic section, the Depression, Anxiety, and Stress Scale (DASS 21) and a list
of 19 potential sources of stress and concern to be ranked on a Likert scale. The purpose of the
DASS 21 is to assess the severity of the core symptoms of depression, anxiety, and stress. The
researchers surveyed 374 surveys and found that all 19 potential sources of concern had a
significant positive correlation with levels of depression, anxiety, and stress.
The top five concerns were academic performance, pressure to succeed, post-graduation
plans, finances, and family relationships, with most relating directly to college student life.
Results also indicated that students living off campus and upperclassmen ranked the highest in
levels of stress, anxiety, and depression. Factors may be due to decreased support and additional
stress and challenges from independent living including, paying rent, and maintaining diet and
nutrition. The findings from this study may be beneficial to other postsecondary institutions
24
seeking to understand and address student needs and to improve student mental health on campus
(Beiter et al., 2015).
For students with a psychological disability, symptoms can have a negative impact on
their academic functioning as it relates to motivation, concentration, and social relationships; all
factors that can impact a student’s experience and success in the postsecondary setting (Unger,
1998). Additional barriers include stereotypes and stigma, awareness and access to information
and services and resources, and organizational and institutional barriers (Stein, 2013). Students
may experience a lack of awareness and understanding of mental illness by peers, faculty, and
school administrators.
There may be gaps in service provision such as inadequate financial aid when students
take health leaves and need to extend their enrollment, insufficient campus based mental health
services and lack of awareness of campus services such as the counseling center or disability
services (Mowbray & Collins, 2005). Due to the added stressors experienced by students with
psychological disabilities, it is important for college administrators to identify protective factors
that may contribute to academic success. The next section will review literature on positive
psychology constructs of psychological well-being and resilience as it relates to students with
disabilities.
Psychology Well-being and Resilience
Research on college students and resilience have been expanding as the academic
environment can be particularly stressful due to high-stakes academic pressure, minimal
academic support compared to high school, social adjustment, and isolation during transitions.
To understand the health needs of college students, the American College Health Association
Research (2009) administered the National College Health Assessment (NCHA) survey to 106
25
American institutions and found that stress negatively impacts academic performance for about a
third of the college population and causes problems with physical health, sleep, diet and anxiety
and depression. However, positive psychology research on resilience and PWB have found that
despite stress and risk factors, individuals have internal and external protective factors associated
with successful coping from adverse events. Some internal and external factors include
optimism, adaptability, positive self-efficacy, positive peer relationships and effective parenting
(Francis, Duke & Siko, 2020; Hartley, 2010; Mastern, 2001).
In one study, Hartley (2011) sought to examine the relationship between intrapersonal
and interpersonal resilience and academic persistence. Results showed that intrapersonal
resilience factors of tenacity, tolerance of stress, and spirituality contributed to variance in
student’s cumulative university grade point average (GPA), standardized test scores, and high
school GPA. Students who were committed to their academics had higher GPAs and
unexpectedly, students who reported being able to tolerate stress had lower cumulative GPAs.
To interpret the negative relationships, other information may be needed such as adversity
experienced in childhood and college and more research is needed to further examine the
relationships between tolerating stress, mental health, and academic persistence. Overall, the
study found that interpersonal and intrapersonal resilience factors are important to academic
persistence and may contribute to health promotion on college campuses.
In a review of research on the impacts of college on students, Pascarella and Terenzini
(2005) found that academic support is a protective factor and key to resilience. Specifically, they
found that students who lived near or on campus were more likely to graduate from college than
students who commuted. Academic support may include campus libraries, writing centers, and
support from faculty. Similarly, Mahmoud, Staten, Hall & Lennie (2012) sought to examine the
26
relationship of depression, anxiety and stress with life satisfaction and coping strategies among
college students. They found that students with greater dissatisfaction with life reported higher
levels of depression, anxiety, and stress. Additionally, they noted the importance of
understanding student well-being by considering their social network when evaluating levels of
depression, anxiety, and stress.
Psychological Well-being and Resilience among College Students with Disabilities
College students with disabilities often experience additional risk factors and barriers that
impact their overall well-being. Such risk factors may be related to the nature of their disability
such as challenges with executive functioning, feelings of inadequacy, limited sense of
belonging, difficulty establishing and maintaining relationships, limited involvement in campus
social life, negative faculty and peer perceptions and deciding not to disclose their disabilities or
seek support (Dryer, Henning, Trammel, Hathaway & College, 2007; Tyson & Shaw, 2016;
Hong, 2015; Thomas-Ebanks, 2014). Additional barriers may include limited understanding and
awareness regarding their disability, needs and available support. These risk factors and barriers
may contribute to poor health and mental health, frustration, stress, decreased self-esteem, and
decreased life satisfaction and overall well-being (Francis, Duke & Siko, 2020).
Although there are additional risk factors for students with disabilities, there are also
many important protective factors. A strong protective factor of resilience for college students
with psychological disabilities includes having counseling and psychosocial support. Having a
close relationship with an advisor or counselor has been found to help students remain in college
and a protective factor against drop out (Wiener and Wiener, 1997). Peer support groups,
including mindfulness meditation groups, have also been found to increase well-being not only
for the students with disabilities in college, but also for their family members (Lunsky et al.,
27
2017). Positive factors may include disability support services which will be discussed in the
following section as well as an overview of the history of disability legislation.
Disability Legislation and Postsecondary Education
Americans with Disabilities Act and Section 504 of the Rehabilitation Act
Federal and civil rights laws such as the Americans with Disabilities Act (ADA) of 1990
and Section 504 of the Rehabilitation Act of 1973 (Section 504) have helped remove barriers that
historically prevented individuals with disabilities from participating in typical classroom
education (U.S. Department of Education, 2011). The ADA is a civil rights law signed by
President George H.W. Bush, that protects discrimination in all areas of public life including
employment, schools, transportation, and all public and private places that are open to the public.
It applies to employment practices (Title I) and programs and services provided by state and
local government entities (Title II) and private entities (Title III). Section 504 of the
Rehabilitation Act applies to any postsecondary institution that receives some type of federal
financial assistance which is almost all colleges and universities in the U.S. Under the ADA and
Section 504, postsecondary institutes are required to provide reasonable accommodations and
auxiliary aids to qualified students with disabilities (Madaus & Shaw, 2004). The ADA
Amendments Act of 2008 clarified and amended the definition of “disability.” Disability is
defined as a physical or mental impairment that substantially limits one or more major life
activities. The legislative purpose is so that students with disabilities have equal access and an
equal opportunity to participate in courses, programs, and activities.
To ensure that educational institutions are not engaging in discriminatory acts, the U.S.
Department of Education has a law enforcement agency called the Office for Civil Rights
(OCR). Local OCR offices investigates and resolves complaints of discrimination that may be
28
filed by parents, students, and others. OCR typically utilizes a collaborative approach in
resolving complaints and negotiates for voluntary compliance with recipients. If voluntary
compliance is not established, OCR may go through an administrative hearing process or make a
referral to the U.S. Department of Justice (US. Department of Education, 2011).
Fair Housing Act
The Fair Housing Act (FHA) was signed into law and became effective on March 12,
1989. The FHA prohibits discrimination based off protected class of race, color, national origin
religion, sex, familiar status, and disability. It protects people from discrimination in nearly all
housing including when they are “renting, buying a home, getting a mortgage, seeking housing
assistance or engaging in other housing-related activities” and in university housing (FHA,
1989). This law includes a provision that housing providers must make reasonable
accommodations and allow reasonable modifications that may be necessary to allow individuals
with disabilities to enjoy their housing. The types of housing that are covered under the FHA
includes college and university housing.
Reasonable accommodations are a change, exception or adjustment to a rule, policy,
practice, or service. For example, a “no pets” rental or postsecondary campus housing may need
to modify their policy and allow assistance animals. Under the FHA, an assistance animal “is an
animal that works, provides assistance, or performs tasks for the benefit of a person with a
disability, or that provides emotional support that alleviates one or more identified effects of a
person’s disability.” An assistance animal has two types, a service animal or emotional support
animal, and it is clearly specified that they are not considered a pet. A reasonable modification is
a structural change made to existing housing premises to afford the individual with a disability
29
full enjoyment of the premises. Reasonable modifications may include the installation of a ramp
into a building or adding a grab bar to a tenant’s bathroom.
Service Animals
The ADA was enacted to address equal opportunity for individuals with disabilities,
including the promotion of independent living and economic self-sufficiency. Under titles II and
III of the ADA, public and private entities must permit service animals to accompany people
with disabilities in all areas where members of the public can go. A service animal is defined as
a dog that is “individually trained to do work or perform tasks for people with disabilities”
(Department of Justice, 2011). The work or task performed must be directly related to the
individual’s disability and can include a wide variety of services, such as assisting and guiding
those who are blind or have low vision, alerting those who are deaf or hard of hearing, or
retrieving items for an individual with a physical disability. With respect to psychological or
mental health disabilities, the service animal may perform tasks to alleviate symptoms of PTSD,
anxiety, and panic disorders, or interrupt impulsive, compulsive, negative or self-harm behaviors
(Von Bergen, 2015).
Currently, only dogs are recognized as service animals except for a miniature house
under a separate ADA provision; animals that merely provide comfort such as emotional support,
therapy, comfort, and companion animals, are not considered service animals. When it is not
obvious what purpose an animal serves, only two questions may be asked: (1) is the dog a
service animal required because of a disability, and (2) what work or task has the dog been
trained to perform. Staff cannot ask about the individual’s disability, require medical
documentation or certification of service dog training, or ask that the dog demonstrate its ability
to perform the work or task (Department of Justice, 2011). In comparison with the Fair Housing
30
Act and Air Carrier Access Act, the ADA makes a distinction between the definition of a service
animal and emotional support animal. However, the ADA service animal definition does not
affect or limit the broader definitions of “assistance animals” under the Fair Housing Act or
“service animal” under the Air Carrier Access Act. There are also some state and local laws that
define “service animal” more broadly than the ADA. Due to the complexity of the laws around
service and emotional support animals, it has been challenging for many postsecondary
institutions when determining appropriate accommodations for students with disabilities.
Postsecondary Services for Students with Disabilities
Although the ADA and Section 504 require accommodations and auxiliary aids in
postsecondary institutions, they do not dictate how the services need to be facilitated.
Instead, professionals and experts in the disability services field have developed standards to
guide service provision. The Association of Higher Education and Disabilities (AHEAD) is a
national organization and professional resource for disability service providers. AHEAD has
developed evidenced based ethical, professional and program standards for disability service
professionals and has established a best practice model in the field (Guzman & Balzazar, 2010).
