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Social Media Use and Its Connection to Mental Health: A Systematic Review

Fazida karim.

1 Psychology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA

2 Business & Management, University Sultan Zainal Abidin, Terengganu, MYS

Azeezat A Oyewande

3 Family Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA

4 Family Medicine, Lagos State Health Service Commission/Alimosho General Hospital, Lagos, NGA

Lamis F Abdalla

5 Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA

Reem Chaudhry Ehsanullah

Safeera khan.

Social media are responsible for aggravating mental health problems. This systematic study summarizes the effects of social network usage on mental health. Fifty papers were shortlisted from google scholar databases, and after the application of various inclusion and exclusion criteria, 16 papers were chosen and all papers were evaluated for quality. Eight papers were cross-sectional studies, three were longitudinal studies, two were qualitative studies, and others were systematic reviews. Findings were classified into two outcomes of mental health: anxiety and depression. Social media activity such as time spent to have a positive effect on the mental health domain. However, due to the cross-sectional design and methodological limitations of sampling, there are considerable differences. The structure of social media influences on mental health needs to be further analyzed through qualitative research and vertical cohort studies.

Introduction and background

Human beings are social creatures that require the companionship of others to make progress in life. Thus, being socially connected with other people can relieve stress, anxiety, and sadness, but lack of social connection can pose serious risks to mental health [ 1 ].

Social media

Social media has recently become part of people's daily activities; many of them spend hours each day on Messenger, Instagram, Facebook, and other popular social media. Thus, many researchers and scholars study the impact of social media and applications on various aspects of people’s lives [ 2 ]. Moreover, the number of social media users worldwide in 2019 is 3.484 billion, up 9% year-on-year [ 3 - 5 ]. A statistic in Figure  1  shows the gender distribution of social media audiences worldwide as of January 2020, sorted by platform. It was found that only 38% of Twitter users were male but 61% were using Snapchat. In contrast, females were more likely to use LinkedIn and Facebook. There is no denying that social media has now become an important part of many people's lives. Social media has many positive and enjoyable benefits, but it can also lead to mental health problems. Previous research found that age did not have an effect but gender did; females were much more likely to experience mental health than males [ 6 , 7 ].

Impact on mental health

Mental health is defined as a state of well-being in which people understand their abilities, solve everyday life problems, work well, and make a significant contribution to the lives of their communities [ 8 ]. There is debated presently going on regarding the benefits and negative impacts of social media on mental health [ 9 , 10 ]. Social networking is a crucial element in protecting our mental health. Both the quantity and quality of social relationships affect mental health, health behavior, physical health, and mortality risk [ 9 ]. The Displaced Behavior Theory may help explain why social media shows a connection with mental health. According to the theory, people who spend more time in sedentary behaviors such as social media use have less time for face-to-face social interaction, both of which have been proven to be protective against mental disorders [ 11 , 12 ]. On the other hand, social theories found how social media use affects mental health by influencing how people view, maintain, and interact with their social network [ 13 ]. A number of studies have been conducted on the impacts of social media, and it has been indicated that the prolonged use of social media platforms such as Facebook may be related to negative signs and symptoms of depression, anxiety, and stress [ 10 - 15 ]. Furthermore, social media can create a lot of pressure to create the stereotype that others want to see and also being as popular as others.

The need for a systematic review

Systematic studies can quantitatively and qualitatively identify, aggregate, and evaluate all accessible data to generate a warm and accurate response to the research questions involved [ 4 ]. In addition, many existing systematic studies related to mental health studies have been conducted worldwide. However, only a limited number of studies are integrated with social media and conducted in the context of social science because the available literature heavily focused on medical science [ 6 ]. Because social media is a relatively new phenomenon, the potential links between their use and mental health have not been widely investigated.

This paper attempt to systematically review all the relevant literature with the aim of filling the gap by examining social media impact on mental health, which is sedentary behavior, which, if in excess, raises the risk of health problems [ 7 , 9 , 12 ]. This study is important because it provides information on the extent of the focus of peer review literature, which can assist the researchers in delivering a prospect with the aim of understanding the future attention related to climate change strategies that require scholarly attention. This study is very useful because it provides information on the extent to which peer review literature can assist researchers in presenting prospects with a view to understanding future concerns related to mental health strategies that require scientific attention. The development of the current systematic review is based on the main research question: how does social media affect mental health?

Research strategy

The research was conducted to identify studies analyzing the role of social media on mental health. Google Scholar was used as our main database to find the relevant articles. Keywords that were used for the search were: (1) “social media”, (2) “mental health”, (3) “social media” AND “mental health”, (4) “social networking” AND “mental health”, and (5) “social networking” OR “social media” AND “mental health” (Table  1 ).

Out of the results in Table  1 , a total of 50 articles relevant to the research question were selected. After applying the inclusion and exclusion criteria, duplicate papers were removed, and, finally, a total of 28 articles were selected for review (Figure  2 ).

PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Inclusion and exclusion criteria

Peer-reviewed, full-text research papers from the past five years were included in the review. All selected articles were in English language and any non-peer-reviewed and duplicate papers were excluded from finally selected articles.

Of the 16 selected research papers, there were a research focus on adults, gender, and preadolescents [ 10 - 19 ]. In the design, there were qualitative and quantitative studies [ 15 , 16 ]. There were three systematic reviews and one thematic analysis that explored the better or worse of using social media among adolescents [ 20 - 23 ]. In addition, eight were cross-sectional studies and only three were longitudinal studies [ 24 - 29 ].The meta-analyses included studies published beyond the last five years in this population. Table  2  presents a selection of studies from the review.

IGU, internet gaming disorder; PSMU, problematic social media use

This study has attempted to systematically analyze the existing literature on the effect of social media use on mental health. Although the results of the study were not completely consistent, this review found a general association between social media use and mental health issues. Although there is positive evidence for a link between social media and mental health, the opposite has been reported.

For example, a previous study found no relationship between the amount of time spent on social media and depression or between social media-related activities, such as the number of online friends and the number of “selfies”, and depression [ 29 ]. Similarly, Neira and Barber found that while higher investment in social media (e.g. active social media use) predicted adolescents’ depressive symptoms, no relationship was found between the frequency of social media use and depressed mood [ 28 ].

In the 16 studies, anxiety and depression were the most commonly measured outcome. The prominent risk factors for anxiety and depression emerging from this study comprised time spent, activity, and addiction to social media. In today's world, anxiety is one of the basic mental health problems. People liked and commented on their uploaded photos and videos. In today's age, everyone is immune to the social media context. Some teens experience anxiety from social media related to fear of loss, which causes teens to try to respond and check all their friends' messages and messages on a regular basis.

On the contrary, depression is one of the unintended significances of unnecessary use of social media. In detail, depression is limited not only to Facebooks but also to other social networking sites, which causes psychological problems. A new study found that individuals who are involved in social media, games, texts, mobile phones, etc. are more likely to experience depression.

The previous study found a 70% increase in self-reported depressive symptoms among the group using social media. The other social media influence that causes depression is sexual fun [ 12 ]. The intimacy fun happens when social media promotes putting on a facade that highlights the fun and excitement but does not tell us much about where we are struggling in our daily lives at a deeper level [ 28 ]. Another study revealed that depression and time spent on Facebook by adolescents are positively correlated [ 22 ]. More importantly, symptoms of major depression have been found among the individuals who spent most of their time in online activities and performing image management on social networking sites [ 14 ].

Another study assessed gender differences in associations between social media use and mental health. Females were found to be more addicted to social media as compared with males [ 26 ]. Passive activity in social media use such as reading posts is more strongly associated with depression than doing active use like making posts [ 23 ]. Other important findings of this review suggest that other factors such as interpersonal trust and family functioning may have a greater influence on the symptoms of depression than the frequency of social media use [ 28 , 29 ].

Limitation and suggestion

The limitations and suggestions were identified by the evidence involved in the study and review process. Previously, 7 of the 16 studies were cross-sectional and slightly failed to determine the causal relationship between the variables of interest. Given the evidence from cross-sectional studies, it is not possible to conclude that the use of social networks causes mental health problems. Only three longitudinal studies examined the causal relationship between social media and mental health, which is hard to examine if the mental health problem appeared more pronounced in those who use social media more compared with those who use it less or do not use at all [ 19 , 20 , 24 ]. Next, despite the fact that the proposed relationship between social media and mental health is complex, a few studies investigated mediating factors that may contribute or exacerbate this relationship. Further investigations are required to clarify the underlying factors that help examine why social media has a negative impact on some peoples’ mental health, whereas it has no or positive effect on others’ mental health.

Conclusions

Social media is a new study that is rapidly growing and gaining popularity. Thus, there are many unexplored and unexpected constructive answers associated with it. Lately, studies have found that using social media platforms can have a detrimental effect on the psychological health of its users. However, the extent to which the use of social media impacts the public is yet to be determined. This systematic review has found that social media envy can affect the level of anxiety and depression in individuals. In addition, other potential causes of anxiety and depression have been identified, which require further exploration.

The importance of such findings is to facilitate further research on social media and mental health. In addition, the information obtained from this study can be helpful not only to medical professionals but also to social science research. The findings of this study suggest that potential causal factors from social media can be considered when cooperating with patients who have been diagnosed with anxiety or depression. Also, if the results from this study were used to explore more relationships with another construct, this could potentially enhance the findings to reduce anxiety and depression rates and prevent suicide rates from occurring.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

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Mental health and the pandemic: What U.S. surveys have found

The coronavirus pandemic has been associated with worsening mental health among people in the United States and around the world . In the U.S, the COVID-19 outbreak in early 2020 caused widespread lockdowns and disruptions in daily life while triggering a short but severe economic recession that resulted in widespread unemployment. Three years later, Americans have largely returned to normal activities, but challenges with mental health remain.

Here’s a look at what surveys by Pew Research Center and other organizations have found about Americans’ mental health during the pandemic. These findings reflect a snapshot in time, and it’s possible that attitudes and experiences may have changed since these surveys were fielded. It’s also important to note that concerns about mental health were common in the U.S. long before the arrival of COVID-19 .

Three years into the COVID-19 outbreak in the United States , Pew Research Center published this collection of survey findings about Americans’ challenges with mental health during the pandemic. All findings are previously published. Methodological information about each survey cited here, including the sample sizes and field dates, can be found by following the links in the text.

The research behind the first item in this analysis, examining Americans’ experiences with psychological distress, benefited from the advice and counsel of the COVID-19 and mental health measurement group at Johns Hopkins Bloomberg School of Public Health.

At least four-in-ten U.S. adults (41%) have experienced high levels of psychological distress at some point during the pandemic, according to four Pew Research Center surveys conducted between March 2020 and September 2022.

Young adults are especially likely to have faced high levels of psychological distress since the COVID-19 outbreak began: 58% of Americans ages 18 to 29 fall into this category, based on their answers in at least one of these four surveys.

Women are much more likely than men to have experienced high psychological distress (48% vs. 32%), as are people in lower-income households (53%) when compared with those in middle-income (38%) or upper-income (30%) households.

In addition, roughly two-thirds (66%) of adults who have a disability or health condition that prevents them from participating fully in work, school, housework or other activities have experienced a high level of distress during the pandemic.

The Center measured Americans’ psychological distress by asking them a series of five questions on subjects including loneliness, anxiety and trouble sleeping in the past week. The questions are not a clinical measure, nor a diagnostic tool. Instead, they describe people’s emotional experiences during the week before being surveyed.

While these questions did not ask specifically about the pandemic, a sixth question did, inquiring whether respondents had “had physical reactions, such as sweating, trouble breathing, nausea, or a pounding heart” when thinking about their experience with the coronavirus outbreak. In September 2022, the most recent time this question was asked, 14% of Americans said they’d experienced this at least some or a little of the time in the past seven days.

More than a third of high school students have reported mental health challenges during the pandemic. In a survey conducted by the Centers for Disease Control and Prevention from January to June 2021, 37% of students at public and private high schools said their mental health was not good most or all of the time during the pandemic. That included roughly half of girls (49%) and about a quarter of boys (24%).

In the same survey, an even larger share of high school students (44%) said that at some point during the previous 12 months, they had felt sad or hopeless almost every day for two or more weeks in a row – to the point where they had stopped doing some usual activities. Roughly six-in-ten high school girls (57%) said this, as did 31% of boys.

