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Social and emotional wellbeing of individuals and communities is related to mental health

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If you or someone you know is considering suicide, please contact the National Suicide Prevention Lifeline: 1-800-273-TALK (8255), available 24 hours a day, seven days a week. All calls are confidential, and anyone can use this service. For more information, visit SuicidePreventionLifeline.org.
Attending college comes with extra challenges that can impact mental health. Meeting deadlines, managing budgets, and planning for the future may trigger feelings of anxiety or depression. It may also lead to alcohol dependence.

Rather than self-medicating through substance abuse, students experiencing mental health issues should seek extra support during college. Therapy, support groups, and medications can make a big impact on quality of life.

This guide features resources to manage student mental health. Read on to learn common types of mental health challenges and how to seek help for each.

Understanding Student Mental Health

The COVID-19 pandemic has impacted students' mental health. Due to the stigma around mental health, some students may feel less inclined to openly share about their struggles. Despite how it may seem, many students experience mental health issues.

A survey by the Association for University and College Counseling Center Directors shows college student mental health has been a growing concern since 2013. The survey found 95% of college counseling center directors believed the number of students with significant psychological problems was an increasing campus issue.

The directors also reported that 21% of students who visit the campus counseling center presented severe mental health concerns. At the same time, 40% of students presented mild health concerns.

More recent data published in 2021 echoes the same sentiment on mental health for students. The University of Florida's mental health clinic saw a 106% increase of adult patients attending their first appointment in August between 2019 and 2020. The amount increased by another 4% in 2021.

Stress and Anxiety

Symptoms of generalized anxiety disorder may become magnified during high-stress seasons of life. In fact, people are most at risk between childhood and middle age.

Everyone experiences this condition differently. Stress and anxiety may manifest as procrastination, insomnia, worry, and inability to focus. These two conditions may also cause physical symptoms like shortness of breath, headaches, upset stomach, or increased heartbeat.

Some studies show a correlation between stress and healthy hormone levels. People with menstrual cycles may experience irregularities in the length between cycles. Acne levels can also increase.

Where to Get Help

Students can manage their stress and anxiety in many ways. First, they can seek help from a licensed therapist, counselor, or psychiatrist. The Anxiety & Depression Association of America publishes a therapist directory of providers who specialize in this condition.

The Centers for Disease Control and Prevention also offers coping ideas. Many of the recommendations, including meditating and eating nutritiously, benefit general health. Spending time with friends and connecting with nature may also ease symptoms. Students may also explore online support groups.

Depression

Depression ranges from extended periods of mild sadness to prolonged feelings of intense hopelessness. Some students experience depression and anxiety at once. Depression can make people feel lethargic, unmotivated, and uninterested in things they once loved. Some people may have trouble sleeping, while others may sleep too much.

Certain life experiences may trigger depression, which some professionals call situational depression. This may occur after earning a series of bad grades, losing a job, losing a loved one, or undergoing a traumatic experience. Fortunately, medication can work as a temporary or long-term aid for both situational and ongoing depression.

No matter how depression manifests, students should seek help and support from their community and professionals.

Where to Get Help

People experiencing thoughts of suicide or self-harm should immediately contact the Suicide Prevention Lifeline. This organization offers free 24/7 phone and chat assistance. Caller information stays confidential.

Students can join an online support group to manage day-to-day symptoms. People who need assistance from medication should talk to a doctor. The American Psychological Association (APA) publishes a list of licensed care providers.

Drug Abuse and Alcoholism

Some students turn to drugs or alcohol to numb feelings of anxiety or depression. The National Institute on Alcohol Abuse and Alcoholism surveyed college students and found that 33% of college students surveyed say they engaged in binge drinking in the past month. Binge drinking can cause permanent changes in brain chemistry and physical health.

Students should not let feelings of shame surrounding drug abuse and alcoholism prevent them from seeking help. Genetics make some people prone to addiction. With professional help and community support, sobriety is possible.

Where to Get Help

Alcoholics Anonymous is a popular support group with meetings all across America. Students who want more one-on-one or immediate assistance can contact an alcohol and drug rehab hotline.

If talking to someone in person or over the phone seems intimidating, online resources may help. WebMD publishes a directory of types of substance abuse and informative articles about rehab. American Addiction Centers make it easy to locate the nearest rehabilitation center.