Typically, postsecondary institutions follow the AHEAD guidelines and develop their own
policies and processes for disability services and facilitating accommodations.
Each institution should have a DSS office and/or designated professional to facilitate
equal access on their campuses and have policies and procedures for determining reasonable
accommodations which includes student’s eligibility for services, documentation standards,
documentation review and the overall accommodation process (Shaw & Dukes, 2005). The DSS
office determines whether accommodations are “reasonable” which entails adequate notice of
disability and requests to the disability service office. SWDs need to be “otherwise qualified,”
31
and are required to meet the essential and technical standards of the institution or program with
or without accommodations. In addition, institutions do not need to provide accommodations
that would fundamentally alter any core requirements that are essential to the university or
program of study (Simon, 2011).
In college, students have the right to disclose or not disclose about their disability and
need to understand the advantages and disadvantages of both options. Without disclosure,
accommodations do not need to be provided (Shaw, Madaus & Banerjee, 2009). If a student
chooses to disclose, they will need to initiate requests with the DSS office and/or appropriate
contact and follow the accommodation process. Paul Grossman, a leading disability law expert
and retired civil rights attorney for the OCR and U.S. Department of Education states that once
the student discloses their disability, legally, the accommodation process begins. OCR
encourages an interactive process which is ongoing communication between students and
disability service providers at every step of the accommodation request process. This is
consistent with what the Equal Employment Opportunity Commission (EEOC) has required of
employers when working with employees with disabilities (Grossman, 2001).
Eligibility for services include determining whether a student is a qualified individual
with a disability utilizing the ADA’s definition. Disability categories include medical,
psychological, learning and autism spectrum disorders, deaf or hard of hearing (DHH), blind low
vision (BLV) and traumatic brain injuries (TBI). Institutions may require students to submit
documentation related to their disability that verifies eligibility for accommodations.
Documentation may include medical diagnostics results and reports, clinical observations,
psychoeducation assessments, or any written material from a professional treatment provider. If
disabilities are temporary or frequently changing, updated documentation may be required.
32
Students with chronic, long term or stable disabilities may not be expected to update their
documentation (Grossman, 2001).
Accommodations, Auxiliary Aids and Services
To provide equal access, institutions must make reasonable accommodations and provide
auxiliary aids and services (Simon, 2011). Access has many facets and may pertain to physical
access on and/or off campus and to any institutional programming such as orientation, housing,
dining, transportation, and student health and counseling services. The buildings and facilities
that are being utilized in connection with the institution must be physically accessible which may
include elevators, ramps, and wheelchair accessibility. Auxiliary aids and services may include
qualified sign language interpreters, video relay interpreting (real-time captioning), voice, text
and video-based telecommunications products and systems, braille and enlarged print, screen
readers or screen reader software, adaptive equipment, and software (ADA, 1990).
Academic adjustments and accommodations are required so that students have equal
opportunities to participate in the institution's programs, services, and activities. Sharpe,
Johnson, Izzo and Murray (2005) sought to examine the range of accommodations used by
postsecondary graduates with disabilities and found that the most common accommodations
were extended time on tests and testing in a quiet environment. Additionally, the study showed
that most of the participants were satisfied with the types of accommodations they received and
indicated that the accommodations were appropriate.
Other common accommodations may include assistive technology such as speech-to-text
or text-to speech software, accessible materials, reduced course loads and classroom
accommodations such as note taking assistance and accessible classroom furniture (Brinkerhoff,
Shaw & McGuire, 1992). Students may require housing accommodations such as an accessible
33
room, single room and/or ability to have an emotional support animal (ESA). Accommodations
that may be less common or complex to facilitate include more than double time on exams,
course substitutions, reduced or alternative classroom participation, remote classroom attendance
through alternative means such as video conferencing, attendance, and assignment deadline
modifications.
Accommodation needs differ from students and are determined on an individualized
basis. Rather than focusing on the student’s disability type or category, accommodations are
intended to address the functional limitations on a major life activity a student is experiencing
due to their disability (Shaw & Dukes, 2005). The determination of accommodations is often a
very subjective process and there may be detriments from both over-accommodating and
denying accommodations. When colleges automatically or without analysis approve all requests,
academic standards may be lowered and there may be inconsistencies due to prejudice. This
may lead to complaints filed by students and families.
At the same time, a decision to deny an accommodation should be thoroughly assessed,
and not taken lightly. Grossman (2001) shares that many highly respected institutions have been
in serious legal matters for not engaging in a thoughtful consideration process. For this reason, it
is imperative that institutions follow best practice standards and have a clear accommodation
process. Disability professionals should have a procedure for review and implementation of
accommodations and make careful distinctions as to when accommodations are reasonable and
where they may be a fundamental alteration to program requirements (Shaw & Dukes, 2006).
Accommodation Outcomes and Students with Disabilities
Although federal legislation has increased accessibility in postsecondary education, there
is limited research on the effectiveness of accommodations and if available, have been
34
specifically focused on students with learning disabilities. One study conducted an analysis of
five studies that tested the Maximum Potential Thesis (MPT) (Zuriff, 2000). The MPT theory
suggests that students without learning disabilities would not benefit from an extended time
accommodation on exams because they are already working at their maximum potential under
timed conditions. On the other hand, students with a learning disability may have slower
processing speed and are not functioning at their maximum potential unless they have extra time.
Results demonstrated lack of empirical support as three out of the five studies failed to support
the MPT theory. The studies revealed that students with learning disabilities scored higher under
untimed conditions in 31 of 32 tests. Ironically, students without learning disabilities also scored
higher on 16 tests with extra time. These results directly contradict the MPT theory and had
significant limitations of the study design such as small sample size.
Another study was only able to identify and compare the types of disability support
services offered by two year and four-year postsecondary institutions. Black, Smith, Harding, &
Stodden (2002) found that two-year institutions typically provided greater support with academic
accommodations such as assistive technology, formative and summative assessment and greater
access to developmental and remedial instruction to students with disabilities. The study was
limited in that they do not have data on the number of students receiving specific
accommodations, on student satisfaction nor on quality and effectiveness of services.
In efforts to explore how college students utilize disability support services and
accommodations and to understand the student’s perception of the impact of the services, Stein
(2013) conducted a qualitative study and interviewed 16 participants who were enrolled at a
public university in the mid-Atlantic area of the United States. All students were registered with
their university’s DSS office and identified as having a psychological disability, with anxiety and
35
mood disorders most represented. The researcher utilized grounded theory analysis for coding
data and results indicated several core themes from the participants' descriptions of their
experiences and perceptions with disability services. The participants received a variety of
accommodations including note taking, extended time, distraction-free environment for testing,
frequent breaks, access to notes/PowerPoints, preferential seating, excused absences, and priority
registration. The two most frequently reported were testing and note taking accommodations.
The participants shared that testing accommodations helped mitigate symptoms related to
their psychological disability such as inability to focus and concentrate, difficulty taking tests in
large classroom settings and feeling anxious during certain classes. Note taking
accommodations were beneficial due to student’s symptoms that interfere with their ability to
take quality notes such as memory and concentration. Overall, the students reported that
accommodations and other support provided by disability services were essential to academic
achievement. Most participants reported that they would not be able to achieve their academic
goals without disability support services.
Emotional Support Animal Accommodations
Although the prevalence and challenges of ESA accommodations were framed and
briefly discussed in Chapter 1, this section is included to provide a fuller understanding of the
research relevant to the study. According to the 2019-2020 National Pet Owners Survey
conducted by the American Pet Products Association (APPA), roughly 85 million families own a
pet in the U.S., with the most popular pet being dogs (63.4 million) and second popular was cats
(42.7 million) (American Pet Products Association, 2021). The popularity of animals as
companions has resulted in the rise of animals used for service, assistance, and emotional
support, which also corresponds with the rise of psychological and mental health problems.
36
Unlike service animals, an ESA does not have to be trained to perform a task for an individual
with a disability (Hammill, Phattaphone, Anderson & Brandt, 2018). An ESA, sometimes
referred to as therapy animal or support animal, is not limited to dogs, but can also be a cat or
other animal species due to their nature of providing support, well-being, comfort, a calming
presence, and unconditional affection (Von Bergen, 2015). Housing becomes a unique
consideration for students with disabilities and their ESA. Like other housing entities, most
colleges and university’s residential facilities have “no pets” rules and policies. Students who
seek to have their ESA permitted in campus housing, must make an accommodation request to
the DSS office, and have a treatment professional verify their disability and need for their ESA
to reside in campus housing with them. The treatment professional is usually a physician,
psychiatrist, or any other mental health professional who supports and verifies the ESA in
reducing or alleviating any symptoms that negatively impact the student’s day to day functioning
in their campus dwelling. After receiving a student request to bring an animal to campus, an
administrator must consider whether the request is an appropriate and reasonable
accommodation.
Recognized Benefits and Effects of Animals
Awareness of the powerful connections between humans, emotional and other companion
animals is on the rise and there is strong evidence of emotional and health benefits (Barker,
Rogers, Turner, Karpf & Suthers-Mccabe, 2003; Risley-Curtiss, 2010). Research has found that
the presence of animals may have physiological benefits. In a study evaluating the effects of pet
ownership on cardiovascular response to psychological stress among individuals in high-stress
professions, results suggest that the intervention of a pet lowered responses to stress and
improved task performance. The researchers believe that pets may evoke positive feelings,
37
resulting in an increased capacity for individuals to adapt to stress (Allen, Skykoff & Izzo, 2001).
In a similar study, Allen, Blascovich, Tomaka & Kelsey (1991) found that the presence of pet
dogs during performance of stressful tasks, reduced the subjects’ physiological responses to
acute stress compared to the presence of a human friend. These researchers also speculate that
pet dogs may induce positive feelings, thereby reducing situational and psychological threat.
There have also been established medical benefits of dog ownership. Studies have found that
individuals with dogs are more active, have better cardiovascular health, lowered blood pressure
and lowered risk of cognitive decline related to Alzheimer’s disease and dementia (Cherniack &
Cherniack, 2015; Knight & Edwards, 2008; Wells, 2009).
Animal-Assisted Therapy. The growing body of research supporting animal and human
companionship has resulted in the therapeutic use of animals in different health care settings.
