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Improving college student mental health: Research on promising campus interventions

Hiring more counselors isn’t enough to improve college student mental health, scholars warn. We look at research on programs and policies schools have tried, with varying results.

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This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License .

by Denise-Marie Ordway, The Journalist's Resource September 13, 2023

This <a target="_blank" href="https://journalistsresource.org/education/college-student-mental-health-research-interventions/">article</a> first appeared on <a target="_blank" href="https://journalistsresource.org">The Journalist's Resource</a> and is republished here under a Creative Commons license.<img src="https://journalistsresource.org/wp-content/uploads/2020/11/cropped-jr-favicon-150x150.png" style="width:1em;height:1em;margin-left:10px;">

If you’re a journalist covering higher education in the U.S., you’ll likely be reporting this fall on what many healthcare professionals and researchers are calling a college student mental health crisis.

An estimated 49% of college students have symptoms of depression or anxiety disorder and 14% seriously considered committing suicide during the past year, according to a national survey of college students conducted during the 2022-23 school year. Nearly one-third of the 76,406 students who participated said they had intentionally injured themselves in recent months.

In December, U.S. Surgeon General Vivek Murthy issued a rare public health advisory calling attention to the rising number of youth attempting suicide , noting the COVID-19 pandemic has “exacerbated the unprecedented stresses young people already faced.”

Meanwhile, colleges and universities of all sizes are struggling to meet the need for mental health care among undergraduate and graduate students. Many schools have hired more counselors and expanded services but continue to fall short.

Hundreds of University of Houston students held a protest earlier this year , demanding the administration increase the number of counselors and make other changes after two students died by suicide during the spring semester, the online publication Chron reported.

In an essay in the student-run newspaper , The Cougar, last week, student journalist Malachi Key blasts the university for having one mental health counselor for every 2,122 students, a ratio higher than recommended by the International Accreditation of Counseling Services , which accredits higher education counseling services.

But adding staff to a campus counseling center won’t be enough to improve college student mental health and well-being, scholars and health care practitioners warn.

“Counseling centers cannot and should not be expected to solve these problems alone, given that the factors and forces affecting student well-being go well beyond the purview and resources that counseling centers can bring to bear,” a committee of the National Academies of Sciences, Engineering, and Medicine writes in a 2021 report examining the issue.

Advice from prominent scholars

The report is the culmination of an 18-month investigation the National Academies launched in 2019, at the request of the federal government, to better understand how campus culture affects college student mental health and well-being. Committee members examined data, studied research articles and met with higher education leaders, mental health practitioners, researchers and students.

The committee’s key recommendation: that schools take a more comprehensive approach to student mental health, implementing a wide range of policies and programs aimed at preventing mental health problems and improving the well-being of all students — in addition to providing services and treatment for students in distress and those with diagnosed mental illnesses.

Everyone on campus, including faculty and staff across departments, needs to pitch in to establish a new campus culture, the committee asserts.

“An ‘all hands’ approach, one that emphasizes shared responsibility and a holistic understanding of what it means in practice to support students, is needed if institutions of higher education are to intervene from anything more than a reactive standpoint,” committee members write. “Creating this systemic change requires that institutions examine the entire culture and environment of the institution and accept more responsibility for creating learning environments where a changing student population can thrive.”

In a more recent analysis , three leading scholars in the field also stress the need for a broader plan of action.

Sara Abelson , a research assistant professor at Temple University’s medical school; Sarah Lipson , an associate professor at the Boston University School of Public Health; and Daniel Eisenberg ,  a professor of health policy and management at the University of California, Los Angeles’ School of Public Health, have been studying college student mental health for years.

Lipson and Eisenberg also are principal investigators for the Healthy Minds Network , which administers the Healthy Minds Study , a national survey of U.S college students conducted annually to gather information about their mental health, whether and how they receive mental health care and related issues.

Abelson, Lipson and Eisenberg review the research to date on mental health interventions for college students in the 2022 edition of Higher Education: Handbook of Theory and Research . They note that while the evidence indicates a multi-pronged approach is best, it’s unclear which specific strategies are most effective.

Much more research needed

Abelson, Lipson and Eisenberg stress the need for more research. Many interventions in place at colleges and universities today — for instance, schoolwide initiatives aimed at reducing mental health stigma and encouraging students to seek help when in duress – should be evaluated to gauge their effectiveness, they write in their chapter, “ Mental Health in College Populations: A Multidisciplinary Review of What Works, Evidence Gaps, and Paths Forward .”

They add that researchers and higher education leaders also need to look at how campus operations, including hiring practices and budgetary decisions, affect college student mental health. It would be helpful to know, for example, how students are impacted by limits on the number of campus counseling sessions they can have during a given period, Abelson, Lipson and Eisenberg suggest.

Likewise, it would be useful to know whether students are more likely to seek counseling when they must pay for their sessions or when their school charges every member of the student body a mandatory health fee that provides free counseling for all students.

“These financially-based considerations likely influence help-seeking and treatment receipt, but they have not been evaluated within higher education,” they write.

Interventions that show promise

The report from the National Academies of Sciences, Engineering, and Medicine and the chapter by Abelson, Lipson and Eisenberg both spotlight programs and policies shown to prevent mental health problems or improve the mental health and well-being of young people. However, many intervention studies focus on high school students, specific groups of college students or specific institutions. Because of this, it can be tough to predict how well they would work across the higher education landscape.

Scientific evaluations of these types of interventions indicate they are effective:

• Building students’ behavior management skills and having them practice new skills under expert supervision . An example: A class that teaches students how to use mindfulness to improve their mental and physical health that includes instructor-led meditation exercises.
• Training some students to offer support to others , including sharing information and organizing peer counseling groups. “Peers may be ‘the single most potent source of influence’ on student affective and cognitive growth and development during college,” Abelson, Lipson and Eisenberg write.
• Reducing students’ access to things they can use to harm themselves , including guns and lethal doses of over-the-counter medication.
• Creating feelings of belonging through activities that connect students with similar interests or backgrounds.
• Making campuses more inclusive for racial and ethnic minorities, LGBTQ+ students and students who are the first in their families to go to college. One way to do that is by hiring mental health professionals trained to recognize, support and treat students from different backgrounds. “Research has shown that the presentation of [mental health] symptoms can differ based on racial and ethnic backgrounds, as can engaging in help-seeking behaviors that differ from those of cisgender, heteronormative white men,” explain members of National Academies of Sciences, Engineering, and Medicine committee.

Helping journalists sift through the evidence

We encourage journalists to read the full committee report and aforementioned chapter in Higher Education: Handbook of Theory and Research . We realize, though, that many journalists won’t have time to pour over the combined 304 pages of text to better understand this issue and the wide array of interventions colleges and universities have tried, with varying success.

To help, we’ve gathered and summarized meta-analyses that investigate some of the more common interventions. Researchers conduct meta-analyses — a top-tier form of scientific evidence — to systematically analyze all the numerical data that appear in academic studies on a given topic. The findings of a meta-analysis are statistically stronger than those reached in a single study, partly because pooling data from multiple, similar studies creates a larger sample to examine.

Keep reading to learn more. And please check back here occasionally because we’ll add to this list as new research on college student mental health is published.

Peer-led programs

Stigma and Peer-Led Interventions: A Systematic Review and Meta-Analysis Jing Sun; et al. Frontiers in Psychiatry, July 2022.

When people diagnosed with a mental illness received social or emotional support from peers with similar mental health conditions, they experienced less stress about the public stigma of mental illness, this analysis suggests.

The intervention worked for people from various age groups, including college students and middle-aged adults, researchers learned after analyzing seven studies on peer-led mental health programs written or published between 1975 and 2021.

Researchers found that participants also became less likely to identify with negative stereotypes associated with mental illness.

All seven studies they examined are randomized controlled trials conducted in the U.S., Germany or Switzerland. Together, the findings represent the experiences of a total of 763 people, 193 of whom were students at universities in the U.S.

Researchers focused on interventions designed for small groups of people, with the goal of reducing self-stigma and stress associated with the public stigma of mental illness. One or two trained peer counselors led each group for activities spanning three to 10 weeks.

Five of the seven studies tested the Honest, Open, Proud program, which features role-playing exercises, self-reflection and group discussion. It encourages participants to consider disclosing their mental health issues, instead of keeping them a secret, in hopes that will help them feel more confident and empowered. The two other programs studied are PhotoVoice , based in the United Kingdom, and

“By sharing their own experiences or recovery stories, peer moderators may bring a closer relationship, reduce stereotypes, and form a positive sense of identity and group identity, thereby reducing self-stigma,” the authors of the analysis write.

Expert-led instruction

The Effects of Meditation, Yoga, and Mindfulness on Depression, Anxiety, and Stress in Tertiary Education Students: A Meta-Analysis Josefien Breedvelt; et al. Frontiers in Psychiatry, April 2019.

Meditation-based programs help reduce symptoms of depression, anxiety and stress among college students, researchers find after analyzing the results of 24 research studies conducted in various parts of North America, Asia and Europe.

Reductions were “moderate,” researchers write. They warn, however, that the results of their meta-analysis should be interpreted with caution considering studies varied in quality.

A total of 1,373 college students participated in the 24 studies. Students practiced meditation, yoga or mindfulness an average of 153 minutes a week for about seven weeks. Most programs were provided in a group setting.

Although the researchers do not specify which types of mindfulness, yoga or meditation training students received, they note that the most commonly offered mindfulness program is Mindfulness-Based Stress Reduction and that a frequently practiced form of yoga is Hatha Yoga .

Meta-Analytic Evaluation of Stress Reduction Interventions for Undergraduate and Graduate Students Miryam Yusufov; et al. International Journal of Stress Management, May 2019.

After examining six types of stress-reduction programs common on college campuses, researchers determined all were effective at reducing stress or anxiety among students — and some helped with both stress and anxiety.

Programs focusing on cognitive-behavioral therapy , coping skills and building social support networks were more effective in reducing stress. Meanwhile, relaxation training, mindfulness-based stress reduction and psychoeducation were more effective in reducing anxiety.

The authors find that all six program types were equally effective for undergraduate and graduate students.

The findings are based on an analysis of 43 studies dated from 1980 to 2015, 30 of which were conducted in the U.S. The rest were conducted in Australia, China, India, Iran, Japan, Jordan, Kora, Malaysia or Thailand. A total of 4,400 students participated.

Building an inclusive environment

Cultural Adaptations and Therapist Multicultural Competence: Two Meta-Analytic Reviews Alberto Soto; et al. Journal of Clinical Psychology, August 2018.

If racial and ethnic minorities believe their therapist understands their background and culture, their treatment tends to be more successful, this analysis suggests.

“The more a treatment is tailored to match the precise characteristics of a client, the more likely that client will engage in treatment, remain in treatment, and experience improvement as a result of treatment,” the authors write.

Researchers analyzed the results of 15 journal articles and doctoral dissertations that examine therapists’ cultural competence . Nearly three-fourths of those studies were written or published in 2010 or later. Together, the findings represent the experiences of 2,640 therapy clients, many of whom were college students. Just over 40% of participants were African American and 32% were Hispanic or Latino.

The researchers note that they find no link between therapists’ ratings of their own level of cultural competence and client outcomes.

Internet-based interventions

Internet Interventions for Mental Health in University Students: A Systematic Review and Meta-Analysis Mathias Harrer; et al. International Journal of Methods in Psychiatric Research, June 2019.

Internet-based mental health programs can help reduce stress and symptoms of anxiety, depression and eating disorders among college students, according to an analysis of 48 research studies published or written before April 30, 2018 on the topic.

All 48 studies were randomized, controlled trials of mental health interventions that used the internet to engage with students across various platforms and devices, including mobile phones and apps. In total, 10,583 students participated in the trials.

“We found small effects on depression, anxiety, and stress symptoms, as well as moderate‐sized effects on eating disorder symptoms and students’ social and academic functioning,” write the authors, who conducted the meta-analysis as part of the World Mental Health International College Student Initiative .

The analysis indicates programs that focus on cognitive behavioral therapy “were superior to other types of interventions.” Also, programs “of moderate length” — one to two months – were more effective.

The researchers note that studies of programs targeting depression showed better results when students were not compensated for their participation, compared to studies in which no compensation was provided. The researchers do not offer possible explanations for the difference in results or details about the types of compensation offered to students.

About The Author

Denise-Marie Ordway

55 research questions about mental health

Last updated

11 March 2024

Reviewed by

Brittany Ferri, PhD, OTR/L

Research in the mental health space helps fill knowledge gaps and create a fuller picture for patients, healthcare professionals, and policymakers. Over time, these efforts result in better quality care and more accessible treatment options for those who need them.

Use this list of mental health research questions to kickstart your next project or assignment and give yourself the best chance of producing successful and fulfilling research.

• Why does mental health research matter?

Mental health research is an essential area of study. It includes any research that focuses on topics related to people’s mental and emotional well-being.

As a complex health topic that, despite the prevalence of mental health conditions, still has an unending number of unanswered questions, the need for thorough research into causes, triggers, and treatment options is clear.

Research into this heavily stigmatized and often misunderstood topic is needed to find better ways to support people struggling with mental health conditions. Understanding what causes them is another crucial area of study, as it enables individuals, companies, and policymakers to make well-informed choices that can help prevent illnesses like anxiety and depression.

• How to choose a strong mental health research topic

As one of the most important parts of beginning a new research project, picking a topic that is intriguing, unique, and in demand is a great way to get the best results from your efforts.

Mental health is a blanket term with many niches and specific areas to explore. But, no matter which direction you choose, follow the tips below to ensure you pick the right topic.

Prioritize your interests and skills

While a big part of research is exploring a new and exciting topic, this exploration is best done within a topic or niche in which you are interested and experienced.

Research is tough, even at the best of times. To combat fatigue and increase your chances of pushing through to the finish line, we recommend choosing a topic that aligns with your personal interests, training, or skill set.

Consider emerging trends

Topical and current research questions are hot commodities because they offer solutions and insights into culturally and socially relevant problems.

Depending on the scope and level of freedom you have with your upcoming research project, choosing a topic that’s trending in your area of study is one way to get support and funding (if you need it).

Not every study can be based on a cutting-edge topic, but this can be a great way to explore a new space and create baseline research data for future studies.

Assess your resources and timeline

Before choosing a super ambitious and exciting research topic, consider your project restrictions.

You’ll need to think about things like your research timeline, access to resources and funding, and expected project scope when deciding how broad your research topic will be. In most cases, it’s better to start small and focus on a specific area of study.

Broad research projects are expensive and labor and resource-intensive. They can take years or even decades to complete. Before biting off more than you can chew, consider your scope and find a research question that fits within it.

Read up on the latest research

Finally, once you have narrowed in on a specific topic, you need to read up on the latest studies and published research. A thorough research assessment is a great way to gain some background context on your chosen topic and stops you from repeating a study design. Using the existing work as your guide, you can explore more specific and niche questions to provide highly beneficial answers and insights.

• Trending research questions for post-secondary students

As a post-secondary student, finding interesting research questions that fit within the scope of your classes or resources can be challenging. But, with a little bit of effort and pre-planning, you can find unique mental health research topics that will meet your class or project requirements.

Examples of research topics for post-secondary students include the following:

How does school-related stress impact a person’s mental health?

To what extent does burnout impact mental health in medical students?

How does chronic school stress impact a student’s physical health?

How does exam season affect the severity of mental health symptoms?

Is mental health counseling effective for students in an acute mental crisis?

• Research questions about anxiety and depression

Anxiety and depression are two of the most commonly spoken about mental health conditions. You might assume that research about these conditions has already been exhausted or that it’s no longer in demand. That’s not the case at all.

According to a 2022 survey by Centers for Disease Control and Prevention (CDC), 12.5% of American adults struggle with regular feelings of worry, nervousness, and anxiety, and 5% struggle with regular feelings of depression. These percentages amount to millions of lives affected, meaning new research into these conditions is essential.

If either of these topics interests you, here are a few trending research questions you could consider:

Does gender play a role in the early diagnosis of anxiety?

How does untreated anxiety impact quality of life?

What are the most common symptoms of anxiety in working professionals aged 20–29?

To what extent do treatment delays impact quality of life in patients with undiagnosed anxiety?

To what extent does stigma affect the quality of care received by people with anxiety?

Here are some examples of research questions about depression:

Does diet play a role in the severity of depression symptoms?

Can people have a genetic predisposition to developing depression?

How common is depression in work-from-home employees?

Does mood journaling help manage depression symptoms?

What role does exercise play in the management of depression symptoms?

• Research questions about personality disorders

Personality disorders are complex mental health conditions tied to a person’s behaviors, sense of self, and how they interact with the world around them. Without a diagnosis and treatment, people with personality disorders are more likely to develop negative coping strategies during periods of stress and adversity, which can impact their quality of life and relationships.

There’s no shortage of specific research questions in this category. Here are some examples of research questions about personality disorders that you could explore:

What environments are more likely to trigger the development of a personality disorder?

What barriers impact access to care for people with personality disorders?

To what extent does undiagnosed borderline personality disorder impact a person’s ability to build relationships?

How does group therapy impact symptom severity in people with schizotypal personality disorder?

What is the treatment compliance rate of people with paranoid personality disorder?

• Research questions about substance use disorders

“Substance use disorders” is a blanket term for treatable behaviors and patterns within a person’s brain that lead them to become dependent on illicit drugs, alcohol, or prescription medications. It’s one of the most stigmatized mental health categories.

The severity of a person’s symptoms and how they impact their ability to participate in their regular daily life can vary significantly from person to person. But, even in less severe cases, people with a substance use disorder display some level of loss of control due to their need to use the substance they are dependent on.

This is an ever-evolving topic where research is in hot demand. Here are some example research questions:

To what extent do meditation practices help with craving management?

How effective are detox centers in treating acute substance use disorder?

Are there genetic factors that increase a person’s chances of developing a substance use disorder?

How prevalent are substance use disorders in immigrant populations?

To what extent do prescription medications play a role in developing substance use disorders?

• Research questions about mental health treatments

Treatments for mental health, pharmaceutical therapies in particular, are a common topic for research and exploration in this space.

