Mental health help-seeking willingness among U.S. college students: A resilience factor associated with many sexual minority identities

•Help-seeking history was a strong predictor of help-seeking willingness.•Help-seeking willingness was persistently elevated for many sexual minority groups, even after controlling for help-seeking history.•Poor help-seeking willingness among many racial and ethnic minority students was driven by a lack of help-seeking history.•Suicide risk was positively associated with help-seeking willingness, but this association reversed after controlling for help-seeking history. For populations with elevated mental health risks such as college students and minority groups, understanding openness to seeking professional help can inform ways to improve service engagement. This study explores help-seeking willingness among U.S. college students by sexual orientation. Data were drawn from the 2021 National College Health Assessment (N = 64,079). The main outcome of interest was help-seeking willingness (i.e., reported openness to seeking professional mental health help when needed). A secondary outcome was help-seeking history (i.e., past mental health service utilization). Logistic regression analyses were conducted using R version 4.0.5. Increased help-seeking willingness was detected among students with a help-seeking history, whether within the past 12 months (OR=7.40, 99%CI: 6.78–9.08) or beyond (OR=2.26, 99%CI: 2.11–2.42). Even after controlling for various covariates including help-seeking history, elevated odds of help-seeking willingness persisted for gay (AOR=2.01, 99%CI: 1.63–2.49), bisexual (AOR=1.35, 99%CI: 1.23–1.49), questioning (AOR=1.22, 99%CI: 1.04–1.45), pansexual (AOR=1.31, 99%CI: 1.06–1.63), and queer (AOR=1.78, 99%CI: 1.35–2.38), relative to heterosexual students. Help-seeking willingness is a mental health resilience factor unique to several sexual minority groups. Examining what yields greater help-seeking willingness for these sexual minority student groups may inform interventions that enable all college students to seek help when they are in distress.