Animal-assisted therapy (AAT) is a therapeutic program using dogs or other animals that have
been trained to be obedient, calm, and comforting, as an intervention for a broad range of
medical and mental health conditions (Hammill, Phattaphone, Anderson & Brandt, 2018). AAT
has been used as an adjunct to physical therapy by having patients engage and interact physically
with the animal. This may include walking a dog, brushing the animal, or playing fetch. AAT is
used in mental health settings where a child with anxiety may be encouraged to gently pet and
talk to an animal. Through the animal, the child may learn appropriate touch, reduce anxiety and
loneliness, and increase a sense of connection (Chandler, 2005; Janelle & Lundahl, 2007). A
study examining whether AAT reduced the anxiety levels of hospitalized psychiatric patients,
found that there was a statistically significant reduction in anxiety scores for patients with a
variety of psychiatric conditions (Barker & Dawson, 1998). In the higher education setting,
Folse, Minder, Aycock, and Santant (1994) conducted an experimental study using AAT in
38
efforts to reduce depression, anxiety, and stress among college students. Results showed
significant improvements on depression scores through a pre and post assessment using the Beck
Depression Inventory (BDI).
Emotional Support Animals and Mental Health
As mental health concerns rise among college students, so does the number of students
requesting to bring their ESAs with them to college (Highfill & Goodman-Wilson, 2019; Von
Bergen, 2015). The aforementioned studies offer a variety of data related to emotional and
health benefits of companionship between humans and pets. However, the literature contains
little information on the relationship between emotional support animals as an accommodation
and college students with disabilities. Most studies on assistance animals have been on the use
of AAT and its effectiveness. Alternatively, Highfill and Goodman-Wilson (2017) explored the
relationship between pet ownership and psychological benefits among college students. Results
suggest that the relationship between pet ownership and well-being among college students is
complex. Overall findings indicated pet ownership did not lead to any direct difference on levels
of stress and anxiety. However, the finding did show that in the context of high stress, pet
owners experienced fewer symptoms of somatic anxiety. Qualitative results from the survey also
indicated that pet owners reported a daily decrease in stress due to living with their pets. These
results also suggest that allowing students to bring a pet to campus may contribute to retention
and academic persistence.
In efforts to expand on this study, the same researchers Goodman-Wilson and Highfill
(2019), sought to explore the specific advantages and disadvantages of having ESAs on a college
campus. Students were asked to describe the benefits and disadvantages they experienced from
having an ESA and faculty were asked to describe their experiences with ESAs. Both faculty
39
and students were asked about their knowledge of the rules governing ESAs on campus. Results
indicate widespread confusion around policies and the definition of ESAs and skepticism about
the legitimacy of the number of ESAs on campus. A frequently reported misconception was that
ESAs require special training and the most problematic misconception is that ESAs are allowed
in academic spaces. Although there were misconceptions about ESAs, there was consensus that
they are a positive presence on campus and that students reported many benefits of ESAs
including promoting motivation for daily routine and a sense of purpose in caring for someone
other than themselves.
Emotional Support Animals and Psychological Well-being
Although there have been several studies examining the psychological impact of the
relationship between companion animals and humans, no published studies have directly
measured the impact of ESAs on psychological well-being among college students with
disabilities. Relevant studies have focused on understanding pets in the family system and as
companions from counseling and psychology perspectives. Cain (1985) studied the evolution of
pet keeping and found that pet keeping serves many functions including emotional support,
social buffer against negative health effects from stress, parenting experience and demonstrates
parenting ability. Findings of research on the role of pets fit the theoretical construct of social
support and there is evidence of a strong relationship between social support and enhanced health
in humans. Social support has been found to protect against medical and mental health
conditions including cancer, depression, schizophrenia, and suicidality (Serpell & Paul, 2011).
In another study on college students, Kurdek (2008) evaluated the extent to which pet dogs
exhibited four features of an attachment figure to humans and characteristics of persons with
strong attachments to their pet dogs. Results showed that physical closeness and secure base
40
were the most salient features that students reported for their level of attachment to their pet
dogs. The findings provide evidence that pet owners establish attachment bonds with their dogs
as well as attachment with their mothers, fathers, siblings, best friends, and significant others.
High levels of attachment were positively linked to pet owner characteristics of caregiving and
openness.
Literature suggests that ESAs are a growing trend on college campuses and may
represent a positive approach for supporting students with mental health disabilities. However, a
better understanding is needed about the impact of ESAs on college students and their campus
communities. Previous research has found some challenges around ESAs on college campuses,
including lack of clarity and unity between the terms of an ESA and service animal, interpersonal
issues among suitemates or roommates including those with allergies to animals, unclear
institutional policies and practices and limited empirical data on ESAs in higher education
(Goodman-Wilson & Highfill, 2019; Hammill, 2018; Schoenfeld-Tacher, Hellyer, Cheung &
Kagan, 2017; Von Bergen, 2015). Although the studies suggest that ESAs may provide benefits
to students with disabilities, there are few quantitative research specifically on outcomes of well-
being. The present study presents an opportunity to extend upon the previous findings, by
assessing the impact of ESAs among their owners, specifically among students with disabilities
in postsecondary residential education settings. The following section transitions to an overview
of key constructs regarding disability and literature review on experiences of college students
with disabilities as it relates to mental health, psychological well-being, and resiliency.
Summary
This literature review discussed key variables such as disability and accommodation type
and their relationship to the mental health, psychological well-being, and resilience of college
41
students with disabilities. The passage of the ADA and Section 504 of the Rehabilitation Act of
1973 has granted individuals with disabilities civil rights protection and equal access to
postsecondary education. This has contributed to an increased enrollment of college students
with disabilities and particularly, there has been an increase of students with psychological
disabilities. Many earlier studies examined and reported a variety of internal, external, and
systemic barriers and challenges faced by college students with disabilities. Some internal
factors include negative self-perception, weak neurocognitive processes, episodic nature of
psychological symptoms and side effects from psychotropic medication. Challenges with
transportation, finances and housing were considered external factors. Lastly, systemic barriers
included lack of coordination among service providers, lack of understanding from peers and
faculty, departmental and professional barriers, issues with confidentiality and lack of
information and access to support services (McEwan & Downie, 2013).
In response to the findings of barriers and challenges that college students with
disabilities face, researchers sought to explore students' perceptions on postsecondary support
services such as disability services and academic accommodations. Although there is a breadth
of research on barriers and perceptions, quantitative research on accommodation effectiveness
has been limited, specifically regarding the benefits of an ESA accommodation. Previous studies
that have focused on accommodation effectiveness have been primarily on students with learning
disabilities (LD) and attention deficit disorder (ADHD) as it relates to academic achievement.
This study is interested in a comparative analysis of accommodation effectiveness, specifically
how an ESA accommodation impacts mental health symptoms, psychological well-being, and
resilience, among college students with disabilities. Additionally, this study is interested in
examining the impact of the nature and type of disability among this student population.
42
Purpose of the Study
The purpose of this study is to provide a deeper understanding of how postsecondary
disability support services meet the needs and impacts students with disabilities by examining
variables that may contribute to students’ mental health and well-being. Specifically, this study
will investigate the relationship between demographics of ethnicity, gender, class standing,
disability type and accommodation type, particularly emotional support animals, on symptoms of
depression, anxiety, and stress and on resiliency and psychological well-being in college students
with disabilities.
Research Question 1. Are there differences by race/ethnicity, class standing and disability type
on symptoms of depression, anxiety and stress, psychological well-being, and resilience, in
college students with disabilities?
Hypothesis 1.1. There will be group differences in depression, anxiety and stress,
psychological well-being and resilience based on students’ gender and ethnicity.
Hypothesis 1.2. There will be group differences in depression, anxiety and stress,
psychological well-being and resilience based on students’ disability type.
Hypothesis 1.3. There will be group differences in depression, anxiety and stress,
psychological well-being and resilience based on students’ class standing.
Research Question 2. Is there a difference in symptoms of depression, anxiety, stress,
psychological well-being, and resilience between college students with disabilities who have an
emotional support animal (ESA) accommodation and students who have other non-ESA
accommodations?
43
Hypothesis 2. Students with an ESA accommodation will have lower depression, anxiety
and stress, and higher psychological well-being and resilience than students who have
other non-ESA accommodations.
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Chapter Three: Methodology
This study examines the influence of academic accommodations on psychological well-
being, resilience and depression and anxiety, among college students with disabilities. This
chapter will review the methods utilized for the study and include participant demographics,
description of survey instruments and procedure for data collection.
Participants
Participants were undergraduate and graduate students enrolled at a large, private west
coast research university and registered with the university’s Disability Services and Programs
(DSP) office with one or more disability types. Students were recruited over a one-month period
in the Spring semester of 2020. Participants came from a pool of 2,043 undergraduate students
and 699 graduate students, for a total of 2,742 students registered with DSP’s student database.
Students registered with DSP comprise 5.6% of the entire student population at the institution (n
= 48,321). The top four primary disability types for this pool of students were:
Psychological/Mental Health (n = 681, 26%), AD(H)D (n = 671, 25%), Medical (n = 451, 17%),
Learning Disability (n = 429, 16%). The top three accommodation types approved for this pool
of students were Testing (n = 2,252, 75.5%), Classroom (n = 1,581, 53%) and Alternative
Format (n = 621, 20.8%). Emotional support animals (ESA) accommodations are a subtype of
housing, and 56 students (18.8%) are approved for an ESA accommodation.
1
Table 1 shows a
frequency count and percentages for all disability types and the most common accommodation
types for all students with disabilities at the study site.
1
Data are from the Spring semester of 2020 and came from the Disability Services and Programs office study site
45
Table 1
Frequency Distribution for Disability and Accommodation Types of Students
with Disabilities at Study Site
n %
Disability Type
Psychological/Mental Health 681 26.0
AD(H)D 671 25.0
Medical 451 17.0
Learning Disability 429 16.0
Musculoskeletal/Mobility 180 7.0
Traumatic Brain Injury (TBI)/Acute Brain
Injury (ABI)
50 2.0
Blind/Low Vision (BLV) 54 2.0
Temporary Illness or Injury 50 2.0
Deaf/Hard of Hearing 37 1.0
Autism Spectrum Disorder (ASD)-Related 31 1.0
Accommodation Type
Testing 2252 75.5
Classroom 1581 53.0
Alternative Format 621 20.8
Communication Access 39 1.3
Housing 256 8.6
Emotional Support Animal (ESA) 56 18.8
A total of 277 students with disabilities volunteered to participate in this study. Of the
277 survey responses, 28 could not be included in the study due to incomplete responses. A total
of 249 survey responses were used in the final data analyses. Participants in this study ranged in
age from 18-67 years old (M = 25.09 years, SD = 8.44). As shown in Table 2, the gender
preferences of participants from largest to smallest group included female (n = 178, 71.5%),
male (n = 51, 20.5%), non-binary (n = 8, 3.2%) and agender, transgender, gender non-
conforming (n = 7). There were two students who indicated their gender preference were not
listed and three preferred not to answer. Student’s gender, race/ethnicity, class standing, transfer
status and schools/programs are included in Tables 2 and 3 below.