On both questions, high school students who identify as lesbian, gay, bisexual, other or questioning were far more likely than heterosexual students to report negative experiences related to their mental health.

Mental health tops the list of worries that U.S. parents express about their kids’ well-being, according to a fall 2022 Pew Research Center survey of parents with children younger than 18. In that survey, four-in-ten U.S. parents said they’re extremely or very worried about their children struggling with anxiety or depression. That was greater than the share of parents who expressed high levels of concern over seven other dangers asked about.

While the fall 2022 survey was fielded amid the coronavirus outbreak, it did not ask about parental worries in the specific context of the pandemic. It’s also important to note that parental concerns about their kids struggling with anxiety and depression were common long before the pandemic, too . (Due to changes in question wording, the results from the fall 2022 survey of parents are not directly comparable with those from an earlier Center survey of parents, conducted in 2015.)

Among parents of teenagers, roughly three-in-ten (28%) are extremely or very worried that their teen’s use of social media could lead to problems with anxiety or depression, according to a spring 2022 survey of parents with children ages 13 to 17 . Parents of teen girls were more likely than parents of teen boys to be extremely or very worried on this front (32% vs. 24%). And Hispanic parents (37%) were more likely than those who are Black or White (26% each) to express a great deal of concern about this. (There were not enough Asian American parents in the sample to analyze separately. This survey also did not ask about parental concerns specifically in the context of the pandemic.)

Looking back, many K-12 parents say the first year of the coronavirus pandemic had a negative effect on their children’s emotional health. In a fall 2022 survey of parents with K-12 children , 48% said the first year of the pandemic had a very or somewhat negative impact on their children’s emotional well-being, while 39% said it had neither a positive nor negative effect. A small share of parents (7%) said the first year of the pandemic had a very or somewhat positive effect in this regard.

White parents and those from upper-income households were especially likely to say the first year of the pandemic had a negative emotional impact on their K-12 children.

While around half of K-12 parents said the first year of the pandemic had a negative emotional impact on their kids, a larger share (61%) said it had a negative effect on their children’s education.

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John Gramlich is an associate director at Pew Research Center .

How Americans View the Coronavirus, COVID-19 Vaccines Amid Declining Levels of Concern

Online religious services appeal to many americans, but going in person remains more popular, about a third of u.s. workers who can work from home now do so all the time, how the pandemic has affected attendance at u.s. religious services, economy remains the public’s top policy priority; covid-19 concerns decline again, most popular.

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Factors that influence mental health of university and college students in the UK: a systematic review

• Fiona Campbell 1 ,
• Lindsay Blank 1 ,
• Anna Cantrell 1 ,
• Susan Baxter 1 ,
• Christopher Blackmore 1 ,
• Jan Dixon 1 &
• Elizabeth Goyder 1  

BMC Public Health volume  22 , Article number:  1778 ( 2022 ) Cite this article

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Worsening mental health of students in higher education is a public policy concern and the impact of measures to reduce transmission of COVID-19 has heightened awareness of this issue. Preventing poor mental health and supporting positive mental wellbeing needs to be based on an evidence informed understanding what factors influence the mental health of students.

To identify factors associated with mental health of students in higher education.

We undertook a systematic review of observational studies that measured factors associated with student mental wellbeing and poor mental health. Extensive searches were undertaken across five databases. We included studies undertaken in the UK and published within the last decade (2010–2020). Due to heterogeneity of factors, and diversity of outcomes used to measure wellbeing and poor mental health the findings were analysed and described narratively.

We included 31 studies, most of which were cross sectional in design. Those factors most strongly and consistently associated with increased risk of developing poor mental health included students with experiences of trauma in childhood, those that identify as LGBTQ and students with autism. Factors that promote wellbeing include developing strong and supportive social networks. Students who are prepared and able to adjust to the changes that moving into higher education presents also experience better mental health. Some behaviours that are associated with poor mental health include lack of engagement both with learning and leisure activities and poor mental health literacy.

Improved knowledge of factors associated with poor mental health and also those that increase mental wellbeing can provide a foundation for designing strategies and specific interventions that can prevent poor mental health and ensuring targeted support is available for students at increased risk.

Peer Review reports

Poor mental health of students in further and higher education is an increasing concern for public health and policy [ 1 , 2 , 3 , 4 ]. A 2020 Insight Network survey of students from 10 universities suggests that “1 in 5 students has a current mental health diagnosis” and that “almost half have experienced a serious psychological issue for which they felt they needed professional help”—an increase from 1 in 3 in the same survey conducted in 2018 [ 5 ]. A review of 105 Further Education (FE) colleges in England found that over a three-year period, 85% of colleges reported an increase in mental health difficulties [ 1 ]. Depression and anxiety were both prevalent and widespread in students; all colleges reported students experiencing depression and 99% reported students experiencing severe anxiety [ 5 , 6 ]. A UK cohort study found that levels of psychological distress increase on entering university [ 7 ], and recent evidence suggests that the prevalence of mental health problems among university students, including self-harm and suicide, is rising, [ 3 , 4 ] with increases in demand for services to support student mental health and reports of some universities finding a doubling of the number of students accessing support [ 8 ]. These common mental health difficulties clearly present considerable threat to the mental health and wellbeing of students but their impact also has educational, social and economic consequences such as academic underperformance and increased risk of dropping out of university [ 9 , 10 ].

Policy changes may have had an influence on the student experience, and on the levels of mental health problems seen in the student population; the biggest change has arguably been the move to widen higher education participation and to enable a more diverse demographic to access University education. The trend for widening participation has been continually rising since the late 1960s [ 11 ] but gained impetus in the 2000s through the work of the Higher Education Funding Council for England (HEFCE). Macaskill (2013) [ 12 ] suggests that the increased access to higher education will have resulted in more students attending university from minority groups and less affluent backgrounds, meaning that more students may be vulnerable to mental health problems, and these students may also experience greater challenges in making the transition to higher education.

Another significant change has been the introduction of tuition fees in 1998, which required students to self fund up to £1,000 per academic year. Since then, tuition fees have increased significantly for many students. With the abolition of maintenance grants, around 96% of government support for students now comes in the form of student loans [ 13 ]. It is estimated that in 2017, UK students were graduating with average debts of £50,000, and this figure was even higher for the poorest students [ 13 ]. There is a clear association between a student’s mental health and financial well-being [ 14 ], with “increased financial concern being consistently associated with worse health” [ 15 ].

The extent to which the increase in poor mental health is also being seen amongst non-students of a similar age is not well understood and warrants further study. However, the increase in poor mental health specifically within students in higher education highlights a need to understand what the risk factors are and what might be done within these settings to ensure young people are learning and developing and transitioning into adulthood in environments that promote mental wellbeing.

Commencing higher education represents a key transition point in a young person’s life. It is a stage often accompanied by significant change combined with high expectations of high expectations from students of what university life will be like, and also high expectations from themselves and others around their own academic performance. Relevant factors include moving away from home, learning to live independently, developing new social networks, adjusting to new ways of learning, and now also dealing with the additional greater financial burdens that students now face.

The recent global COVID-19 pandemic has had considerable impact on mental health across society, and there is concern that younger people (ages 18–25) have been particularly affected. Data from Canada [ 16 ] indicate that among survey respondents, “almost two-thirds (64%) of those aged 15 to 24 reported a negative impact on their mental health, while just over one-third (35%) of those aged 65 and older reported a negative impact on their mental health since physical distancing began” (ibid, p.4). This suggests that older adults are more prepared for the kind of social isolation which has been brought about through the response to COVID-19, whereas young adults have found this more difficult to cope with. UK data from the National Union of Students reports that for over half of UK students, their mental health is worse than before the pandemic [ 17 ]. Before COVID-19, students were already reporting increasing levels of mental health problems [ 2 ], but the COVID-19 pandemic has added a layer of “chronic and unpredictable” stress, creating the perfect conditions for a mental health crisis [ 18 ]. An example of this is the referrals (both urgent and routine) of young people with eating disorders for treatment in the NHS which almost doubled in number from 2019 to 2020 [ 19 ]. The travel restrictions enforced during the pandemic have also impacted on student mental health, particularly for international students who may have been unable to commence studies or go home to see friends and family during holidays [ 20 ].

With the increasing awareness and concern in the higher education sector and national bodies regarding student mental health has come increasing focus on how to respond. Various guidelines and best practice have been developed, e.g. ‘Degrees of Disturbance’ [ 21 ], ‘Good Practice Guide on Responding to Student Mental Health Issues: Duty of Care Responsibilities for Student Services in Higher Education’ [ 22 ] and the recent ‘The University Mental Health Charter’ [ 2 ]. Universities UK produced a Good Practice Guide in 2015 called “Student mental wellbeing in higher education” [ 23 ]. An increasing number of initiatives have emerged that are either student-led or jointly developed with students, and which reflect the increasing emphasis students and student bodies place on mental health and well-being and the increased demand for mental health support: Examples include: Nightline— www.nightline.ac.uk , Students Against Depression— www.studentsagainstdepression.org , Student Minds— www.studentminds.org.uk/student-minds-and-mental-wealth.html and The Alliance for Student-Led Wellbeing— www.alliancestudentwellbeing.weebly.com/ .

Although requests for professional support have increased substantially [ 24 ] only a third of students with mental health problems seek support from counselling services in the UK [ 12 ]. Many students encounter barriers to seeking help such as stigma or lack of awareness of services [ 25 ], and without formal support or intervention, there is a risk of deterioration. FE colleges and universities have identified the need to move beyond traditional forms of support and provide alternative, more accessible interventions aimed at improving mental health and well-being. Higher education institutions have a unique opportunity to identify, prevent, and treat mental health problems because they provide support in multiple aspects of students’ lives including academic studies, recreational activities, pastoral and counselling services, and residential accommodation.

In order to develop services that better meet the needs of students and design environments that are supportive of developing mental wellbeing it is necessary to explore and better understand the factors that lead to poor mental health in students.

Research objectives

The overall aim of this review was to identify, appraise and synthesise existing research evidence that explores the aetiology of poor mental health and mental wellbeing amongst students in tertiary level education. We aimed to gain a better understanding of the mechanisms that lead to poor mental health amongst tertiary level students and, in so doing, make evidence-based recommendations for policy, practice and future research priorities. Specific objectives in line with the project brief were to:

To co-produce with stakeholders a conceptual framework for exploring the factors associated with poorer mental health in students in tertiary settings. The factors may be both predictive, identifying students at risk, or causal, explaining why they are at risk. They may also be protective, promoting mental wellbeing.

To conduct a review drawing on qualitative studies, observational studies and surveys to explore the aetiology of poor mental health in students in university and college settings and identify factors which promote mental wellbeing amongst students.

To identify evidence-based recommendations for policy, service provision and future research that focus on prevention and early identification of poor mental health

Methodology

Identification of relevant evidence.

The following inclusion criteria were used to guide the development of the search strategy and the selection of studies.

We included students from a variety of further education settings (16 yrs + or 18 yrs + , including mature students, international students, distance learning students, students at specific transition points).

Universities and colleges in the UK. We were also interested in the context prior to the beginning of tertiary education, including factors during transition from home and secondary education or existing employment to tertiary education.

Any factor shown to be associated with mental health of students in tertiary level education. This included clinical indicators such as diagnosis and treatment and/or referral for depression and anxiety. Self-reported measures of wellbeing, happiness, stress, anxiety and depression were included. We did not include measures of academic achievement or engagement with learning as indicators of mental wellbeing.

Study design

We included cross-sectional and longitudinal studies that looked at factors associated with mental health outcomes in Table 5 .

Data extraction and quality appraisal

We extracted and tabulated key data from the included papers. Data extraction was undertaken by one reviewer, with a 10% sample checked for accuracy and consistency The quality of the included studies were evaluated using the Newcastle-Ottawa Scale [ 26 ] and the findings of the quality appraisal used in weighting the strength of associations and also identifying gaps for future high quality research.

Involvement of stakeholders

We recruited students, ex-students and parents of students to a public involvement group which met on-line three times during the process of the review and following the completion of the review. During a workshop meeting we asked for members of the group to draw on their personal experiences to suggest factors which were not mentioned in the literature.