Besides the clinical trials required for a drug to receive FDA approval, studies into the efficacy, risks, and patient experiences are essential to better understand mental health therapies.

These types of studies can easily become large in scope, but it’s possible to conduct small cohort research on mental health therapies that can provide helpful insights into the actual experiences of the people receiving these treatments.

Here are some questions you might consider:

What are the long-term effects of electroconvulsive therapy (ECT) for patients with severe depression?

How common is insomnia as a side effect of oral mental health medications?

What are the most common causes of non-compliance for mental health treatments?

How long does it take for patients to report noticeable changes in symptom severity after starting injectable mental health medications?

What issues are most common when weaning a patient off of an anxiety medication?

• Controversial mental health research questions

If you’re interested in exploring more cutting-edge research topics, you might consider one that’s “controversial.”

Depending on your own personal values, you might not think many of these topics are controversial. In the context of the research environment, this depends on the perspectives of your project lead and the desires of your sponsors. These topics may not align with the preferred subject matter.

That being said, that doesn’t make them any less worth exploring. In many cases, it makes them more worthwhile, as they encourage people to ask questions and think critically.

Here are just a few examples of “controversial” mental health research questions:

To what extent do financial crises impact mental health in young adults?

How have climate concerns impacted anxiety levels in young adults?

To what extent do psychotropic drugs help patients struggling with anxiety and depression?

To what extent does political reform impact the mental health of LGBTQ+ people?

What mental health supports should be available for the families of people who opt for medically assisted dying?

• Research questions about socioeconomic factors & mental health

Socioeconomic factors—like where a person grew up, their annual income, the communities they are exposed to, and the amount, type, and quality of mental health resources they have access to—significantly impact overall health.

This is a complex and multifaceted issue. Choosing a research question that addresses these topics can help researchers, experts, and policymakers provide more equitable and accessible care over time.

Examples of questions that tackle socioeconomic factors and mental health include the following:

How does sliding scale pricing for therapy increase retention rates?

What is the average cost to access acute mental health crisis care in [a specific region]?

To what extent does a person’s environment impact their risk of developing a mental health condition?

How does mental health stigma impact early detection of mental health conditions?

To what extent does discrimination affect the mental health of LGBTQ+ people?

• Research questions about the benefits of therapy

Therapy, whether that’s in groups or one-to-one sessions, is one of the most commonly utilized resources for managing mental health conditions. It can help support long-term healing and the development of coping mechanisms.

Yet, despite its popularity, more research is needed to properly understand its benefits and limitations.

Here are some therapy-based questions you could consider to inspire your own research:

In what instances does group therapy benefit people more than solo sessions?

How effective is cognitive behavioral therapy for patients with severe anxiety?

After how many therapy sessions do people report feeling a better sense of self?

Does including meditation reminders during therapy improve patient outcomes?

To what extent has virtual therapy improved access to mental health resources in rural areas?

• Research questions about mental health trends in teens

Adolescents are a particularly interesting group for mental health research due to the prevalence of early-onset mental health symptoms in this age group.

As a time of self-discovery and change, puberty brings plenty of stress, anxiety, and hardships, all of which can contribute to worsening mental health symptoms.

If you’re looking to learn more about how to support this age group with mental health, here are some examples of questions you could explore:

Does parenting style impact anxiety rates in teens?

How early should teenagers receive mental health treatment?

To what extent does cyberbullying impact adolescent mental health?

What are the most common harmful coping mechanisms explored by teens?

How have smartphones affected teenagers’ self-worth and sense of self?

• Research questions about social media and mental health

Social media platforms like TikTok, Instagram, YouTube, Facebook, and X (formerly Twitter) have significantly impacted day-to-day communication. However, despite their numerous benefits and uses, they have also become a significant source of stress, anxiety, and self-worth issues for those who use them.

These platforms have been around for a while now, but research on their impact is still in its infancy. Are you interested in building knowledge about this ever-changing topic? Here are some examples of social media research questions you could consider:

To what extent does TikTok’s mental health content impact people’s perception of their health?

How much non-professional mental health content is created on social media platforms?

How has social media content increased the likelihood of a teen self-identifying themselves with ADHD or autism?

To what extent do social media photoshopped images impact body image and self-worth?

Has social media access increased feelings of anxiety and dread in young adults?

• Mental health research is incredibly important

As you have seen, there are so many unique mental health research questions worth exploring. Which options are piquing your interest?

Whether you are a university student considering your next paper topic or a professional looking to explore a new area of study, mental health is an exciting and ever-changing area of research to get involved with.

Your research will be valuable, no matter how big or small. As a niche area of healthcare still shrouded in stigma, any insights you gain into new ways to support, treat, or identify mental health triggers and trends are a net positive for millions of people worldwide.

Get started today

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• Open access
• Published: 17 December 2022

University students’ use of mental health services: a systematic review and meta-analysis

• T. G. Osborn 1 ,
• R. Saunders 1 , 2 &
• P. Fonagy 1  

International Journal of Mental Health Systems volume  16 , Article number:  57 ( 2022 ) Cite this article

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International estimates suggest around a third of students arrives at university with symptoms indicative of a common mental disorder, many in late adolescence at a developmentally high-risk period for the emergence of mental disorder. Universities, as settings, represent an opportunity to contribute to the improvement of population mental health. We sought to understand what is known about the management of student mental health, and asked: (1) What proportion of students use mental health services when experiencing psychological distress? (2) Does use by students differ across health service types?

A systematic review was conducted following PRISMA guidelines using a Context, Condition, Population framework (CoCoPop) with a protocol preregistered on Prospero (CRD42021238273). Electronic database searches in Medline, Embase, PsycINFO, ERIC and CINAHL Plus, key authors were contacted, citation searches were conducted, and the reference list of the WHO World Mental Health International College Student Initiative (WMH-ICS) was searched. Data extraction was performed using a pre-defined framework, and quality appraisal using the Joanna Briggs Institute tool. Data were synthesised narratively and meta-analyses at both the study and estimate level.

7789 records were identified through the search strategies, with a total of 44 studies meeting inclusion criteria. The majority of included studies from the USA (n = 36), with remaining studies from Bangladesh, Brazil, Canada, China, Ethiopia and Italy. Overall, studies contained 123 estimates of mental health service use associated with a heterogeneous range of services, taking highly variable numbers of students across a variety of settings.

This is the first systematic quantitative survey of student mental health service use. The empirical literature to date is very limited in terms of a small number of international studies outside of the USA; studies of how services link together, and of student access. The significant variation we found in the proportions of students using services within and between studies across different settings and populations suggests the current services described in the literature are not meeting the needs of all students.

Globally, university students could be considered a privileged group given the significant variation in percentage of national populations with a university education [ 1 ]. However, for those who do attend university usually do so at a developmentally high risk period for the emergence of mental heath problems [ 2 , 3 ]. Psychological distress, encompassing symptoms ranging from normal fluctuations in mood to the emergence of a serious mental illness, is an increasingly common experience among university students which can have significant consequences for individuals [ 4 , 5 ]. Recent international evidence suggests 35% of first year students report symptoms indicative of lifetime mental disorder, and 31.4% report symptoms in the previous 12 months [ 6 ]. International longitudinal research is more limited. Studies in Norway, the UK and the USA has shown both psychological distress and common mental disorders (CMD) have increased in prevalence among both students and similar aged non-student populations over the last 10 years [ 7 , 8 , 9 , 10 , 11 ]. Suicidal behaviour, while lower in students compared to matched non-student populations, has also increased over a similar timeframe in England and Wales [ 12 ]. International estimates among students suggest around 4.3% have attempted suicide in their lifetime [ 6 ]. The short- and longer-term consequences of mental health difficulties can be significant including poorer academic performance, relationship breakdown, and exclusion from the labour market [ 6 , 13 , 14 ]. Current students face greater financial and academic pressures compared to 20 years ago, which may be contributing to poorer mental health outcomes [ 2 , 15 , 16 , 17 ]. These findings suggest a significant mental health need among this population. [ 1 ].

For students in mental distress, the support available to them is likely to vary signficiantly between and within countries. For example, in many high-income countries (HIC) students may have a range of effective mental health services available to them but these services are often fragmented, uncoordinated and underutilised [ 6 , 19 , 20 ]. For example, US studies suggest around a 1/3 of students received treatment [ 9 ], while epidemiological studies suggest this varies widely independent of need based on sex and gender, ethnicity, age, and where they attend university [ 6 , 20 , 21 , 22 , 23 ]. Barriers such as self-stigma, perceived need, and self-reliance influence when and how they seek help, while student’s also report a lack of awareness of appropriate services, concerns about confidentiality and discrimination, cost, or may perceive services to be ineffective or inappropriate [ 19 , 24 , 25 ]. These barriers may explain why some students only seek help in crisis and others tend to rely on informal sources of support [ 26 , 27 ]. International studies suggest very few students with need, receive support globally. One recent international cross-sectional study found 19.8% of first year university students, and 36% of those who may meet criteria for CMD report having ever used a mental health service, defined as medication or psychological counselling [ 6 ]. Compared to HICs, much less is known about students in Lower and Middle Income Countries (LMIC), although individual studies suggest very small numbers of students report accessing support when in distress [ 18 , 28 ].

While a limited number of studies have highlighted the scale and nature of the problem outside of the USA, there is a renewed effort to understand and address barriers to treatment that stop some students reaching help in the first place [ 4 , 16 , 27 ]. The World Health Organization’s (WHO) World Mental Health International College Student Initiative (WMH-ICS) aims to provide greater clarity on the unmet need of this group [ 16 ]. In the UK, there has been a policy focus on improving access to mental health interventions through greater integration between the National Health Service (NHS) and Universities, and an emphasis on mobilising university resources towards the mental health of students [ 29 , 30 ]. Previous reviews in the USA have looked at which students are most likely to seek help [ 20 , 31 ], however this is obviously confounded by the nature of services available to them. There are no systematic reviews conducted on the variety of services available to students internationally, how these integrate with each other and how use varies by types of service that deliver interventions to support mental health and wellbeing. Studies have examined individual services such as university counselling centres, external psychological services, or inpatient settings but have not compared the differential use of these by students with different clinical presentations. Given the developmental period in which many students attend university these settings are important in contributing to improving overall population mental health [ 3 , 32 ]. By understanding where variation occurs could indicate areas of differential access, highlighting where care pathways could be improved and inform policy initiatives.

This systematic review was conducted to address this gap, by answering two review questions: (1) what proportion of university students use mental health services when experiencing psychological distress? And (2) does utilisation differ across health service type?

This review was reported in accordance with PRISMA guidelines [ 33 ] (see Additional file 1 : Appendix S1). A protocol for this review was pre-registered on the 22/02/21 on PROSPERO ( https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021238273 ).

Deviations from initial protocol

On the 26th of April 2021 we made an amendment to only include studies published in the year 2000 or after over concerns around changes to the student population that would create issues of comparability [ 4 ]. On the 27th of July 2021 we amended the focus of the review as the original aims were considered too broad for a coherent synthesis. The amendment removed one review question related to student characteristics associated with service use which could be explored in future analysis.

Eligibility criteria

Studies were included that:

Measured the use or utilisation of mental health services (as a primary or secondary outcome).

Studies that included adults (aged 18 +) studying at a university.

Studies were excluded:

That employed an empirical study design that aimed to test an intervention or approach to address or effect access or use of healthcare services.

Where it was not possible to extract sociodemographic and utilisation data for student participants.

Where participants under 18 were recruited.

Where participants weren’t all university students.

Studies needed to be published in English due to the languages spoken by the primary reviewer (TO).

Search strategy

The following electronic databases were searched on the 9th of March 2021, 3rd of November 2021 and the 23rd of August 2022: MEDLINE (Ovid); EMBASE (Ovid); PsycINFO (Ovid); ERIC (ESBCO); and CINAHL plus (ESBCO). The search strategy using a Context, Condition, Population (CoCoPop) framework with the concepts of “students”, “mental health/illness”, “access” and “mental health services” [ 34 ]. Key words and MeSH terms were developed in Medline between 2nd of December 2020 and 9th of March 2021, and adapted for each database (see Additional file 1 : Appendix S2). On the 16th and 17th of June 2021, the 14th of December 2021 and the 16th of November 2022 forward and backward citation searching was conducted. The publicly available reference list of studies published by the WHO’s WMH-ICS was searched on the 23rd of April 2021, the 14th of December 2021 and the 16th of November 2022. The authors of the originally included studies were contacted on the 18th of June 2021, where possible, to help identify any unpublished or ongoing research.

Data extraction

Records retrieved from electronic database searches were exported to Endnote X9, where duplicates were removed. Abstracts and full texts of potentially relevant articles were screened against the inclusion and exclusion criteria on Rayyan software. A random sample of approximately 10% of titles and abstracts identified in the initial searches were screened independently by a second reviewer (SL) using a purpose designed screening tool (see Additional file 1 : Appendix S3). Data from the included studies were extracted independently by two reviewers (TO and SL) using a pre-defined data extraction framework (see Additional file 1 : Appendix S4). Data were extracted into Excel. After data were extracted for two studies, the data extraction framework was checked for interpretation by both TO and SL. Study authors were contacted where additional data or clarification was required. The main items of interest were:

i Condition: use or utilisation

We defined use as the occurrence or number of uses of a mental health service over a defined time-period [ 35 ]. Indicators could include attendances, usage, inpatient days, admissions, contacts, episodes, or costs due to the receipt of treatment or attendance [ 35 ]. These indicators may be measured through self-report, clinical records, and/ or other routinely collected data. As observational or more naturalistic study designs were included in this review, outcomes are likely to be reported as prevalence or incidence and therefore as a proportion of the total study sample. Therefore, the effect measures were proportions with a 95% confidence interval as the main outcome [ 34 ].

ii Context: mental health service

An amended version of the WHO’s definition of a mental health service was used, this being ‘the means by which effective interventions are delivered for the dominant or subdominant intention to improve wellbeing or mental health’ [ 36 ]. This included outpatient services, day treatment, inpatient wards, community mental health teams, General Practice, mental health hospitals, and university counselling services [ 36 ]. To facilitate comparison of proportions by service type an adapted version of the Description and Evaluation of Services for Disabilities in Europe (DESDE) instrument was used (see Appendix S5) [ 37 ]. This is a hierarchical classification system, with six initial categories: (1) Information for care, (2) Accessibility to care, (3) Self-help and volunteer care, (4) Outpatient Care, (5) Day care, and (6) Residential care. A random 10% sample were double coded by two reviews (TO and SL). No service descriptions could be classified beyond the first level of the DESDE hierarchy. Therefore, to further specify, we used the National Institute for Health and Care Excellence (NICE) treatment stepped care categories, referred to as ‘treatment type’ [ 38 ], and the service location—being either on campus, off campus, or potentially either.

iii Other items

We also collected sociodemographic characteristics, study design, duration of study, data collection methods, data analysis methods, setting and date of study, raw data for the outcome, indicator(s) used, and time point(s) outcomes where reported, source of funding and conflicts of interest.

Quality assessment

We assessed risk of bias using the Joanna Briggs Institute (JBI) appraisal checklist for systematic review reporting prevalence data [ 34 ]. The checklist prompts the reviewer to answer nine questions with four possible response options: “yes”/ “no”/ “unclear”/ “not applicable”. Each study was assigned low, moderate, or high quality based on the number of yes answers it scored to indicate study quality. Studies with 1–3 ‘yes’ were low, 3–6 indicating moderate, and 7–9 as high quality. Quality appraisal was conducted independently on all studies meeting the inclusion criteria by two reviewers (TO and SL). Where there were disagreements, these were discussed until agreement was reached. No studies were excluded based on the study quality to enable sensitivity analyses to be conducted by removing studies rated as low quality.

Synthesis methods

I narrative synthesis.

Initially, a non-statistical narrative synthesis was conducted to describe the included studies relevant to the review questions [ 34 ]. Study participants and the measures of psychological symptoms were not universally well described. Therefore, the samples were qualitatively summarised and then categorised based on whether this was a general student sample, subgroup sample or a sample of students with more severe current psychological distress, referred to as ‘at risk’.

ii Meta-analysis

Most studies provided data for multiple service types, therefore three-level mixed effects models were used to account for clustering. Where the study provided a single estimate or an overall estimate of service use they were included in one of three conventional random effects meta-analytic models: (1) overall service use (any service), (2) overall outpatient service use, (3) overall residential service use reflecting the service types commonly observed in the data. Following this, to specifically test differences between these service types all estimates were then included into a three-level mixed effects model, where sub-group analysis and meta-regression were also conducted [ 39 ]. Further analyses were conducted for studies providing multiple estimates within the same study using two three-level mixed effects models to account for clustering: (1) outpatient service use; (2) service use where the service could be classed within multiple DESDE service categories.

For all pooled proportions, a priori subgroup analysis and meta-regression were conducted based on population group. Post-hoc analyses were conducted based on service location, treatment type, reporting timeframes, publication year, study design, and country, due to the substantial estimated heterogeneity. To conduct meta-regression for recall time-period a continuous variable was created based on the number of months participants were asked to recall service use (e.g., 12 months). If the reporting time-period did not use months (e.g., the student’s lifetime), it was estimated using the average age of the participants.

Heterogeneity was further explored by identifying outliers above or below the 95% confidence interval of the pooled proportion; by conducting influencer analysis; drafting a Baujat plot and conducting Graphic Display of Heterogeneity (GOSH) plots [ 39 ].

Sensitivity analyses were conducted for pooled estimates where low quality studies, estimates of lifetime service use and outliers and influential cases were excluded then all described analyses were repeated. Publication bias was not assessed due to the substantial between study heterogeneity [ 39 ].

Search results

A total of 7739 unique titles / abstracts were identified through database searches, and a further 52 through other search strategies (see Fig.  1 and Additional file 1 : Appendix S6). Inter-rater agreement for data screening was Cohen’s Kappa ( K ) = 0.85 indicating strong agreement [ 40 ].

