Public Health Approaches to Promoting University Students' Mental Health: A Global Perspective

Overcoming mental health challenges in higher education: a narrative review

Background

Mental health among higher education students is a critical public health concern, with numerous studies documenting its impact on student well-being and academic performance. However, comprehensive research on the factors contributing to mental health deterioration, including barriers to seeking psychological help, remains insufficient. Gathering evidence on this topic is crucial to advancing policies, advocacy, and improving mental health services in higher education.

Objective

This review explores the unique challenges faced by vulnerable student groups and highlights the factors influencing student well-being and academic engagement, including those exacerbated by the COVID-19 pandemic. The review also addresses barriers to accessing mental health services across various regions and provides evidence-informed recommendations for improving mental health policies and services in higher education, covering both well-researched and underexplored contexts.

Methods

This narrative review synthesizes findings from over 50 studies on mental health in higher education. A targeted search was conducted using PubMed, Google Scholar, PsycINFO, CINAHL, and Scopus for studies published between 2013 and 2023. Data were analyzed through a deductive thematic content analysis approach, focusing on key predetermined themes related to student well-being, barriers to mental health services, and recommendations for policy improvements.

Results

Several factors influence the mental health of higher education students, with vulnerable groups-including women, minorities, socioeconomically disadvantaged, international, and first-year students-experiencing higher levels of depression, anxiety, and stress. Factors that impact students' well-being and academic performance include academic pressure, financial stress, lack of social support, isolation, trauma, lack of inclusive practices, and pandemic-related stressors. Institutional barriers, inconsistent well-being measures, data-sharing issues, and regulatory limitations hinder students' access to mental health services, while stigma and lack of trust in mental health professionals impede care.

Conclusion

Improving mental health strategies in higher education requires enhancing mental health services, addressing socioeconomic inequalities, improving digital literacy, standardizing services, involving youth in service design, and strengthening research and collaboration. Future research should prioritize detailed intervention reports, cost analyses, diverse data integration, and standardized indicators to improve research quality and applicability.

Unhealthy Lifestyle Contributes to Negative Mental Health and Poor Quality of Life in Young University Students

Background: A negative lifestyle is reported to be related to poor mental health and quality of life (QOL). However, there is little information on this in university students. The objective of the present study was to investigate the association between mental health (i.e., anxiety, depression symptoms and stress), QOL, SWLS and lifestyle parameters (i.e., PA, sleep duration, ST and food habits) among Chilean university students and then to determine the differences in mental health, QOL, SWLS and lifestyle parameters according to gender. Methods: This cross-sectional study included a total of 211 university students (128 females and 83 males) aged 18-28 years. Mental health, QOL and lifestyle were measured through validated questionnaires. Results: Bad food habits (lowest score in the food survey) were linked to anxiety (2.3 [0.22-4.36], p = 0.03), depressive symptoms (3.75 [1.54-5.9], p = 0.001) and stress (2.24 [0.31-4.17], p = 0.023). Furthermore, <6 h of sleep was related to poorer mental health (13.5 [7.6-19.5], p = 0.001), anxiety (4.2 [2.0-6.4], p < 0.001), depressive symptoms (5.5 [3.2-7.9], p < 0.001) and stress (3.8 [1.8-5.9], p < 0.001). In addition, ≥4 h of ST was linked positively to negative mental health (8.3 [2.86-13.7], p = 0.003), depressive symptoms (3.45 [1.47-5.4], p = 0.001) and anxiety (3.2 [1.05-5.4], p = 0.004). Non-physical activity was related to the scores for anxiety (2.6 [0.20-5.0], p = 0.030), depression (2.7 [0.009-5.3], p = 0.049) and stress (2.4 [0.12-4.7], p = 0.039). Conclusions: this study showed that unhealthy lifestyle factors (i.e., insufficient sleep, lack of PA and prolonged ST) were strongly associated with poorer mental health and QOL in university students. These findings highlight the importance of addressing these aspects of lifestyle in intervention and health promotion programs aimed at young university students in order to improve their mental health and overall QOL.

University students' access to mental health services: A qualitative study of the experiences of health service professionals through the lens of candidacy in England

OBJECTIVES

In order to develop a better understanding of students' access to mental health services, we explored the experiences of health care professionals interacting with university students with mental health problems.