Methods of synthesis

We undertook a narrative synthesis [ 27 ] due to the heterogeneity in the exposures and outcomes that were measured across the studies. Data showing the direction of effects and the strength of the association (correlation coefficients) were recorded and tabulated to aid comparison between studies.

Search strategy

Searches were conducted in the following electronic databases: Medline, Applied Social Sciences Index and Abstracts (ASSIA), International Bibliography of Social Sciences (IBSS), Science,PsycINFO and Science and Social Sciences Ciatation Indexes. Additional searches of grey literature, and reference lists of included studies were also undertaken.

The search strategy combined a number of terms relating to students and mental health and risk factors. The search terms included both subject (MeSH) and free-text searches. The searches were limited to papers about humans in English, published from 2010 to June 2020. The flow of studies through the review process is summarised in Fig.  1 .

Flow diagram

The full search strategy for Medline is provided in Appendix 1 .

Thirty-one quantitative, observational studies (39 papers) met the inclusion criteria. The total number of students that participated in the quantitative studies was 17,476, with studies ranging in size from 57 to 3706. Eighteen studies recruited student participants from only one university; five studies (10 publications) [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ] included seven or more universities. Six studies (7 publications) [ 35 , 36 , 37 , 38 , 39 , 40 , 41 ] only recruited first year students, while the majority of studies recruited students from a range of year groups. Five studies [ 39 , 42 , 43 , 44 , 45 ] recruited only, or mainly, psychology students which may impact on the generalisability of findings. A number of studies focused on students studying particular subjects including: nursing [ 46 ] medicine [ 47 ], business [ 48 ], sports science [ 49 ]. One study [ 50 ] recruited LGBTQ (lesbian, gay, bisexual, transgender, intersex, queer/questioning) students, and one [ 51 ] recruited students who had attended hospital having self-harmed. In 27 of the studies, there were more female than male participants. The mean age of the participants ranged from 19 to 28 years. Ethnicity was not reported in 19 of the studies. Where ethnicity was reported, the proportion that were ‘white British’ ranged from 71 – 90%. See Table 1 for a summary of the characteristics of the included studies and the participants.

Design and quality appraisal of the included studies

The majority of included studies ( n  = 22) were cross-sectional surveys. Nine studies (10 publications) [ 35 , 36 , 39 , 41 , 43 , 50 , 51 , 52 , 53 , 62 ] were longitudinal in design, recording survey data at different time points to explore changes in the variables being measured. The duration of time that these studies covered ranged from 19 weeks to 12 years. Most of the studies ( n  = 22) only recruited participants from a single university. The use of one university setting and the large number of studies that recruited only psychology students weakens the wider applicability of the included studies.

Quantitative variables

Included studies ( n  = 31) measured a wide range of variables and explored their association with poor mental health and wellbeing. These included individual level factors: age, gender, sexual orientation, ethnicity and a range of psychological variables. They also included factors that related to mental health variables (family history, personal history and mental health literacy), pre-university factors (childhood trauma and parenting behaviour. University level factors including social isolation, adjustment and engagement with learning. Their association was measured against different measures of positive mental health and poor mental health.

Measurement of association and the strength of that association has some limitations in addressing our research question. It cannot prove causality, and nor can it capture fully the complexity of the inter-relationship and compounding aspect of the variables. For example, the stress of adjustment may be manageable, until it is combined with feeling isolated and out of place. Measurement itself may also be misleading, only capturing what is measureable, and may miss variables that are important but not known. We included both qualitative and PPI input to identify missed but important variables.

The wide range of variables and different outcomes, with few studies measuring the same variable and outcomes, prevented meta-analyses of findings which are therefore described narratively.

The variables described were categorised during the analyses into the following categories:

Vulnerabilities – factors that are associated with poor mental health

Individual level factors including; age, ethnicity, gender and a range of psychological variables were all measured against different mental health outcomes including depression, anxiety, paranoia, and suicidal behaviour, self-harm, coping and emotional intelligence.

Six studies [ 40 , 42 , 47 , 50 , 60 , 63 ] examined a student’s ages and association with mental health. There was inconsistency in the study findings, with studies finding that age (21 or older) was associated with fewer depressive symptoms, lower likelihood of suicide ideation and attempt, self-harm, and positively associated with better coping skills and mental wellbeing. This finding was not however consistent across studies and the association was weak. Theoretical models that seek to explain this mechanism have suggested that older age groups may cope better due to emotion-regulation strategies improving with age [ 67 ]. However, those over 30 experienced greater financial stress than those aged 17-19 in another study [ 63 ].

Sexual orientation

Four studies [ 33 , 40 , 64 , 68 ] examined the association between poor mental health and sexual orientation status. In all of the studies LGBTQ students were at significantly greater risk of mental health problems including depression [ 40 ], anxiety [ 40 ], suicidal behaviour [ 33 , 40 , 64 ], self harm [ 33 , 40 , 64 ], use of mental health services [ 33 ] and low levels of wellbeing [ 68 ]. The risk of mental health problems in these students compared with heterosexual students, ranged from OR 1.4 to 4.5. This elevated risk may reflect the greater levels of isolation and discrimination commonly experienced by minority groups.

Nine studies [ 33 , 38 , 39 , 40 , 42 , 47 , 50 , 60 , 63 ] examined whether gender was associated mental health variables. Two studies [ 33 , 47 ] found that being female was statistically significantly associated with use of mental health services, having a current mental health problem, suicide risk, self harm [ 33 ] and depression [ 47 ]. The results were not consistent, with another study [ 60 ] finding the association was not significant. Three studies [ 39 , 40 , 42 ] that considered mediating variables such as adaptability and coping found no difference or very weak associations.

Two studies [ 47 , 60 ] examined the extent to which ethnicity was associated with mental health One study [ 47 ] reported that the risks of depression were significantly greater for those who categorised themselves as non-white (OR 8.36 p = 0.004). Non-white ethnicity was also associated with poorer mental health in another cross-sectional study [ 63 ]. There was no significant difference in the McIntyre et al. (2018) study [ 60 ]. The small number of participants from ethnic minority groups represented across the studies means that this data is very limited.

Family factors

Six studies [ 33 , 40 , 42 , 50 , 60 ] explored the association of a concept that related to a student’s experiences in childhood and before going to university. Three studies [ 40 , 50 , 60 ] explored the impact of ACEs (Adverse Childhood Experiences) assessed using the same scale by Feletti (2009) [ 69 ] and another explored the impact of abuse in childhood [ 46 ]. Two studies examined the impact of attachment anxiety and avoidance [ 42 ], and parental acceptance [ 46 , 59 ]. The studies measured different mental health outcomes including; positive and negative affect, coping, suicide risk, suicide attempt, current mental health problem, use of mental health services, psychological adjustment, depression and anxiety.

The three studies that explored the impact of ACE’s all found a significant and positive relationship with poor mental health amongst university students. O’Neill et al. (2018) [ 50 ] in a longitudinal study ( n  = 739) showed that there was in increased likelihood in self-harm and suicidal behaviours in those with either moderate or high levels of childhood adversities (OR:5.5 to 8.6) [ 50 ]. McIntyre et al. (2018) [ 60 ] ( n  = 1135) also explored other dimensions of adversity including childhood trauma through multiple regression analysis with other predictive variables. They found that childhood trauma was significantly positively correlated with anxiety, depression and paranoia (ß = 0.18, 0.09, 0.18) though the association was not as strong as the correlation seen for loneliness (ß = 0.40) [ 60 ]. McLafferty et al. (2019) [ 40 ] explored the compounding impact of childhood adversity and negative parenting practices (over-control, overprotection and overindulgence) on poor mental health (depression OR 1.8, anxiety OR 2.1 suicidal behaviour OR 2.3, self-harm OR 2.0).

Gaan et al.’s (2019) survey of LGBTQ students ( n  = 1567) found in a multivariate analyses that sexual abuse, other abuse from violence from someone close, and being female had the highest odds ratios for poor mental health and were significantly associated with all poor mental health outcomes [ 33 ].

While childhood trauma and past abuse poses a risk to mental health for all young people it may place additional stresses for students at university. Entry to university represents life stage where there is potential exposure to new and additional stressors, and the possibility that these students may become more isolated and find it more difficult to develop a sense of belonging. Students may be separated for the first time from protective friendships. However, the mechanisms that link childhood adversities and negative psychopathology, self-harm and suicidal behaviour are not clear [ 40 ]. McLafferty et al. (2019) also measured the ability to cope and these are not always impacted by childhood adversities [ 40 ]. They suggest that some children learn to cope and build resilience that may be beneficial.

McLafferty et al. (2019) [ 40 ] also studied parenting practices. Parental over-control and over-indulgence was also related to significantly poorer coping (OR -0.075 p  < 0.05) and this was related to developing poorer coping scores (OR -0.21 p  < 0.001) [ 40 ]. These parenting factors only became risk factors when stress levels were high for students at university. It should be noted that these studies used self-report, and responses regarding views of parenting may be subjective and open to interpretation. Lloyd et al.’s (2014) survey found significant positive correlations between perceived parental acceptance and students’ psychological adjustment, with paternal acceptance being the stronger predictor of adjustment.

Autistic students may display social communication and interaction deficits that can have negative emotional impacts. This may be particularly true during young adulthood, a period of increased social demands and expectations. Two studies [ 56 ] found that those with autism had a low but statistically significant association with poor social problem-solving skills and depression.

Mental health history

Three studies [ 47 , 51 , 68 ] investigated mental health variables and their impact on mental health of students in higher education. These included; a family history of mental illness and a personal history of mental illness.

Students with a family history or a personal history of mental illness appear to have a significantly greater risk of developing problems with mental health at university [ 47 ]. Mahadevan et al. (2010) [ 51 ] found that university students who self-harm have a significantly greater risk (OR 5.33) of having an eating disorder than a comparison group of young adults who self-harm but are not students.

Buffers – factors that are protective of mental wellbeing

Psychological factors.

Twelve studies [ 29 , 39 , 40 , 41 , 42 , 43 , 46 , 49 , 54 , 58 , 64 ] assessed the association of a range of psychological variables and different aspects of mental wellbeing and poor mental health. We categorised these into the following two categories: firstly, psychological variables measuring an individual’s response to change and stressors including adaptability, resilience, grit and emotional regulation [ 39 , 40 , 41 , 42 , 43 , 46 , 49 , 54 , 58 ] and secondly, those that measure self-esteem and body image [ 29 , 64 ].

The evidence from the eight included quantitative studies suggests that students with psychological strengths including; optimism, self-efficacy [ 70 ], resilience, grit [ 58 ], use of positive reappraisal [ 49 ], helpful coping strategies [ 42 ] and emotional intelligence [ 41 , 46 ] are more likely to experience greater mental wellbeing (see Table 2 for a description of the psychological variables measured). The positive association between these psychological strengths and mental well-being had a positive affect with associations ranging from r  = 0.2–0.5 and OR1.27 [ 41 , 43 , 46 , 49 , 54 ] (low to moderate strength of association). The negative associations with depressive symptoms are also statistically significant but with a weaker association ( r  = -0.2—0.3) [ 43 , 49 , 54 ].

Denovan (2017a) [ 43 ] in a longitudinal study found that the association between psychological strengths and positive mental wellbeing was not static and that not all the strengths remained statistically significant over time. The only factors that remained significant during the transition period were self-efficacy and optimism, remaining statistically significant as they started university and 6 months later.

Parental factors

Only one study [ 59 ] explored family factors associated with the development of psychological strengths that would equip young people as they managed the challenges and stressors encountered during the transition to higher education. Lloyd et al. (2014) [ 59 ] found that perceived maternal and paternal acceptance made significant and unique contributions to students’ psychological adjustment. Their research methods are limited by their reliance on retrospective measures and self-report measures of variables, and these results could be influenced by recall bias.