PRISMA flow diagram

As a result of these search strategies, 44 studies were deemed eligible for inclusion. Within these studies there were 123 estimates of service use. Seven of these studies were smaller analyses of larger surveys conducted in the USA [ 23 , 41 , 42 , 43 , 44 , 45 , 46 ]. These seven studies were excluded from meta-analysis as their estimates would double count participants. 29 studies and 42 estimates were included in conventional two-level meta-analyses pooling estimates of overall service use, and then a three-level meta-analysis to test differences by service type. 25 studies and 60 estimates were included in further analyses using three-level meta-analysis. Inter-rater agreement for data extraction was K  = 0.82 indicating strong agreement [ 40 ].

Study characteristics

I study origin.

Studies were conducted in a range of mostly high-income countries. The majority were from the United States, where 34 of the 44 studies were based [ 9 , 23 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ]. The remainder from Australia [ 73 , 74 ], Brazil [ 75 , 76 ], China [ 77 ], Canada [ 78 ], Ethiopia [ 79 ], Bangladesh [ 28 ], and Italy [ 80 ]. A total of nineteen studies were samples of students from separate individual universities [ 43 , 46 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 67 , 68 , 70 , 73 , 75 , 76 , 77 , 79 , 80 ]. Whereas the remaining twenty-four were samples across multiple universities [ 9 , 20 , 23 , 28 , 41 , 44 , 45 , 47 , 56 , 57 , 58 , 59 , 61 , 62 , 63 , 64 , 65 , 66 , 69 , 71 , 72 , 74 , 78 ].

ii Study design and methods

Most studies (n = 36) were either primary or secondary analyses of cross-sectional surveys [ 9 , 20 , 23 , 41 , 43 , 44 , 45 , 47 , 49 , 50 , 51 , 53 , 54 , 55 , 56 , 58 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 73 , 74 , 75 , 78 , 79 ] (see Table 1 ). Outcomes were assessed using standardised questionnaires and open questions. Of the remaining seven studies, one was a longitudinal study [ 46 ], one was a cohort study using a mix of a baseline survey and linked electronic medical records from the university counselling centre [ 77 ], two were secondary data analyses of electronic medical records from university counselling or health centres [ 52 , 59 , 60 ], and two were mixed method studies [ 48 , 80 ].

iii Study participants

Sample sizes varied substantially ranging from 15 to 730,785 participants. Most studies included general samples of student attending a university with fifteen studies studying specific subgroups of students [ 41 , 44 , 51 , 52 , 58 , 59 , 61 , 63 , 65 , 69 , 70 , 71 , 73 , 74 , 75 , 76 ]. Thirteen studies included samples of students ‘at risk’ [ 23 , 48 , 49 , 50 , 56 , 57 , 62 , 64 , 66 , 68 , 72 , 79 , 80 ]. Two studies sampled university faculty members, in addition to university students, although these participants were not asked about mental health service use [ 41 , 47 ]. One study included students at community college and 4-year institutions in the USA [ 23 ].

iv Mental health services

Overall, most estimates were associated with services classified into the outpatient service category of the DESDE instrument (see Table 2 ). Seventy-four estimates associated with thirty-seven studies were outpatient services [ 9 , 20 , 28 , 41 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 54 , 55 , 57 , 59 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 70 , 71 , 72 , 73 , 75 , 76 , 77 , 78 , 79 , 80 ]. Thirty-seven estimates associated with twenty-two studies could be classed as multiple service categories [ 9 , 20 , 23 , 41 , 47 , 50 , 53 , 56 , 57 , 61 , 62 , 63 , 64 , 65 , 66 , 68 , 69 , 70 , 71 , 74 , 78 ]. Residential service category was appropriate for seven estimates associated with five studies [ 9 , 57 , 61 , 66 , 70 ]. Inter-rater agreement for service coding was Κ  = 0.89, indicating strong agreement [ 40 ].

Across the service categories, 38 estimates related to services providing a range of treatments, 1 providing advice and support, 25 providing low intensity treatment, 35 related to high intensity treatment and 17 related to specialist treatment. Of these estimates thirteen related to services located off campus; 29 were on campus, whereas the remaining 79 estimates could have been located on or off a university campus.

v Defining and measuring use of health services

While all studies implicitly conceptualised mental health service use as an event or occurrence by a person in a time-period, the operational assessment was heterogeneous. In the cross-sectional and longitudinal studies, measurement varied by recall period and by item wording [ 9 , 20 , 23 , 28 , 41 , 43 , 44 , 45 , 47 , 49 , 50 , 51 , 53 , 54 , 55 , 56 , 58 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 78 , 79 ]. Only one study used a validated instrument assessing use over the previous two weeks [ 79 ], one asked student about their use over the previous two months [ 49 ], sixteen over the last 12 months [ 9 , 23 , 28 , 42 , 43 , 44 , 45 , 46 , 50 , 56 , 57 , 58 , 67 , 70 , 72 , 74 ], four while students were at university [ 41 , 47 , 68 , 71 ], and ten asked participants to report about previous use in their lifetime or ever [ 55 , 61 , 62 , 63 , 64 , 65 , 66 , 69 , 78 ]. One cross-sectional study asked student participants to both recall use of university counselling centre while at university, and the students use of other mental health service over their lifetime [ 66 ]. Nearly all cross-sectional studies gave participants a binary response option—either yes or no. Only one study used an ordered categorical response option where participants were asked to state whether they had used a particular service using a Likert scale ranging from 1–5 (never-often) [ 50 ]. Of the two mixed methods studies one reported current use [ 48 ], and the other reported on lifetime use [ 80 ]. Secondary analyses of electronic medical records examined number of unique visits per student over the study period [ 52 , 59 , 60 ].

Quality appraisal

Overall, the quality of the studies included in the review were moderate with around a quarter of the total samples rated as either high [ 43 , 44 , 45 , 46 , 56 , 67 , 72 , 79 ], or low quality [ 49 , 52 , 54 , 61 , 65 , 69 , 76 ]. The main area of weakness came from questions related to the validity and reliability of the assessment of mental health service use, with only six studies being rated as “yes” in both questions [ 45 , 46 , 56 , 67 , 74 , 79 ]. A further area of significant weakness was found in question eight which related to whether appropriate statistical analyses had been conducted with four studies rated as “yes” [ 49 , 53 , 59 , 63 ] (see Table 1 and Additional file 1 : Appendix S7). Inter-rater agreement for quality appraisal was Κ  = 0.88 indicating strong agreement [ 40 ].

What proportion of university students use mental health services when experiencing psychological distress?

I. overall use of any mental health service, narrative summary (n = 10; k = 11).

Ten studies reporting on students’ use of any mental health service use with estimates ranging between 13.7 and 68.6% of the study population reporting use [ 9 , 41 , 47 , 50 , 53 , 57 , 61 , 64 , 70 , 71 , 74 , 78 ]. Estimates ranged from 13.7 to 68.6% of the study population reporting using a service. It was difficult conclude the source of this variation. The highest estimate, at 68.6%, was the only for an on-campus service. Treatment offered by the service did not appear to be associated with variation across estimates. Broader operational service definitions tended to have higher estimates [ 53 , 74 ]. For example, in one study 49% of Chinese international students reported using “any form of help”, whereas all other estimates within the same study relating to specific services were low.

There was some evidence to suggest more severe current psychological distress was associated with higher previous mental health service use. For example, in studies with at risk samples reported estimates between 25.7 and 49% [ 50 , 57 , 74 ]. Whereas estimates in general populations of students had a lower range between 19.7 and 45% [ 9 , 47 , 53 , 78 ]. Variation also appeared to be related to the reporting period, where studies reporting on lifetime mental health service use tended to have higher estimates [ 61 , 78 ] (see Tables 1 and 2 ).

Meta-analysis (n = 9; k = 9)

The overall pooled proportion effect size using a random effects model was estimated to be 0.35 (95%CI: 0.22;0.50) (see Fig.  2 ). The between study heterogeneity was estimated at τ 2  = 0.69, and Ι 2  = 99.9%. The prediction interval ranged from 0.06 to 0.81. This indicated a wide range of future possible estimates. Overall, these results indicate substantial heterogeneity across the included estimates of mental health service use.

Forest plot for overall mental health service use by population group

Subgroups and meta-regressions for overall use

No variables were associated with an overall reduction in between study heterogeneity using meta-regressions. Subgroup analyses found differences by service location ( Q  = 40.41, df:2, p  < 0.001), and reporting period ( Q  = 5.92, df:2, p  = 0.05), However, meta-regressions found lower proportions were associated with off-campus service ( β  = − 1.35, 95%CI:− 2.52; − 0.18, p  =  0 .03), and higher proportions associated with longer reporting periods ( β  = 0.0043, 95%CI:− 0.001; 0.0075, p  = 0.02) (see Additional file 1 : Appendix S8).

ii Overall outpatient use

Narrative summary (n = 25; k = 27).

Twenty-five studies reported estimates of students overall outpatient service use with between 2.6 and 75% of the study populations reporting service use [ 9 , 28 , 41 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 54 , 57 , 59 , 61 , 62 , 63 , 66 , 67 , 69 , 70 , 71 , 72 , 73 , 75 , 76 , 77 , 80 ]. Use of on-campus services were lower ranging between 2.6 and 33.5% [ 9 , 41 , 47 , 50 , 51 , 52 , 58 , 59 , 60 , 66 , 69 , 73 , 77 ]. There was only one estimate of off-campus service use at 13.7% [ 49 ], whereas the remaining estimates were for services that could be either on or off campus between 7 and 75%. These differences could also be partly explained by differences in population group and treatment offered by the service. The lowest two estimates overall were in subgroups of students namely international students (2.6%) [ 52 ], and students in China (5.1%) [ 77 ], and among students Bangladeshi universities (7.1%) [ 28 ]. Whereas the highest estimates overall and in the category of either on campus or off campus services were in a study of medical students with more severe current psychological distress using services offering potentially any treatment (75%) [ 73 ]; previously homeless students or who had been in care where a broad service model had been developed for them (68%) [ 48 ], and veterinary students (62.5%) [ 61 ]. For this estimate participants reported against the use of “counselling”—which could have a broad interpretation in the USA. A further study also using a broad outpatient service definition was associated with a high estimate of 68% [ 49 ]. Overall, studies asking students to recall service use over their lifetime reported a higher range of estimates [ 61 , 62 , 63 , 69 , 80 ], compared to studies with shorter recall periods (see Tables 1 and 2 ).

Meta-analysis for overall outpatient use (n = 24; k = 26)

The overall pooled proportion effect size using a random effects model was estimated to be 0.21 (95%CI = 0.15;0.30) (see Fig.  3 ). The between study heterogeneity was estimated at τ 2  = 1.12 and Ι 2  = 99.9%. The prediction interval ranged from 0.03 to 0.72. This indicated a wide range of future possible estimates. Overall, these results indicate substantial heterogeneity across the included estimates of residential mental health service use.

Forest Plot for outpatient overall service use by population group

Sub-group analyses and meta-regressions for overall outpatient use

No meta-regression model resulted in a significant reduction in overall between-study heterogeneity. Subgroup analyses found overall differences by service location ( Q  = 9.03, df:1, p  = 0.002), population group ( Q  = 35.40, df:2, p  < 0.001), study design ( Q  = 94.68, df:3, p  < 0.001) (see Additional file 1 : Appendix S9). Meta-regressions were conducted finding lower proportions of service utilisation were associated with service providing low intensity treatment ( β  = − 0.91; 95%CI = − 1.78;− 0.04; p  = 0.04), and on campus services compared than those either on or off campus ( β  = − 1.10, 95%CI: − 1.85; − 0.36, p  = 0.005). Higher proportions of use were associated in ‘at risk’ to general populations of students ( β  = 1.62, 95%CI:0.88; 2.37, p  < 0.001), and mixed methods studies ( β  = 2.41, 95%CI:0.08; 4.73, p  = 0.04).

iii Overall residential service use

Narrative summary (n = 5; k = 7).

Four studies reported six estimates of residential service use [ 9 , 57 , 61 , 66 , 70 ], ranging from 1 to 5.4%. Population group appeared to be associated with this variation, with the study reporting on general populations of students having a lower estimate than other groups (see Tables 1 and 2 , and Additional file 1 : Appendix S10 for a detailed narrative summary).

Meta-analysis for overall residential service use (n = 5; k = 7)

The overall pooled proportion effect size using a random effects model was estimated to be 0.03 (95%CI:0.02;0.05) (see Fig.  4 ). The between study heterogeneity was estimated at τ 2  = 0.30, and Ι 2  = 99.4%. There was a prediction interval which ranged from a proportion of 0.007 to 0.12. This indicated a wide range of future possible estimates. Overall, these results indicate substantial heterogeneity across the included estimates of residential mental health service use.

Forest Plot for overall residential service use

Subgroup analyses and meta-regressions for overall residential service use

Meta-regressions only a found a reduction in between study heterogeneity association with population group (τ 2  = 0.19, Ι 2  = 86.6%). High estimates were associated with ‘at risk’ students ( β  = 1.29, 95%CI: 0.84; 1.73, p  = 0.001), and subgroup of students ( β  = 1.50, 95%CI: 0.80; 2.21, p  = 0.0041) when compared to general populations of students (see Additional file 1 : Appendix S10).

Does service use differ across health service type?

I differences in use by service type.

Subgroup analysis conducted using a three-level meta-analysis suggested differences between service types ( F  = 63.25, df:2,39, p  < 0.001). A meta-regression was conducted where compared to overall service use, both overall outpatient service and overall residential service use was associated with lower proportion of university students reporting using these services (outpatient: β  = − 0.77, 95%CI: − 1.26; − 0.29; p  = 0.01; residential: β  = − 3.05, 95%CI: − 3.63; − 2.47, p  < 0.001).

Sensitivity analyses found mixed results (see Table 3 ). For example, excluding estimates of lifetime service use had an attenuating effect on all pooled proportions, whereas removing low quality studies resulted in a lower pooled proportion only in overall service use. When outliers and influential estimates were removed the pooled proportion for overall service use was higher. A reduction in between study heterogeneity was only observed when outliers and influential cases were removed (see Table 3 ). Sensitivity analyses continued to suggest differences by service location and treatment type for overall outpatient service use, by service location for overall service use, except when excluding estimates of lifetime use (see Additional file 1 : Appendix S11, 12 and 13).

Further analyses using three-level meta-analysis

I estimates meeting multiple service categories, narrative summary (n = 12; k = 23).

Twelve studies reported on twenty-one estimates associated with services that could be classified as any DESDE classifications [ 9 , 47 , 53 , 55 , 56 , 62 , 63 , 64 , 65 , 70 , 74 , 78 ]. These estimates ranged from 5 to 68%. Lower estimates were reported in services offering specialist or high intensity treatment compared to a range of treatments, whereas higher estimates tended be in campus services. In general, studies asking students report service use over their lifetime were associated with higher estimates [ 55 , 62 , 63 , 64 , 65 , 78 ] (see Tables 1 and 2 ).

Meta-analysis (n = 12; k =  23)

The pooled proportion based on the three-level meta-analytic model was 0.20 (95%CI:0.13; 0.31, p < 0.001). Ι 2 level 3  = 82.9% of the total variation can be attributed to between-cluster, and  Ι 2 level 2  = 13.76% to within-cluster heterogeneity. We found that the three-level model provided a significantly better fit compared to a two-level model with level 3 heterogeneity constrained to zero (χ 2 1  = 8.10, p 0.004).

Subgroup analyses and meta-regressions

Subgroup analyses found differences by service location ( F  = 11.201, df:2,18, p  < 0.001). Meta regressions found on campus, and off campus location was associated with a high proportion when compared service potentially located in both locations (On campus: β  = 1.83, 95%CI:0.83, 2.83, p  = 0.001; off campus: β  = 0.91, 95%CI:0.003, 1.81, p  = 0.05) (see Additional file 1 : Appendix S14, and Appendix S16 for sensitivity analyses).

ii Specific outpatient services

Narrative summary (n = 13; k = 37).

Between 6.98% and 62.5% of students reporting outpatient service use out of the ten studies and twenty-seven estimates [ 49 , 55 , 61 , 64 , 65 , 66 , 67 , 68 , 70 , 71 , 76 , 79 ]. These estimates were between 6.98% and 62.5% of the study populations reporting outpatient service use. It was difficult to determine what this variation was associated with. The definitions used to measure service use may explain some variation. For example, the highest estimate of 62.5% related to individual counselling, and lowest estimate of 6.98% related to group counselling within the same study, and both classed as low intensity treatments [ 61 ]. The country a service was located appeared to potentially be associated with some variation. Estimates in a study of students at risk in Ethiopia were both low compared to most other estimates in the USA [ 79 ]. In general, higher estimates tended to be in studies asking students to report whether they had ever used a mental health service [ 49 , 55 , 61 , 64 , 65 , 68 , 78 ].

Meta-analysis (n = 13; k = 37)

The pooled proportion based on the three-level meta-analytic model was 0.19 (95%CI:0.13; 0.28, p  < 0.001). Ι 2 level 3  = 31.3% of the total variation can be attributed to between-cluster, and  Ι 2 level 2  = 64.3% to within-cluster heterogeneity. We did not find that the three-level model provided a significantly better fit compared to a two-level model with level 3 heterogeneity constrained to zero (χ 2 1  = 1.99, p  = 0.16).

Subgroup analyses found differences by treatment type ( F  = 34.83, df:3,33, p  < 0.001) and service location ( F  = 35.58, df:2,34, p  < 0.001). Meta regressions found low intensity ( β  = − 0.94, 95%CI: − 1.17, − 0.71, p  <  0.0 01), specialist treatment ( β  = − 2.06, 95%CI: − 2.81, − 1.32, p  <  0.0 01) and on campus locations were associated with lower proportions ( β  = − 0.93, 95%CI: − 1.15, − 0.71, p  < 0.001) (see Additional file 1 : Appendix S15, and Appendix S17 for sensitivity analyses).

Main findings

This is the first systematic review and meta-analysis to synthesize evidence relating to the proportion of university students using mental health services, and how this varies by service type. In summary, we found there are wide variety of services available taking varying proportions of students, although overwhelmingly these were from HICs, in particular the USA. Across studies when estimates were grouped and pooled in service categories, we found around a 1/3 of students use services overall while attending university, with around 1/5 of students using outpatient services, and between 1 and 3% have used services that could be classed as residential. Our findings suggest where there is greater availability of support there is greater use, as indicated by higher use being associated with services offering a range of treatments. There was limited evidence to suggest services on campus were used more than those off campus, and students with more severe current psychological distress were associated with greater past service use. However, there are significant limitations with the current literature, including few international studies, particularly from LMICs, little clarity on how services link together, no studies of patient flow and limited consistent description of services.