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Table 2
Frequency Distribution for Demographics of Student Participants
n %
Gender
Agender 2 .8
Female 178 71.5
Male 51 20.5
Transgender 2 .8
Gender Non-conforming 3 1.2
Non-binary 8 3.2
Not listed 2 .8
Prefer Not to Answer 3 1.2
Race/Ethnicity
White or Anglo 110 44.2
Hispanic or Latino 35 14.1
Black or African American 12 4.8
American Indian or Alaska Native 1 .4
Asian or Asian-American 37 14.9
Native Hawaiian or Pacific Islander 1 .4
Middle Eastern 12 4.8
Bi-racial or Multi-racial 31 12.4
Prefer not to Answer 10 4
Class Standing
Freshmen 20 8.0
Sophomore 46 18.5
Junior 46 18.5
Senior 39 15.7
Masters 61 24.5
Doctoral 34 13.7
Transfer Status
Yes 48 19.3
No 191 76.7
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Table 3
Frequency Distribution for Demographics of Student Participant’s
Schools and Programs of Study
n %
School of Engineering 24 9.6
School for Communication and Journalism 12 4.8
School of Education 5 2.0
College of Letters, Arts and Sciences 82 32.9
School of Accounting 2 .8
School of Music 5 2.0
School of Business 21 8.4
School of Law 11 4.4
Innovation Academy 1 .4
School of Medicine 14 5.6
School of Gerontology 1 .4
School of Dentistry 4 1.6
School of Art and Design 3 1.2
School of Architecture 1 .4
School of Cinematic Arts 14 5.6
School of Pharmacy 5 2.0
School of Public Policy 9 3.6
School of Social Work 26 10.4
Dual Degree Program 2 .8
The largest group of ethnicities who participated in the study were White (n = 110,
44.2%), followed by Asian or Asian American (n = 37, 14.9%), Hispanic or Latino (n = 35,
14.1%) and Bi-racial or Multi-racial (n = 31, 12.4%). The largest group of university class
standing was master’s students (n = 61, 24.5%), followed by Sophomores (n = 46, 18.5%) and
Juniors (n = 46, 18.5%). The smallest group was Seniors (n = 39, 15.7%). A majority were non-
transfer students (n = 191, 76.7%) and 48 students (19.3%) indicated they transferred to the
university. A broad range of 19 university schools and programs were reported with the top four
including: School of Engineering (n = 46, 18.5%), College of Letters, Arts and Sciences (n = 46,
18.5%), School of Social Work (n = 46, 18.5%), and School of Business (n = 46, 18.5%).
48
Student participants in this study identified as having one or more disability and
accommodation types as presented in Table 4. It is important to note that participants were able
to select multiple disability and accommodation types. The largest reported disability type were
Psychological/Mental health (n = 163, 65.5%), followed by Attention-deficit/hyperactivity
Disorder (ADHD) (n = 79 31.7%), Medical (n = 63, 25.3%), Learning Disability (LD) (n = 44,
17.7%), Musculoskeletal/Mobility (n=16, 6.4%), Autism Spectrum Disorder (n = 10, 4%),
Traumatic/Acute Brain Injury (TBI/ABI) (n = 8, 3.2%), Deaf/Hard of Hearing (DHH) (n = 6,
2.4%) and Blind/Low Vision (BLV) (n = 5, 2%). The top two reported accommodation types
were Testing (n = 209, 83.9%) and Classroom (n = 146, 58.6%). After accommodation types
were disaggregated by students, 48 students were approved for an ESA accommodation and 201
students were approved for non-ESA accommodations.
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Table 4
Frequency Distribution for Disability and Accommodation
Types of Student Participants
n %
Disability Type
Psychological/Mental Health 163 65.5
AD(H)D 79 31.7
Medical 63 25.3
Learning Disability 44 17.7
Musculoskeletal/Mobility 16 6.4
Traumatic Brain Injury (TBI)/Acute
Brain Injury (ABI)
8 3.2
Blind/Low Vision (BLV) 5 2.0
Deaf/Hard of Hearing 6 2.4
Autism Spectrum Disorder (ASD)-
Related
10 4.0
Accommodation Type
Testing 209 83.9
Classroom 146 58.6
Alternative Format 54 21.7
Communication Access 19 7.6
Housing 30 12.0
Emotional Support Animal (ESA) 48 19.3
Non-ESA 201 80.7
Instruments
A quantitative survey was created consisting of the following sections (a) demographic
and background information, (b) depression, anxiety, and stress (c) psychological well-being and
(d) resilience. Each instrument is described in the section below.
Depression, Anxiety and Stress
Depression, anxiety, and stress are common symptoms of psychological and mental
health disorders that negatively affect an individual’s thoughts, feelings, and behaviors. The
three variables will be measured in this study using the DASS-21, a 21-item measure that
includes three subscales assessing symptoms of depression, anxiety, and stress (Antony, Bieling,
50
Cox, Enns, & Swinson, R. P., 1998). The depression subscale (DASS-D) measures dysphoric
mood such as hopelessness, low self-esteem, and sadness and a sample statement includes “I
couldn’t seem to experience any positive feeling at all.” The Anxiety scale (DASS-A) assesses
physiological arousal, and feelings of fear and/or panic and a sample statement include “I
experienced trembling (e.g., in the hands).” Lastly, the (DASS-S) Stress scale measures tension,
irritability and tendency of overreaction and a sample statement includes “I tended to over-react
to situations.” The Cronbach’s alpha for the original instrument’s subscales were .94
(depression), .87 (anxiety), and .91 (stress) and overall, demonstrated strong concurrent validity
with other measures. DASS-D is highly correlated with other established measures of depression
(.78) and moderately correlated with other anxiety measures (.51 and .71). DASS-S moderately
correlated with measures of depression and anxiety (.69, .70 and .68) and DASS-A correlated
most highly with another anxiety measure (.85). The DASS-21 was chosen for its instrument
length and because it has been found reliable and valid in assessing symptoms of depression,
anxiety, and tension/stress (Anthony et al., 1998).
Each of the subscales contain eight items and participants use a four-point
severity/frequency scale (with 0 = Did not apply to me at all; 3 = Applied to me very much or
most of the time) to rate the extent to which they have experienced each state over the past week.
For scoring, each subscale gets a total score that references its own rating scale that ranges from
normal, mild, moderate, severe to extremely severe. The score rating scale for depression is:
Normal (0-9), Mild (10-13), Moderate (14-20), Severe (21-27) and Extremely Severe (28+). The
score rating scale for anxiety is: Normal (0-7), Mild (8-9), Moderate (10-14), Severe (15-19) and
Extremely Severe (20+). The score rating scale for stress is: Normal (0-14), Mild (15-18),
Moderate (19-25), Severe (26-33) and Extremely Severe (37+).
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Psychological Well-being
Psychological well-being is a construct based on humanistic theories of positive thinking
(Ryan & Deci, 2000). Researchers have used human functioning aspects such as meaning and
purpose, positive social relationships, interest, contribution to others well-being, competence,
self-acceptance, optimism and being respected, to measure psychological well-being (Diener &
Biswas-Diener, 2009). Diener & Biswas-Diener (2009) wanted a brief scale that would create a
broad overview of an individual’s well-being and created the Psychological Well-Being (PWB)
Scale.
The scale is a self-report survey with 8-items that yields a single PWB score. All items
are phrased positively, and a sample statement includes “I lead a purposeful and meaningful
life.” Each item is answered on a seven-point Likert scale (with 1 = Strongly Disagree; 7 =
Strongly Agree) and total PWB scores can range from 8 (lowest) to 56 (highest). The higher the
PWB score, the more participants view themselves positively in areas of functioning. The
measure has good psychometric properties with high internal reliability and high convergence.
The original PWB scale yielded a Cronbach’s alpha of .87 and strongly correlated with the total
scores of other psychological well-being scales (0.80 and 0.69). The PWB scale was chosen
because it provides a good brief scale of overall self-report.
Resilience
The Brief Resilience Scale (BRS) was developed to measure an individual’s ability to
bounce back or recover from stress. The BRS is the only measure that assesses the original and
most basic definition of resilience (Smith, Dalen, Wiggins, Tooley, Christopher & Bernard,
2008). The scale includes 6-items with both positive and negative phrasing. A sample positive
statement includes “I tend to bounce back quickly after hard times,” and a negative statement
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includes “I tend to take a long time to get over set-backs in my life.” Participants are asked to
indicate the extent to which they agree with statements by using a five-point Likert scale (with 1
= strongly disagree; 5 = strongly agree). A total score is calculated, and the possible school
range is Low resilience (1.00-2.99), Normal resilience (3.00-4.30) and High resilience (4.31-
5.00). The original BRS had good internal consistency with Cronbach’s alpha ranging from 0.80
- 0.91 and test-retest reliability in two samples ranging from 0.69 - 0.62. The BRS was chosen
because it is a reliable and valid scale to measure a student's ability to bounce back or recover
from stress.
A list of all measures and copies of the measures are included in Appendix A - E.
Procedure
Sample Selection
For the participant selection, the study collaborated with the disability services (DS)
office at a large private research one university on the west coast. Participants for this study
were recruited using convenience sampling via the DS office’s student database and were
students registered with the DS office with one or more disability types and approved for one or
more accommodation types.
Survey Procedure
Data collection occurred during the Spring 2020 semester from February 4 through
March 11. Microsoft Outlook was used to email student participants and the email included
information about the study, confidentiality, a hyperlink to access the survey and researcher
contact information. The opened hyperlink included a description of the survey and indicated
that the survey should be completed by the student who received the email and who is registered
with DSP with a disability. The survey was created using Qualtrics, an online survey platform,
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and took about 15-20 minutes to complete. At the end of the survey, participants were provided
with an external link to a separate survey, where they could enter their email address to enter the
lottery drawing for one of three $50 Amazon gift cards. After the survey closed, three students
were selected at random using a formula in Microsoft Excel. The DS administrator assisted with
awarding the gift cards via email, and the names of the winners were never revealed to the
researcher. After data was collected, SPSS was used for data analysis.