Two studies [ 29 , 64 ] considered the impact of how individuals view themselves on poor mental health. One study considered the impact of self-esteem and the association with non-accidental self-injury (NSSI) and suicide attempt amongst 734 university students. As rates of suicide and NSSI are higher amongst LGBT (lesbian, gay, bisexual, transgender) students, the prevalence of low self-esteem was compared. There was a low but statistically significant association between low self-esteem and NSSI, though not for suicide attempt. A large survey, including participants from seven universities [ 42 ] compared depressive symptoms in students with marked body image concerns, reporting that the risk of depressive symptoms was greater (OR 2.93) than for those with lower levels of body image concerns.

Mental health literacy and help seeking behaviour

Two studies [ 48 , 68 ] investigated attitudes to mental illness, mental health literacy and help seeking for mental health problems.

University students who lack sufficient mental health literacy skills to be able to recognise problems or where there are attitudes that foster shame at admitting to having mental health problems can result in students not recognising problems and/or failing to seek professional help [ 48 , 68 ]. Gorcyznski et al. (2017) [ 68 ] found that women and those who had a history of previous mental health problems exhibited significantly higher levels of mental health literacy. Greater mental health literacy was associated with an increased likelihood that individuals would seek help for mental health problems. They found that many students find it hard to identify symptoms of mental health problems and that 42% of students are unaware of where to access available resources. Of those who expressed an intention to seek help for mental health problems, most expressed a preference for online resources, and seeking help from family and friends, rather than medical professionals such as GPs.

Kotera et al. (2019) [ 48 ] identified self-compassion as an explanatory variable, reducing social comparison, promoting self-acceptance and recognition that discomfort is an inevitable human experience. The study found a strong, significant correlation between self-compassion and mental health symptoms ( r  = -0.6. p  < 0.01).

There again appears to be a cycle of reinforcement, where poor mental health symptoms are felt to be a source of shame and become hidden, help is not sought, and further isolation ensues, leading to further deterioration in mental health. Factors that can interrupt the cycle are self-compassion, leading to more readiness to seek help (see Fig.  2 ).

Poor mental health – cycles of reinforcement

Social networks

Nine studies [ 33 , 38 , 41 , 46 , 51 , 54 , 60 , 64 , 65 ] examined the concepts of loneliness and social support and its association with mental health in university students. One study also included students at other Higher Education Institutions [ 46 ]. Eight of the studies were surveys, and one was a retrospective case control study to examine the differences between university students and age-matched young people (non-university students) who attended hospital following deliberate self-harm [ 51 ].

Included studies demonstrated considerable variation in how they measured the concepts of social isolation, loneliness, social support and a sense of belonging. There were also differences in the types of outcomes measured to assess mental wellbeing and poor mental health. Grouping the studies within a broad category of ‘social factors’ therefore represents a limitation of this review given that different aspects of the phenomena may have been being measured. The tools used to measure these variables also differed. Only one scale (The UCLA loneliness scale) was used across multiple studies [ 41 , 60 , 65 ]. Diverse mental health outcomes were measured across the studies including positive affect, flourishing, self-harm, suicide risk, depression, anxiety and paranoia.

Three studies [ 41 , 60 , 62 ] measuring loneliness, two longitudinally [ 41 , 62 ], found a consistently positive association between loneliness and poor mental health in university students. Greater loneliness was linked to greater anxiety, stress, depression, poor general mental health, paranoia, alcohol abuse and eating disorder problems. The strength of the correlations ranged from 0–3-0.4 and were all statistically significant (see Tables 3 and 4 ). Loneliness was the strongest overall predictor of mental distress, of those measured. A strong identification with university friendship groups was most protective against distress relative to other social identities [ 60 ]. Whether poor mental health is the cause, or the result of loneliness was explored further in the studies. The results suggest that for general mental health, stress, depression and anxiety, loneliness induces or exacerbates symptoms of poor mental health over time [ 60 , 62 ]. The feedback cycle is evident, with loneliness leading to poor mental health which leads to withdrawal from social contacts and further exacerbation of loneliness.

Factors associated with protecting against loneliness by fostering supportive friendships and promoting mental wellbeing were also identified. Beliefs about the value of ‘leisure coping’, and attributes of resilience and emotional intelligence had a moderate, positive and significant association with developing mental wellbeing and were explored in three studies [ 46 , 54 , 66 ].

The transition to and first year at university represent critical times when friendships are developed. Thomas et al. (2020) [ 65 ] explored the factors that predict loneliness in the first year of university. A sense of community and higher levels of ‘social capital’ were significantly associated with lower levels of loneliness. ‘Social capital’ scales measure the development of emotionally supportive friendships and the ability to adjust to the disruption of old friendships as students transition to university. Students able to form close relationships within their first year at university are less likely to experience loneliness (r-0.09, r- 0.36, r- 0.34). One study [ 38 ] investigating the relationship between student experience and being the first in the family to attend university found that these students had lower ratings for peer group interactions.

Young adults at university and in higher education are facing multiple adjustments. Their ability to cope with these is influenced by many factors. Supportive friendships and a sense of belonging are factors that strengthen coping. Nightingale et al. (2012) undertook a longitudinal study to explore what factors were associated with university adjustment in a sample of first year students ( n  = 331) [ 41 ]. They found that higher skills of emotion management and emotional self-efficacy were predictive of stable adjustment. These students also reported the lowest levels of loneliness and depression. This group had the skills to recognise their emotions and cope with stressors and were confident to access support. Students with poor emotion management and low levels of emotional self-efficacy may benefit from intervention to support the development of adaptive coping strategies and seeking support.

The positive and negative feedback loops

The relationship between the variables described appeared to work in positive and negative feedback loops with high levels of social capital easing the formation of a social network which acts as a critical buffer to stressors (see Fig.  3 ). Social networks and support give further strengthening and reinforcement, stimulating positive affect, engagement and flourishing. These, in turn, widen and deepen social networks for support and enhance a sense of wellbeing. Conversely young people who enter the transition to university/higher education with less social capital are less likely to identify with and locate a social network; isolation may follow, along with loneliness, anxiety, further withdrawal from contact with social networks and learning, and depression.

Triggers – factors that may act in combination with other factors to lead to poor mental health

Stress is seen as playing a key role in the development of poor mental health for students in higher education. Theoretical models and empirical studies have suggested that increases in stress are associated with decreases in student mental health [ 12 , 43 ]. Students at university experience the well-recognised stressors associated with academic study such as exams and course work. However, perhaps less well recognised are the processes of transition, requiring adapting to a new social and academic environment (Fisher 1994 cited by Denovan 2017a) [ 43 ]. Por et al. (2011) [ 46 ] in a small ( n  = 130 prospective survey found a statistically significant correlation between higher levels of emotional intelligence and lower levels of perceived stress ( r  = 0.40). Higher perceived stress was also associated with negative affect in two studies [ 43 , 46 ], and strongly negatively associated with positive affect (correlation -0.62) [ 54 ].

University variables

Eleven studies [ 35 , 39 , 47 , 51 , 52 , 54 , 60 , 63 , 65 , 83 , 84 ] explored university variables, and their association with mental health outcomes. The range of factors and their impact on mental health variables is limited, and there is little overlap. Knowledge gaps are shown by factors highlighted by our PPI group as potentially important but not identified in the literature (see Table 5 ). It should be noted that these may reflect the focus of our review, and our exclusion of intervention studies which may evaluate university factors.

High levels of perceived stress caused by exam and course work pressure was positively associated with poor mental health and lack of wellbeing [ 51 , 52 , 54 ]. Other potential stressors including financial anxieties and accommodation factors appeared to be less consistently associated with mental health outcomes [ 35 , 38 , 47 , 51 , 60 , 62 ]. Important mediators and buffers to these stressors are coping strategies and supportive networks (see conceptual model Appendix 2 ). One impact of financial pressures was that students who worked longer hours had less interaction with their peers, limiting the opportunities for these students to benefit from the protective effects of social support.

Red flags – behaviours associated with poor mental health and/or wellbeing

Engagement with learning and leisure activities.

Engagement with learning activities was strongly and positively associated with characteristics of adaptability [ 39 ] and also happiness and wellbeing [ 52 ] (see Fig.  4 ). Boulton et al. (2019) [ 52 ] undertook a longitudinal survey of undergraduate students at a campus-based university. They found that engagement and wellbeing varied during the term but were strongly correlated.

Engagement and wellbeing

Engagement occurred in a wide range of activities and behaviours. The authors suggest that the strong correlation between all forms of engagement with learning has possible instrumental value for the design of systems to monitor student engagement. Monitoring engagement might be used to identify changes in the behaviour of individuals to assist tutors in providing support and pastoral care. Students also were found to benefit from good induction activities provided by the university. Greater induction satisfaction was positively and strongly associated with a sense of community at university and with lower levels of loneliness [ 65 ].

The inte r- related nature of these variables is depicted in Fig.  4 . Greater adaptability is strongly associated with more positive engagement in learning and university life. More engagement is associated with higher mental wellbeing.

Denovan et al. (2017b) [ 54 ] explored leisure coping, its psychosocial functions and its relationship with mental wellbeing. An individual’s beliefs about the benefits of leisure activities to manage stress, facilitate the development of companionship and enhance mood were positively associated with flourishing and were negatively associated with perceived stress. Resilience was also measured. Resilience was strongly and positively associated with leisure coping beliefs and with indicators of mental wellbeing. The authors conclude that resilient individuals are more likely to use constructive means of coping (such as leisure coping) to proactively cultivate positive emotions which counteract the experience of stress and promote wellbeing. Leisure coping is predictive of positive affect which provides a strategy to reduce stress and sustain coping. The belief that friendships acquired through leisure provide social support is an example of leisure coping belief. Strong emotionally attached friendships that develop through participation in shared leisure pursuits are predictive of higher levels of well-being. Friendship bonds formed with fellow students at university are particularly important for maintaining mental health, and opportunities need to be developed and supported to ensure that meaningful social connections are made.

The ‘broaden-and-build theory’ (Fredickson 2004 [ 85 ] cited by [ 54 ]) may offer an explanation for the association seen between resilience, leisure coping and psychological wellbeing. The theory is based upon the role that positive and negative emotions have in shaping human adaptation. Positive emotions broaden thinking, enabling the individual to consider a range of ways of dealing with and adapting to their environment. Conversely, negative emotions narrow thinking and limit options for adapting. The former facilitates flourishing, facilitating future wellbeing. Resilient individuals are more likely to use constructive means of coping which generate positive emotion (Tugade & Fredrickson 2004 [ 86 ], cited by [ 54 ]). Positive emotions therefore lead to growth in coping resources, leading to greater well-being.

Health behaviours at university

Seven studies [ 29 , 31 , 38 , 45 , 51 , 54 , 66 ] examined how lifestyle behaviours might be linked with mental health outcomes. The studies looked at leisure activities [ 63 , 80 ], diet [ 29 ], alcohol use [ 29 , 31 , 38 , 51 ] and sleep [ 45 ].

Depressive symptoms were independently associated with problem drinking and possible alcohol dependence for both genders but were not associated with frequency of drinking and heavy episodic drinking. Students with higher levels of depressive symptoms reported significantly more problem drinking and possible alcohol dependence [ 31 ]. Mahadevan et al. (2010) [ 51 ] compared students and non-students seen in hospital for self-harm and found no difference in harmful use of alcohol and illicit drugs.

Poor sleep quality and increased consumption of unhealthy foods were also positively associated with depressive symptoms and perceived stress [ 29 ]. The correlation with dietary behaviours and poor mental health outcomes was low, but also confirmed by the negative correlation between less perceived stress and depressive symptoms and consumption of a healthier diet.

Physical activity and participation in leisure pursuits were both strongly correlated with mental wellbeing ( r  = 0.4) [ 54 ], and negatively correlated with depressive symptoms and anxiety ( r  = -0.6, -0.7) [ 66 ].

Thirty studies measuring the association between a wide range of factors and poor mental health and mental wellbeing in university and college students were identified and included in this review. Our purpose was to identify the factors that contribute to the growing prevalence of poor mental health amongst students in tertiary level education within the UK. We also aimed to identify factors that promote mental wellbeing and protect against deteriorating poor mental health.

Loneliness and social isolation were strongly associated with poor mental health and a sense of belonging and a strong support network were strongly associated with mental wellbeing and happiness. These associations were strongly positive in the eight studies that explored them and are consistent with other meta-analyses exploring the link between social support and mental health [ 87 ].