METHODS

We interviewed 23 professionals working across university advice and counselling services, NHS general practice, crisis, and psychological services in North and East London between June 2022 and January 2023. Our approach drew on reflexive thematic analysis and the principles of abductive analysis. The notion of candidacy - that is, how different needs are deemed deserving of health service attention - was particularly helpful to our understanding of the ongoing phenomenon of interest in the data.

RESULTS

Each student's access to mental health support was highly contingent on the student's dynamic social context and the pressures and organisation of the local health system. Professionals described how different students viewed different needs as deserving of health service attention. Which students reached the professional's service depended on the resources and relationships a student could draw upon, and the service's relative permeability. Once there, what action professionals took was strongly influenced by the professional's service expertise, resource constraints, the relationships the professional's service had with other organisations, the students' wishes, and whether students regarded treatment offers as acceptable.

CONCLUSIONS

Candidacy offers a useful lens to view university students' access to mental health support. Access appears to be an increasingly intricate task for students, given the fragmented service landscape, surging demand for mental health care and challenges of emerging adulthood. Our findings suggest that policy goals to increase use of mental health services are unlikely to improve outcomes for students without policy makers and health systems giving holistic consideration of inter-service relationships and available resources.

Australian University Students' Experience of Animal-Assisted Education: An Exploratory Study

University students experience poorer mental health outcomes when compared to the general population. Poor mental health has been associated with reduced wellbeing and low academic performance, resulting in higher rates of withdrawal. Animal-assisted education is an intervention found to result in a reduction in anxiety and an increased learning engagement among primary and secondary students. However, minimal research has been conducted regarding the inclusion of therapy dogs in the learning environments of students in tertiary education. This study explored the influence of animal-assisted education on the experience of university students. A total of 56 university students engaged with animal-assisted education over a 13-week period and completed an online survey comprised of open- and closed-response questions. The findings showed that all perceived benefits of the therapy dog, including improved mood and reduction of anxiety, increased motivation and engagement in learning activities, as well as an improved social engagement with peers and the educator. Preliminary findings demonstrated that the inclusion of animal-assisted education into the teaching of university students may assist in supporting their mental health and overall learning experience. Research is needed to explore the most effective ways to incorporate animal-assisted education into university settings for both students and therapy dogs.

Mental health awareness, stigma, and help-seeking attitudes among Albanian university students in the Western Balkans: a qualitative study

Introduction

The significance of mental health and its impact on overall well-being is increasingly acknowledged across various sectors, including higher education. However, despite this growing recognition, the stigma associated with mental health issues and related help-seeking, particularly within certain cultural groups and socio-economic contexts, continues to pose a formidable barrier to effective care, especially among university students. Addressing these challenges, this study explores the intricate interplay of factors affecting mental health awareness and stigma, including help-seeking behaviors among Albanian university students in three Western Balkan countries: Kosovo, North Macedonia, and Albania. By dissecting these multi-layered influences, this study aims to develop targeted interventions to enhance mental well-being and dismantle barriers to care in these regions.

Methods

This qualitative study involved 60 Albanian university students from Kosovo, North Macedonia, and Albania, using focus groups to gather data. The discussions were structured around the socio-ecological model, facilitating a comprehensive exploration of the individual, interpersonal, organizational, and societal factors influencing mental health awareness, stigma, and help-seeking behaviors.

Results

Findings from the study indicate a moderate awareness of mental health issues among students. Familial and cultural stigma among Albanians in the Balkans hinder open discussions and access to professional help. There is a notable lack of support from higher education institutions, with only 20% of students reporting that their mental health needs are met. These needs include affordable and confidential counseling, empathetic faculty interactions, and a supportive campus environment. Additionally, there is a lack of continuous and professional help within the community. Societal attitudes deeply rooted in Albanian cultural norms and traditional beliefs perpetuate stigma, limiting effective health care and help-seeking behavior.

Discussion

The results emphasize the need for a culturally sensitive and holistic approach to mental health interventions that integrates strategies across multiple levels of the socio-ecological model. Enhancing mental health literacy, reducing stigma, and advocating for supportive legislation and policies in the Western Balkan region are critical. Moreover, the study highlights the urgent necessity for universities in particular to improve their mental health services, which will significantly enhance both the academic success and personal development of students.