Findings in the context of existing evidence

The finding of the proportion of students using mental health services is broadly consistent with average proportions of students reporting problems in previous literature from the USA and North America. In 2012 around 18% of students reported receiving any form of mental health treatment, and 36% among students with a likely mental health problem [ 20 ]. Annual cross-sectional surveys confirm that service use is aligned with prevalence in the USA and Canada with increases in service utilisation between 2007 and 2017 to around one third of university students using services [ 8 , 9 ]. Comparisons with estimates in non-student populations are difficult to interpret because of heterogeneous measures used to estimate need, limited international longitudinal analyses, and few studies assessing the effect of university on mental health trajectories [ 4 ]. A systematic review of service use among non-student young adults found only 16% reported using any mental health service, lower than our findings [ 81 ]. This is unlikely to be due to differences in need as individual studies suggest mental disorder has increased in both groups, at a similar rate [ 10 , 11 ]. US studies featured predominantly in both this previous review and ours, therefore differences in reported service use may reflect differences in the availability of services and insurance coverage between groups in the USA. Studies in non-students included relatively young populations with an average age of 21 [ 81 ]. In the USA context, the transition to university could prompt the earlier emergence of mental health difficulties as students may face significant new pressures, a new social context and new financial challenges prompting earlier help seeking [ 4 , 9 , 20 , 25 , 27 , 82 ].

Our review predominantly reports on studies of US university students in four-year institutions, and therefore our findings likely confounded by what is available there. Higher proportions of students using campus services maybe due to student’s awareness of, and ability to reach and pay for these services in comparison to other services [ 83 ]. Four-year US institutions receive comparably higher levels of funding than US community colleges, influencing their ability to provide students with comprehensive mental health services [ 23 , 47 , 84 ]. Studies using both national and regional US samples found four-year university students report higher use of services on campus compared to community college students, despite higher prevalence of mental health problems in community colleges [ 23 , 47 ]. Cost was cited as the most common barrier to seeking help among community college students [ 23 ]. International studies included in this review reported different patterns of service use, which may reflect different patterns of service provision, demand among students, and barriers to help seeking [ 73 , 74 , 75 , 78 , 79 , 80 ]. For example, countries such as Australia where there may be fewer barriers to support outside of university, students sought help from a broad range of providers, most frequent being General Practitioners [ 73 ]. The limited number of studies outside the USA may reflect the relatively recent increases in the number and diversity of students attending university in other HIC countries, such as the UK [ 4 ]. Only recent research has highlighted the very limited research focus on LMIC [ 85 ], perhaps the reflecting the potentially smaller proportion of their national populations attending university compared to most HICs [ 1 ]. However, recent efforts through the WHO WMH-ICS indicates some change in this field [ 6 , 16 ]. This in the context of the growing emphasis on the importance of global mental health and the role higher education might play in contributing to improvements in population health [ 1 , 3 ].

The level of heterogeneity observed was striking when compared to the published literature potentially illustrating the wide range of services, likely with a range of entry requirements, and populations of students. This could also reflect inequalities in population coverage and use of mental health services relative to need across the student populations, as noted in other literature [ 18 , 21 , 22 ]. A review in non-student populations found being female, Caucasian, homosexual, or bisexual meant you were more likely to use services, which is similar to findings in students [ 81 ]. However, in our review, some studies of international students had comparably lower use of services, one study reporting only 2.6% used a service [ 52 ]. Other studies examining use in other populations in our review reported much higher proportions, as high as 75% [ 73 ]. It may be that variation among students is even greater than non-students due to the wide variety of needs among students. Despite students in the USA and other HICs potentially having more available services, such as those on campus, these may be particularly underutilised by some groups who experience more significant barriers to help-seeking both inside and outside university [ 18 , 21 , 22 ]. If some groups of students are consistently underrepresented in services, it is unlikely activities and interventions these services provide will be appropriate for their needs, and will continue to be underutilised by these students [ 86 ].

Strengths and limitations

This is the first systematic review to summarise and pool evidence quantitatively about the management of student mental health. This allowed us to explore and then quantify variation in the way mental health services are used by university students. However, there are limitations to the current review. Firstly, generalising the findings of this review outside of the USA should be cautioned given the limited number of international studies. Secondly, there were specific challenges to classifying services studies described or listed. For example, it was not always clear whether the services were interpreted in the same way by all participants or services with similar names were comparable to each other between studies. While we double coded a random sample of these services, this could have introduced classification bias when grouping the services in this review. We found some outlying estimates that may have been explained by the broad definitions used. For example, ‘counselling’ could provide help for a range of needs or be interpreted differently by students answering a survey. While other reviews have commented that there is variation by treatment received, service location, and by specific populations of students [ 20 , 31 ]. There was not always detailed and consistent data across our included studies to thoroughly evaluate these relationships quantitatively. However, we used a range of synthesis methods to understand the literature.

The methods to examine use of mental health services in the included studies were heterogeneous. While most included binary response options, the reporting periods varied. This meant there were challenges determining whether students used a service at university or before they were students and whether students continued to use services from before university or were new presentations. This may have led to an overestimation of the proportion of students using mental health services. However, we did conduct sensitivity analyses where we excluded these estimates and used meta-regressions to control for reporting period in all analyses. Most of the studies were in the USA. We would therefore caution generalising the findings of this review beyond the USA given the specificities of the healthcare system and infrastructure available to students there, in contrast even to other Western countries.

Implications for practice, policy, and research

The findings from this review emphasise the importance of a range of service provision being available to students who are experiencing psychological distress, and supports current policy efforts to develop well integrated services to help span levels of need. However, reviews in countries with a significant policy emphasis on integration, such as the UK, highlight the challenges defining this process, and the traditionally top-down approach has led to mixed success [ 87 ]. The authors argue this may relate to the highly contextual nature of the problems integration aims to address, therefore it should focus on what needs to be done rather than simply the goal of integration [ 87 ]. The findings of our review, particularly the variety of services, groups of students and numbers using mental health services, support this point. This emphasises the need for detailed local needs assessments, the co-production of the process of integration with relevant stakeholders, and adaptations to meet the needs of the local student population [ 32 , 87 ].

Given the important developmental period students often attend university and the potential important role university’s could play in improving population mental health, the findings of the review suggest a series of important avenues for future research. (1) There is a urgent need to conduct robust international studies to understand student mental health need; (2) international research describing service models available to, acceptable to, and used by, students and similar aged young people; (3) given the few students using formal mental health services across all studies identified in this review, international research should continue to understand alternative models and interventions which might be acceptable and accessible students, such as task shifting, the use of technology, and capacity building within social networks [ 3 , 32 ]; (4) there are no studies of patient flow and how services are linked together which should be a priority of research particularly given the policy emphasis on integration; (5) there is a limited number of studies examining the adequacy of treatment students receive which could help understand how well services are meeting the needs of students who reach services [ 42 ]. (6) To understand how best to adapt current care pathways the experiences of students, healthcare professionals and other stakeholders need to be explored. In some HICs qualitative studies have spoken to students, and staff in counselling services [ 19 , 24 , 25 , 82 ], however given the variation of services we found in this review our findings emphasize the need to speak to healthcare professionals, students and other young in a range of settings; (7) The observed differences between the findings of this review and a review in non-student populations [ 81 ], it is crucial to understand whether university attendance adds additional risk to mental health trajectories. Our findings suggest significant inequalities in access to mental health services among students and settings, the literature should be systematically reviewed to examine this further.

Globally, future research should pay close attention to health and social inequalities between those with and without a university degree. In many countries, particularly those with a small proportions of people ultimately attaining a university degree, there is the potential to exacerbate inequalities by improving the health of a potentially privileged group of people [ 1 , 88 ]. Any initiatives aiming to address student mental health should be considered in the relation to wider population as part of a broader strategy to improve population mental health [ 3 ].

This review is the first effort to systematically describe mental health services available to students and quantify students’ use of them. Most studies were in HICs, in particularly the USA, where we found around a third of students had used a mental health service, similar to the proportion of students with symptoms indicative of mental disorder. However, we found significant variation in the utilisation of mental health services across populations of students, settings, and countries. There were some services, such as those on-campus, used more than others potentially reflecting supply and demand patterns in the included study settings. The empirical literature to date is very limited in terms of the relatively small number of international studies, and few studies examining how services link together, and how students move between them which limits our understanding of the problems students face. Our findings support the current renewed effort to study student mental health internationally and emphasises the importance of well-integrated services to support students’ needs.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Other materials are available in Additional file 1 : Appendices 1–17.

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Acknowledgements

Professor Steve Pilling, Dr Laura Gibbon and Dr Emma Broglia for their advice on the design and conduct of this review.

This report is independent research funded by the National Institute for Health Research ARC North Thames. The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care.

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Mr Tom Osborn (TO) directed the review; conducted the screening, data extraction and quality appraisal; and carried out coding and analyses. Ms. Siying Li (SL) conducted the screening, data extraction, quality appraisal and coding. Professor Peter Fonagy (PF) and Dr. Rob Saunders (RS) contributed to the planning of the review, advised throughout the review process, and commented on the draft. All authors read and approved the final manuscript.

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Supplementary Information

Additional file 1..

Appendix S1. PRISMA checklist. Appendix S2. Key words and MeSH terms. Appendix S3. Screening tool and eligibility assessment tool. Appendix S4. Data Extraction Form (2). Appendix S5. Relevant Sections from the eDESDE-LTC coding framework used for coding services. Appendix S6. search results. Appendix S7. Quality Appaisal (2). Appendix S8. Overall service use. Appendix S9. Overall outpatient service use. Appendix S10. Overall residential service use. Appendix S11. Sensitivity analyses. Appendix S12. Sensitivity analyses – overall service use. Appendix S13. Sensitivity analyses – overall outpatient service use. Appendix S14. Specific service use (multiple DESDE categories) analyses. Appendix S15. Specific outpatient service use analyses. Appendix S16. Sensitivity analyses - specific service use (multiple DESDE categories). Appendix S17. Sensitivity analyses - specific outpatient service use.

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Osborn, T.G., Li, S., Saunders, R. et al. University students’ use of mental health services: a systematic review and meta-analysis. Int J Ment Health Syst 16 , 57 (2022). https://doi.org/10.1186/s13033-022-00569-0

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• University students
• Utilisation
• Accessibility
• Mental health services
• Systematic review
• Meta-analysis

International Journal of Mental Health Systems

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Students Get Real About Mental Health—and What They Need from Educators

Explore more.

• Perspectives
• Student Support

M ental health issues among college students have skyrocketed . From 2013 to 2021, the number of students who reported feelings of depression increased 135 percent, and the number of those with one or more mental health problems doubled. Simply put, the well-being of our students is in jeopardy.

To deepen our understanding of this crisis, we asked 10 students to speak candidly about their mental health. We learned that the issues they face are uniquely theirs and yet collectively ours. We hope these responses will inform your teaching and encourage you to create safe classroom spaces where students feel seen and supported.

Students Share Their Mental Health Struggles—and What Support They Need

We asked these students and recent graduates, In what ways has your mental health affected your college experience, and how can professors better support you? Here’s what they had to say.

Elizabeth Ndungu, graduate student in the School of Professional Studies at Columbia University, United States: My mental health has affected me deeply, and I have sought therapy (which is a big thing for me, as I was born and raised in Africa and therapy is a “Western” concept). I’m a caregiver, so unexpected medical emergencies happen a lot, which mentally stresses me out. However, my professors have given me the time I need to perform my best. They’ve listened.

In general, I think professors can better support students by

Observing and reaching out to students if they notice a pattern of behavior.

Being kind. Giving a student a second chance may very well change their life for the better.

Being supportive. Remember students’ names, learn one unique thing about them that’s positive, or connect with them on LinkedIn or other social media platforms and show them that they have a mentor.

I think schools can better support students by

Admitting diverse students. Don’t just say it—do it. Seek out ways to make the school population more DEIA (diversity, equity, inclusion, accessibility) friendly, especially at historically white colleges. Inclusivity should be everywhere.

Making DEIA initiatives a priority. If you are educating organizations’ next leaders, make sure DEIA initiatives are in each program and cohort. Each of our classes should be tied to knowledge, strategy, and DEIA and its impact.

Raising awareness around mental health. Provide onsite and remote resources for mental assistance, automate low complexity tasks that will cause stress to students, invest in your staff and resources, and ensure that they are happy. Because dealing with unhappy staff will make unhappy students.

Pritish Dakhole, sophomore studying engineering at Birla Institute of Technology and Science, Pilani, India: Mental health is still stigmatized in India. We do not have easy access to therapy sessions, and it is a difficult topic to talk about with family. Thankfully, the scenario is changing.

I have been affected both positively and negatively by my mental health. Positively, because I have become more open-minded and perceptive. Negatively, because it has drained my will to continue, made me tired from all the overthinking, and made me turn to harmful addictions to distract myself from the pain.

Professors and schools could provide better support through

Webinars and meetings that make students aware of the issues they face and how to tackle them.

Group sessions—preferably anonymous—to remove fear.

Feedback systems so that the college is made aware of the problems that lead to a bad mental state.

Flexible education systems that allow students to take breaks during periods of excessive burnout.

Ocean Ronquillo-Morgan, Class of ’21, studied computer science and business administration at the University of Southern California, United States: In February 2021, I called 911 twice in the span of two weeks. I thought I was dying. I felt confused, felt like my body was about to give way, then I called the paramedics. They hooked me up to an EKG and checked my pulse. It was the first time in my life that I experienced panic attacks.

I don’t think anything else could have been done at the classroom level besides extending deadlines in extenuating circumstances. That’s the unfortunate nature of post-education institutions—you still need to make it “fair” for all students.

Alberto Briones, Class of ’22, studied operations and information management at Northern Illinois University, United States: Mental health can be a touchy subject. I have experienced depression and anxiety, but just thinking about all the things I could miss in life if I gave up is what gave me the strength to keep going.

Something professors can do to support students’ mental health is give students time to study between tests. Sometimes professors schedule tests on the same day, and suddenly students must study for three or four exams, all in the same day. It becomes overwhelming and they have to prioritize what tests they need to study more for.

Anjali Bathra Ravikumar, sophomore studying management information systems at The University of Texas at Austin, United States: It is stressful to be an international student at a competitive university in a competitive major. I often find myself having breakdowns and calling my parents in a panic about my future. The relatively restricted job opportunities because of my visa status and uncertainty about whether I’ll be able to forge the career that I want are major reasons behind this.

I have noticed that a lot of my international-student friends are constantly hustling as well, since we feel that we always need to be 10 steps ahead and cannot afford to slow down.

The best thing that a professor can do for me is provide as much guidance as possible in their respective field. Most of my professors have done that. This helps weed out some of the doubts that I have about potential career paths and gives me better clarity about the future. I feel that I cannot ask for more since I don’t expect everyone to be informed of what life is like for an international student.

Schools, on the other hand, can do a lot for us, such as tailor career management resources, offer international student group counseling (I attended one session and it was very liberating), provide financial relief (this is the absolute best thing that can be done for us) during rough times such as COVID-19. For example, when millions of international students had to take online classes during the pandemic, schools could have offered reduced tuition rates.

Something else that can seem small but goes a long way is using inclusive language in university announcements and communication. Most of the emails that we receive from the university feel more tailored to or are directly addressing in-state students (especially when major changes were happening at the beginning of the pandemic), and it is natural for us to feel left out. It might be a simple thing, but a couple of lines at the end of each email announcement with links addressing our specific concerns would make a lot of difference to us since we wouldn’t have to do our own research to figure out what it means for us.

EDUCATE YOURSELF BEFORE DIVING INTO MENTAL HEALTH TALKS

Starting a mental health conversation with students before we are prepared can be harmful. Here’s some advice from “ It’s Time We Talk About Mental Health in Business Classrooms ” by Bahia El Oddi, founder of Human Sustainability Inside Out, and Carin-Isabel Knoop, executive director of the Case Research and Writing Group at Harvard Business School, on how to get ready for these critical conversations.

Learn to talk about mental health. Enhance your mental health literacy through free resources such as the Learn Mental Health Literacy course (specifically for educators), the World Health Organization , and the National Institute of Mental Health . Consult the CDC for language about mental and behavioral health and the American Psychiatry Association for ways to describe individuals presenting with potential mental health disorders .

Reflect on your own biases. Consider how your own story—being raised by a parent with a mental health disorder, for example—may influence how you react and relate to others. Determine your level of openness to discussing the struggles you or your loved ones face or have faced. While it is possible to discuss mental health in the classroom without these anecdotes or personal connections, the courage to be open about your own past can have a transformative effect on classroom discussion.

Understand students may need extra support. Make yourself accessible and approachable to your students from the start so you can establish trust early. Advise them to seek professional help when necessary.

Nick Neral, Class of ’18, studied marketing management at the University of Akron, United States: At the end of my first year of college, I decided to stop participating in Division I athletics and my mental health plummeted. After calling our campus counseling center and waiting six weeks for my first intake appointment, I was told I couldn’t start therapy for two more months, but I could get medication within a couple of days.

After getting prescriptions for an SSRI and Xanax, I never heard from another clinician at my school again. They had no clue if I got the meds, if I took them, how I was doing, and whether I was on campus every day.

When my mental health was at its poorest, I was very disconnected from my classes. I went to, I think, five or six out of 30 finance classes I had during the semester.

I think professors are in this mindset that 20 percent of the class will naturally excel, a majority will do well enough, and a small chunk probably can’t be saved. Sometimes we don’t need saving in the classroom, we just need professors looking out for our well-being. There’s more to the story when a kid doesn’t show up to 80 percent of their classes.

My experience—and seeing others go through similar events—led me to create a platform where therapists can create content and free resources at forhaley.com . Anyone can filter through the content based on how they’re feeling and what’s going on in their life without paying anything or creating an account.

