When Identities Collide: What U.S. Research Reveals About Student Mental Health — and Why It Matters Even More in South Africa

The Study at a Glance

A new U.S. study (Kim & Rhinehart, 2025) digs into how marginalized identities affect the mental health of college students already living with psychological disorders. It’s a wide-ranging survey of over 5,000 students across two- and four-year colleges, and it brings two issues into sharp relief:

• Women students reported more severe mental health challenges than their male peers — a consistent finding even when other factors were controlled.

• Students with ADHD, especially those who are also first-generation college students (FGCS), faced the steepest climb: heightened symptoms coupled with barriers to seeking psychological services.

• FGCS overall were the least likely to access campus mental health support, regardless of gender or disability status.

The study makes it clear: intersectionality matters. It’s not just being a woman, or having ADHD, or being first-generation.

When these identities overlap, the challenges compound.

Why Gender Still Matters

It’s worth pausing on the gender findings.

Despite higher emotional intelligence and greater willingness to seek help, women in this study still reported worse outcomes. Social pressures, gender-based violence, and body image concerns are all cited as contributors. The message is sobering: resilience and coping skills don’t fully shield women from systemic stressors.

For institutions, that means campus mental health strategies can’t just be generic wellness workshops. They need trauma-informed supports, peer groups tailored for women, and a conscious effort to address sexism and harassment as public health issues.

The Overlooked Weight of Being First-Generation

FGCS status plays out differently. In the U.S., FGCS don’t always report worse mental health than peers, but they are consistently less likely to use support services. This disconnect is telling: barriers aren’t only psychological — they’re cultural, financial, and systemic.

If you’re the first in your family to step into higher education, seeking therapy may feel indulgent, shameful, or simply foreign. And if services aren’t culturally attuned, or if providers lack the vocabulary to honor family and community dynamics, students opt out.

That’s where need meets silence.

Neurodivergence in Context: ADHD and Autism

The Kim & Rhinehart study approached ADHD and autism side by side, but the signals were uneven.

ADHD — particularly when combined with FGCS status — stood out as a significant predictor of heightened mental health challenges. Autism, by contrast, did not emerge as a strong statistical driver in the dataset.

Yet this absence should not be mistaken for absence of need. It likely reflects under-diagnosis, under-reporting, and the bluntness of measuring mental health only through overwhelm, anxiety, and depression.

Both conditions carry substantial risks.

Autistic students are known to experience higher rates of depression, anxiety, and suicidality than their non-autistic peers. Students with ADHD are at similarly elevated risk for mood and anxiety disorders, substance misuse, and academic stress — but in the study’s analysis, ADHD combined with FGCS status was where the heaviest load fell.

These students not only showed heightened symptoms but were also less likely to access campus services, making ADHD–FGCS an especially vulnerable intersection.

South African Realities

In South Africa, the challenges faced by neurodivergent students intensify:

• ADHD awareness remains low. Misconceptions among educators and families are common, stigma is high, and clinical guidelines for adults are thin. Many students go undiagnosed, leaving them without recognition or accommodations.

• Autism is under-recognized. Diagnosis is often delayed — especially for women and rural students — and campus systems rarely offer autism-specific expertise or sensory-friendly services.

• Service scarcity cuts both ways. University counseling units are overstretched and disability offices often lack neurodivergent literacy. Local and technical colleges, where many first-generation students begin, have even fewer supports.

• Cultural barriers compound the problem. Collectivist family expectations may view help-seeking as weakness, while misunderstanding of ADHD and autism frames difficulties as laziness or poor discipline.

The Uneven Burden

While both ADHD and autism carry heavy psychological costs, ADHD may currently exert the greater visible load in South Africa’s higher education landscape — particularly when layered with FGCS status and gender. This is because ADHD intersects directly with executive function demands of university life (self-directed learning, time management, financial stress), and because low awareness means many FGCS students never recognize their challenges as neurodevelopmental in origin.

For autistic students, the burden is different but no less severe: invisibility.

Without diagnosis, tailored services, or cultural understanding, their needs remain unrecorded and unmet.

The risk is not fewer challenges, but challenges that go unnamed — and therefore unsupported.

South Africa: The Amplifier Effect

Now layer this onto the South African context more broadly.

• Higher FGCS prevalence: Because of apartheid-era exclusion and ongoing inequality, a far greater share of South African students are first-generation. What is a risk factor in the U.S. becomes the norm here.

• Lower ADHD awareness: In the U.S., adult ADHD is slowly making its way into clinical guidelines, campus policies, and public discourse. In South Africa, ADHD literacy remains low. Misconceptions are common among teachers, clinicians, and families. Stigma is high. That means many students either go undiagnosed or are left unsupported.

• Underfunded services: Campus counseling units are chronically under-resourced. Treatment gaps for all mental health disorders are wide. The odds of a FGCS woman with ADHD finding tailored support on campus are slim to none.

• Cultural mismatch: Much like in the U.S., collectivist family values can make “help-seeking” look selfish or weak. But in South Africa, where extended family obligations and financial precarity weigh heavily, the mismatch is magnified.

Put plainly: the intersections the U.S. study flags — gender, ADHD, FGCS, and autism — are likely even more consequential here, where systemic barriers are higher and safety nets thinner.

What This Means in Practice

1. Awareness is not optional. Students can’t seek help for ADHD or autism if they don’t know what these are, if their families don’t recognize them, or if their lecturers dismiss them as laziness or rudeness. Awareness campaigns — in multiple languages and grounded in local realities — are foundational.

2. Gender-sensitive supports. South African universities need trauma-informed programming that directly addresses gender-based violence and discrimination, not just stress management.

3. Culturally responsive counseling. For FGCS, counseling that honors family obligations and community identity is more effective than models imported wholesale from Western psychology.

4. Affordable, accessible options. Telehealth, group psychoeducation, and peer-led support circles may be more scalable than one-to-one therapy in our context.

5. Policy recognition. Universities must formally recognize ADHD and autism in disability frameworks, ensuring access to academic accommodations.

Where Do We Go From Here?

The Kim & Rhinehart paper is not about South Africa. But its findings offer a mirror. If U.S. campuses with stronger infrastructure are already struggling to meet the needs of women, FGCS, and neurodivergent students, what does that say about our own system?

It says the warning lights are already flashing. Without intentional investment in awareness, cultural sensitivity, and gender-informed mental health services, South Africa risks losing not just students to dropout — but whole futures to untreated distress.

Key Takeaway:
Intersectionality is not an abstract theory; it’s lived reality.

For South African women who are first-generation and neurodivergent, the overlapping weight of gender inequity, cultural barriers, and service gaps is more than additive — it’s exponential.