Mental health profiles and the related socio-demographic predictors in Hong Kong university students under the COVID-19 pandemic: A latent class analysis

While the COVID-19 pandemic has brought about significant challenges to mental health of university students, there is limited research in this area. Particularly, few studies examined the person-centered mental health symptom profiles such as depression and anxiety and the related socio-demographic predictors. Using Latent Class Analysis (LCA), this study investigated the symptom profiles of depression and anxiety in university students in Hong Kong under the COVID-19 pandemic and the socio-demographic predictors. A total of 978 undergraduate students completed an online questionnaire including socio-demographic factors and measures of depression and anxiety during the summer of 2022. The LCA identified three latent classes: "normal" group, "moderate comorbid depression and anxiety" group and "severe comorbid depression and anxiety" group. Multinominal logistic regression showed that comparing with the "normal" group and the "moderate symptom" group, the "severe symptom" group had higher personal financial difficulties and individual/family member unemployment during the pandemic. In contrast, other socio-demographic factors (age, gender, year of study, living status, and COVID-19 infection status) had no significant association with group status. The study contributes to understanding of person-centered depression and anxiety symptom profiles and the risk role of personal financial difficulty in mental health of university students under the pandemic.

Treatment rates and barriers to mental health service utilisation among university students in South Africa

BACKGROUND

Mental health problems are common and impairing among university students, yet only a minority of students with psychological disorders access treatment. Understanding barriers to treatment is integral to planning services, especially in resource constrained settings like South Africa (SA).

METHODS

Data collected across 17 institutions in the online SA National Student Mental Health Survey were used to: (1) estimate 12-month prevalence of common mental health problems and self-harm; (2) estimate the proportion of students receiving treatments for the various mental health problems; (3) explore barriers to treatment; and (4) investigate sociodemographic predictors of treatment mediated through the various barriers endorsed by students with mental health problems. Prevalence analyses were carried out using cross-tabulations and prediction analyses using modified Poisson regression models.

RESULTS

Prevalence of clinically significant mental health problems is high relative to international comparisons, with the prevalence of severe, mild and moderate symptoms of any disorder and/or self-harm of 24.8% (SD = 0.3), 18.8% (SD = 0.3) and 27.6% (SD = 0.4) respectively. Treatment rates were 35.2% (S.E. = 0.6) among students with mental health problems who perceived need for treatment and 21.3% (S.E. = 0.4) irrespective of perceived need. Treatment rates were highest for mood disorders (29.9%, S.E. = 0.6) and lowest for externalising disorders (23.8%, S.E. = 0.5). Treatment rates were much less variable across disorder types among students with perceived need than irrespective of perceived need, indicating that perceived need mediated the associations of disorder types with received treatment. Adjusting for disorder profile, probability of obtaining treatment was significantly and positively associated with older age, female gender, study beyond the first year, traditional sexual orientation, and diverse indicators of social advantage (full-time study, high parent education, and attending Historically White Institutions). Among students with mental health problems, numerous barriers to treatment were reported adjusting for disorder profile, including lack of perceived need (39.5%, S.E. = 0.5) and, conditional on perceived need, psychological (54.4%, S.E. = 1.0), practical (77.3%, S.E. = 1.1), and other (79.1%, S.E. = 1.1) barriers. Typically, students reported multiple barriers to treatment. Differences in perceived need explained the gender difference in treatment, whereas practical barriers were most important in accounting for the other predictors of treatment.

CONCLUSION

Mental health problems are highly prevalent but seldom treated among SA university students. Although many barriers were reported, practical barriers were especially important in accounting for the associations of social disadvantage with low rates of treatment. Many of these practical barriers are however addressable.

The General Mattering Scale, the Anti-Mattering Scale, and the Fear of Not Mattering Inventory: Psychometric Properties and Links with Distress and Hope Among Chinese University Students

Purpose

Mattering is essential to university students' mental health. Feeling valued by others or unimportant can affect their overall well-being. However, most measures for assessing mattering have been developed and tested in Western countries, with limited evaluation of the measures when administered to university students in other regions. This study evaluated the reliability and validity of three mattering-related instruments - the General Mattering Scale (GMS), Anti-Mattering Scale (AMS), and Fear of Not Mattering Inventory (FNMI) among Chinese university students using classical test theory and Rasch analysis.

Methods

The study comprised 3594 university students from 19 universities across 13 provinces in mainland China, with a balanced gender distribution of 47.2% females and 52.8% males. Participants' ages ranged from 18 to 37, averaging 20.02 years. Most (78.4%) were in four-year programs, with the rest in three-year programs. The majority were freshmen (54.2%), and 86.3% had siblings. The predominant major was engineering (43.4%), followed by roughly equal representations in science, social science, and literature/art.