Another factor that appeared to be protective was older age when starting university. A wide range of personal traits and characteristics were also explored. Those associated with resilience, ability to adjust and better coping led to improved mental wellbeing. Better engagement appeared as an important mediator to potentially explain the relationship between these two variables. Engagement led to students being able to then tap into those features that are protective and promoting of mental wellbeing.

Other important risk factors for poor mental wellbeing that emerged were those students with existing or previous mental illness. Students on the autism spectrum and those with poor social problem-solving also were more likely to suffer from poor mental health. Negative self-image was also associated with poor mental health at university. Eating disorders were strongly associated with poor mental wellbeing and were found to be far more of a risk in students at university than in a comparative group of young people not in higher education. Other studies of university students also found that pre-existing poor mental health was a strong predictor of poor mental health in university students [ 88 ].

At a family level, the experience of childhood trauma and adverse experiences including, for example, neglect, household dysfunction or abuse, were strongly associated with poor mental health in young people at university. Students with a greater number of ‘adverse childhood experiences’ were at significantly greater risk of poor mental health than those students without experience of childhood trauma. This was also identified in a review of factors associated with depression and suicide related outcomes amongst university undergraduate students [ 88 ].

Our findings, in contrast to findings from other studies of university students, did not find that female gender associated with poor mental health and wellbeing, and it also found that being a mature student was protective of mental wellbeing.

Exam and course work pressure was associated with perceived stress and poor mental health. A lack of engagement with learning activities was also associated with poor mental health. A number of variables were not consistently shown to be associated with poor mental health including financial concerns and accommodation factors. Very little evidence related to university organisation or support structures was assessed in the evidence. One study found that a good induction programme had benefits for student mental wellbeing and may be a factor that enables students to become a part of a social network positive reinforcement cycle. Involvement in leisure activities was also found to be associated with improved coping strategies and better mental wellbeing. Students with poorer mental health tended to also eat in a less healthy manner, consume more harmful levels of alcohol, and experience poorer sleep.

This evidence review of the factors that influence mental health and wellbeing indicate areas where universities and higher education settings could develop and evaluate innovations in practice. These include:

Interventions before university to improve preparation of young people and their families for the transition to university.

Exploratory work to identify the acceptability and feasibility of identifying students at risk or who many be exhibiting indications of deteriorating mental health

Interventions that set out to foster a sense of belonging and identify

Creating environments that are helpful for building social networks

Improving mental health literacy and access to high quality support services

This review has a number of limitations. Most of the included studies were cross-sectional in design, with a small number being longitudinal ( n  = 7), following students over a period of time to observe changes in the outcomes being measured. Two limitations of these sources of data is that they help to understand associations but do not reveal causality; secondly, we can only report the findings for those variables that were measured, and we therefore have to support causation in assuming these are the only factors that are related to mental health.

Furthermore, our approach has segregated and categorised variables in order to better understand the extent to which they impact mental health. This approach does not sufficiently explore or reveal the extent to which variables may compound one another, for example, feeling the stress of new ways of learning may not be a factor that influences mental health until it is combined with a sense of loneliness, anxiety about financial debt and a lack of parental support. We have used our PPI group and the development of vignettes of their experiences to seek to illustrate the compounding nature of the variables identified.

We limited our inclusion criteria to studies undertaken in the UK and published within the last decade (2009–2020), again meaning we may have limited our inclusion of relevant data. We also undertook single data extraction of data which may increase the risk of error in our data.

Understanding factors that influence students’ mental health and wellbeing offers the potential to find ways to identify strategies that enhance the students’ abilities to cope with the challenges of higher education. This review revealed a wide range of variables and the mechanisms that may explain how they impact upon mental wellbeing and increase the risk of poor mental health amongst students. It also identified a need for interventions that are implemented before young people make the transition to higher education. We both identified young people who are particularly vulnerable and the factors that arise that exacerbate poor mental health. We highlight that a sense of belonging and supportive networks are important buffers and that there are indicators including lack of engagement that may enable early intervention to provide targeted and appropriate support.

Availability of data and materials

Further details of the study and the findings can be provided on request to the lead author ([email protected]).

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Acknowledgements

We acknowledge the input from our public advisory group which included current and former students, and family members of students who have struggled with their mental health. The group gave us their extremely valuable insights to assist our understanding of the evidence.

This project was supported by funding from the National Institute for Health Research as part of the NIHR Public Health Research  Programme (fuding reference 127659 Public Health Review Team). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

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Campbell, F., Blank, L., Cantrell, A. et al. Factors that influence mental health of university and college students in the UK: a systematic review. BMC Public Health 22 , 1778 (2022). https://doi.org/10.1186/s12889-022-13943-x

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Healthy lifestyle can help prevent depression – and new research may explain why

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A healthy lifestyle that involves moderate alcohol consumption, a healthy diet, regular physical activity, healthy sleep and frequent social connection, while avoiding smoking and too much sedentary behaviour, reduces the risk of depression, new research has found.

Although our DNA – the genetic hand we’ve been dealt – can increase our risk of depression, we’ve shown that a healthy lifestyle is potentially more important. Barbara Sahakian

In research published today in Nature Mental Health , an international team of researchers, including from the University of Cambridge and Fudan University, looked at a combination of factors including lifestyle factors, genetics, brain structure and our immune and metabolic systems to identify the underlying mechanisms that might explain this link.

According to the World Health Organization, around one in 20 adults experiences depression, and the condition poses a significant burden on public health worldwide. The factors that influence the onset of depression are complicated and include a mixture of biological and lifestyle factors.

To better understand the relationship between these factors and depression, the researchers turned to UK Biobank, a biomedical database and research resource containing anonymised genetic, lifestyle and health information about its participants.

By examining data from almost 290,000 people – of whom 13,000 had depression – followed over a nine-year period, the team was able to identify seven healthy lifestyle factors linked with a lower risk of depression. These were:

• moderate alcohol consumption
• healthy diet
• regular physical activity
• healthy sleep
• never smoking
• low-to-moderate sedentary behaviour
• frequent social connection

Of all of these factors, having a good night’s sleep – between seven and nine hours a night – made the biggest difference, reducing the risk of depression, including single depressive episodes and treatment-resistant depression, by 22%.

Frequent social connection, which in general reduced the risk of depression by 18%, was the most protective against recurrent depressive disorder.

Moderate alcohol consumption decreased the risk of depression by 11%, healthy diet by 6%, regular physical activity by 14%, never smoking by 20%, and low-to-moderate sedentary behaviour by 13%.

Based on the number of healthy lifestyle factors an individual adhered to, they were assigned to one of three groups: unfavourable, intermediate, and favourable lifestyle. Individuals in the intermediate group were around 41% less likely to develop depression compared to those in the unfavourable lifestyle, while those in the favourable lifestyle group were 57% less likely.

The team then examined the DNA of the participants, assigning each a genetic risk score. This score was based on the number of genetic variants an individual carried that have a known link to risk of depression. Those with the lowest genetic risk score were 25% less likely to develop depression when compared to those with the highest score – a much smaller impact than lifestyle.

In people at high, medium, and low genetic risk for depression, the team further found that a healthy lifestyle can cut the risk of depression. This research underlines the importance of living a healthy lifestyle for preventing depression, regardless of a person's genetic risk.

Professor Barbara Sahakian, from the Department of Psychiatry at the University of Cambridge, said: “Although our DNA – the genetic hand we’ve been dealt – can increase our risk of depression, we’ve shown that a healthy lifestyle is potentially more important.

“Some of these lifestyle factors are things we have a degree control over, so trying to find ways to improve them – making sure we have a good night’s sleep and getting out to see friends, for example – could make a real difference to people’s lives.”

To understand why a healthy lifestyle might reduce the risk of depression, the team studied a number of other factors.

First off, they examined MRI brain scans from just under 33,000 participants and found a number of regions of the brain where a larger volume – more neurons and connections – was linked to a healthy lifestyle. These included the pallidum, thalamus, amygdala and hippocampus.

Next, the team looked for markers in the blood that indicated problems with the immune system or metabolism (how we process food and produce energy). Among those markers found to be linked to lifestyle were the C-reactive protein, a molecule produced in the body in response to stress, and triglycerides, one of the primary forms of fat that the body uses to store energy for later.

These links are supported by a number of previous studies. For example, exposure to stress in life can affect how well we are able to regulate blood sugar, which may lead to a deterioration of immune function and accelerate age-related damage to cells and molecules in the body. Poor physical activity and lack of sleep can damage the body’s ability to respond to stress. Loneliness and lack of social support have been found to increase the risk of infection and increase markers of immune deficiency.

The team found that the pathway from lifestyle to immune and metabolic functions was the most significant. In other words, a poorer lifestyle impacts on our immune system and metabolism, which in turn increases our risk of depression.

Dr Christelle Langley, also from the Department of Psychiatry at the University of Cambridge, said: “We’re used to thinking of a healthy lifestyle as being important to our physical health, but it’s just as important for our mental health. It’s good for our brain health and cognition, but also indirectly by promoting a healthier immune system and better metabolism.”

Professor Jianfeng Feng, from Fudan University and Warwick University, added: “We know that depression can start as early as in adolescence or young adulthood, so educating young people on the importance of a healthy lifestyle and its impact on mental health should begin in schools.”

This study was supported by grants from organisations including the National Natural Science Foundation of China and the Ministry of Science, China*.

Reference Zhao, Y & Yang, L et al. The brain structure, immunometabolic and genetic mechanisms underlying the association between lifestyle and depression. Nature Mental Health; 11 Sept 2023; DOI: 10.1038/s44220-023-00120-1

*A full list of funders can be found in the paper.

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Expert Commentary

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

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Burden of Mental Disorders and Suicide Attributable to Childhood Maltreatment

• 1 The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
• 2 Department of Clinical, Educational, and Health Psychology, Division of Psychology and Language Sciences, University College London, London, United Kingdom
• 3 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York

Question   What proportion of mental health conditions and burden in Australia is attributable to childhood maltreatment?

Findings   This meta-analysis found, after controlling for genetic and environmental confounding, that childhood maltreatment accounts for 21% to 41% of common mental health conditions in Australia, with the highest attributable proportion for suicide attempts and self-harm. More than 1.8 million cases of depressive, anxiety, and substance use disorders, 66 143 years of life lost, and 184 636 disability-adjusted life-years could be prevented if childhood maltreatment was eradicated in Australia.

Meaning   Efforts to prevent child maltreatment exposure have the potential to improve mental health at a population level in Australia.

Importance   The proportion of mental disorders and burden causally attributable to childhood maltreatment is unknown.

Objective   To determine the contribution of child maltreatment to mental health conditions in Australia, accounting for genetic and environmental confounding.

Design, Setting, and Participants   This meta-analysis involved an epidemiological assessment accounting for genetic and environmental confounding between maltreatment and mental health and 3 cross-sectional national surveys: the Australian Child Maltreatment Study (ACMS) 2023, National Study of Mental Health and Well-being 2020-2022, and Australian Burden of Disease Study 2023. Causal estimates were derived on the association between childhood maltreatment and mental health conditions from a meta-analysis of quasi-experimental studies. This was combined with the prevalence of maltreatment from the ACMS to calculate the population attributable fraction (PAF). The PAF was applied to the number and burden of mental health conditions in Australia, sourced from 2 population-based, nationally representative surveys of Australians aged 16 to 85 years, to generate the number and associated burden of mental disorders attributable to child maltreatment.

Exposure   Physical abuse, sexual abuse, emotional abuse, or neglect prior to age 18 years.

Main Outcomes and Measures   Proportion and number of cases, years of life lost, years lived with disability, and disability-adjusted life-years of mental health conditions (anxiety, depression, harmful alcohol and drug use, self-harm, and suicide attempt) attributable to childhood maltreatment.

Results   Meta-analytic estimates were generated from 34 studies and 54 646 participants and applied to prevalence estimates of childhood maltreatment generated from 8503 Australians. Childhood maltreatment accounted for a substantial proportion of mental health conditions, ranging from 21% (95% CI, 13%-28%) for depression to 41% (95% CI, 27%-54%) of suicide attempts. More than 1.8 million cases of depressive, anxiety, and substance use disorders could be prevented if childhood maltreatment was eradicated. Maltreatment accounted for 66 143 years of life lost (95% CI, 43 313-87 314), primarily through suicide, and 184 636 disability-adjusted life-years (95% CI, 109 321-252 887).