Principal Investigator Positionality
Interest for this research study was a direct reflection of this principal investigator’s
career background in mental health and in the field of disability services in higher
education. Since this principal investigator works at the DS office and was collecting data and
conducting data analyses for this quantitative study, several vital steps were taken to ensure the
protection of students who participated in the study. It was especially important to maintain
awareness of delineating the study’s data from personal views and opinions. To ensure
appropriate research protocols, an electronic institutional review board (IRB) application was
submitted for review and approved as a study with minimal risks. To ensure privacy, a DS staff
administrator was identified as a liaison since this investigator was also a professional staff
member in the office. To ensure appropriate FERPA protections, the DS database was accessed
only by the DS staff administrator for this study and used only for the purpose of
recruitment. The DS staff administrator was asked to reach out to all registered DS students with
a recruitment letter via email anonymously and students were directed to contact the principal
investigator with questions and/or concerns.
54
Chapter Four: Results
The following chapter provides a comprehensive overview of the results of the study,
including preliminary analyses, analyses of the research questions, as well as post-hoc analyses.
Preliminary Analysis
Correlations
Pearson product correlation analyses were conducted to explore the relationships between
study variables: Age, Depression, Anxiety, Stress, Psychological Well-being, and Resilience.
Table 4 shows the correlations along with the means and standard deviations for each study
variable. For this study, age of the student was indirectly correlated with anxiety (r = -.133, p =
.05) and stress (r = -.133, p = .05), and directly correlated with resilience (r = .169, p = .01).
However, age was not associated with depression or psychological well-being.
Depression was highly correlated with anxiety (r = .642, p = .01) and stress (r = .739, p =
.01) and as one would expect, indirectly correlated with psychological well-being (r = -.759, p =
.01) and resilience (r = -.411, p = .05). Anxiety was significantly correlated with all variables in
the study. Similarly, stress was significantly correlated with all variables. Psychological well-
being was directly correlated with resilience (r = .443, p = .01). See Table 5.
55
Table 5
Means, Standard Deviations, and Pearson Product Correlations for Measured Variables of Student
Participant Data
M SD 1 2 3 4 5 6
1. Age 25.09 8.44 1 -
.110
-.133
*
-
.133
*
.098 .169
**
2. Depression 16.45 12.35 1
.642
**
.739
*
*
-
.759
**
-
.411
**
3. Anxiety 15.27 10.74
1 .714
*
*
-
.503
**
-
.385
**
4. Stress 20.70 10.58
1 -
.542
**
-
.399
**
5. Psychological
Well-being
41.73 10.23
1 .443
**
6. Resilience 2.89 .81
1
*. Correlation is significant at the 0.05 level (p < .05)
**. Correlation is significant at the 0.01 level (p < .01)
Analyses of Research Questions
Research Question 1
Research Question 1 states, “Are there differences by gender, ethnicity, disability type
and class standing on symptoms of depression, anxiety, stress, psychological well-being and
resilience, in college students with disabilities?”
Hypothesis 1.1. There will be group differences in depression, anxiety and stress,
psychological well-being and resilience based on students’ gender and ethnicity.
Hypothesis 1.2. There will be group differences in depression, anxiety and stress,
psychological well-being and resilience based on students’ disability type.
56
Hypothesis 1.3. There will be group differences in depression, anxiety and stress,
psychological well-being and resilience based on students’ class standing.
Hypothesis 1.1 was supported. A two-way Analysis of variance (ANOVA) and Multivariate
analysis of variance (MANOVA) were computed with the independent variables of ethnicity and
gender on Depression, Anxiety and Stress subscales of the DASS-21, Psychological Well-being,
and Resilience as dependent variables. The overall MANOVA model was significant for only
the main effect of gender (Female, Male, Other) in the three DASS-21 subscales, Psychological
Well-being, and Resilience, [F (6, 450) = 2.203, p = 0.042, Wilks Lambda = .944]. Subsequent
ANOVA analyses revealed significant gender differences in Depression (D), Psychological
Well-being and Resilience (see Table 6). For the subscale of Depression (D), Females and
Males scored lower than Other gender identities. For the scale of Psychological Well-being,
Females and Males scored higher than Other gender identities. Finally, for the scale of
Resilience, although the ANOVA was significant, subsequent post hocs did not yield specific
gender group differences. The means for the dependent variables by gender are presented in
Table 7.
57
Table 6
Univariate Analysis of Variance for Gender in DASS (3 subscales), Psychological
well-being and Resilience
Variables df F p Post Hocs for Gender
Depression (D) 2 3.376 .036 Female < Other
Male < Other
Anxiety (A) 2 1.767 .173
Stress (S) 2 .609 .545
Psychological Well-being 2 4.681 .010 Female > Other
Male > Other
Resilience 2 3.226 .41
Table 7
Mean Scores and Standard Deviations of Depression and
Psychological Well-being by Gender
Gender M SD n
Depression (D)
Female 15.91 11.77 178
Male 15.59 13.01 49
Other 23.40 14.16 20
Psychological Well-being
Female 42.27 9.37 178
Male 42.59 12.22 49
Other 34.70 9.86 20
Hypothesis 1.2 was supported. A one-way Analysis of variance (ANOVA) and Multivariate
analysis of variance (MANOVA) were computed for the independent variable of disability type
with the Depression, Anxiety and Stress subscales of the DASS-21, Psychological Well-being,
and Resilience as dependent variables. The overall MANOVA model was highly significant for
the main effect of disability type in the three DASS subscales, Psychological Well-being, and
Resilience, [F (12, 624) = 2.773, p = 0.001, Wilks Lambda = .872]. Disability type was grouped
58
into five categories: Mental Health (MH), MH & Attention Deficit Hyperactivity Disorder
(ADHD), Medical, ADHD and Other disability types. Subsequent ANOVA analyses revealed
significant disability type group differences in all dependent variables of Depression, Anxiety,
Stress, Psychological Well-being, and Resilience (see Table 8). For the subscale of Depression
(D), students with disabilities from the MH and MH & ADHD groups scored higher than
students with Other disability types. For the subscale of Anxiety (A), students from the MH &
ADHD group scored higher than students with Other disability types. For the subscale of Stress
(S), students from the MH group scored higher than students with Other disability types.
Students from the MH & ADHD group scored higher than students from the Medical and Other
disability type groups. For Psychological Well-being, students from the MH & ADHD group
scored lower than students from the Medical, ADHD and Other disability type groups. Finally,
for Resilience, students from the MH group scored lower than students from the Medical and
Other disability type groups. Students from the Medical and Other disability type group scored
higher than students from the MH & ADHD group. The means for the dependent variables by
disability type are in Table 9.
59
Table 8
Univariate Analysis of Variance for Disability Type in DASS (3 subscales), Psychological
Well-being and Resilience
df F p Post Hocs for Disability Type
Depression (D) 4 4.604 .001 MH > Other
MH and ADHD > Other
Anxiety (A) 4 5.263 .001 MH and ADHD > Other
Stress (S) 4 6.610 .001 MH > Other
MH and ADHD > Other
MH and ADHD > Medical
Psychological Well-being 4 6.095 .001 MH and ADHD < Medical
MH and ADHD < ADHD
MH and ADHD < Other
Resilience 4 6.743 .001 MH < Medical
MH < Other
Medical > MH and ADHD
Other > MH and ADHD
60
Table 9
Mean Scores and Standard Deviations of DASS (3 subscales), Psychological
Well-being and Resilience by Disability Type
Disability Type M SD n
Depression (D)
MH 18.35 12.95 103
MH & ADHD 19.73 11.41 59
Other 10.65 10.45 31
Anxiety (A)
MH & ADHD 19.76 11.18 59
Other 10.65 10.02 31
Stress (S)
MH 21.84 10.13 103
MH & ADHD 24.95 9.41 59
Medical 16.27 10.79 30
Other 15.48 9.72 31
Psychological Well-being
MH & ADHD 40.39 10.52 59
Medical 44.77 8.99 30
ADHD 46.30 8.99 20
Other 46.39 8.96 31
Resilience
MH 2.68 .74 103
Hypothesis 1.3 was supported. A one-way Analysis of variance (ANOVA) and Multivariate
analysis of variance (MANOVA) were computed for the independent variable of class standing
with the Depression, Anxiety and Stress subscales of the DASS and Psychological Well-being
and Resilience as dependent variables. The overall MANOVA model was significant for class
standing in the three DASS subscales, Psychological Well-being, and Resilience, [F (15, 651) =
2.038, p = .011, Wilks Lambda = .881]. Class standing was grouped into six categories:
Freshmen, Sophomore, Junior, Senior, Masters and Doctoral. Subsequent ANOVA analyses
revealed significant class standing differences for only the subscale of Anxiety (A) (see Table
61
10). For Anxiety (A), Sophomore and Junior students scored higher than Doctoral students.
The means for the dependent variables by class standing are presented in Table 11.
Table 10
Univariate Analysis of Variance for Class Standing in DASS (3
subscales), Psychological well-being and Resilience
df F p
Depression (D) 5 1.603 .160
Anxiety (A) 5 3.964 .002
Stress (S) 5 1.134 .343
Psychological Well-being 5 .682 .637
Resilience 5 .674 .643
Table 11
Mean Scores and Standard Deviations of Anxiety (A) subscale
by Class Standing
Class Standing M SD n
Anxiety (A) Freshmen 13.68 12.00 19
Sophomore 18.96 10.01 46
Junior 19.04 11.90 46
Senior 13.64 9.86 39
Masters 13.73 9.51 60
Doctoral 11.12 10.16 34
Research Question 2
Research Question 2 states, “Is there a difference in symptoms of depression, anxiety,
stress, psychological well-being, and resilience between college students with disabilities who
have an emotional support animal (ESA) accommodation and students who have other non-ESA
accommodations?”
62
Hypothesis 2. Students with an ESA accommodation will have lower depression, anxiety
and stress, and higher psychological well-being and resilience than students who have
other non-ESA accommodations.
Hypothesis 2 was supported. A one-way Analysis of variance (ANOVA) and Multivariate
analysis of variance (MANOVA) were computed for the independent variable of accommodation
type with the Depression, Anxiety and Stress subscales of the DASS, Psychological Well-being
and Resilience as dependent variables. The overall MANOVA model was significant for the
main effect of accommodation type (ESA and Non-ESA) in the three DASS subscales,
Psychological Well-being, and Resilience, [F (3, 243) = 2.654, p = .049, Wilks Lambda = .968].
Subsequent ANOVAS did not reveal any significant group differences by accommodation type.
Therefore, post hoc analyses were not computed. See Table 12.
Table 12
Univariate Analysis of Variance for Accommodation Type in
DASS (3 subscales), Psychological well-being and Resilience
Variables df F p
Depression (D) 1 .274 .601
Anxiety (A) 1 1.947 .164
Stress (S) 1 .379 .539
Psychological Well-being 1 .334 .564
Resilience 1 .276 .600
63
Chapter Five: Discussion
The purpose of this study was to bridge a gap in the current literature by empirically
investigating the relationship of disability services accommodations to mental health and
psychological well-being of college students with disabilities. Specifically, this study sought to
examine differences in mental health symptoms, psychological well-being and resilience by
gender, ethnicity, disability type, class standing and emotional support animal accommodations.