Results

The three scales showed high reliability and factorial validity, with Rasch analysis confirming their unidimensionality and monotonicity, although 2 of 15 items (one GMS item and one FNMI item) had lower fit. There were no substantial differences in item functioning between male and female respondents. Further analyses indicated that mattering, anti-mattering, and fear of not mattering all explained significant unique variance in levels of hope and distress.

Conclusion

All three mattering-related instruments are suitable for assessing Chinese students' mattering, anti-mattering, and fear of not mattering and changes in levels of these mattering dimensions. Moreover, each measure represents a unique element of the mattering construct in terms of associations with levels of hope and distress assessed in during the COVID-19 pandemic.

South African university students' experiences of online group cognitive behavioural therapy: Implications for delivering digital mental health interventions to young people

Mental disorders are common among university students. In the face of a large treatment gap, resource constraints and low uptake of traditional in-person psychotherapy services by students, there has been interest in the role that digital mental health solutions could play in meeting students' mental health needs. This study is a cross-sectional, qualitative inquiry into university students' experiences of an online group cognitive behavioural therapy (GCBT) intervention. A total of 125 respondents who had participated in an online GCBT intervention completed a qualitative questionnaire, and 12 participated in in-depth interviews. The findings provide insights into how the context in which the intervention took place, students' need for and expectations about the intervention; and the online format impacted their engagement and perception of its utility. The findings of this study also suggest that, while online GCBT can capitalise on some of the strengths of both digital and in-person approaches to mental health programming, it also suffers from some of the weaknesses of both digital delivery and those associated with in-person therapies.

Anxious, Depressed, and Suicidal: Crisis Narratives in University Student Mental Health and the Need for a Balanced Approach to Student Wellness

There is growing global awareness of the poor mental health of university students, as well as the need to improve students' access to services and expand the range of available evidence-based interventions. However, a crisis narrative is emerging, particularly in the wake of the COVID-19 pandemic, that runs the risk of positioning all students as potential patients in need of formal psychiatric interventions. Our aim in this commentary is to critically present the evidence that supports increased attention to student mental health, while also raising a concern that the crisis narrative may itself have unintended harmful consequences. We highlight some of the potential dangers of overtly medicalizing and thus pathologizing students' experiences of everyday distress, inadequacies of formal diagnostic categories, limitations of focusing narrowly on psychotherapeutic and psychiatric interventions, and the short-sightedness of downplaying key social determinants of students' distress. We argue for an integrative and balanced public health approach that draws on the rigor of psychiatric epidemiology and the advances that have been made to identify evidence-based interventions for students, while simultaneously being mindful of the shortcomings and potential dangers of working narrowly within the paradigm of diagnostic labels and psychotherapeutic interventions.

Intention to use digital mental health solutions: A cross-sectional survey of university students attitudes and perceptions toward online therapy, mental health apps, and chatbots

Background

Globally, the high prevalence of mental disorders among university students is a growing public health problem, yet a small minority of students with mental health problems receive treatment. Digital mental health solutions could bridge treatment gaps and overcome many barriers students face accessing treatment. However, there is scant evidence, especially in South Africa (SA), relating to university students' use of and intention to use digital mental health solutions or their attitudes towards these technologies. We aim to explore university 2students attitudes towards and perceptions of digital mental health solutions, and the factors associated with their intention to use them.

Methods

University students from four SA universities (n = 17 838) completed an online survey to assess experience with, attitudes and perceptions of, and intentions to use, digital mental health solutions. We conducted an exploratory factor analysis to identify factors underlying attitudes and perceptions, and then used multivariate ordinal regression analysis was used to investigate the factors' association with students' intention to use digital mental health solutions.

Results

Intention to use digital mental health solutions was high, and attitudes towards and perceptions of digital mental health solutions were largely positive. Importantly, our analysis also shows that 12.6% of users were willing to utilise some form of digital mental health solutions but were unwilling to utilise traditional face-to-face therapies. The greatest proportion of variance was explained by the factor 'Attitudes towards digital technologies' utility to improve student counselling services, provided they are safe'.

Conclusion

SA university students are already engaging with digital mental health solutions, and their intention to do so is high. Certain attitudes and perceptions, particularly concerning the utility, effectiveness, and safety, underlie willingness to engage with these solutions, providing potential targets for interventions to increase uptake.