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An estimated one million international students are enrolled in U.S. universities. However, little was known about the landscape of their mental health and help-seeking behaviors. Drawing from a large national university student sample (N = 228,421, 8.49% non-U.S. citizen) from the Healthy Minds Study, data indicated the rates of major depressive disorder, generalized anxiety disorder, eating disorder, non-suicidal self-injury, and suicidal ideation were 27.4%, 20.0%, 26.4%, 17.2%, and 8.8% respectively among international students, with high inter-country variabilities. Contrary to our expectations, there is no strong and consistent evidence suggesting international students were at higher risk for common mental health concerns compared to domestic students. However, among students who were screened positive for these mental health disorders (n = 96,567), there was a significant difference between service utilization rates for international students and domestic students (32.0% vs. 49.8%), even after controlling for gender, age, socioeconomic status, perceived need for help, mental health stigma, and using informal support. Our results highlight the urgency for addressing mental health concerns and equitable mental health care among international students. [ABSTRACT FROM AUTHOR]