Conclusions and Relevance   This study provides the first estimates of the causal contribution of child maltreatment to mental health in Australia. Results highlight the urgency of preventing child maltreatment to reduce the population prevalence and burden of mental disorders.

Read More About

Grummitt L , Baldwin JR , Lafoa’i J , Keyes KM , Barrett EL. Burden of Mental Disorders and Suicide Attributable to Childhood Maltreatment. JAMA Psychiatry. Published online May 08, 2024. doi:10.1001/jamapsychiatry.2024.0804

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Birdwatching Can Help Students Improve Mental Health, Reduce Distress

A new study finds people who have nature-based experiences report better well-being and lower psychological distress than those who do not. Birdwatching in particular yielded promising results, with higher gains in subjective well-being and more reduction in distress than more generic nature exposure, such as walks. Because birdwatching is an easily accessible activity, the results are encouraging for college students – who are among those most likely to suffer from mental health problems.

“There has been a lot of research about well-being coming out through the pandemic that suggests adolescents and college-aged kids are struggling the most,” said Nils Peterson, corresponding author of the study and a professor of forestry and environmental resources at North Carolina State University. “Especially when you think about students and grad students, it seems like those are groups that are struggling in terms of access to nature and getting those benefits.

“Bird watching is among the most ubiquitous ways that human beings interact with wildlife globally, and college campuses provide a pocket where there’s access to that activity even in more urban settings.”

To quantitatively measure subjective well-being, researchers used a five-question survey known as the World Health Organization-Five Well-Being Index (WHO-5). This tool asks participants to assign a rating of zero through five to statements about well-being, depending on how often they have felt that way in the last two weeks. For example, given the prompt “I have felt calm and relaxed,” a participant would mark a zero for “at no time” or a five for “all of the time.” Researchers can calculate a raw well-being score by simply adding the five responses, with zero being the worst possible and 25 the best possible quality of life.

Researchers split the participants into three groups: a control group, a group assigned five nature walks and a group assigned five 30-minute birdwatching sessions. While all three groups had improved WHO-5 scores, the birdwatching group started lower and ended higher than the other two. Using STOP-D, a similar questionnaire designed to measure psychological distress, researchers also found that nature engagement performed better than the control, with participants in both birdwatching and nature walks showing declines in distress.

This study differed from some previous research, Peterson said, in that it compared the effects of birdwatching and nature engagement to a control group rather than a group experiencing more actively negative circumstances.

“One of the studies that we reviewed in our paper compared people who listen to birds to people who listened to the sounds of traffic, and that’s not really a neutral comparison,” Peterson said. “We had a neutral control where we just left people alone and compared that to something positive.”

The study supports the idea that birdwatching helps improve mental health and opens up many avenues for future research. For example, future study could examine why birdwatching helps people feel better or the moderating effects of race, gender and other factors.

The paper, “ Birdwatching linked to increased psychological well-being on college campuses: A pilot-scale experimental study ,” is published in Environmental Psychology. Co-authors include Lincoln Larson, Aaron Hipp, Justin M. Beall, Catherine Lerose, Hannah Desrochers, Summer Lauder, Sophia Torres, Nathan A. Tarr, Kayla Stukes, Kathryn Stevenson and Katherine L. Martin, all from NC State.

-pitchford-

Note to Editors: The study abstract follows.

“Birdwatching linked to increased psychological well-being on college campuses: A pilot-scale experimental study”

Authors: Nils Peterson, Lincoln Larson, Aaron Hipp, Justin Beall, Catherine Lerose, Hannah Desrochers, Summer Lauder, Sophia Torres, Nathan Tarr, Kayla Stukes, Kathryn Stevenson, Katherine Martin

Published: April 26, 2024 in Environmental Psychology

DOI: 10.1016/j.jenvp.2024.102306

Abstract: Exposure to nature is known to improve human health, but little is known about how one of the most common forms of nature engagement, birdwatching, impacts psychological well-being – especially among campus populations at great risk for experiencing mental health challenges. This study engaged 112 campus participants in a stepped design experiment evaluating the degree to which five >30 min weekly birdwatching (n = 62) and nature walk (n = 77) exposures impacted self-reported subjective well-being (WHO-5) and psychological distress (STOP-D) levels relative to a control group (n = 81). The directions of all relationships supported hypotheses that nature-based experiences, and birdwatching in particular, would increase well-being and reduce distress. These results build on preliminary evidence of a causal relationship between birdwatching and well-being and highlight the value of considering well-being impacts for specific types of activities in nature, underscoring the need for future research with larger and more diverse samples.

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Going light: Students ditch smartphones in mental health study

The Stanford Social Media Lab wrapped up a study on the effect of smartphones and social media usage on mental health on May 12. The study asked participants to abandon normal smartphones for a week and switch to the Light Phone instead.

“Its slogan is: ‘a phone designed to be used as little as possible,’” said Georgia Walker-Keleher ’26, co-founder of the study and member of the research team.

Davey Agrawal ’26, a participant in the study, explained how the Light Phone eliminated the possibility of social media “taking over parts of your day when you don’t want it to.” For Agrawal, this was an immense positive. “I felt clear-minded throughout the week, and, I would say, it was easier to focus.”

The Light Phone by Light is equipped with a small, 96 by 55 millimeter e-ink display and runs the company’s specialized operating system “Light OS.”

“You can still take calls, you can still text people, you can set alarms, but there are no apps. There’s no social media,” said Angela Lee, a fifth-year Ph.D. student in communications who ran the study. The goal of the study was to “understand the effects of smartphone [and] social media use on psychological well being,” Lee said.

A full analysis of the study’s findings is still in the works, but anecdotal accounts like are overwhelmingly positive. “There were a lot of people who chose to keep the phone in the end,” Walker-Keleher said.

Agrawal and Jenna Ali ’25, both participants in the study, spoke highly of the Light Phone. They highlighted not only the mental health benefits of limiting access to social media, but also the time management and productivity it afforded. 

Agrawal explained that while using the Light Phone, he would occasionally check Instagram on his iPad, “but each time I would have to do that, it’s very intentional.” Ali said that the use of a Light Phone allowed her to “really live in the moment.” “You don’t need to be on social media to have connections with people” she said.

Light was founded as a kickstarter in 2015, with the mission of “[being] an alternative to the tech monopolies that are fighting more and more aggressively for our time & attention,” according to Light’s website .

The idea for the study originally came from Walker-Keleher and her roommate Caroline Chen ’26, an editor at The Daily.

“In the spring of last year, I had been using the Light Phone for [a few months], and people would see it and be curious and ask about and want to try it,” Walker-Keleher said. She said that she reached out to several labs on campus and received interest from the Stanford Social Media lab.

Then she reached out to Joe Hollier, one of the founders of Light Phone. Walker-Keleher said she “asked him if he would be willing to donate phones or give phones for a Stanford study.”

She emphasized that the research results were independent to the industry partners.

Over 80 students took part in the research. After receiving their Light Phones and being helped through the setup process, participants agreed to completely switch over to the Light Phone for a week and fill out a series of surveys along the way.

Participants were split into three groups, a “high-interest group,” a test group and control group. The test and control group were recruited from classes in the communications department. “[Switching phones] requires a large incentive … we accomplished that by using it as a research credit for a [communications] class,” said Emma Charity ’25, a member of the research team. 

The high-interest group was made up of participants who expressed interest in response to flyers and emails. This group was told, “If you want to, we will compensate you for your time if you’re willing to switch over from your smartphone,” Lee said. All three groups filled out the same set of surveys throughout the week.

Agrawal and Ali were overwhelmingly positive in their reviews of the light phone, but they also highlighted a few particular challenges. “I wish that it had Spotify so that I could stream music … Also, the directions could be a little better,” Ali said.

Agrawal highlighted the phone’s lack of support for WhatsApp. Light Phone wrote on its website that they hope to support WhatsApp in the future, but “don’t currently have plans or a timeline for that functionality.”

A complete analysis of the collected data is expected to release soon. “It’ll hopefully have a lot of implications for this ongoing debate about how smartphones and social media specifically affects mental health and wellbeing,” Lee said.

She noted that there is a scarcity of experimental studies in this field. “We know this is a big question that a lot of people have, and people have a lot of strong priors or beliefs about it,” she said.

Walker-Keleher said that group intends to re-run the study next fall.

“I hope that this [study] sparks people’s interest in how their technical talent and how their interest in tech issues can spur actual products and actual change,” Charity said.

A previous version of this article misspelled Agrawal’s last name. The Daily regrets this error.

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Are We Talking Too Much About Mental Health?

Recent studies cast doubt on whether large-scale mental health interventions are making young people better. Some even suggest they can have a negative effect.

By Ellen Barry

In recent years, mental health has become a central subject in childhood and adolescence. Teenagers narrate their psychiatric diagnosis and treatment on TikTok and Instagram. School systems, alarmed by rising levels of distress and self-harm, are introducing preventive coursework in emotional self-regulation and mindfulness.

Now, some researchers warn that we are in danger of overdoing it. Mental health awareness campaigns, they argue, help some young people identify disorders that badly need treatment — but they have a negative effect on others, leading them to over-interpret their symptoms and see themselves as more troubled than they are.

The researchers point to unexpected results in trials of school-based mental health interventions in the United Kingdom and Australia: Students who underwent training in the basics of mindfulness , cognitive behavioral therapy and dialectical behavior therapy did not emerge healthier than peers who did not participate, and some were worse off, at least for a while.

And new research from the United States shows that among young people, “self-labeling” as having depression or anxiety is associated with poor coping skills, like avoidance or rumination.

In a paper published last year , two research psychologists at the University of Oxford, Lucy Foulkes and Jack Andrews, coined the term “prevalence inflation” — driven by the reporting of mild or transient symptoms as mental health disorders — and suggested that awareness campaigns were contributing to it.

“It’s creating this message that teenagers are vulnerable, they’re likely to have problems, and the solution is to outsource them to a professional,” said Dr. Foulkes, a Prudence Trust Research Fellow in Oxford’s department of experimental psychology, who has written two books on mental health and adolescence.

Until high-quality research has clarified these unexpected negative effects, they argue, school systems should proceed cautiously with large-scale mental health interventions.

“It’s not that we need to go back to square one, but it’s that we need to press pause and reroute potentially,” Dr. Foulkes said. “It’s possible that something very well-intended has overshot a bit and needs to be brought back in.”

This remains a minority view among specialists in adolescent mental health, who mostly agree that the far more urgent problem is lack of access to treatment.

About 60 percent of young Americans with severe depression receive no treatment, according to Mental Health America, a nonprofit research group. In crisis, desperate families fall back on emergency rooms, where teens often remain for days before a psychiatric bed opens up. There is good reason to embrace a preventive approach, teaching schoolchildren basic skills that might forestall crises later, experts say.

Dr. Foulkes said she understood that her argument runs counter to that consensus, and when she began to present it, she braced for a backlash. To her surprise, she said, many educators reached out to express quiet agreement.

“There’s definitely a fear about being the one to say it,” she said.

A deflating result

In the summer of 2022, the results of a landmark study on mindfulness training in British classrooms landed — like a lead balloon.

The trial, My Resilience in Adolescence, or MYRIAD, was ambitious, meticulous and expansive, following about 28,000 teenagers over eight years. It had been launched in a glow of optimism that the practice would pay off, improving the students’ mental health outcomes in later years.

Half of the teenagers were trained by their teachers to direct their attention to the present moment — breathing, physical sensations or everyday activities — in 10 lessons of 30 to 50 minutes apiece.

The results were disappointing . The authors reported “no support for our hypothesis” that mindfulness training would improve students’ mental health. In fact, students at highest risk for mental health problems did somewhat worse after receiving the training, the authors concluded.

But by the end of the eight-year project, “mindfulness is already embedded in a lot of schools, and there are already organizations making money from selling this program to schools,” said Dr. Foulkes, who had assisted on the study as a postdoctoral research associate. “And it’s very difficult to get the scientific message out there.”

Why, one might ask, would a mental health program do harm?