Results of this study suggest that variables such as gender, class standing, and disability type
may be used as important variables in understanding factors that contribute to the mental health,
psychological well-being, and resilience of college students with disabilities. The following
chapter provides a summary and discussion of the results, as well as theoretical and applied
implications. Limitations of this study are also discussed as well as possible directions for future
research.
Discussion of Results
Group Differences by Gender
Unlike many survey instruments that only allow respondents to select one cisgender
identifier, the survey in this study permitted multiple terms to describe sexual/and or gender
identities. Other identifiers included, Agender, Transgender, Gender Non-Conforming and Non-
binary. Results from this study confirmed the hypothesis that there would be gender differences;
however, there were insignificant group differences by ethnicity. Both female and male students
reported lower levels of depression and higher psychological well-being than students with other
gender identities. This gender group gap in well-being has been established through prior
research on LGBTQ+ youth with disabilities.
64
In a meta-synthesis, Duke (2011) revealed that college students with disabilities who
identify with non-binary gender identities such as LGBTQ+, often experience frequent
discrimination and are at higher risk for depression, anxiety, and substance abuse. In one study,
the college student participant that identified as a gay male with multiple disabilities, reported
limited university services such as peer support, counseling and disability services that could
support them (Henry, Fuerth & Figliozzi, 2010). Finally, Greathouse et al. (2018) noted in a
meta-analysis that LGBTQ+ students reported higher rates of self-injurious behaviors, substance
use, suicidal ideation, suicide attempts and feeling anxious and depressed than their heterosexual
and cisgender peers.
Results from this study are consistent with prior research, showing that experiences of
LGBTQ+ students with disabilities are disparate to those of heterosexual and cisgender students
across mental health and overall well-being. A possible explanation is that LGBTQ+ students
with disabilities must deal with stigma related to their intersecting identities of disability and
gender, as well as navigate difficult social factors such as negative attitudes and discrimination
from faculty, teaching assistants (TA’s) and peers. Particularly, previous research has found that
these students experience microaggressions related to the intersectionality of their LGBTQ+ and
disability identities in their academic communities. The term microaggression evolved from
studies on racism and has extended to include gender, sexual orientation, and disability (Sue,
2010). It is defined as “subtle insults (verbal, nonverbal, and/or visual) directed toward people of
color often automatically and unconsciously” and “brief, everyday exchanges that send
denigrating messages...to people in a minority group” (Sue et al., 2007). These exchanges occur
daily and may seem innocuous, but the experience of microaggressions may have serious
65
implications, fueling negative feelings of inequities for students of minoritized groups (Miller,
2015).
Group Differences by Disability Type
Disability type group differences were also observed for depression, anxiety, stress as
well as psychological well-being and resilience. Students with both mental health disabilities
and ADHD had significantly higher levels of depression, anxiety, and stress than students with
medical and other disability types. In addition, they had lower PWB and resiliency. These
patterns correspond to previous research that suggest college students with mental health
disabilities face increased risk factors throughout their academic career.
According to Mowbray et al. (2006), the academic rigors of college may worsen mental
health symptoms. In addition to typical stressors related to independence and social support,
students with mental health issues face further stressors including cognitive impairments, stigma,
lack of social support and conflicted interpersonal relationships. Psychiatric and mental health
symptoms can interfere with emotional and behavioral skills, such as concentration, memory,
and irritable mood, declining academic performance and decreased self-efficacy (Megivern,
Pellerito, & Mowbray, 2003). Side effects of psychotropic medications and the cyclical nature
of mental health symptoms may adversely impact concentration, alertness, thinking, attendance,
and participation (Kiuhara & Huefner, 2008). These students’ cognitive and behavioral
symptoms may elicit discrimination, social stigma, and negative perception. Faculty may not
trust students' motives and think they are manipulating them and misusing university support
such as disability services. Consequently, these negative factors lead to lowered well-being, low
self-esteem, and confidence, and worsening mental health symptoms such as depression and
anxiety.
66
Group Differences by Class Standing
Another significant result from this study is group differences by students’ class standing.
Sophomore and Junior students reported higher levels of anxiety than Doctoral students. This
pattern is consistent with the prior finding of significance by disability type, particularly mental
health disabilities. Previous research has shown that the onset of mental health disabilities
occurs between ages 18 and 25, a time when young adults are often seeking postsecondary
education and beginning their careers (Collins & Mowbray, 2005; Kiuhara & Huefner, 2008;
Sharpe et al., 2004). Specifically, rates of depression, anxiety and suicidality are rising among
US college students (Liu, Stevens, Wong, Yasui & Chen, 2018).
It is plausible that Sophomore and Junior students may experience heightened levels of
anxiety because of increased academic rigors related to their studies. They may be taking more
core curriculums that are often more demanding and challenging. As students’ progress in their
academic career, it is also likely they experience increased stress and pressure regarding post-
graduation plans as it relates to internships, employment and graduate or professional studies.
This hypothesis is confirmed by Farrer, Gulliver, Bennett, Fassnacht and Griffiths (2016), who
sought to understand psychosocial predictors of depression and anxiety among university
students. They found that the most prevalent psychosocial issues associated with increased risk
of depression and anxiety, were feeling too much pressure to succeed, issues with time
management, anxiety related to exams, work life balance and lack of confidence. Moreover,
during college, students encounter new experiences and interpersonal relationships that foster
exploration of their identities as it relates to ethnicity, gender, sexuality (Liu et al, 2018). These
psychosocial factors may also increase stress that may impact mental health symptoms during
college. On the other hand, it is likely that Doctoral students have had more life experiences and
67
may have learned compensatory skills to better manage their anxiety and well-being. This
hypothesis has yet to be adequately tested and should be addressed in future studies.
Group differences by Accommodation Type
Although it was hypothesized that there would be group differences based on students’
accommodation type, there were no significant group differences in mental health symptoms,
psychological well-being, and resiliency of students with disabilities in this study. Several
plausible explanations could be given, including the nature of accommodations.
Many students who are approved for an ESA accommodation, also have other non-ESA
classroom accommodations. Each accommodation addresses different barriers and functional
limitations related to the students’ disability (Shaw & Dukes, 2005). For example, a student with
a psychological disability may be approved for an ESA to address their emotional challenges
living alone and approved for extended time on exams to address their challenges with focus and
attention in the classroom setting. Thus, a student can be approved for multiple accommodations
which makes it difficult to discern the specific outcomes of each accommodation type.
It is also important to note the variability of accommodations across different academic
and campus settings. An ESA is considered a housing accommodation, to allow the individual
with a disability an equal opportunity to enjoy and use a dwelling (Office of Fair Housing and
Equal Opportunity, 2020), whereas a testing accommodation addresses equal access in another
academic setting such as the classroom. Depending on how the students utilize their
accommodations, the accommodations may result in different outcomes. This was confirmed in
a research study on faculty perceptions of accommodation effectiveness. Brokelman (2011)
found that the effectiveness and outcomes of an accommodation varies depending on the type of
course and on different characteristics of students and faculty. Students who are comfortable
68
with their disabilities may be more proactive about utilizing their accommodations and have
better academic and well-being outcomes than other students who choose not to discuss their
disability-related needs. Additionally, courses have different structures and students may not
choose to utilize their accommodations in every course or they may be selective with which
accommodations to use per course. It’s difficult to determine the outcome of different
accommodations when there are so many competing factors and individuals involved with the
accommodation process.
Implications for Practice
This study highlights the importance of understanding the impact of mental health
challenges and overall, well-being among college students with disabilities. The result of this
study provides several implications for higher education practitioners, scholars and others
wanting to support this population of students.
The survey responses from this study indicate that mental health and psychological
conditions are at the forefront of disability types. Approximately 65.5% student participants
reported being diagnosed with a psychological disability, the largest reported disability type in
survey responses. This is consistent with data from the research site, in students registered with
a psychological disability also result in the largest disability population. The data may further
suggest that the number of college students with psychological disabilities is rapidly growing,
consistent with conclusions in the introduction about a national mental health crisis on college
campuses.
LGBTQ + College Students
When considering the findings associated with students’ gender identity, results imply
that lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) college students experience
69
more mental health challenges and have lower psychological well-being than their heterosexual
or cisgender peers. This is consistent with previous research publications which revealed that
LGBTQ+ youth with disabilities were at higher risk for significant mental health challenges
including depression, anxiety and suicidal ideations, and frequently experienced discrimination
(Duke, 2011). It is important to note that students in this study utilized multiple terms to
describe their gender identities, which should prompt faculty, staff, and others to avoid making
assumptions when using pronouns. Moreover, it is imperative for practitioners to seek education
on the identities and needs of students through training, professional development, and
independent research. Results of the low numbers of students reporting LGBTQ+ identities may
imply a lack of awareness of disability services on campus. Many students are unaware that
mental health and psychological conditions may be considered as a disability. Institutional
leaders should educate and promote accommodations to the campus community and disability
services centers must actively collaborate with other offices such as the LGBTQ+ centers. All
student support offices must work together to create a welcoming and inclusive environment, and
holistically serve and include LGBTQ+ students with disabilities.
College Students with Psychological Disabilities
Higher education has not only witnessed a population increase of students with
disabilities, but there has been an expansion particularly for students with psychological
disabilities. Results of this study found that students with psychological disabilities experienced
more mental health symptoms, such as depression and anxiety, and had lower resilience and
PWB than students with other disabilities. Moreover, undergraduate sophomores and juniors
experience significantly higher levels of anxiety than doctoral students. Consistent with prior
research, it is very likely that these students experience greater difficulties and barriers
70
throughout their academic career. Although the progression of disability legislation has paved
the way for equal access in higher education, there is a significant gap between legislating access
and truly integrating equity and inclusion in the campus communities.
In higher education, equity and inclusion focuses on welcoming and integrating students
from underrepresented groups into the university community. Inclusion and integration may
foster a student's sense of belongingness, connectedness, and enriched participation throughout
their academic experience (Belch, 2011). Furthermore, it is important that postsecondary
institutions shift from problem centered and reactive approaches to using a positive psychology
framework with prevention, planning and student support.
