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Mental health is an ever-growing crisis among adolescents and young adults, with suicide as second leading cause of death and the number of those negatively affected continually on the rise. Transitions are one of the major stressors prevalent among these age groups, placing individuals at risk for mental health deficits. This quantitative voluntary response comparative study assesses the transitional mental health of pre-nursing students and students in the nursing program at East Tennessee State University. Emailed to all with a declared major of pre-nursing or nursing, this study measured mental health using evidenced based assessment tools. The PHQ-9 for depression and the GAD-7 for anxiety, along with additional demographic information and mental health service usage questions, was sent to and completed by participants. A total of n = 173 responses were received. Of these responses n = 99 or 57.2 percent were nursing students, a participation rate of 9.6 percent, and n = 74 or 42.8 percent were pre-nursing students. The research revealed that depression and anxiety scores were above the cutoff for moderate depression and anxiety in both groups, as well as identified a deficit in availability of mental health resources, with over 10 percent of students unable to access counseling or psychiatric services. Contraindicatory to literature, which predicted improving mental health in the progression through university studies, this study reveals a variable and even worsening trajectory of mental health as students transition into the nursing program and progressed through college.