Researchers in the study speculated that the training programs “bring awareness to upsetting thoughts,” encouraging students to sit with darker feelings, but without providing solutions, especially for societal problems like racism or poverty. They also found that the students didn’t enjoy the sessions and didn’t practice at home.

Another explanation is that mindfulness training could encourage “co-rumination,” the kind of long, unresolved group discussion that churns up problems without finding solutions.

As the MYRIAD results were being analyzed, Dr. Andrews led an evaluation of Climate Schools, an Australian intervention based on the principles of cognitive behavioral therapy, in which students observed cartoon characters navigating mental health concerns and then answered questions about practices to improve mental health.

Here, too, he found negative effects. Students who had taken the course reported higher levels of depression and anxiety symptoms six months and 12 months later.

Co-rumination appears to be higher in girls, who tend to come into the program more distressed, as well as more attuned to their friends, he said. “It might be,” he said, “that they kind of get together and make things a little bit worse for each other.”

Dr. Andrews, a Wellcome Trust research fellow, has since joined an effort to improve Climate Schools by addressing negative effects. And he has concluded that schools should slow down until “we know the evidence base a bit more.” Sometimes, he said, “doing nothing is better than doing something.”

The awareness paradox

One problem with mental health awareness, some research suggests, is that it may not help to put a label to your symptoms.

Isaac Ahuvia, a doctoral candidate at Stony Brook University, recently tested this in a study of 1,423 college students . Twenty-two percent “self-labeled” as having depression, telling researchers “I am depressed” or “I have depression,” but 39 percent met the diagnostic criteria for depression.

He found that the students who self-labeled felt that they had less control over depression and were more likely to catastrophize and less likely to respond to distress by putting their difficulties in perspective, compared with peers who had similar depression symptoms.

Jessica L. Schleider, a co-author of the self-labeling study, said this was no surprise. People who self-label “appear to be viewing depression as a biological inevitability,” she said. “People who don’t view emotions as malleable, view them as set and stuck and uncontrollable, tend to cope less well because they don’t see a point to trying.”

But Dr. Schleider, an associate professor of medical social sciences at Northwestern University and the director of the university’s Lab for Scalable Mental Health, pushed back on the prevalence inflation hypothesis. She disagreed with the claim that students are overdiagnosing themselves, noting that Mr. Ahuvia’s findings suggest otherwise.

Awareness campaigns are bound to have multiple effects, helping some students and not others. And ultimately, she argued, the priority for public health should be reaching young people in the most distress.

“The urgency of the mental health crisis is so clear,” she said. “In the partnerships that I have, the emphasis is on the kids truly struggling right now who have nothing — we need to help them — more so than a possible risk for a subset of kids who aren’t really struggling.”

Maybe, she said, we need to look beyond the “universal, school-assembly-style approach,” to targeted, light-touch interventions, which research has shown can be effective at decreasing anxiety and conduct disorders, especially in younger children.

“There is a risk of throwing the baby out with the bathwater,” Dr. Schleider said. “The response can’t be ‘Forget all of it.’ It should be ‘What about this intervention was unhelpful?’”

Other researchers echoed her concern, pointing to studies that show that on average, students benefit from social and emotional learning courses.

One of the largest, a 2023 meta-analysis of 252 classroom programs in 53 countries, found that students who participated performed better academically, displayed better social skills and had lower levels of emotional distress or behavioral problems. In that context, negative effects in a handful of trials appear modest, the researchers said.

“We clearly have not figured out how to do them yet, but I can’t imagine any population-based intervention that the field got right the first time,” said Dr. Andrew J. Gerber, the president and medical director of Silver Hill Hospital and a practicing child and adolescent psychiatrist.

“Really, if you think about almost everything we do in schools, we don’t have great evidence for it working,” he added. “That doesn’t mean we don’t do it. It just means that we’re constantly thinking about ways to improve it.”

‘We want everyone to have it’

These debates are taking place a long way away from classrooms, where mental health curriculums are increasingly commonplace.

Allyson Kangisser, a counselor at Woodsdale Elementary School in Wheeling, W.Va., said the focus in her school is on basic coping skills. In the early grades, students are asked, “What things can you do to take care of yourself when you’re having big feelings?”

Starting in third grade, they take on more complex material, such as watching cartoon characters to distinguish transient stress from chronic conditions like depression. “We’re not trying to have them diagnose themselves,” Ms. Kangisser said. “We are saying, what do you feel — this one? Or this one?”

At the school’s sixth annual mental health fair last month, Woodsdale students walked through a giant inflatable brain, its lobes neatly labeled. They did yoga stretches and talked about regulating their emotions. Ms. Kangisser said the event is valuable precisely because it is universal, so troubled children are not singled out.

“The mental health fair, everybody does it,” she said. “It’s not ‘You need it, and you don’t.’ We want everyone to have it, because you just never know.”

By the time the students reach college, they will have absorbed enormous amounts of information about mental health — from school, but also from social media and from one another.

Dr. Jessica Gold, chief wellness officer for the University of Tennessee system, said the college students she sees are recognizably different — more comfortable speaking about their emotions and more willing to be vulnerable. They also overuse diagnostic terms and have the self-assurance to question a psychiatrist’s judgment.

“It’s sort of a double-edged sword,” she said. “We want people to talk about this more, but we don’t want that to lead to overdiagnosis or incorrect diagnosis or overtreatment. We want it to lead to normalizing of having feelings.”

Lucy Kim, a Yale senior who has lobbied for better mental health support on campus, described the prevalence inflation hypothesis as “disheartening, dismissive and potentially dangerous,” providing another way to discount the experiences of young people.

“As a college student, I see a generation of young people around me impacted by a depth and breadth of loneliness, exhaustion and disillusionment suggestive of a malaise that goes deeper than the general vicissitudes of life,” said Ms. Kim, 23.

Overdiagnosis does happen, she said, and so does glorification of mental health disorders. But stigma and barriers to treatment remain the bigger problem. “I can confidently say I have never heard anyone respond to disclosures of depression with ‘That’s so cool, I wish I had that, too,’” she said.

Ellen Barry is a reporter covering mental health for The Times. More about Ellen Barry

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Dismissed and discharged: health systems still failing people with poor mental health

22 May 2024

Funded by MIND Australia , the world first study found that people with psychosocial disabilities - people who live with disabilities as a result of poor mental health - not only experience distress when dealing with the NDIS, but also face ‘service pullback’ when they present to emergency departments when requiring emergency care.

Speaking with NDIS participants, the nationwide study found that when participants disclosed that they had NDIS support, clinicians wrongly assumed the NDIS provides medical and mental health crisis care.

It’s a concerning finding, particularly following the discrimination, non-inclusivity and lack of equality experienced by people with a disability, identified in the NDIS review and the disability royal commission .

In Australia, 1.1 million people have a psychosocial disability which causes limitations or restrictions in their everyday activities . Additional, 58% of these people also have a nervous or emotional condition, 42% have problems with memory or periods of confusion, 41% have behavioural conditions, and 40% have a mental illness (such as schizophrenia).

86% also have at least one other disabling condition (63% physical disability; 38% intellectual disability; and 33% sensory disability).

UniSA researcher and PhD candidate Heather McIntyre says that the disconnect between the NDIS and emergency departments is failing people with psychosocial disabilities.

“Time and time again we hear about people experiencing distress when they contact the NDIS – they fight to be heard, fight for support, and are often dismissed, so the last thing they need is to go through this again when they require emergency care,” McIntyre says.

“This is particularly concerning for people with a mental health condition, especially those with fluctuating psychosocial disabilities who may struggle with communication.

“Because many emergency department staff aren’t aware of the limitations of NDIS supports, they wrongly assume that the NDIS provides a higher level of care than it does.

“This leaves many people with a psychosocial disability being discharged at emergency without appropriate treatment and returned to the situation that caused them to present in the first place.

“It’s an inequitable and unsafe approach that is putting thousands of people at risk.”

McIntyre says there is an urgent need to strengthen service integration between the NDIS and emergency departments.

“Communication between the two services is not occurring seamlessly, which affects continuity of care. This needs to change,” McIntyre says.

“We must start at the pointy end: emergency department clinicians need more training and education to better understand how the NDIS works and how to best support people with a disability.

“They need to learn how to support people with neurodiversity and hearing impairments, how to build trust and how to really listen, as well as to provide low sensory environments.

“But equally, stronger connections and pathways must be established between NDIS providers and emergency departments so that everyone is on the same page.

“With budget cuts to the NDIS of 14 billion over the next four years, peoples’ disability supports will further be reduced, resulting in more emergency department presentations when supports are insufficient.

“In emergency departments we need to step up care, not ration care, if we are to support people with disabilities who already feel abandoned by the health system.”

………………………………………………………………………………………………………………………….

Notes to editors

The article is available online: McIntyre, H., Loughhead, M., Hayes, L., Allen, C., Barton-Smith, D., Bickley, B. et al. (2024)  ‘ Everything would have gone a lot better if someone had listened to me’: A nationwide study of emergency department contact by people with a psychosocial disability and a National Disability Insurance Scheme plan .  International Journal of Mental Health Nursing, 00, 1–12.

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Media contact: Annabel Mansfield M: +61 479 182 489 E: [email protected]

Researcher: Heather McIntyre E : [email protected]

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• Published: 27 February 2024

Adolescent mental health and academic performance: determining evidence-based associations and informing approaches to support in educational settings

• Xzania Lee 1 ,
• Anya Griffin 1 , 2 ,
• Maya I. Ragavan 3 &
• Mona Patel 1 , 2  

Pediatric Research ( 2024 ) Cite this article

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In 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association (CHA) declared a “National State of Emergency in Children’s Mental Health.” 1 The statement identified how the pandemic exacerbated the already worsening mental health problem among US youth due to the compounding challenges faced by youth and acknowledged the significant impact of this mental health crisis on youth. This declaration made a call for schools, policymakers, and advocates for children and adolescents to prioritize and focus on pediatric mental health.

Adolescent mental health and academic performance are intricately linked aspects of development, each influencing and being influenced by the other. The recognition of this bidirectional association has sparked considerable interest within the research community, prompting an investigation into the nuanced dynamics between mental health and educational outcomes during the formative adolescent years. Numerous studies have explored the connection and influence between mental health and academic performance, and further acknowledge that the multifaceted interconnectedness of mental health and academic performance require a holistic view. 2 , 3 , 4 Researchers have identified that higher academic aspirations are associated with better mental health outcomes and that socioemotional well-being is needed for academic thriving. 5 , 6 Furthermore, Yu and associates described how interpersonal relationships are positively correlated with academic performance, especially student-peer relationships, which had more influence than the parent-student or teacher-student relationship on academic achievement. 7 , 8 Finally, impacts of social determinants of health have been shown to exert profound influences on both mental health and academic outcomes further emphasizing the need to consider the broader ecological context in which adolescents develop and the importance of considering a socioecological model, suggesting that factors such as family, school, and community environments play pivotal roles in shaping both mental health and academic outcomes. 6 , 9

In this article by Monzonis-Carda and associates, the authors explore the bidirectional longitudinal association between the dual-factor model of mental health and academic performance in adolescents. The dual-factor model of mental health, in contrast to traditional models of mental health which focus on psychopathological symptoms, integrates mental health wellbeing and psychopathology into a mental health continuum. 10 The authors hypothesize that a bidirectional association between academic performance and adolescent mental health would be present in their sample of 266 secondary school students from Spain. They assessed mental health through the Spanish language Behavior Assessment System for Children and Adolescents (BASC-S3) and examined grade point average, and academic performance based on the Test of Educational Abilities. They then employed a cross-lagged modeling approach to analyze the bidirectional association over 2 years. The key findings suggested that higher academic performance at baseline was associated with better mental health over time, but better mental health was not associated with academic performance. Therefore, the association was not bidirectional as expected. Based on these findings, the authors posit academic performance may be a predictor of adolescents’ mental health status; and conversely, mental health may not be a predictor of adolescents’ academic performance. They offered school-based recommendations for the promotion of good mental health practices for students with low academic performance and supported future policy and health and educational professionals to promote adolescent mental health wellbeing. Overall, the article underscores the importance of considering academic performance as a target for interventions to promote adolescents’ mental health. It suggests that focusing on reducing school pressure and establishing personalized academic goals could contribute to better psychological well-being.