Attention Deficit Hyperactivity Disorder

Some people may view ADHD as more of a childhood disorder. However, some people go undiagnosed until adulthood. Researchers believe the condition may manifest between the ages of 10-25 as late-onset ADHD.

ADHD symptoms may appear as hyperactivity, procrastination, an inability to focus, and impulsive behavior. Students who notice a decline in quality of work and grades despite their best efforts should consider pursuing a possible ADHD diagnosis.

Where to Get Help

Students can begin by consulting with a general care practitioner. Primary care physicians may prescribe medicine or make recommendations for lifestyle changes. Or, they may refer the patient to a mental health specialist.

Some students with ADHD find success in completing schoolwork using the body doubling technique. Body doubling occurs when two or more people work on similar independent tasks alongside one another. This may look like a study session with a friend. Additionally, some organizations offer support groups and online resources.

Eating Disorders

Eating disorders impact people regardless of their gender. Students dealing with body image issues or feeling a lack of control in their life may develop an eating disorder. Common types of eating disorders include anorexia and bulimia. Students coping with an eating disorder often skip meals, but they may binge eat after a long period of hunger. These people may feel a sense of guilt when eating foods they deem unhealthy and regurgitate soon after eating.

Orthorexia is a less commonly talked about type of eating disorder. People experiencing orthorexia have an obsession with eating healthy. They excessively avoid many types of foods and check nutrition labels frequently.

Where to Get Help

People managing eating disorders may find accountability and solidarity through an online support group. The National Eating Disorders Association also runs a helpline.

Unfollowing triggering accounts on social media, like fitness influencers or models may benefit some people. Students with a history of disordered eating may need to avoid using calorie-counting apps, which could trigger a relapse.

In some cases, attending rehab can help people achieve a healthy weight and mindset.

Obsessive-Compulsive Disorder

People with OCD experience recurrent and uncontrollable thoughts, also known as obsessions. Some people describe these as urges or as seeing disturbing mental images. These thoughts may lead to repeated actions, also known as compulsions.

OCD manifests in different ways. Some people with the disorder may have a fear of germs or an obsession with order and symmetry. Others may experience uncontrollable thoughts about harming others or unwanted thoughts about sex.

Where to Get Help

A licensed psychiatrist may prescribe medication or offer management techniques for patients with OCD. Engaging in talk therapy with a counselor may also help. These professionals can also offer ideas on managing impulses, especially if the action is physically harmful.

Some people may find it easier to communicate about sensitive topics in the privacy of their homes. The International OCD Foundation offers a list of teletherapy providers. Joining an online support group allows people to share management techniques with their peers.

School Resources

Many colleges and universities may offer special accommodations for learners with OCD. For example, if a type of assignment triggers a compulsion, a student may substitute it with a different assignment. They may also receive permission to access a private testing center to complete exams.

Students receiving treatment for OCD should communicate any absences due to appointments or medication changes. Some professors may waive missed attendance points if learners maintain open communication.

Some schools may facilitate OCD peer groups, where students share techniques and healthy coping skills.

Post-Traumatic Stress Disorder

PTSD occurs in some individuals after experiencing a startling or dangerous event. During a scary moment, distress is a normal response. This fight-or-flight impulse encourages survival.

However, people with PTSD may feel unsafe and afraid long after the event ends. People with this disorder may also feel like they relive the situation through flashbacks. They may also experience recurring dreams about the event.

Fortunately, PTSD may resolve with time. However, many people must seek talk and exposure therapy to face their fears and feel better. Attempting to avoid thinking about the event or avoiding the event's location are symptoms of PTSD.

Where to Get Help

Speaking with other people with PTSD may help a person feel less alone. Even connecting with a moderated social media support group may help. However, some people need professional help to learn coping strategies.

Since PTSD commonly occurs in veterans, the U.S. Department of Veterans Affairs connects them with resources. This government department publishes tools for helping veterans find PTSD therapists.

Insider Perspective: Pursuing My Education With a Mental Disorder

Blake LeVine is a life coach and author with a master's degree in social work from Adelphi University. A bipolar disorder survivor, Blake has been healthy since 2005. He knows the importance of managing mental illness and uses his experiences to help clients deal with conditions like depression, anxiety, and PTSD.

He wrote "Beating Bipolar: How One Therapist Tackled His Illness ... and How What He Learned Could Help You."