Attitudes and Biases
Social discrimination and stigma are often significant barriers to academic integration for
students with psychological disabilities or mental health challenges. Stigma is one of the most
common reasons that students choose not to disclose their disability or seek support, resulting in
social isolation and feelings of shame (Collins & Mowbray, 2005). Students who did seek help
and request accommodations, have particularly experienced stigmatization and negative attitudes
from faculty members. Therefore, while the attention to improving service provision is
necessary and useful, there also needs to be significant change among members of the campus
community and their attitudes and biases towards mental illnesses. It is believed that the source
of stigma is often from lack of training and awareness (Belch & Marshak, 2006; Collins &
Mowbray, 2005). Studies have found that individuals familiar with mental illness or have had
personal experience with friends, colleagues, or relatives, are less likely to exhibit stigma and
discrimination (Brockelman, Chadsey & Loeb, 2006).
Service Coordination
71
To minimize barriers, improvements in campus service provision is critical so that
students have wrap-around support. College campuses are often decentralized with gaps in
support services. There should be efforts and established processes to increase linkages between
community mental health services and college support offices such as counseling centers, crisis
support and disability services offices. This is achieved by increased communication between
campus services providers and with community mental health providers for coordination of
support and care.
An exemplary higher education program for mental health wellness promotion and
suicide prevention is Cornell University’s Mental Health Framework (Cornell University, 2004;
Eells, Marchell, Corson-Rikert, & Dittman, 2012). For their program, Cornell University
adopted components like a suicide prevention program implemented by the United States Air
Force (Knox, Litts, Talcott, Feig, & Caine, 2003). Cornell’s framework uses a public health
approach that promotes a wrap-around model of campus support which can foster resilience
among students with mental health challenges. Several key practices can be outlined specifically
for DS practitioners including (a) more intentional outreach programming targeting current and
prospective students and ensuring they are aware of disability services; (b) offering or
connecting students to programs that support social connection with peers and faculty; (c)
connecting early interventions that help students identify their academic and social strengths and
weaknesses with proactive academic planning as it relates to their disabilities; (d) implementing
early-stage planning for crisis related situations; and (e) developing disability specific
accommodations and supports, while encouraging self-advocacy. These practices support prior
research that promote positive psychology praxis in higher education through fostering
72
protective factors that may contribute to a student’s academic success and positive outcomes
(Hartley, 2013; Ryff & Singer, 1996).
Improving Practice and Policy
Overall, results from this study accentuate the importance for policies and procedures
when supporting students with psychological disabilities or mental health challenges. A
comprehensive campus plan is necessary, including more attention in training advisors, faculty,
and staff in recognizing and responding to students in distress or crises. A student crisis support
system allows members of the college campus to identify students in distress before a crisis
occurs. An educational program that can be adopted by postsecondary institutions is Mental
Health First Aid (MHFA). MHFA is an evidenced based educational program and has been
found to be effective in improving mental health literacy and teaches responders how to assist an
individual experiencing a mental health condition or disorder (Morgan, Ross & Reavley, 2018).
Programs such as MHFA equip essential individuals to assess and to coordinate an institutional
response and offer support to students as needed during or after crises.
There is a need for innovative approaches and frameworks to support and foster long
term well-being among these students. For example, Francis et al., 2020 introduced a conceptual
framework called, “Be Ready, Be Well,” to support students and their family’s well-being in
college. The framework has three components called “cogs”: (a) well-being practices, (b)
students with disabilities, and (c) family (see Figure 1). It also includes “barrier wedges” which
represent barriers that prevent well-being. The concept of the turning cogs reflects the
interdependence of well-being among the students and their families. Well-being practices
include evidenced based strategies to support well-being such as mindfulness meditation and
exercise as well as therapy techniques such as dialectical behavior therapy, cognitive behavior
73
therapy and individualized weekly therapy. This framework is dynamic and universal, and can
be used by students, their families, college faculty and administrators to promote well-being
through different means.
Figure 1
Be Ready, Be Well Conceptual Framework
Note. This figure illustrates the bidirectional relationships between the three cogs of the Be
Ready, Be Well Framework: well-being practices, students with disabilities and families.
Barriers to well-being are displayed as stripped wedges. From “Be Ready, Be Well: A
Conceptual Framework for Supporting Well-being Among College Students with Disabilities,”
by G. Francis, J. Duke, L. and Siko, 2020, Journal of Postsecondary Education and Disability,
33(2), p. 141. Copyright 2020 by Association on Higher Education and Disability. Reprinted
with permission.
At a higher institutional level, it is paramount to have a committee that identifies and
reviews policies and practices to support this student population. It is necessary to establish and
refine policies related to voluntary and involuntary health leaves, admissions, student code of
conduct, classroom attendance and technical program standards and requirements. These are all
74
areas where a student's mental health disability and symptoms may pose challenges and prevent
equal access to the university and academic processes. Policies may help with setting boundaries
around student behavior and accountability. However, at the same time many institutional
policies and procedures can create barriers for students with mental health challenges or
psychological disabilities. Therefore, modifications to policies are also necessary and may
include reasonable accommodations such as flexibility to class attendance policies, flexible
course load and health deferral. Balancing legal obligations to providing reasonable
accommodations with university policies and procedures is often a challenging task. The need
for internal and external legal counsel who are well versed in disability services in higher
education is critical and extremely beneficial for DS practitioners and campus leadership.
Limitations
There are several limitations to the current study that should be addressed. It should be
noted that these limitations do not invalidate the results of the current study but should be
addressed to strengthen future studies. The first limitation relates to the sampling method. A
convenience sample method was used to collect data from college students from one private
university on the west coast of the United States. Specifically, participants were a self-disclosed
population of students who use services at the University’s DSS office. This study did not
include students who may have disabilities and chose not to register. Additionally, the
participants of this study may have family backgrounds of higher socioeconomic status (SES)
and have more access to health or medical treatment services. Thus, they have the capability to
submit disability verification documentation that is typically required for students registering
with disability support services and seeking accommodations. Typically, the documentation
needs to be clinical, informative, and relevant, and completed by qualified evaluators who are
75
considered health care professionals licensed or specialized in treating the disability condition
being assessed. Health services and treatment are often costly and students with different SES
may have lack of access due to financial and insurance insecurity. Due to the narrow
characteristics of participants in this study and differences in this study’s type of institution, the
results may not be generalizable to the greater population of students with disabilities in higher
education.
Second, this study had limited outcomes on the relationship between accommodations
and students' mental health, resilience, and psychological well-being. Particularly, when
examining the difference between ESA’s and non-ESA accommodations. The lack of
significance implies the possibility of other variables which predict mental health, resilience, and
psychological well-being more powerfully. Accommodations are individually determined based
on a student’s disability and intended to address specific barriers and functional limitations
students experience in the academic setting. There are many types of accommodations that
address different barriers and may result in different personal and academic outcomes.
Accommodations may provide a sense of relief that fosters well-being, but it may or may not
impact academic performance. Additionally, students may engage in other types of support such
as counseling services or other academic resources to address their challenges. Therefore, the
influence of accommodations on a student’s mental health, resilience and well-being varies with
the nature of the student’s disability, accommodations utilized and other psycho-socio-cultural
factors. Future studies can evaluate the differential effect of accommodations through narrowing
down the study population by accommodation type with comparison groups and looking at
additional psychosocial variables including, SES, social support, interpersonal relationships,
minority statuses, social and cultural background.
76
Lastly, a third limitation was the type of design used for this study. Due to the non-
experimental nature of this study, statistical analyses could only be provided on the degree of
relationships between the independent and dependent variables. This study design could not
imply a causal effect between accommodation type and mental health symptoms, psychological
well-being, or resilience. Future studies should consider using an experimental study design,
emulating a mini research laboratory. The study would consist of participants who newly
acquired an ESA and utilize a pre and posttest design.
Recommendations for Future Studies
Further research could be conducted to add more depth to issues raised in this study.
College students struggling with mental health challenges are on the rise and on campus
counseling centers, disability services offices and other student support offices have begun
responding to the needs of these students. Despite continued discourse on mental health, few
empirical studies have been conducted on the role of disability services and accommodations on
experiences and outcomes among college students with psychological disabilities and LBGTQ+
students with disabilities.
Students with mental health challenges have unique needs that require support for them
to successfully navigate and complete their academic career. There is a need to determine how
to best support these students. One way to start is through institutional research by conducting
individual needs assessments and program evaluations to determine the best combination of
services for students. Many students also enter university who do not have an official diagnosis
but may be at risk of unsuccessful postsecondary transition due to lack of awareness,
undiagnosed or undisclosed diagnoses. It is necessary to enhance visibility and awareness of
disability services and determine which institutional methods may foster increased enrollment
77
with DSS offices. Research that promotes early identification and resources for these students
will help them develop appropriate supports that may contribute to academic success and
retention. It is especially important to not only continue to research factors that support
academic success but consider factors that contribute to overall student well-being.
Previous literature has shown how negative attitudes among faculty regarding disability
and accommodations can pose barriers and result in negative experiences for students with
psychological disabilities (Becker, Martin, Wajeeh, Warn & Shern, 2002; Olney & Kim, 2001).
Brockelman, Chadsey & Loeb (2006) sought to assess the relationship between professional
training, social media, and interpersonal relationships on faculty perceptions of working with
students with psychological disabilities. They found three strong positive predictors of faculty
perceptions when working with students with psychological disabilities which included having a
friend with a psychological disability, knowing a student with a psychological disability, and
personal experience. Future research should continue to understand the impact of faculty
experiences on their perceptions in working with students with disabilities, particularly for
psychological disabilities. It is important to research the factors and strategies that have resulted
in positive experiences for faculty. There is a high need for collaboration between student and
academic services and to develop and implement evidenced based training and materials for
faculty university wide on working with students with disabilities.
Conclusion
This study contributed to empirical literature regarding how demographics of ethnicity,
gender, class standing, disability type and accommodation type may impact mental health,
psychological well-being, and resilience among college students with disabilities. Results of this
study revealed that gender identity, disability type and class standing were predictors of mental
78
health symptoms, psychological well-being, and resilience. More specifically, LGBTQ+ gender
identity was significantly related to higher depression and lower psychological well-being and
Sophomore and Junior class standing students had significantly higher anxiety than doctoral
students. Gender identity and class standing were not found to be correlated with resilience.
However, disability type, particularly mental health and psychological disabilities were
correlated with higher depression, anxiety and stress, and lower psychological well-being and
resilience.
Findings from this study suggest that mental health is prevalent on college campuses, and
it is imperative to support mental health throughout a student's academic career. This study also
indicates that postsecondary institutions should explore ways of engaging students in their early
years of college to foster psychological well-being and resiliency, both of which are important
factors related to positive mental health. Although many studies have investigated and identified
mental health needs of college students nationwide, little has been published on the experiences
of LGBTQ+ college students with disabilities. This study provided a unique opportunity for
researchers and practitioners in understanding the overall low psychological and mental health
well-being of LGBTQ+ college students.