While the article provides some important insights into the association between mental health and academic performance in adolescents, some limitations were noted. While there is some limited adjustment for socioeconomic status, the article lacks a comprehensive exploration of social determinants of health and impacts of adverse childhood events (ACES), such as cultural background, and other important social and familial dynamics. These factors play a pivotal role in shaping an adolescent’s mental health and academic performance and may result in an oversimplified understanding of the complex interplay between mental health and academic outcomes. The study further focuses on academic grades and “abilities” as indicators of academic performance. Academic success is multifaceted and includes factors like motivation, engagement, and teacher-student relationships, and a more nuanced exploration of these components could provide a richer understanding of the relationship between mental health and academic outcomes. The study authors reviewed limitations that require further investigation including the use of BASC-S3 as the primary self-reported measure of adolescent mental health. Depending on individual developmental level of insight and situational context, adolescents are often unreliable and inaccurate reporters of their functioning, and adolescents in clinical populations tend to overreport symptoms and provide inaccurate information regarding their functioning on the BASC-S3. 11 , 12 Incorporating objective measures or multi-method assessments and the inclusion of multi-rater methods (i.e., teachers, caregivers, etc.) may provide a more detailed picture of the student’s true socioemotional functioning through the provision of differing perspectives of each student’s functioning. 13 The study’s authors also acknowledge a relatively small sample size, homogeneity of the study population, and short study length to determine longitudinal outcomes may further limit generalizability to other populations. Lack of testing for sex assigned at birth and self-identified gender effects, and not integrating broader social determinant impact upon adolescent mental health may result in misguided or ineffective approaches to promoting mental health in adolescents. Further, previous research and psychological assessment literature have indicated the significant impact of social determinants of health and ACES on youth academic achievement and behavioral health outcomes. Students with elevated social risk, including ACES, are often at increased risk for mental health and academic achievement deterioration. 14 This supports the need for school leaders and policymakers to continue to focus efforts on maximizing the recognition of these factors for youth and promote the implementation of programs to address roots of social risk and integration of socioemotional mental health supports in academic institutions. 15 Due to the interconnectedness of mental wellness and academic success, addressing aspects of mental health functioning within the school setting will equip students with the essential skills to navigate challenges, manage stress, and build resilience. By bolstering emotional, behavioral, and social skills, students are primed to engage in learning, establish positive relationships with peers and teachers, and cope with the pressures of academic stress and daily life hassles. 16 A structured educational tier one (i.e., general education curriculum) mental health intervention will assist students with stress reduction, and behavior management, improve executive functioning skills, and establish a scholastic environment conducive to effective knowledge consumption and academic performance. 17 Incorporating evidence-based practices to support student emotional wellness holistically nurtures the development of students and provides a foundation for lifelong well-being and academic excellence. While this article contributes to the understanding of the association between mental health and academic performance, it also highlights the need for future exploration of factors that influence the causality between adolescent mental health and academic performance and further informs the recommendation to have mental health interventions and social-emotional learning curriculums in educational settings.

The 2021 joint declaration of the “National State of Emergency in Children’s Mental Health” catalyzed federal, state, and local awareness of evolving needs in pediatric mental health in the United States of America. While there has been increasing bipartisan support and focus for mental health funding at all levels of government, appropriate allocation of such funding to support identifying factors that impact pediatric mental health and using a data-driven approach to effective programming is critical. An example of more recent federally supported funding programs for child mental health includes the Health Resources & Services Administration (HRSA) funded Pediatric Mental Health Care Access (PMHCA) program, which has seen increased funding from 2018 through 2022, with an additional 80 million dollars added by the Bipartisan Safer Communities Act. ( https://mchb.hrsa.gov/programs-impact/programs/pediatric-mental-health-care-access ) Currently, under-resourced and under-reimbursed health systems fraught with post-pandemic short staffing and pre-pandemic existing behavioral health access challenges pose continued roadblocks to access. Pediatric policy recommendations to aid with improving meaningful pediatric mental health access include:

Increased funding and support for access to meaningful mental health resources in the community and schools

Integrated behavioral health delivery models within primary care and specialty care will be critical in enhancing access to care.

Increase the behavioral health workforce, training programs for primary care pediatricians and pediatric psychologists are needed, as the number of child psychiatrists and pediatric psychologists is currently not sufficient to meet demand.

Innovative and integrative team-based models including non-traditional licensed and non-licensed behavioral health support teams, including community health work may allow further access and a more impactful peer-to-peer support structure.

Behavioral health reimbursement shifts may ultimately be required to build infrastructure to address the current critical socio-emotional needs of our youth. Ultimately, research informing a more comprehensive perspective, including health-related social needs and ACES will be essential for advancing the field with evidence-based mental health interventions for youth.

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Xzania Lee, Anya Griffin & Mona Patel

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Lee, X., Griffin, A., Ragavan, M.I. et al. Adolescent mental health and academic performance: determining evidence-based associations and informing approaches to support in educational settings. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03098-3

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Sad Girl Playlists Aren’t Just Trendy—Study Finds Sad Music Can Boost Your Mental Health

• New research suggests that listening to sad music can positively impact a person’s mood based on the sense of connectedness it provides.
• Experts cite three responses to sad music: grief, melancholia, and sweet sorrow.
• Experts agree that music of all kinds can play a role in people’s mental health and mood, but music is a personal, unique experience for each listener.

A new study found that listening to sad music can impact a person’s mood positively, based on a revived sense of connectedness.

When you’re at a party or social gathering you may queue an upbeat song, such as “That’s What I Like” by Bruno Mars. On other days, you might just want to listen to something that’s a bit more gloomy and relatable like Taylor Swift’s “Anti-Hero.”

Whatever music you enjoy listening to most, whether that be hip-hop, country, rock, or jazz, it can oftentimes influence your mood and feelings.

This is especially true when it comes to sad music. Various features of a song, including tempo, mode, instrument choice, and dynamics, can prompt negative emotions in listeners, Tara Venkatesan, PhD, a cognitive scientist at Oxford University and an operatic soprano, told Health.

However, a new study published in the Journal of Aesthetic Education , which Venkatesan was a part of, suggests that while listening to sad music can certainly make people feel sad, doing so may also impact a person’s mood positively and allow them to feel a sense of connectedness.

“Our main point is that the value of sad music lies in its ability to create a sense of connection, regardless of whether it actually evokes sadness in the listener,” Venkatesan clarified. “And it’s that sense of connection, not necessarily the experience of sadness itself, which is what makes listening to sad music really great!”

Getty Images / Westend61

Why Do People Love Sad Music?

The researchers hypothesized that people value sad music for the same reasons they might value sad conversations—a sense of genuine connection.

For example, when someone tells you about their horrible break up, you might feel sad yourself because of how genuinely devastated and lonely they are feeling, Venkatesan explained. However, as you continue talking, you might feel like there’s something meaningful about that interaction and connected with this person in a unique way.

The research team demonstrated sad music’s ability to provide a sense of connection in two parts.

In the first part, the researchers wanted to show that emotional expression is a characteristic value of what music is all about. They gave nearly 400 participants a description of four different songs including:

• A song that “conveys deep and complex emotions” but is “technically very flawed”
• A song that is “technically flawless” but “does not convey deep or complex emotions”
• A song that is “deeply emotional” and “technically flawless”
• A song that is both unemotional and “technically flawed”

Participants were asked to rank songs based on which pieces embodied “what music is all about.”

They found that participants valued emotional expression more than technical proficiency when reviewing their song choices. Highly emotional songs, even of lesser technical value, were chosen at a much higher rate.

For the second part of their experiment, the authors asked 450 new participants to rate how connected they felt when listening to music or participating in conversations that expressed 72 different emotions, including inspiration, love, sadness, contempt, etc.

They found that the emotions that make people feel connected in conversation are also the emotions whose expression in music matched the “what music is all about” highly rated songs: sadness, love, joy, loneliness , and sorrow.

Furthermore, participants said that songs expressing sad emotions like suffering and despair are unpleasant to listen to but still capture the essence of what music is all about and make for high-connection conversations.

“In other words, regardless of whether we enjoy sad music, we value sad music because it creates a sense of connection,” Venkatesan explained.

Other research has suggested that people listen to sad music for no particular motivation other than the fact that they like this music or band. In fact, a 2014 study highlights that nearly a third of participants listened to sad music when they were in a positive mood.

Does Listening to Sad Music Evoke Sadness? 

Whether or not sad music makes a person feel sad depends on each individual and their experience, Shannon Bennett, PhD , site clinical director for NewYork-Presbyterian’s Center for Youth Mental Health, told Health .

For example, a person might feel sad when they hear a certain song because that song might be connected to a particular memory. Since our emotions and memories are very connected, when we listen to a song that evokes a certain memory, it can cause us to feel sad.

“If a piece of music is connected to either of those experiences that could then bring on a real feeling of sadness,” Bennett explained. “But that to me is a more personal experience in terms of how intense that feeling is, how long it lasts, and then importantly what we do with it.”

This aligns with a 2016 study that found people who listen to sad music can perpetuate cycles of negative thinking and often prompts them to think about sad memories or negative thoughts.

Music, and our response to it, is a unique and personal experience.

While sad music can generally make people feel sad, depending on the mental health state of an individual, it can evoke other emotions as well, added Venkatesan. She cited previous research on people’s experience of sad music and noted three main categories expressed: grief, melancholia, and sweet sorrow.

“While grief consisted mainly of negative emotions like despair, both melancholia and sweet sorrow consisted of more mixed emotions like longing and nostalgia and even positive emotions like comfort and pleasure,” she said.

Music and Mental Health

Bennett clarified that sad music does not automatically indicate sad emotion for the listener—it can actually impact the listener’s mental health positively.

“Music can be a way to practice just sitting with a feeling that sometimes is harder to sit with and that is actually emotionally very helpful,” she added. “We call that an emotional exposure that in fact is used in some very well-researched therapy protocols to help us to sit with emotions that we sometimes don’t want to sit with.”

Sad music can also make people feel connected in the same way a heartfelt conversation makes us feel connected, said Venkatesan. “It is very likely that the sense of connection we experience when listening to sad music has positive health benefits.”

Some studies suggest that listening to sad music creates a feeling of “emotional communion” where you share feelings of sadness with the singer or composer. Venkatesan explained that in this case, listening to sad songs may act as a form of virtual contact which can help people feel accepted, understood, and less lonely.

She added that other studies suggest that listening to sad songs allows us to connect with ourselves and reflect on our own emotional experiences which can help with mood regulation.

Venkatesan noted that music, in general, has a profound effect on our brains and physiology and therefore can also impact our mood.

For example, some research suggests that relaxing music can decrease levels of salivary cortisol and psychological stress, which is an indicator of decreased stress and better regulation when responding to a stressor.

Bennett noted in the same way that a sad song might evoke a sad emotional state, there are ways to use music to evoke a positive emotional state. There are also ways that people can choose positive behaviors that might move them in the direction of positive emotion.

Bennett concluded, “My hope is that this research will help people just recognize that feeling sad is okay and also that there are things that we can do to help us move out of that feeling.”

Attie-Picker M, Venkatesan T, Newman GE, Knobe J. On the value of sad music . J Aesthet Educ . Published online April 18, 2023.

Tallahassee Memorial Healthcare. How music affects your mind, mood and body. 

Taruffi L, Koelsch S. The paradox of music-evoked sadness: an online survey . PLoS One . 2014;9(10):e110490. doi:10.1371/journal.pone.0110490

Garrido S, Schubert E, Bangert D. Musical prescriptions for mood improvement: an experimental study . Arts Psychother . 2016;51:46-53. doi:10.1016/j.aip.2016.09.002

Van den Tol AJM, Edwards J, Heflick NA. Sad music as a means for acceptance-based coping . Music Sci . 2016;20(1):68-83. doi:10.1177/1029864915627844

Ooishi Y, Mukai H, Watanabe K, Kawato S, Kashino M. Increase in salivary oxytocin and decrease in salivary cortisol after listening to relaxing slow-tempo and exciting fast-tempo music . PLoS One . 2017;12(12):e0189075. doi:10.1371/journal.pone.0189075

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