Q. What Kind of Mental Health Issues Did You Have as a Student?

I was diagnosed with bipolar I disorder. I was in and out of psychiatric hospitals for two years. It was tough. I missed a lot of school and had trouble with friendships. My family experienced a lot of pressure to find the right treatments to help me rebuild my life. I'm stable now, but it took me a long time to put my life back together.

Q. When Did the Disorder Start to Manifest?

It started to manifest in my teens. I showed the first signs of it around age 15 or 16. I had been doing well in my life and was high-achieving in high school. But things started to unravel. I had my first manic episode that required a hospitalization. I couldn't sleep. I was nervous about my health. I thought I was dying and ended up going to the emergency room.

A few weeks later, I was diagnosed with bipolar. It took two years to find the right treatment. Medicine and therapy would go well, but I'd fall back into an incident again.

Q. Did You Have a Hard Time Functioning Academically?

Before all of this happened, I was in advanced classes and I did well in school. After it happened, it was much harder to attend school. For a short time, I had to go to a special school for kids with special needs. I went from excelling in school to having to reintegrate into school again.

Q. How Did It Affect You Socially?

Before, I was confident and had many friends. Afterwards, I felt knocked down. I was worried that other kids would make fun of me, or if I wanted to date, people wouldn't want to date me because of the illness. I became insecure for a while. Part of what I needed to do in therapy was find the courage to make friends again, potentially start to date, and get ready to be an adult.

Q. What Words of Encouragement Would You Give to Students Struggling With Mental Illness?

When I was sick, I felt so alone and hopeless. I would tell a young person going through it that there are many people experiencing these issues. If you take the right steps, you can have a full life. I'm happily married, I have two children, I've been educated all over the world, and I've written six books.

If I had known when I was so sick that any of that would have happened, it would have kept me a lot more positive. I really believe that if you take care of your mental health, you can do anything you set out to do in life.

The key is to accept what you're facing and get help. I love that all the pain I went through is helping inspire people.

General Tips for Student Wellness

The following general tips may work in conjunction with professional help and group therapy to improve a student's overall mental health. Sometimes, small practices add up to make big differences.

Eat Nutritious and Consistent Meals

Science backs up the idea of brain food. Managing mental health in college involves eating an adequate amount of whole foods. Avoiding meals or eating empty calories depletes energy levels and may negatively impact a person's mood. Eating at the same time every day may also improve digestive health.

Exercise

Exercise benefits physical health, but also mental health. In fact, exercise releases feel-good endorphins. Additionally, exercise can form an avenue for social interactions. Going on outdoor walks with friends may even increase low vitamin D levels. Healthy vitamin D levels may ease depression symptoms.

Find a Creative Outlet

A creative outlet allows for self-expression and mindfulness. Writing, painting, and taking photos may provide enjoyment and stress relief. Sharing meaningful art may help others with similar disorders feel less alone. The American Art Therapy Association publishes an Art Therapist Locator.

Apps That Promote Mental Health

This app helps solve mental health struggles and enhance student mental health. The app features a daily mood and a progress tracker. Users can also journal their feelings and add photos to the entries. The app encourages people to develop a problem-solving plan and schedule actions on a calendar. The video breathing exercises and stress-buster strategies may also help students manage stress. This psychologist-designed app features mental health courses and exercises. Users can track their daily moods. This app best suits people with mild to moderate mental health conditions. While no app can replace therapy or treatment, this tool may aid between appointments. Sometimes, leaving the house to attend an appointment may feel like a big struggle. This app lets people connect with a licensed therapist from home. The app pairs users with therapists with a license in the corresponding state. Users can communicate with their therapist through texts, video calls, pictures, or audio. This app helps people recovering from an eating disorder. The app aims to help people co-manage their eating disorders. Users can celebrate wins by earning rewards and view graphs that display their progress. The app's developers used self-monitoring research for its creation. This app helps users deal with nightmares following a traumatic event. The app uses imagery rehearsal therapy techniques to make nightmares less disturbing. The app especially caters to current and former service members. The creators designed this tool to supplement, but not replace, therapy. Calm provides pleasant bedtime stories, guided meditations, and breathing exercises to promote relaxation and mindfulness. The app helps users with varying goals. These goals include improving sleep quality, general self-improvement, or reducing stress and anxiety. The app offers some free resources, but most of the content requires a paid membership.