Shreyas Gavit, Class of ’20 in the MBA program at Oakland University, United States: Mental health has affected me because I’ve been depressed and feel trapped; I can’t just go to my home country and come back to the United States whenever I need to. Instead, I have to wait on visa dates, which are a total mess.

Schools and professors could provide more guidance in understanding how immigration has been affected due to COVID-19.

Nigel Hammett, Class of ’19, studied industrial and systems engineering at North Carolina Agricultural & Technical State University, United States: Throughout college I faced mental stress—not only from school, like everyone, but also from many constant family issues going on back home that required my energy. At times, I learned how to push through my feelings and submerge myself in my schoolwork, although I should have unpacked my trauma and handled it in a more mature way.

Students need an environment that encourages inclusive, candid dialogue around how we are feeling. There’s a correlation between social and mental health to overall success in our respective careers.

Alek Nybro, Class of ’21, studied marketing at St. Edward’s University, United States: Anxiety shows up differently for every person. I consider myself to be high functioning. This means when the going gets tough, I dig down and keep pushing, but often to extents that aren’t physically, emotionally, or mentally healthy.

In school, I didn’t know when to step back and take a break. That’s probably my biggest regret about my college years.

Professors could help students by making everything iterative. There shouldn’t be a final grade for assignments or projects. If you want to go back and revise something for a better grade, you should be able to do so.

Patrick Mandiraatmadja, first-year graduate student studying technology management at Columbia University, United States: There are times when I have felt overwhelmed by the number of deadlines and exams crammed into a specific week or few days. I always want to put in my best effort to study, which can lead to less sleep and more anxiety. Then college becomes more about getting through assignments and exams just for the sake of it and less about the learning.

Because of the amount of work or busy work, I have less opportunity to go out and do the things that make me feel alive and excited about life—whether it’s being with friends, exploring my city, exercising, involving myself with professional and social networks outside of school, or simply taking a walk and enjoying my day.

Students want to know that our professors and schools care. Part of that is providing an environment where we can talk about our personal struggles. I also think professors and schools should update the policies on homework, assignments, and exams. Sometimes we may push through and neglect our mental health, not taking the time to care for ourselves, just to get through that homework or finish that exam. The added pressure causes us increased anxiety; it’s no wonder today’s young people are some of the most anxious and unmotivated compared to previous generations.

What We Learned from These Students

These students and young alumni offer an honest glimpse into how mental health struggles have affected their college experiences. Although every student faces their own unique—and sometimes complicated—challenges, we are learning that sometimes the best response is the simplest one.

We must show our students that we care. So lend an empathetic ear, offer that deadline extension, and turn your classroom into a safe haven for open discussion. Your students need it.

Special thanks to Justin Nguyen , founder of Declassified Media , for connecting HBP to these students and young alumni who volunteered to share their experiences.

Help shape our coverage: These students spoke candidly; now it’s your turn. What are the biggest challenges you face in addressing student mental health in and out of the classroom? What experiences have stood out to you? Let us know .

Elizabeth Ndungu is a graduate student in the School of Professional Studies at Columbia University.

Pritish Dakhole is a sophomore studying engineering at Birla Institute of Technology and Science in Pilani, India.

Ocean Ronquillo-Morgan is a member of the University of Southern California’s Class of ’21.

Alberto Briones is a member of Northern Illinois University’s Class of ’22.

Anjali Bathra Ravikumar is a sophomore at The University of Texas at Austin.

Nick Neral studied marketing management at the University of Akron and is a member of the Class of ’18.

Shreyas Gavit studied in the MBA program at Oakland University and graduated as a member of the Class of ’20.

Nigel Hammett studied industrial and systems engineering at North Carolina A&T State University and graduated as a member of Class of ’19.

Alek Nybro studied marketing at St. Edward’s University and graduated as a member of the Class of ’21.

Patrick Mandiraatmadja is a first-year graduate student studying technology management at Columbia University.

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207 Mental Health Research Topics For Top Students

College and university students pursuing psychology studies must write research papers on mental health in their studies. It is not always an exciting moment for the students since getting quality mental health topics is tedious. However, this article presents expert ideas and writing tips for students in this field. Enjoy!

What Is Mental Health?

It is an integral component of health that deals with the feeling of well-being when one realizes his or her abilities, cope with the pressures of life, and productively work. Mental health also incorporates how humans interact with each other, emote, or think. It is a vital concern of any human life that cannot be neglected.

How To Write Mental Health Research Topics

One should approach the subject of mental health with utmost preciseness. If handled carelessly, cases such as depression, suicide or low self-esteem may occur. That is why students are advised to carefully choose mental health research paper topics for their paper with the mind reader.

To get mental health topics for research paper, you can use the following sources:

• The WHO website
• Websites of renowned psychology clinics
• News reports and headlines.

However, we have a list of writing ideas that you can use for your inspiration. Check them out!

Top Mental Disorders Research Topics

• Is the psychological treatment of mental disorders working for all?
• How do substance-use disorders impede the healing process?
• Discuss the effectiveness of the mental health Gap Action Programme (mhGAP)
• Are non-specialists in mental health able to manage severe mental disorders?
• The role of the WHO in curbing and treating mental disorders globally
• The contribution of coronavirus pandemic to mental disorders
• How does television contribute to mental disorders among teens?
• Does religion play a part in propagating mental disorders?
• How does peer pressure contribute to mental disorders among teens?
• The role of the guidance and counselling departments in helping victims of mental disorders
• How to develop integrated and responsive mental health to such disorders
• Discuss various strategies for promotion and prevention in mental health
• The role of information systems in mental disorders

Mental Illness Research Questions

• The role of antidepressant medicines in treating mental illnesses
• How taxation of alcoholic beverages and their restriction can help in curbing mental illnesses
• The impact of mental illnesses on the economic development of a country
• Efficient and cost-effective ways of treating mental illnesses
• Early childhood interventions to prevent future mental illnesses
• Why children from single-parent families are prone to mental illnesses
• Do opportunities for early learning have a role in curbing mental diseases?
• Life skills programmes that everyone should embrace to fight mental illnesses
• The role of nutrition and diet in causing mental illness
• How socio-economic empowerment of women can help promote mental health
• Practical social support for elderly populations to prevent mental illnesses
• How to help vulnerable groups against mental illnesses
• Evaluate the effectiveness of mental health promotional activities in schools

Hot Mental Health Topics For Research

• Do stress prevention programmes on TV work?
• The role of anti-discrimination laws and campaigns in promoting mental health
• Discuss specific psychological and personality factors leading to mental disorders
• How can biological factors lead to mental problems?
• How stressful work conditions can stir up mental health disorders
• Is physical ill-health a pivotal contributor to mental disorders today?
• Why sexual violence has led many to depression and suicide
• The role of life experiences in mental illnesses: A case of trauma
• How family history can lead to mental health problems
• Can people with mental health problems recover entirely?
• Why sleeping too much or minor can be an indicator of mental disorders.
• Why do people with mental health problems pull away from others?
• Discuss confusion as a sign of mental disorders

Research Topics For Mental Health Counseling

• Counselling strategies that help victims cope with the stresses of life
• Is getting professional counselling help becoming too expensive?
• Mental health counselling for bipolar disorders
• How psychological counselling affects victims of mental health disorders
• What issues are students free to share with their guiding and counselling masters?
• Why are relationship issues the most prevalent among teenagers?
• Does counselling help in the case of obsessive-compulsive disorders?
• Is counselling a cure to mental health problems?
• Why talking therapies are the most effective in dealing with mental disorders
• How does talking about your experiences help in dealing with the problem?
• Why most victims approach their counsellors feeling apprehensive and nervous
• How to make a patient feel comfortable during a counselling session
• Why counsellors should not push patients to talk about stuff they aren’t ready to share

Mental Health Law Research Topics

• Discuss the effectiveness of the Americans with Disabilities Act
• Does the Capacity to Consent to Treatment law push patients to the wall?
• Evaluate the effectiveness of mental health courts
• Does forcible medication lead to severe mental health problems?
• Discuss the institutionalization of mental health facilities
• Analyze the Consent to Clinical Research using mentally ill patients
• What rights do mentally sick patients have? Are they effective?
• Critically analyze proxy decision making for mental disorders
• Why some Psychiatric Advance directives are punitive
• Discuss the therapeutic jurisprudence of mental disorders
• How effective is legal guardianship in the case of mental disorders?
• Discuss psychology laws & licensing boards in the United States
• Evaluate state insanity defence laws

Controversial Research Paper Topics About Mental Health

• Do mentally ill patients have a right to choose whether to go to psychiatric centres or not?
• Should families take the elderly to mental health institutions?
• Does the doctor have the right to end the life of a terminally ill mental patient?
• The use of euthanasia among extreme cases of mental health
• Are mental disorders a result of curses and witchcraft?
• Do violent video games make children aggressive and uncontrollable?
• Should mental institutions be located outside the cities?
• How often should families visit their relatives who are mentally ill?
• Why the government should fully support the mentally ill
• Should mental health clinics use pictures of patients without their consent?
• Should families pay for the care of mentally ill relatives?
• Do mentally ill patients have the right to marry or get married?
• Who determines when to send a patient to a mental health facility?

Mental Health Topics For Discussion

• The role of drama and music in treating mental health problems
• Explore new ways of coping with mental health problems in the 21 st century
• How social media is contributing to various mental health problems
• Does Yoga and meditation help to treat mental health complications?
• Is the mental health curriculum for psychology students inclusive enough?
• Why solving problems as a family can help alleviate mental health disorders
• Why teachers can either maintain or disrupt the mental state of their students
• Should patients with mental health issues learn to live with their problems?
• Why socializing is difficult for patients with mental disorders
• Are our online psychology clinics effective in handling mental health issues?
• Discuss why people aged 18-25 are more prone to mental health problems
• Analyze the growing trend of social stigma in the United States
• Are all people with mental health disorders violent and dangerous?

Mental Health Of New Mothers Research Topics

• The role of mental disorders in mother-infant bonding
• How mental health issues could lead to delays in the emotional development of the infant
• The impact of COVID-19 physical distancing measures on postpartum women
• Why anxiety and depression are associated with preterm delivery
• The role of husbands in attending to wives’ postpartum care needs
• What is the effectiveness of screening for postpartum depression?
• The role of resilience in dealing with mental issues after delivery
• Why marginalized women are more prone to postpartum depression
• Why failure to bond leads to mental disorders among new mothers
• Discuss how low and middle-income countries contribute to perinatal depression
• How to prevent the recurrence of postpartum mental disorders in future
• The role of anti-depression drugs in dealing with depression among new mothers
• A case study of the various healthcare interventions for perinatal anxiety and mood disorders

What Are The Hot Topics For Mental Health Research Today

• Discuss why mental health problems may be a result of a character flaw
• The impact of damaging stereotypes in mental health
• Why are many people reluctant to speak about their mental health issues?
• Why the society tends to judge people with mental issues
• Does alcohol and wasting health help one deal with a mental problem?
• Discuss the role of bullying in causing mental health disorders among students
• Why open forums in school and communities can help in curbing mental disorders
• How to build healthy relationships that can help in solving mental health issues
• Discuss frustration and lack of understanding in relationships
• The role of a stable and supportive family in preventing mental disorders
• How parents can start mental health conversations with their children
• Analyze the responsibilities of the National Institute for Health and Care Excellence (NICE)
• The role of a positive mind in dealing with psychological problems

Good Research Topics On Refugees Mental Health

• Why do refugees find themselves under high levels of stress?
• Discuss the modalities of looking after the mental health of refugees
• Evaluate the importance of a cultural framework in helping refugees with mental illnesses
• How refugee camp administrators can help identify mental health disorders among refugees
• Discuss the implications of dangerous traditional practices
• The role of the UNHCR in assisting refugees with mental problems
• Post-traumatic Stress Disorder among refugees
• Dealing with hopelessness among refugees
• The prevalence of traumatic experiences in refugee camps
• Does cognitive-behavioural therapy work for refugees?
• Discuss the role of policy planning in dealing with refugee-mental health problems
• Are psychiatry and psychosomatic medicine effective in refugee camps?
• Practical groups and in‐group therapeutic settings for refugee camps

Adolescent Mental Health Research Topics

• Discuss why suicide is among the leading causes of death among adolescents
• The role of acting-out behaviour or substance use in mental issues among adolescents
• Mental effects of unsafe sexual behaviour among adolescents
• Psychopharmacologic agents and menstrual dysfunction in adolescents
• The role of confidentiality in preventive care visits
• Mental health disorders and impairment among adolescents
• Why adolescents not in school risk developing mental disorders
• Does a clinical model work for adolescents with mental illnesses?
• The role of self-worth and esteem in dealing with adolescent mental disorders
• How to develop positive relationships with peers
• Technology and mental ill-health among adolescents
• How to deal with stigma among adolescents
• Curriculum that supports young people to stay engaged and motivated

Research Topics For Mental Health And Government

• Evaluate mental health leadership and governance in the United States
• Advocacy and partnerships in dealing with mental health
• Discuss mental health and socio-cultural perspective
• Management and coordination of mental health policy frameworks
• Roles and responsibilities of governments in dealing with mental health
• Monitoring and evaluation of mental health policies
• What is the essence of a mental health commission?
• Benefits of mental well-being to the prosperity of a country
• Necessary reforms to the mental health systems
• Legal frameworks for dealing with substance use disorders
• How mental health can impede the development of a country
• The role of the government in dealing with decaying mental health institutions
• Inadequate legislation in dealing with mental health problems

Abnormal Psychology Topics

• What does it mean to display strange behaviour?
• Role of mental health professionals in dealing with abnormal psychology
• Discuss the concept of dysfunction in mental illness
• How does deviance relate to mental illness?
• Role of culture and social norms
• The cost of treating abnormal psychology in the US
• Using aversive treatment in abnormal psychology
• Importance of psychological debriefing
• Is addiction a mental disease?
• Use of memory-dampening drugs
• Coercive interrogations and psychology

Behavioural Health Issues In Mental Health

• Detachment from reality
• Inability to withstand daily problems
• Conduct disorder among children
• Role of therapy in behavioural disorders
• Eating and drinking habits and mental health
• Addictive behaviour patterns for teenagers in high school
• Discuss mental implications of gambling and sex addiction
• Impact of maladaptive behaviours on the society
• Extreme mood changes
• Confused thinking
• Role of friends in behavioural complications
• Spiritual leaders in helping deal with behavioural issues
• Suicidal thoughts

Latest Psychology Research Topics

• Discrimination and prejudice in a society
• Impact of negative social cognition
• Role of personal perceptions
• How attitudes affect mental well-being
• Effects of cults on cognitive behaviour
• Marketing and psychology
• How romance can distort normal cognitive functioning
• Why people with pro-social behaviour may be less affected
• Leadership and mental health
• Discuss how to deal with anti-social personality disorders
• Coping with phobias in school
• The role of group therapy
• Impact of dreams on one’s psychological behaviour

Professional Psychiatry Research Topics

• The part of false memories
• Media and stress disorders
• Impact of gender roles
• Role of parenting styles
• Age and psychology
• The biography of Harry Harlow
• Career paths in psychology
• Dissociative disorders
• Dealing with paranoia
• Delusions and their remedy
• A distorted perception of reality
• Rights of mental caregivers
• Dealing with a loss
• Handling a break-up

Consider using our expert research paper writing services for your mental health paper today. Satisfaction is guaranteed!

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Evidence-based Approaches to Support Student Mental Health

• Andrea Feldman
• 24 April 2024

The college years throw a lot of new challenges at us. Maybe you’re the first in your family to go to college. You’re developing a new sense of independence. Figuring out how to live with roommates. Dealing with new financial responsibilities and academic pressures.

That’s a lot all by itself — but as Associate Professor Sam Rosenthal noted during her recent Health Equity lecture outlining the behavioral health of college-age students, a staggering 75% of mental health disorders are established by the mid-twenties. That means that the 18-25 cohort exhibits the highest rates of anxiety and depressive symptoms, and they’re also extremely vulnerable to developing parallel addictive behaviors.

“Those with social support reduce their risk of insomnia by 33%, their risk of anxiety by 47% and their risk of depression by 50%. That’s dramatic.”

But the data is only one side of the story, and Rosenthal prefaced her talk by noting, “I do want you to know we’re going to get to a positive note of the solutions by the end.” And it may not surprise you to learn that community-building — strengthening our real-world bonds to others — plays a crucial role in improving our individual mental health. (Put down that phone, while you’re at it.)

A Career Built on Studying Behavioral Health

Rosenthal has built an impressive career on her research into the multi-factor forces driving mental-health trends in young adults.

In addition to teaching and serving as the director of JWU’s Center for Student Research and Interdisciplinary Collaboration, she serves as an evaluator for the Rhode Island Department of Health and as the lead epidemiologist for the State Epidemiological Outcomes Workgroup (SEOW). Under the aegis of SEOW, she administers the RI Young Adult Survey (RIYAS), which focuses on the behavioral health of 18-25-year-olds.

Assessing the Pandemic Spike

Depression rates among young adults have doubled in the past 10 years. But the pandemic sent these rates soaring — Rosenthal calls the spike “extreme” — due to a polycrisis of factors, including social isolation, disrupted academic studies, and unprecedented loss. During the 2020-21 academic year, noted Rosenthal, 60% of college-age students reported at least one mental health disorder, and 75% experienced psychological distress. 1 in 5 young adults in Rhode Island reported losing a loved one to Covid-19.

Once you start taking into account the social upheaval of recent years — from gun violence to racial discrimination, climate change anxiety and political turmoil — and you have a massive amount of collective trauma having a ripple effect on already fragile mental health states.

Rosenthal provided a top-level overview of two recent studies. The Healthy Mind study surveyed more than 76,000 students from 400 institutions during the 2022-23 academic year. In October 2022, Rosenthal and her co-researchers used an NIH grant to survey 586 JWU students assessing their levels of depression, anxiety, insomnia and social support.