These insights present opportunities for targeted research on understanding campus
experiences of students from underrepresented and marginalized populations. A common
mission of colleges and universities is to cultivate and sustain campus communities that are
welcoming, inclusive, understanding, and supportive. Campuses with these qualities afford
students the opportunity to acquire wisdom and insight, independence and understanding of self,
and experience a sense of belonging, respect, and appreciation for others. Minoritized students,
such as those with psychological disabilities and/or those who identify as LGBTQ+, need their
79
campus leaders to revisit their mission from time to time and to stay abreast with best practices
that foster student psychological well-being and resiliency.
80
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Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E., & Binau, S. G. (2019). Age, period,
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152.pdf.
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Education Statistics, 2017 (2018-070), Chapter 3.
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the decision to withdraw from their studies. Psychiatric Rehabilitation Journal, 20, 88–
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Weitzman, E. R. (2004). Poor mental health, depression, and associations with alcohol
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96
Appendix A
Information Sheet for Non-Medical Research
You are invited to participate in a research study conducted by Debbie Jih, M.A., LMFT., under
the supervision of Ruth H. Chung, Ph.D., from the Rossier School of Education at the University
of Southern California (USC). The results will contribute to the completion of Debbie Jih’s
doctoral dissertation. You were selected as a possible participant in this study because you are
an undergraduate or graduate student registered with USC’s Disability and Services and
Programs (DSP) office. Your participation is voluntary and you may ask questions about
anything that is unclear to you.
PURPOSE OF THE STUDY
The purpose of this study is to gather information about student’s thoughts, feelings and overall
well-being as it relates to disability support services and accommodations. Specifically, the
purpose is to examine the role that emotional support animal accommodations have on student’s
mental health, well-being and resiliency. Your participation in this study will thereby contribute
to a better understanding of the different types of accommodations and guide leaders and
administrators as they make decisions about accommodation processes and practices in the field
of disability services in higher education.
You should read the information below and ask questions about anything you do not understand,
before deciding whether to participate. Please take as much time as you need to read the consent
form. You may also decide to discuss it with your family or friends.
Completion of this questionnaire will constitute consent to participate in this research project.
PROCEDURES
You are asked to complete the following online survey that will take about 10-15 minutes. The
survey will need to be completed in one sitting. Participants will not be able to save progress
and return to the website to complete the survey at a later time.
POTENTIAL RISKS AND DISCOMFORTS
There are minimal to no potential negative effects from participating in this study. However, if
you react strongly to any of the questions on the questionnaire and wish to discuss your feelings
or concerns, please contact your disability specialist and/or counselors at the university
counseling center.
POTENTIAL BENEFITS TO PARTICIPANTS AND/OR TO SOCIETY
Your participation in this study will contribute to a better understanding of emotional support
animal accommodations and help with ongoing research on accommodation policies and
practices in the field of disability services in higher education.
97
PAYMENT/COMPENSATION
By participating in this survey, you are eligible to enter a raffle to win 1 of the 2 $50
Amazon.com gift cards or 1 of the 2 $50 Chewy.com gift cards. In order to participate in the
raffle, you will provide your e-mail address at the end of the survey, which will be stored
separately from your survey responses. You will be notified at the e-mail address you provide us
if you are chosen as a raffle winner.
CONFIDENTIALITY
Your survey responses are anonymous and will not be linked to your name, email address, or any
other identifier. For purposes of entering the raffle, we will provide a link at the end of the
survey that will take the respondents to a separate survey where they can enter your contact
information. Those identifiers from the second survey will not be linked to your survey
responses and will be deleted once the raffles are completed. Your responses to the online
survey will be downloaded directly by Debbie Jih. Only members of the research team will have
access to the data associated with this study. The anonymous data will be stored on a secure
computer and retained at the discretion of the investigators. The results of this research may be
used for future research studies, made public, and quoted in professional journals and
conferences, but results from this study will only be reported in an aggregated form without any
potentially identifiable descriptions connected to individuals.
PARTICIPATION AND WITHDRAWAL
This survey is completely voluntary, and you may choose to terminate this survey at any time. If
you volunteer to participate in this study, you may withdraw at any time without consequence.
You may also refuse to answer any questions that you do not want to answer and still remain in
the study. The investigator may withdraw you from this research if circumstances arise which
warrant doing so.
INVESTIGATOR CONTACT INFORMATION
If you have any questions or concerns about the research, please feel free to contact Debbie Jih at
djih@usc.edu or Ruth Chung, Ph.D. at rchung@usc.edu, or call or visit (213)740-0224, at the
Rossier School of Education, USC, WPH 404, Los Angeles, CA 90089-4038.
RIGHTS OF RESEARCH PARTICIPANTS
If you have questions, concerns, or complaints about your rights as a research participant or the
research in general and or if you would like to speak with someone independent of the research
team to obtain answers to questions about the research, or in the event the research staff cannot
be reached, please contact the university park IRB office, The Office for the Protection of
Research Subjects, 3720 South Flower Street #301, Los Angeles, CA 90089-0706, (213) 821-
1154 or oprs@usc.edu .
By clicking the button below, you acknowledge that your participation in the study is voluntary,
that you are at least 18 years of age, and that you are aware that you may choose to terminate
your participation in the study at any time and for any reason:
98
Appendix B
Demographic Information
Please provide the following information:
1. Age
2. Gender
3. What is your racial/ethnic background (check all that apply)
4. What disability (ies) are you registered with at the USC Disability Services and Programs
(DSP) office?
5. What accommodations are you approved for through the USC DSP office?
6. What USC school/program are you in?
7. What degree are you pursuing?
99
Appendix C
DASS21
Lovibond, S.H. & Lovibond, P.F. (1995)
Please read each statement and circle a number 0, 1, 2 or 3 which indicates how much the
statement applied to you over the past week. There are no right or wrong answers. Do not spend
too much time on any statement.
The rating scale is as follows:
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree or a good part of time
3 Applied to me very much or most of the time
1 (s) I found it hard to wind down 0 1 2 3
2 (a) I was aware of dryness of my mouth 0 1 2 3
3 (d) I couldn’t seem to experience any positive feeling at all 0 1 2 3
4 (a) I experienced breathing difficulty (e.g. excessively rapid breathing,
breathlessness in the absence of physical exertion) 0 1 2 3
5 (d) I found it difficult to work up the initiative to do things 0 1 2 3
6 (s) I tended to over-react to situations 0 1 2 3
7 (a) I experienced trembling (e.g. in the hands) 0 1 2 3
8 (s) I felt that I was using a lot of nervous energy 0 1 2 3
9 (a) I was worried about situations in which I might panic and make a fool
of myself 0 1 2 3
10 (d) I felt that I had nothing to look forward to 0 1 2 3
11 (s) I found myself getting agitated 0 1 2 3
12 (s) I found it difficult to relax 0 1 2 3
13 (d) I felt down-hearted and blue 0 1 2 3
14 (s) I was intolerant of anything that kept me from getting on with what I
was doing 0 1 2 3
15 (a) I felt I was close to panic 0 1 2 3
16 (d) I was unable to become enthusiastic about anything 0 1 2 3
17 (d) I felt I wasn’t worth much as a person 0 1 2 3
18 (s) I felt that I was rather touchy 0 1 2 3
19 (a) I was aware of the action of my heart in the absence of physical
exertion (e.g. sense of heart rate increase, heart missing a beat) 0 1 2 3
20 (a) I felt scared without any good reason 0 1 2 3
21 (d) I felt that life was meaningless 0 1 2 3
100
Appendix D
Psychological Well-Being Scale (PWB)
Diener and Biswas-Diener (2009)
Below are 8 statements with which you may agree or disagree. Using the 1–7 scale below,
indicate your agreement with each item by indicating that response for each statement.
7 Strongly agree
6 Agree
5 Slightly agree
4 Mixed or neither agree nor disagree
3 Slightly disagree
2 Disagree
1 Strongly disagree
I lead a purposeful and meaningful life.
My social relationships are supportive and rewarding.
I am engaged and interested in my daily activities
I actively contribute to the happiness and well-being of others
I am competent and capable in the activities that are important to me
I am a good person and live a good life
I am optimistic about my future
People respect me
101
Appendix E
Brief Resilience Scale (BRS)
Smith, Dalen, Wiggins, Tooley, Christopher & Bernard (2008)
Respond to each statement below by circling one answer per row.
Strongly
Disagree
Disagree Neutral Agree
Strongly
Agree
BRS 1
I tend to bounce back quickly after
hard times. 1 2 3 4 5
BRS 2
I have a hard time making it through
stressful events. 5 4 3 2 1
BRS 3
It does not take me long to recover
from a stressful event. 1 2 3 4 5
BRS 4
It is hard for me to snap back when
something bad happens. 5 4 3 2 1
BRS 5
I usually come through difficult
times with little trouble. 1 2 3 4 5
BRS 6
I tend to take a long time to get over
setbacks in my life. 5 4 3 2 1
Scoring: Add the value (1-5) of your responses for all six items, creating a range from 6-30.
Divide the sum by the total number of questions answered (6) for your final score.
Total score: _____ / 6
My score: _____ (average)
BRS Score Interpretation
102
1.00 - 2.99 Low resilience
3.00 - 4.30 Normal resilience
4.31 - 5.00 High resilience
Abstract (if available)
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Asset Metadata
Creator
Jih, Debbie
(author)
Core Title
Students with disabilities in higher education: examining factors of mental health, psychological well-being, and resiliency
School
Rossier School of Education
Degree
Doctor of Education
Degree Program
Education (Leadership)
Degree Conferral Date
2021-08
Publication Date
08/05/2021
Defense Date
06/15/2021
Publisher
University of Southern California
(original),
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(digital)
Tag
academic accommodations,accessibility,College students,disability services,emotional support animals,Higher education,mental health accommodations,mental health disability,OAI-PMH Harvest,postsecondary education,psychological accommodations,psychological disability,psychological well-being,resiliency,students with disabilities
Format
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Language
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Contributor
Electronically uploaded by the author
(provenance)
Advisor
Chung, Ruth (
committee chair
), Schafrik, Janice (
committee member
), Tobey, Patricia (
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)
Creator Email
djih@usc.edu
Permanent Link (DOI)
https://doi.org/10.25549/usctheses-oUC15710828
Unique identifier
UC15710828
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Tags
academic accommodations
accessibility
disability services
emotional support animals
mental health accommodations
mental health disability
postsecondary education
psychological accommodations
psychological disability
psychological well-being
resiliency
students with disabilities