While the Healthy Mind study clocked depression rates at 41%, the JWU case study reported 53% — that’s “higher than what we saw in the national study, but actually comparable to what we saw in the Rhode Island state study,” explained Rosenthal. “And also we have a huge representation of sexual gender minority students, which is likely to be driving some of these higher rates for us as well.” (The JWU study demographics broke down as 15.1% cisgender male, 47.4% cisgender female and 37.5% sexual or gender minority.)

So, what are the solutions for combatting these numbers? For Rosenthal, who has done multiple studies correlating social media use and depression, building up social support networks is “critically important”: “Those with social support reduce their risk of insomnia by 33%, their risk of anxiety by 47% and their risk of depression by 50%. That’s dramatic.”

“Gratitude is really powerful. I often tell my students to break up anxiety with gratitude.”

Mindfulness, Quiet Hours & Other Mental Health Boosts

Rosenthal opened the conversation to students and faculty in the audience to share their ideas for boosting our community connections and strengthening overall well-being.

Sarah and Jasmine, two undergraduate students in the Public Health program , shared how much JWU’s 3-credit Mindfulness for Health & Wellbeing class helped them. (This course is currently an elective, but there is talk of making it requirement.)

The course provides students with the opportunity to learn the principles of mindfulness, develop their own mindfulness mediation practice, and apply principles of mindfulness to daily life.

Prior to taking the class, Jasmine had been struggling with time management. Having never meditated before, it took her some time to acclimate to the practice. But now, she says, “I feel like this class has definitely not only forced me to try new things, but I’ve made it a part of my daily routine. It’s definitely helped me!”

Initially, Sarah noted that she “had a really hard time sitting down with myself and going through [the process].” Gradually, with the guidance of Professor Jennifer Swanberg, “I've been able to develop my own practice that I find beneficial. There are those times where I still feel frustration, but now I feel more prepared to deal with it.”

In the Occupational Therapy department, faculty celebrate Grati-Tuesdays, where they keep a running list of what they are thankful for. “Gratitude is really powerful,” noted Assistant Professor Kathryn Burke. “I often tell my students to break up anxiety with gratitude. Thinking about something that you’re grateful for can sometimes help get your brain out of that downward spiral that everything is terrible.”

Other suggestions included:

• A peer mentorship program to help increase social support
• Moving 11:59pm assignment deadlines to 8pm
• Minimizing the number of early morning classes
• Enforcing quiet hours in residence halls
• Expanding the number of safe community spaces (like the Bridge for Diversity, Equity and Social Justice ) where students can share with their peers

“Creating a sense of belonging is crucially important,” concluded Rosenthal. “We need to have safe spaces to hold people when the rest of the world feels unsafe.”

JWU has a wealth of confidential mental health resources, including counseling services in Providence and Charlotte . Individual counseling sessions and consultations are available by appointment, as well as resources for mental health screenings, education and crisis intervention.

Related Reading:

6 Ways College Students Can Improve Their Mental Health

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The development and evolution of the research topic on the mental health of college students: A bibliometric review based on CiteSpace and VOSviewer

Affiliations.

• 1 School of Marxism, Zhejiang University of Technology, Hangzhou, China.
• 2 School of Humanities and Social Sciences, Beihang University, Beijing, China.
• 3 College of Foreign Languages, Zhejiang University of Technology, Hangzhou, China.
• 4 School of Management, Zhejiang University of Technology, Hangzhou, China.
• 5 Department of Education Information Technology, Faculty of Education, East China Normal University, Shanghai, China.
• PMID: 38638989
• PMCID: PMC11024628
• DOI: 10.1016/j.heliyon.2024.e29477

Background: With the advances in society and in response to changing times, college students have had to face multiple challenges. These challenges frequently affect the mental health of college students, leading to significant consequences for their social lives, personal well-being, and academic achievements, thereby attracting extensive societal attention. Therefore, examining the current status of research topics related to the mental health of college students can assist academia in dissecting the influencing factors and seeking solutions at their source or through early intervention. This can contribute to a better understanding of and effectively address this challenge.

Method: CiteSpace and VOSviewer were used to conduct a bibliometric analysis of 1609 journal articles indexed in the Web of Science (WoS) database over the past two decades (2000-2022), which helped identify the current state of research and hot topics in the field based on development trends. Furthermore, this study analyzes and discusses the core authors, high-productivity countries and organizations, key journals, and keyword clustering in this field. This study clarifies the current research landscape, analyzes evolving trends based on developmental trajectories, and identifies forefront research hotspots. This study provides scholars with reference research directions and ideas for conducting subsequent studies.

Results: Since the beginning of the 21st century, research on college students' mental health has increased, especially in the past three years, and due to the impact of the COVID-19 pandemic and online distance learning, the number of publications has increased rapidly. With the increase in attention and publication volume, the countries and organizations contributing papers as well as core journals have all started to take shape. Cluster and evolution analyses found that several stable research topics have been formed in this research field, and many new and diverse topics are continuously emerging with time.

Conclusion: and prospect: The findings prove that the field of college students' mental health has begun to take shape, gradually shifting from conceptual research to the implementation of specific interventions. However, whether specific interventions are effective and how effective they are require further investigation.

Keywords: Bibliometrics; CiteSpace; Higher education; Mental health; VOSviewer.

© 2024 The Authors. Published by Elsevier Ltd.

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In CDC survey, 37% of U.S. high school students report regular mental health struggles during COVID-19 pandemic

Many high school students have reported experiencing mental health challenges during the coronavirus outbreak, according to recently published survey findings from the Centers for Disease Control and Prevention (CDC). High school students who are gay, lesbian or bisexual, as well as girls, were especially likely to say their mental health has suffered during the pandemic.

This analysis explores U.S. high school students’ self-reported mental health challenges during the COVID-19 pandemic. It expands on Pew Research Center surveys that have explored U.S. adults’ mental health difficulties during this time. Not all of the survey questions asked specifically about mental health during the pandemic.

This analysis relies on the Center for Disease Control and Prevention’s Adolescent Behaviors and Experiences Survey (ABES), which was conducted from January to June 2021 to assess students’ health-related behaviors and experiences during the COVID-19 pandemic. ABES surveyed high school students in grades 9-12 attending U.S. public and private schools. More information about the survey and its methodology can be found on the CDC’s website.

The results from this one-time survey are not directly comparable to previous CDC surveys on these topics.

Overall, 37% of students at public and private high schools reported that their mental health was not good most or all of the time during the pandemic, according to the CDC’s Adolescent Behaviors and Experiences Survey , which was fielded from January to June 2021. In the survey, “poor mental health” includes stress, anxiety and depression. About three-in-ten high school students (31%) said they experienced poor mental health most or all of the time in the 30 days before the survey. In addition, 44% said that, in the previous 12 months, they felt sad or hopeless almost every day for at least two weeks in a row such that they stopped doing some usual activities. (Not all of the survey questions asked specifically about mental health during the pandemic.)

High school students who are gay, lesbian or bisexual reported higher rates of mental health stresses than their heterosexual (straight) peers. The share of LGB high schoolers who said their mental health was not good most of the time or always during the pandemic was more than double that of heterosexual students (64% vs. 30%). More than half of LGB students (55%) said they experienced poor mental health at least most of the time in the 30 days before the survey, while 26% of heterosexual teens said the same. And about three-quarters of LGB high schoolers (76%) said they felt sad or hopeless almost daily for at least two weeks such that they stopped doing some of their usual activities, compared with 37% of heterosexual students.

There were also differences by gender. About half of high school girls (49%) said their mental health was not good most of the time or always during the COVID-19 outbreak – roughly double the share of boys who said this (24%). And roughly four-in-ten girls (42%) reported feeling this way in the 30 days before the survey; 20% of boys said the same. About six-in-ten high school girls (57%) reported that at some point in the 12 months before taking the survey (in the first half of 2021) they felt sad or hopeless almost every day for at least two weeks in a row such that they stopped doing some usual activities, compared with 31% of high school boys who said this.

LGB high schoolers were also more likely than their heterosexual peers to have sought mental health care – including treatment or counseling for alcohol or drug use – via telemedicine during the COVID-19 pandemic. Around one-in-five LGB students (19%) said they received treatment this way at some point during the pandemic, compared with 6% of heterosexual students. Girls were more likely than boys to have received mental health care through telemedicine (10% vs. 7%, respectively).

Pandemic-related disruptions to schooling, socializing and family life have created a situation that the U.S. surgeon general has described as a “ youth mental health crisis ,” with high rates of teens experiencing distress. But public health experts had called attention to teen mental health even before the coronavirus outbreak. For instance, a separate CDC survey conducted in 2015 found that LGB teens were at greater risk of depression than their heterosexual peers. And a Pew Research Center analysis of pre-pandemic data from the National Survey for Drug Use and Health showed teenage girls were more likely than their male peers to report recent experiences with depression , as well as to receive treatment for it.

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Katherine Schaeffer is a research analyst at Pew Research Center

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Supporting mental health and wellbeing of university and college students: A systematic review of review-level evidence of interventions

Joanne deborah worsley.

1 Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom

Andy Pennington

2 Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom

Rhiannon Corcoran

Associated data.

The authors have provided detailed information regarding their search strategy and the articles that were found. The information necessary to replicate the study is in the Supporting information files.

The review of reviews had three aims: (i) to synthesize the available evidence on interventions to improve college and university students’ mental health and wellbeing; (ii) to identify the effectiveness of interventions, and (iii) to highlight gaps in the evidence base for future study.

Electronic database searches were conducted to identify reviews in English from high-income OECD countries published between 1999 and 2020. All review-level empirical studies involving post-secondary students attending colleges of further education or universities that examined interventions to improve general mental health and wellbeing were included. Articles were critically appraised using an amended version of the AMSTAR 2 tool. Evidence from the included reviews were narratively synthesized and organised by intervention types.

Twenty-seven reviews met the review of reviews inclusion criteria. The quality of the included reviews varied considerably. Intervention types identified included: mindfulness-based interventions, psychological interventions, psychoeducation interventions, recreation programmes, relaxation interventions, setting-based interventions, and stress management/reduction interventions. There was evidence that mindfulness-based interventions, cognitive behavioural therapy (CBT), and interventions delivered via technology were effective when compared to a passive control. Some evidence suggested that the effects of CBT-related interventions are sustained over time. Psychoeducation interventions do not appear to be as effective as other forms of intervention, with its effects not enduring over time.

Conclusions

The review of reviews located a sizeable body of evidence on specific interventions such as mindfulness and cognitive-behavioural interventions. The evidence suggests that these interventions can effectively reduce common mental health difficulties in the higher education student body. Gaps and limitations in the reviews and the underlying body of evidence have been identified. These include a notable gap in the existing body of review-level evidence on setting-based interventions, acceptance and commitment training, and interventions for students attending colleges in UK settings.

Introduction

Poor mental health of further and higher education students is a growing public policy concern [ 1 , 2 ]. Recent research indicates that levels of common mental health difficulties, self-harm, and suicide are increasing among young people, especially young women [ 3 – 5 ]. There have been particular concerns about university students, with research and official figures suggesting that there has been an increase in the number of students experiencing mental health problems over recent years. Data on young people aged 16 to 24 years from three UK National Psychiatric Morbidity Surveys (2000, 2007, and 2014) highlighted that the prevalence of common mental health problems, suicide attempts, and self-harm was similar in students and non-students [ 6 ]. Between 2007 and 2014, however, the prevalence of common mental health problems increased in female students but not in female non-students. Although the prevalence of non-suicidal self-harm increased between 2000 and 2014 in both students and non-students, a smaller proportion of students than non-students reported suicide attempts [ 6 ]. US college students are also increasingly reporting common mental health problems and suicidality [ 7 ]. It is, therefore, important for educational institutions to offer accessible and effective interventions for their students.

Research suggests that young people’s mental health is poorer during university study than before entry. In a UK study, anxiety and depression were found to be higher at mid-course compared to one-month pre-entry into university [ 8 ]. Similarly, a UK cohort study found that levels of psychological distress increase on entering university and levels of distress did not return to pre-registration levels [ 9 ]. Other studies have also demonstrated that students’ mental health is poorer during their first year of study compared to pre-entry into university [ 10 ].

Concern around students’ mental health has prompted recent focus on mental health provision [ 11 ]. Services offered within educational institutions typically include either individual or group counselling. Although these services are well-positioned to provide mental health care, many college counselling centres across the US are under-resourced and operate at full capacity during much of the year [ 12 ]. According to an online survey of UK student counselling services, there was an increase in demand for support services over a three-year period in further education sectors [ 13 ]. Similarly, there has been an increase in the number of students seeking support from university counselling services [ 14 ]. Despite this increase, the capacity of professional services to offer 1 to 1 support to large numbers of students is limited [ 2 ]. Although requests for professional support have increased substantially [ 15 ], only a third of higher education students with mental health problems seek support from counselling services in the UK [ 16 ]. Many students do not seek help due to barriers such as stigma or lack of awareness of services [ 17 – 19 ]. Without formal support or intervention, there is a risk of further deterioration.

Given the increase in mental health problems among students and the surge in demand for formal support [ 1 , 20 , 21 ], reactive services alone cannot effectively support student mental health and wellbeing [ 11 ]. Educational institutions have recognised the need to move beyond traditional forms of support and provide alternative, more accessible interventions aimed at improving mental health and wellbeing. Such institutions have unique opportunities to identify, prevent, and treat mental health problems because they support multiple aspects of students’ lives. Although interventions exist to improve general mental health and wellbeing of students, research on the effectiveness of the various interventions has not been effectively synthesised to date. To address this, we conducted a review of review-level evidence to capture the largest body of existing research on general mental health and wellbeing interventions for college and university students. As there was a substantial body of reviews to be synthesised, the purpose of our review of review-level evidence was to summarise and synthesise this evidence and identify remaining gaps and limitations in the evidence base. This review of reviews aimed to: (i) synthesize the available evidence on interventions to improve college and university students’ mental health and wellbeing; (ii) identify the effectiveness of interventions, and (iii) highlight gaps for future study. The review of reviews explored two questions:

• What is the current evidence on interventions to improve the general mental health and wellbeing of college and university students?
• What does the evidence tell us about the effectiveness of current interventions and what interventions are likely to be the most effective?

Study identification

Search strategy.

We conducted a search of English language peer-reviewed literature of MEDLINE and MEDLINE In Process and other Non-Indexed Citations (via OVID) ; PsycINFO (via EBSCOhost) ; Social Science Citation Index (via Web of Science) ; and CINAHL Plus (via EBSCOhost) , from 1999 (01/01/1999) to 2020 (31/12/2020), which reflects review-level evidence of interventions before the global COVID-19 pandemic. Reference lists of all eligible reviews were hand-searched in order to identify additional relevant reviews (citation ‘snowballing’). Examples of each search strategy can be found in S1 File .

Inclusion and exclusion criteria

We included all review-level empirical studies (reviews of Randomised Controlled Trials [RCTs] and/or Non-Randomised Studies of Interventions [NRSIs]) involving post-secondary students attending colleges of further education or universities that examined interventions to improve general mental health and wellbeing. Both universal and indicated interventions aimed at improving mental health were included. Universal interventions are aimed at students without any pre-existing mental health problems, whilst indicated interventions are aimed at students who meet criteria for mild to moderate levels of mental health problems or have acknowledged an existing mental health problem, such as depression or anxiety. Thus, studies were included involving both general student populations and students with mental health problems. Studies were excluded if they examined interventions to address specific, pre-existing neurodevelopmental conditions (e.g., attention deficit hyperactivity disorder) or focused on non-health or wellbeing outcomes (e.g., educational performance outcomes). The search was limited to English language literature. Only peer-reviewed reviews published from year 1999 onwards from high-income countries of the Organisation for Economic Co-operation and Development (OECD) were included.

Titles and abstracts of publications were independently screened by two reviewers (JW and AP). Full-text copies of relevant reviews were obtained and assessed independently for inclusion by two reviewers (JW and AP). Any queries or disagreements were resolved by discussion or by recourse to a third reviewer (RC).

Assessment of methodological quality

All reviews that met the inclusion criteria were critically appraised using an amended version of the AMSTAR 2 tool [ 22 ]. The tool was amended to make it sensitive enough to differentiate between the various methodological standards of this particular body of evidence (see S2 File ). The reviews were quality assessed independently by two reviewers. Based on the results of the critical appraisal, reviews were then categorised as: (i) higher methodological quality (score 10 or above); (ii) moderate methodological quality (score 6 to 9); or (iii) lower methodological quality (score 0 to 5). This is a rating/categorisation of relative methodological quality across this body of evidence.

Data extraction and synthesis

The following data was extracted by the first author and checked for accuracy by the second author: aims, primary study design, setting/country, type of intervention, comparator (if any), population, outcomes reported, main findings in relation to the review questions, limitations, and conclusions specified by authors. Key findings from the reviews were tabulated and narratively synthesised [ 23 ]. Findings were grouped by intervention category, with evidence from higher methodological quality reviews reported first and in greater detail [following 24 , 25 ].

The search generated 4,006 records. Title and abstract screening resulted in 44 articles that met the study inclusion criteria. Full-text screening resulted in the inclusion of 27 reviews. Seventeen reviews were excluded as not meeting inclusion criteria (see S3 File ). A summary of our study selection process is presented in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flow Diagram ( Fig 1 ).

Characteristics of the included reviews

The characteristics of included reviews are summarised within Table 1 . Information on setting (country) should be provided within Table 1 ; however, very few reviews specified the country in which interventions took place.

Overview of quality of included reviews

As shown in Table 1 , the methodological quality of the reviews varied. Using the AMSTAR 2 quality assessment tool, eleven reviews were categorised as higher methodological quality, ten reviews were categorised as moderate methodological quality, and seven reviews were categorised as lower methodological quality.

Findings of included reviews

1. mindfulness-based interventions.

A systematic review and meta-analysis of RCTs (rated as higher methodological quality) of different interventions for common mental health problems in 3396 university and college students found that MBIs were effective in reducing both depression and generalized anxiety disorder in the short term but were not durable [ 26 ]. In their meta-analysis, the authors found evidence that MBIs led to statistically significant reductions in depression (pooled effect size: -0.52, 95% CI: -0.88 to -0.16). Art, exercise and peer support interventions (-0.76, 95% CI: -1.19 to -0.32), and cognitive-behavioural related interventions (-0.59, 95% CI: -0.72 to -0.45) led, however, to greater reductions. They found no evidence that the effects of MBIs on depression were sustained over time. They also found evidence that MBIs significantly reduced anxiety (-0.49, 95% CI: -0.84 to -0.15) but, again, other interventions such as peer support and music (-0.84, 95% CI: -1.19 to -0.49) and CBT related interventions (-0.39, 95% CI: -0.55 to -0.22) led to greater reductions.

Another systematic review and meta-analysis of RCTs, which was graded as higher quality, examined the effectiveness of MBIs for mental health outcomes in 4211 post-secondary students [ 27 ]. Halladay and colleagues found evidence that MBIs significantly reduced symptoms of depression (Standardised Mean Difference [SMD] -0.49, 95% CI: -0.68 to -0.30), anxiety (SMD -0.53, 95% CI: -0.78 to -0.29), and perceived stress (SMD -0.39, 95% CI: -0.50 to -0.27) when compared to a passive control group (receiving no intervention/on waiting list). There was, however, no significant difference between the MBI intervention group in levels of depression, anxiety or perceived stress when compared to an active control group receiving health education, relaxation, physical activity, or other approaches including CBT.

Halladay et al. [ 27 ] also analysed the impacts of different lengths of intervention. They found that there was no significant difference in effects, for depressive symptoms, anxiety and stress, between brief and longer interventions. They also analysed the impact of traditional compared to adapted interventions (i.e., Mindfulness-Based Stress Reduction [MBSR] versus Mindfulness-Based Cognitive Therapy [MBCT] versus other or adapted MBIs), and found that MBCT (SMD: -1.21, 95% CI: -1.76 to -0.66) was more effective than both MBSR (SMD = -0.44, 95% CI: -0.72 to -0.16, p = 0.01) and other MBIs (SMD = -0.29, 95% CI: -0.45 to -0.12, p<0.01). When compared to no intervention, MBCT was found to be the most effective type of MBI.

Studies examining whether effects were sustained over time (follow-up studies) were split by type of intervention. Halladay et al. [ 27 ] found that MBCT interventions demonstrated sustained reductions in depression one month after (post-) intervention in two studies with a total of 64 participants (Mean Difference [MD] on the Beck Depression Inventory -5.06, 95% CI: -6.52 to -3.59). Other MBIs did not demonstrate sustained reductions in depression at one month or 2–3 months post-intervention in three studies (with a total of 374 participants), although reductions in depression were found at 4–5 months post-intervention in two studies (with a total of 191 participants; SMD -0.43, 95% CI: -0.72 to -0.14). MBCT interventions also demonstrated sustained reductions in anxiety symptoms at both 1-month in two studies (with a total of 66 participants; MD on Beck Anxiety Inventory [BAI] -7.12, 95% CI: -8.23 to -5.97) and 6 months in two studies post-intervention (a total of 65 participants; MD on BAI -5.95, 95% CI: -10.78 to -1.13). Other MBIs demonstrated significant reductions 1-month post-intervention in one study using a different measure (with a total of 33 participants; MD Hamilton Anxiety Scale -9.50, CI: -17.27 to -1.73).

A systematic review and meta-analysis of RCTs (rated as higher methodological quality) of MBIs for mental and physical health in university students found that MBIs were effective in reducing distress, depression and state anxiety when compared to passive controls [ 28 ]. In their meta-analysis, the authors found evidence that MBIs led to significantly significant reductions in distress (SMD -0.47, 95% CI: -0.60 to -0.34), depression (SMD -0.40, 95% CI -0.57 to -0.24), and state anxiety (MD -3.18, 95% CI -5.51 to -0.85) when compared to a passive control (receiving no intervention/waiting list). MBIs led to improvements in wellbeing (SMD 0.35, 95% CI 0.21 to 0.50) when compared to a passive control. Effects of MBIs lasted beyond three months for distress (SMD -0.32, 95% CI -0.50 to -0.13). When compared with active control groups, MBIs significantly reduced distress (SMD -0.37, 95% CI -0.56 to -0.18) and state anxiety (MD -5.95, 95% CI -9.49 to -2.41), but not depression (SMD -0.19, 95% CI -0.43 to 0.05) and wellbeing (SMD -0.08, 95% CI -0.43 to 0.27).

Ma and colleagues conducted a meta-analytic review of RCTs (rated as higher methodological quality) of MBIs [ 29 ]. They found that MBIs were effective in reducing depressive symptoms in university students (effect size: 0.52, 95% CI 0.39 to 0.65). The authors found evidence that universal MBIs (effect size: 0.41, 95% CI 0.28 to 0.55), selective MBIs (effect size: 0.44, 95% CI 0.18 to 0.70), and indicated MBIs (effect size: 0.88, 95% CI 0.64 to 1.11) led to significant reductions in depressive symptoms.

Bamber and Morpeth’s [ 30 ] review, graded as moderate quality, included a meta-analysis of evidence on the effects of MBIs on anxiety in 1492 college students. A number of primary study designs were included: studies with two-group comparisons (e.g., MBI versus control) and studies with pre-test and post-test analysis of MBI (one-group MBI). They found MBIs significantly reduced anxiety, compared to no-treatment controls (ES 0.56, 95% CI: 0.42 to 0.70, p<0.001). MBI groups’ pre and post intervention comparisons showed large significant reductions in anxiety. There was, however, a small but significant reduction in control group anxiety pre/post comparisons. They also found that higher numbers of sessions (number not specified) increased the effects of MBIs (p = 0.01), with more sessions leading to greater reductions in anxiety.

Fenton et al. [ 31 ] conducted a moderate quality systematic review of evidence on the impacts of different recreation programmes, including MBIs, on mental health outcomes in post-secondary students in North America. Randomised controlled trials, non-randomised with control, and non-randomised no control studies were all included. They found that mindfulness interventions reduced depression, anxiety, stress, and negative mood.

Conley et al. [ 32 ] conducted a moderate quality review and meta-analysis of evidence on the impact of universal mental health prevention programmes including MBIs for higher education students. The review included two study designs: quasi-experimental and random designs. They found that skill-training programmes with supervised practice were significantly more effective than both skill-training programmes without supervised practice and psychoeducation in reducing depression, anxiety, stress, and general psychological distress. Conley and colleagues found that relaxation interventions demonstrated the most overall benefit in terms of effectiveness, followed by mindfulness interventions and cognitive-behavioural interventions that did not differ from each other.

Regehr et al. [ 33 ] conducted a review and meta-analysis (rated as lower methodological quality) of evidence on the effectiveness of preventative interventions in reducing mental health outcomes in 1431 university students, including randomised and parallel cohort designs. Regehr and colleagues found that mindfulness-based interventions focussing on stress reduction significantly reduced symptoms of anxiety and depression. In their meta-analysis, mindfulness-based interventions were assessed for their impact on anxiety. They found that mindfulness-based interventions led to significant improvements, compared to control groups (SMD -0.73, 95% CI: -1.00 to -0.45).

Conley et al. [ 34 ] reviewed evidence on the effectiveness of 83 (controlled) universal promotion and prevention interventions (rated as lower methodological quality). These authors explored whether skill-orientated interventions were more effective with or without supervised skills practice. The authors also examined the effectiveness of different strategies employed in skill-oriented interventions such as cognitive-behavioural interventions, mindfulness interventions, relaxation interventions, and meditation in quasi-experimental and random designs. They found that skill-oriented interventions were more effective with supervised practice, and that supervised skills practice interventions reduced depression, anxiety, and stress. They found mindfulness interventions to be the most effective form among the skill-oriented programmes containing supervised practice. Mindfulness interventions were significantly more effective in comparison to other interventions (the proportion of all significant post-intervention outcomes combined was 78.8% for mindfulness, in comparison to psychoeducation [12.5%], cognitive behavioural [43.4%], relaxation [27.1%], meditation [13%], and other interventions [21.9%]).

Bamber and Schneider [ 35 ] explored the effects of MBIs such as Mindfulness Based Stress Reduction (MBSR) and Mindfulness Meditation (MM) on mental health outcomes including anxiety and stress in college students (rated as lower methodological quality). Both MBSR and MM were found to significantly reduce symptoms of anxiety and stress.

2. Psychological interventions (e.g., cognitive-behavioural interventions)

Huang et al. [ 26 ] conducted a systematic review and meta-analysis of RCT evidence (rated as higher methodological quality) on the effectiveness of interventions for common mental health difficulties in 3396 university and college students. They found that cognitive behavioural therapy (CBT) had significant positive effects on depression and generalized anxiety disorder. Meta-analysis results showed that cognitive-behavioural-related interventions led to greater reductions in depression (-0.59, 95% CI: -0.72 to -0.45) than mindfulness-based interventions (-0.52, 95% CI: -0.88 to -0.16) and attention/perception modification (-0.46, 95% CI: -1.06 to 0.13). Other interventions (art, exercise, and peer support) led to a greater reduction in depression (-0.76, 95% CI: -1.19 to -0.32). The follow-up (pooled) effect size of cognitive-behavioural related interventions (-0.75, 95% CI: -0.95 to -0.54) had a greater significant effect (the follow-up ranged from 2 weeks to 7 months post intervention).

CBT related interventions were associated with significant (pooled) reductions in anxiety (-0.39, 95% CI: -0.55 to -0.22). The pooled effect of other interventions (peer support and music; -0.84, 95% CI: -1.19 to -0.49) and mindfulness (-0.49, 95% CI: -0.84 to -0.15) for generalised anxiety disorder were associated with greater reductions in anxiety compared to CBT.

Winzer et al. [ 36 ] conducted a systematic review and meta-analysis (rated as higher methodological quality) to assess whether the effects of mental health promotion and mental ill-health prevention interventions were sustained over time. They found that CBT-related interventions led to significant (pooled) effects for 3–6 month and 13–18 month follow-ups in sub-group analyses for combined mental ill-health outcomes (-0.40, 95% CI-0.64 to 0.16; -0.30, 95% CI: -0.51 to 0.08, respectively). They also analysed impacts on combined positive mental health and academic performance at 3–6 months, and found that the interventions had significant effects (pooled effect size: 0.52, 95% CI: 0.06 to 0.98).

Cuijpers et al. [ 37 ] carried out a meta-analysis of evidence (rated as moderate methodological quality) that examined the effectiveness of different forms of psychological treatment, such as CBT and behavioural activation therapy (BAT), for addressing symptoms of depression in 997 college students. The review found a large overall (pooled) effect of the therapies versus controls (g = 0.89, 95% CI: 0.66 to 1.11). It also found that individual therapy was significantly more effective than group therapy (p = 0.003) but that type of treatment (CBT, BAT, or other) was not significantly associated with the size of effect.

In their review and meta-analysis (rated as moderate methodological quality) of the impact of universal mental health prevention programmes for higher education students, Conley et al. [ 32 ] found that skill-training programmes with supervised practice such as cognitive-behavioural interventions, mindfulness interventions, relaxation interventions, and meditation significantly reduced depression, anxiety, stress, and general psychological distress. Programmes without supervised practice were significantly less effective. Comparing the effectiveness of different interventions overall, they also found that relaxation interventions were the most effective (mean effect size: 0.55, 95% CI: 0.41 to 0.68), followed by CBT interventions (0.49, CI: 0.40 to 0.58), MBIs (0.34, CI: 0.19 to 0.49), meditation (0.25, CI: 0.02 to 0.53), and then psychoeducational interventions (0.13: CI: 0.06 to 0.21).

In their review and meta-analysis of evidence (rated as lower methodological quality) on the effectiveness of preventative interventions in reducing mental health outcomes in university students, Regehr et al. [ 33 ] found that cognitive and behavioural interventions focusing on stress reduction significantly reduced symptoms of anxiety and depression. In their meta-analysis, cognitive-behavioural interventions were assessed for their impact on anxiety. They found that cognitive-behavioural interventions (SDM -0.77, 95% CI: -0.97 to -0.57) led to significant improvement, compared to control groups.

Howell and Passmore [ 38 ] conducted a review and (‘initial’) meta-analysis (rated as lower methodological quality) on the impacts of ACT interventions for university student wellbeing (N = 585), including randomized controlled experimental designs. Their meta-analysis showed a small significant (pooled) effect on wellbeing (d = 0.29, 95% CI: 0.11 to 0.47, p = 0.008) when assessed with the Wellbeing Manifestations Measure Scale. ACT interventions were also found to reduce depression, anxiety, and stress.

Conley et al. [ 34 ] examined the effectiveness of different strategies employed in skill-oriented interventions such as cognitive-behavioural interventions, mindfulness interventions, relaxation interventions, and meditation (rated as lower methodological quality). Conley and colleagues found that interventions with supervised skills practice reduced depression, anxiety, and stress. Mindfulness interventions were found to be the most effective (78.8%) form of intervention among the skill-oriented programmes containing supervised practice, followed by cognitive-behavioural interventions (55.8%) which performed significantly better than relaxation (28.9%, OR = 3.11, p<0.01) and meditation (19.4%, OR = 5.26, p<0.001) interventions.

One review graded as lower quality reviewed evidence on the prevention and early intervention for mental health problems in higher education students found that CBT approaches are effective for prevention and early intervention [ 39 ]. The authors also reported that these approaches are effective for at least some months following the CBT intervention. The authors did not report the primary study designs they included.

In a literature review of studies of depression and treatment outcomes among US college students, graded as lower quality, brief individual cognitive therapy was found to be effective at reducing mild to moderate depressive symptoms [ 40 ]. This finding was based on only one RCT, however.

3. Psychoeducational interventions

In their review of RCTs (graded as higher methodological quality), Winzer et al. [ 36 ] explored whether the effects of mental health interventions (e.g., psychoeducational interventions) for students in higher education were sustainable over time. They did not find significant (pooled) effects on combined mental ill health outcomes at 3–6 months, 7–12 months, or 13–18 month follow-ups. They reported no superior effect of psychoeducational intervention. The 3–6 month and 13–18 month follow-up were, however, both only based on one study.

When Conley et al. [ 32 ] reviewed evidence on the impact of universal prevention programmes for higher education students, they found that skill-training programmes with supervised practice (0.45, CI: 0.39 to 0.52) were significantly more effective than both psychoeducation (information only) interventions (0.13, CI: 0.06 to 0.21) and skill-training programmes without supervised practice (0.11, CI: -0.01 to 0.22) in reducing depression, anxiety, stress, and general psychological distress (rated as moderate methodological quality). Psychoeducational interventions yielded significant effects for several mental health related outcomes including anxiety, stress, and general psychological distress (ESs>0.13). However, these interventions did not yield significant effects for depression, social and emotional skills, or interpersonal relationships. Psychoeducational interventions were found to be less effective than relaxation interventions, cognitive-behavioural interventions, mindfulness interventions, and meditation. Although interventions with supervised skills practice produced a significant positive effect averaged across all types of outcomes at follow-up (0.28, CI: 0.16 to 0.40), psychoeducational interventions did not.

In their 2013 review (graded as lower methodological quality), Conley et al. [ 34 ] explored whether skill-oriented interventions that included supervised skills were more effective than psychoeducational programmes. They found that psychoeducational programmes were not as effective as preventive interventions for higher education students.

3a. Educational/personalised feedback interventions

In their review (rated as lower methodological quality) of prevention and early intervention for mental health issues in higher education students, Reavely and Jorm [ 39 ] reported mixed findings on the effectiveness of educational/personalised feedback interventions.

Miller and Chung [ 40 ] explored treatment for depression and found that an intervention using personalised mailed feedback was effective at reducing symptoms of depression (rated as lower methodological quality). This finding was only based on one study, however.

4. Recreation programmes

In their review of RCTs (rated as higher methodological quality) on the effectiveness of interventions for common mental health difficulties, Huang et al. [ 26 ] found that recreational interventions including exercise, art and peer support were effective treatments for depression and anxiety. Although both CBT and MBIs were found to be effective, other interventions (i.e., art, exercise, and peer support) showed larger effects for both depression and generalized anxiety disorder.

When exploring the combined effects of yoga, meditation, and mindfulness on depression, anxiety, and stress in 1373 tertiary education students, Breedvelt et al. [ 41 ] found moderate positive effects for yoga, meditation, and mindfulness on symptoms of depression, anxiety, and stress (rated as higher methodological quality). They found no significant differences in subgroup analysis when they compared the effectiveness of yoga, mindfulness meditation, and MBSR. A small number of the included studies (N = 6) provided long-term follow-up data which ranged from 1 to 24 months. The (pooled) effect at follow-up was found to be small to medium (g = 0.39, 95% CI: 0.17 to 0.61).

A network of meta-analysis of RCTs (rated as higher methodological quality) of exercise interventions for depression in 2010 college students found that exercise interventions were effective in reducing depression [ 42 ]. When compared with usual care, Tai Chi (SMD = -11, 95% CI -16 to -6), yoga (SMD = -9.1, 95% CI -14 to -4), dance (SMD = -5.5, 95% CI -11 to -0.39) and running (-6, 95% CI -10 to -1.6) interventions were effective in reducing depressive symptoms. The authors found Tai Chi to be the most effective exercise intervention followed by yoga.

Fenton et al. [ 31 ] reviewed evidence on the impacts of recreation programmes such as mindfulness, meditation, Tai Chi, yoga, exercise, and animal therapy on mental health outcomes in post-secondary students in North America (rated as moderate methodological quality). They included a number of different primary study designs: non-randomised with control, non-randomised no control, and RCTs. They found that mindfulness, yoga, meditation, exercise, and animal therapy all reduced depression, anxiety, stress, and negative mood.

The review of evidence (rated as moderate methodological quality) on the impact of universal mental health prevention programmes by Conley et al. [ 32 ] found that meditation interventions were more effective than psychoeducational interventions but less effective than relaxation, cognitive-behavioural and mindfulness interventions.

The review (rated as lower methodological quality) by Conley et al. [ 34 ] also examined the relative effectiveness of different approaches used in skill-oriented interventions, including cognitive-behavioural, mindfulness, relaxation, and meditation. They reported that mindfulness interventions were more effective than cognitive-behavioural interventions, relaxation interventions, and meditation; and found that cognitive-behavioural interventions were more effective than both meditation and relaxation interventions which did not differ significantly from each other.

5. Relaxation interventions

In their review of universal mental health prevention programmes for higher education students (rated as moderate methodological quality), Conley et al. [ 32 ] found relaxation interventions to be the most effective. In contrast, Conley et al [ 34 ] examined the relative effectiveness of different strategies used in skill-oriented interventions including cognitive-behavioural, mindfulness, relaxation and meditation, and found that mindfulness interventions and cognitive-behavioural interventions were more effective than relaxation interventions, and that meditation and relaxation interventions did not differ significantly from each other (rated as lower methodological quality).

6. Setting-based interventions

Fernandez et al. [ 43 ] conducted a systematic review of evidence (rated as moderate methodological quality) on the mental wellbeing impacts of setting-based interventions for university students. They included experimental (e.g., RCT) and observational (e.g., controlled trial without randomisation, pre-post/before and after, and time series) study designs. Academic-based interventions, to enhance learning and teaching, were found to significantly improve mental wellbeing.

7. Stress management/reduction interventions

A systematic review and meta-analysis (rated as higher methodological quality) of stress management interventions for college students found that stress reduction interventions were effective in reducing distress [ 44 ]. In their meta-analysis, the authors found evidence that stress management interventions were effective in reducing stress (g = 0.61, 95% CI 0.30 to 0.93), anxiety (g = 0.52, 95% CI 0.25 to 0.78), and depression (g = 0.46, 95% CI 0.16 to 0.77) for students with high stress levels. The authors found evidence that the effects of stress management interventions were sustained over time. The effect of stress management programmes for students with high stress levels remained up to the 12-month follow-up (g = 0.40, 95% CI 0.21 to 0.60). Stress management interventions were also found to be effective in reducing depression (g = 0.36, 95% CI 0.21 to 0.51), anxiety (g = 0.52, 95% CI 0.36 to 0.68), and stress (g = 0.58, 95% CI 0.44 to 0.73) in an unselected college student population.

Yusufov et al. [ 45 ] conducted a meta-analysis (rated as lower methodological quality) of evidence on the impacts of stress reduction interventions. In their meta-analysis of stress reduction interventions, the authors found that stress reduction interventions were effective in reducing anxiety and stress.

Interventions delivered via technology

Different categories of interventions (e.g., CBT) can be delivered through different means. Harrer et al. [ 46 ] systematically reviewed and performed a meta-analysis of evidence (rated as higher methodological quality) on the impacts of internet interventions on symptoms of common mental health problems, wellbeing and functional outcomes among university students. Small effects from internet interventions were found on depression ( g = 0.18, 95% CI: 0.08 to 0.27), anxiety ( g = 0.27, 95% CI: 0.13 to 0.40), and stress ( g = 0.20, 95% CI: 0.02 to 0.38). There were, however, no significant effects on wellbeing. The effects were higher for interventions that were based on CBT principles.

Similarly, Davies et al. [ 47 ] reviewed evidence on the effectiveness of computer-delivered and web-based interventions in improving depression, anxiety, and psychological wellbeing in 1795 higher education students (rated as higher methodological quality). When compared to an inactive control group (receiving no-treatment or on a waiting list), sensitivity meta-analyses showed that interventions significantly improved anxiety (Pooled SMD −0.56; 95% CI: −0.77 to −0.35, p <0.001), depression (SMD −0.43; 95% CI: −0.63 to −0.22, p <0.001), and stress (SMD −0.73; 95% CI: −1.27 to −0.19, p = 0.008). The sensitivity analyses showed no significant effects for anxiety or depression, however, when compared to the active control group (in which participants received materials designed to mimic the time and attention received in the intervention group). Sensitivity analyses also showed no significant difference between the computer and web-based intervention for anxiety or depression when compared to comparison interventions that included a face-to-face version of the intervention, a web-based stress management intervention, another computer-based CBT program, and an online support group.

Lattie et al. [ 48 ] conducted a systematic review of evidence (rated as moderate methodological quality) on the effectiveness of digital mental health interventions on mental health outcomes in college students. All study designs were included. They found that digital mental health interventions can be effective for improving depression, anxiety, and psychological wellbeing among college students.

Conley et al. [ 49 ] conducted a meta-analytic review of evidence on the impact of universal and indicated technology-delivered interventions (TDIs) targeting mental health outcomes in 4763 higher education students, including randomized and quasi-experimental study designs (rated as moderate methodological quality). Universal interventions are aimed at students without any pre-existing mental health problems whereas indicated interventions are aimed at students who meet criteria for mild to moderate levels of mental health problems or have acknowledged an existing mental health problem such as depression or anxiety. They found that both universal and indicated TDIs were significantly effective in reducing symptoms of depression, anxiety, and stress. Indicated interventions produced higher overall (mean) improvements (0.37, CI: 0.27 to 0.47, p<0.001) than universal interventions (0.19, CI: 0.11 to 0.28, p<0.001). Both universal (0.21, CI: 0.11 to 0.31, p<0.001) and indicated (0.39, CI: 0.29 to 0.50, p<0.001) skill-training interventions led to significant improvements. Interventions without skill training were, however, only significant among indicated interventions (0.25, CI: 0.01 to 0.49, p = 0.042). Three of the 22 universal interventions, and eight of the 26 indicated interventions, assessed outcomes at follow-up (ranging between 13 to 52 weeks, and 2 to 26 weeks, respectively). Both universal and indicated interventions sustained significant positive effects on mental health outcomes at follow up (0.30, CI: 0.06 to 0.54, p = 0.015; 0.49, CI: 0.31 to 0.67, p<0.001, respectively).

Farrer et al. [ 50 ] systematically reviewed evidence on the effectiveness of technology-based interventions for mental health outcomes in tertiary students (rated as moderate methodological quality). They included both randomized controlled trials and randomized trials (equivalence trials). In interventions targeting both depression and anxiety, they found that technology-based CBT was effective in reducing anxiety and depression, although to a lesser degree than traditional therapy with human contact.

Other evidence

Conley et al. [ 51 ] conducted a meta-analysis of evidence (rated as moderate methodological quality) on the impacts of indicated prevention programmes for various forms of early-identified mental health problems such as sub-threshold depression and anxiety symptoms. Although they report significant effects, they provided insufficient information on the type of interventions to be categorised.

Rith-Najarian et al. [ 52 ] conducted a systematic review of evidence (rated as moderate methodological quality) on the effectiveness of preventative interventions in reducing depression, anxiety, and stress in university students. Rith-Najarian and colleagues found that prevention programmes reduced symptoms. The average effect sizes for preventative programmes were moderate (g = 0.65, 95% CI 0.57 to 0.73) regardless of delivery format or prevention level. According to delivery format, the effect sizes were similar for group (g = 0.69, 95% CI 0.58 to 0.81), self-administered (g = 0.65, 95% CI 0.50 to 0.81), and online/computer-delivered (0.52, 95% CI 0.41 to 0.63). According to prevention level, effect sizes differed for universal (0.69, 95% CI 0.55 to 0.83), selective (0.73, 95% CI 0.59 to 0.87), and indicated (0.53, 95% CI 0.44 to 0.63).

This review of reviews identified a range of interventions for student mental health and wellbeing, including mindfulness-based interventions (MBIs), psychological interventions (e.g., cognitive-behavioural therapy; CBT), psychoeducation interventions, recreation programmes, relaxation interventions, and setting-based interventions (e.g., academic and curriculum-based strategies). There was evidence that MBIs, CBT, and interventions delivered via technology were effective when compared to a passive control. There is some evidence to suggest that the effects of CBT-related interventions are sustained over time. The effects of interventions delivered via technology were found to be higher for interventions that were based on CBT principles in one higher quality review. Although technology-based CBT was effective in reducing depression and anxiety, traditional therapy with human contact was found to be more effective.

Moving beyond CBT, recreation programmes were also found to be effective. In fact, while both CBT and MBIs were found to be effective, other interventions (i.e., art, exercise, and peer support) were found to be more effective in one higher quality review. The review-level evidence suggests that psychoeducation interventions are not as effective as other interventions such as MBIs, cognitive-behavioural interventions, relaxation interventions, and meditation. The effects of psychoeducation interventions do not appear to sustain over time.

The review of reviews only located single reviews of evidence on acceptance and commitment training interventions [ 38 ] and setting-based interventions such as developing curricula to support wellbeing [ 43 ]. Although these interventions were shown to be effective, it should be noted that some of these reviews only included a small number of studies with small sample sizes [e.g., 38 ], and their findings should be viewed with some caution.

Limitations in the review of reviews

This is the first review of reviews to synthesise evidence on interventions to improve college and university students’ mental health and wellbeing. Despite every effort to gather the best evidence available, the review had several limitations. First, as our searches were limited to English language literature, we did not include evidence from studies reported in other languages. Identification and synthesis of evidence published in other languages is therefore desirable, although this would require sophisticated, technical, multilingual skills during study identification, appraisal and synthesis. Second, the searches were limited to a 21-year date range (1999 to 2020). Although this date range was deemed appropriate as we aimed to identify interventions that are most relevant to modern student populations and contexts, it should be noted that this review of review-level evidence reflects the time period before the global COVID-19 pandemic. Last, scarcity of high quality evidence syntheses on interventions to improve student mental health and wellbeing led to our decision to analyse data from all 27 reviews. This decision impacts on the quality of evidence synthesised. Despite limitations in the methodological strength of some evidence, the search identified a substantial group of higher methodological quality reviews and a large number of systematic reviews and meta-analyses. It should, therefore, be used to inform policies and practice alongside other considerations.

Gaps and limitations in the body of evidence

Although there was a large body of evidence on specific interventions such as mindfulness and cognitive-behavioural interventions, review-level evidence was limited in relation to other interventions such as setting-based interventions and acceptance and commitment training. Therefore, further primary studies examining the efficacy of setting-based interventions and acceptance and commitment training for students are required. Also, as there was a notable gap in the existing body of review-level evidence on interventions for students attending colleges in UK settings, a systematic review should be conducted in this area to identify primary level studies.

There are several limitations in the body of evidence. First, a number of the included reviews did not specify country and setting of the underlying evidence. It is likely that a substantial portion of the evidence is from US institutions, as this is typical for most evidence on health and wellbeing interventions. Another important limitation was that the included reviews only reported findings on beneficial effects of interventions. The underlying primary studies may have only attempted to assess efficacy and not the potential broader impacts of interventions. This is an important omission in the primary literature or the reviews. Interventions aiming for beneficial outcomes can often lead to unintended, adverse impacts for some participants. Primary and secondary research (including reviews) should attempt to identify adverse impacts so they can be eliminated or ameliorated, in accordance with the ‘first do no harm’ principle. A further limitation was that many of the included reviews did not consider the distribution of impacts from interventions across different population subgroups such as socio-economic status, age, gender, disability, and sexuality. As it is entirely possible that some interventions may work better for some students than for others, an evidence base that is more nuanced in terms of individual differences and differential impacts could underpin the tailoring of interventions to suit particular student characteristics leading, in time, to more suitable and effective interventions associated with nuanced, evidence-based delivery strategies. In addition to this, some of the included studies were lacking in detail on the nature of control groups. Greater detail on the nature of control groups should be provided in future studies. Last, few studies examined duration of effects over time. Future studies should routinely assess the duration of effects over time.

Implications

In light of the above, future primary and review-level research should carefully consider the distribution of impacts of interventions by population sub-groups, including socioeconomic, gender, ethnic, age, sexuality, and disability groups [ 53 ]. Intersectionalities between these population characteristics should also be considered. Cultural and faith backgrounds may also be important factors to consider. Future research should also explore latency and durability of effects overtime as some interventions, such as CBT, showed promise of effects sustained post intervention. This could include exploring further and longer pre and post intervention studies and studies exploring the impacts of top-up sessions. Moving beyond CBT, there are wider social determinant interventions which may be particularly important in this context such as debt or financial management, quality of student accommodation and housing, the competitive versus cooperative ethos of the learning environment, and sense of belonging to the student body and to the institution [ 54 ]. With the increasing prevalence of student mental health issues pointing to the influence of these wider determinants, it is clear that primary research in this area that takes note of the distribution of impacts is needed.

The review-of-reviews located a large body of evidence on specific interventions such as mindfulness and cognitive-behavioural interventions. The evidence suggests that these interventions can effectively reduce the common mental health difficulties of students. Evidence on other interventions was, however, limited. For example, although some work has begun developing curricula to support wellbeing, review-level evidence on organisational and structural interventions was limited. Thus, it is not currently possible to determine and rank which interventions work best, where and for whom, as this would require a larger body of evidence on certain intervention types, and comparative studies or reviews. Most of the included reviews did not consider the distribution of the intervention impacts (inequalities) for population subgroups such as age, gender, ethnicity, and socio-economic status. Noting the gaps and limitations in the review-level evidence previously identified, universities should select interventions based on the best available evidence, taking into consideration: the methodological strength of the underlying evidence, and the evidence on effectiveness. A good quality primary evidence-base examining these areas needs to be developed and then systematically reviewed before confident conclusions can be drawn about what works best to sustain positive mental health and wellbeing in today’s diverse and growing post-secondary student population. The need for effective support in this area can only have grown following the global COVID-19 pandemic and the associated disruption to teaching, learning, and university and college life. Following the disruption to teaching and learning, together with other stressors placed on young people from the COVID-19 pandemic, there is an imperative need to support students’ mental health and wellbeing. Future research in this area should elucidate the unique challenges that COVID-19 has presented for students to inform and tailor interventions for this generation and future cohorts facing disruptions to their teaching and learning experience.

Supporting information

S1 checklist, acknowledgments.

We would like to thank the review advisory group for their support and the What Works Centre for Wellbeing.

Funding Statement

The What Works Centre for Wellbeing Communities of Place evidence programme is funded by the Economic and Social Research Council (ESRC) and partners. The funders had no role in data collection and analysis, decision to publish, or preparation of the manuscript.

Data Availability

OSU Center for Teaching and Learning

Supporting student mental health in the college classroom

By Tasha Galardi, OSU College of Health

The teaching landscape has changed in a variety of ways since the start of the COVID pandemic, and one thing many of us are noticing is an increase in the mental health issues that our students are experiencing. The majority of college students today meet the criteria for at least one mental-health problem. Results from the latest  Healthy Minds survey (2022), which received responses from 96,000 U.S. students across 133 campuses during the 2021–22 academic year, found that 44 percent reported symptoms of depression, 37 percent said they experienced anxiety and 15 percent said they have seriously considered suicide. While the rates of mental-health problems are roughly the same among students of all races, students of color are less likely to receive treatment (Lipson et al., 2022). Many students feel that faculty should be at least moderately involved in helping students who struggle with their mental health, in part because most college counseling centers are overwhelmed and have long waiting lists (Cohen et al., 2022).

Instructors play a critical role in supporting student mental health, by sharing resources and incorporating strategies that support student well-being. Mental health challenges negatively impact student performance and classroom dynamics, so efforts to support student mental health not only benefit students in need but also improve the classroom experience for the instructor and other students. There are a variety of practices that instructors can employ to support student mental health, even if they do not know whether any specific students in their class are experiencing issues.

Best Practices for Supporting Student Health and Well-Being:

• It is important to note that while some students have Disability Access Services ( DAS ) accommodations, many do not.
• Rather than accommodating individual requests for flexibility, it might be easier to build flexibility into your course design. For example, you can drop several of the lowest participation scores to allow students to miss a few classes without penalty or offer every student a one-time late submission pass for homework assignments.
• Provide opportunities for students to make up points, such as extra credit and/or the rewriting of an assignment.
• Create simplicity, consistency, and clarity in your course design, and consider a regular schedule for assignment due dates. Keep everything well-organized in Canvas, and make sure links work. Clearly outline expectations, deadlines, and how assignments will be graded. Post regular reminders for upcoming due dates.
• Space out assignments throughout the term. It is better to have more small assignments than just a few larger ones. Scaffold larger assignments by breaking the work up into smaller pieces.
• Signal support for student mental health throughout the term through statements made in class, via announcements, etc. Openly mention upcoming discussions of potentially challenging topics and discuss major events that may impact student mental health. Describe your own self-care practices and destigmatize asking for help.
• Instructors will most likely need to reach out to students who appear to be struggling, because students generally do not initiate these conversations.
• Refer at-risk students to the Student Care Team and/or CAPS .

At times, it can seem overwhelming trying to navigate the needs of our students and their requests for accommodations. It is important to remind them (and perhaps even yourself!) that you are not a trained therapist, and to practice self-care when you need to recover from the emotional labor that teaching can require. But, instructors definitely play a pivotal role in supporting students and this work can be managed with planning and intention. By designing your course in a way that supports student mental health and well-being, you will likely receive fewer requests for special accommodations. And it is rewarding to know that you are helping students be more successful in your class, which impacts their overall success at OSU.

Cohen, K. A., Graham, A. K., & Lattie, E. G. (2022). Aligning students and counseling centers on student mental health needs and treatment resources.  Journal of American College Health ,  70 (3), 724-732.

Coleman, M. E. (2022). Mental health in the college classroom: Best practices for instructors.  Teaching Sociology ,  50 (2), 168-182.

Eaton, R., Hunsaker, S. V., & Moon, B. (2023).  Improving learning and mental health in the college classroom . West Virginia University Press.

Healthy Minds Network (2022).  Healthy Minds Study among Colleges and Universities, year 2021-2022  [Data set]. Healthy Minds Network, University of Michigan, University of California Los Angeles, Boston University, and Wayne State University. https://healthymindsnetwork.org/research/data-for-researchers .

Lipson, S. K., Zhou, S., Abelson, S., Heinze, J., Jirsa, M., Morigney, J., & Eisenberg, D. (2022). Trends in college student mental health and help-seeking by race/ethnicity: Findings from the national healthy minds study, 2013–2021.  Journal of Affective Disorders ,  306 , 138-147.

About the Author: Tasha Galardi is a Senior Instructor in the Human Development and Family Sciences department, and primarily serves as the Human Services internship coordinator. This post was inspired by discussions at a recent CTL Fellows Program event in the College of Health that Tasha facilitated in her current role as a College of Health CTL Fellow.

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