Additional Resources for Students

The APA publishes informative articles about types of mental health struggles. Some articles discuss related topics like human rights and immigration. People can use this site as a tool for learning more about their condition. The site also features a provider locator tool. This government website empowers people with knowledge so they can better understand mental health conditions. People with friends or family members impacted by mental health may also benefit from accessing this site. This website publishes guides for having difficult conversations surrounding mental health. Mental Health America provides helpful articles on how to live mentally healthy. People can discover ways to pay for mental health treatment on this site. This organization also publishes research surrounding mental health. Reading through the statistics may make people feel less alone. NAMI provides resources for all types of demographics impacted by mental health disorders. Family members can also find resources. The site publishes warning signs and symptoms of various conditions. People can pledge to be stigma-free and register to volunteer at events. NAMI provides resources for all types of demographics impacted by mental health disorders. Family members can also find resources. The site publishes warning signs and symptoms of various conditions. People can pledge to be stigma-free and register to volunteer at events. NIMH offers research on mental disorders. On the site, people can read through research on new treatments. This organization conducts research on nearly every type of mental health issue. Student researchers studying psychology can even apply for research grants to conduct their own studies. This website features informative articles and helps people find providers. The site divides the articles by types of mental health diagnoses and topics like relationships and personal growth.
DISCLAIMER: The information provided on this website is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment; instead, all information, content, and materials available on this site are for general informational purposes only. Readers of this website should consult with their physician to obtain advice with respect to any medical condition or treatment.

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Mental Health Counseling is a nonprofit, nonprofit provider of mental health counseling services.

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Focusing on Student Well-Being in Times of Crisis

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One teacher recommends supporting student safety through three Cs: communication, consistency, and control.

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Short Films About Mental Health - Good Mental Health and Wellbeing

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student wellbeing and mental health infographic - Google Search

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awareness covid education covid 19 school psychologists health education medical students college students youth youth mental

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Integrating Mental Health, Mental Illness, and Well-BeingThe contribution of positive mental health frameworks to the advancement of the field has been undeniable. However, definitions that overemphasize positive emotions and productive functioning as key indicators of mental health have been recently challenged because of the potential they have to discriminate against individuals and groups that, for example, might not be able to work productively or function within the environment because of individual physical characteristics or contextual constraints (Galderisi et al., 2015). To address these issues, Keyes has successfully integrated the notions of mental illness, mental health, well-being, and other related terms in the literature into a conceptual framework that allows for a more comprehensive understanding of mental health (Keyes, 2005, 2007; Keyes and Michalec, 2010). The model argues that neither pathogenic approaches focusing on the negative (e.g., mental illness) nor salutogenic approaches focusing on the positive (e.g., well-being) can alone accurately describe the mental health of a person (Keyes and Michalec, 2010). Instead, the model proposes that mental illness and well-being represent two correlated but differentiated latent continua in defining mental health. More specifically, mental illness and well-being lie on two separate spectra, the first going from absent to present mental illness and the second running from low to high well-being (Slade, 2010). The absence of mental illness, therefore, does not necessarily imply high levels of well-being. Correspondingly, low levels of well-being do not always indicate the presence of mental illness. Further, in this model, mental health is defined as not only the absence of mental illness, not the mere presence of high well-being. Complete mental health (i.e., flourishing) is a result of experiencing low mental illness and high levels of well-being. Incomplete mental health (i.e., languishing), on the other hand, refers to the absence of mental illness symptoms and low reported levels of well-being. Two other conditions are possible within this framework. Incomplete mental illness (i.e., struggling) refers to high levels of well-being accompanied by high mental illness symptoms. Lastly, complete mental illness (i.e., floundering) accounts for low levels of well-being and high mental illness symptoms (Keyes and Lopez, 2002).The Present Study

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Integrating Mental Health, Mental Illness, and Well-BeingThe contribution of positive mental health frameworks to the advancement of the field has been undeniable. However, definitions that overemphasize positive emotions and productive functioning as key indicators of mental health have been recently challenged because of the potential they have to discriminate against individuals and groups that, for example, might not be able to work productively or function within the environment because of individual physical characteristics or contextual constraints (Galderisi et al., 2015). To address these issues, Keyes has successfully integrated the notions of mental illness, mental health, well-being, and other related terms in the literature into a conceptual framework that allows for a more comprehensive understanding of mental health (Keyes, 2005, 2007; Keyes and Michalec, 2010). The model argues that neither pathogenic approaches focusing on the negative (e.g., mental illness) nor salutogenic approaches focusing on the positive (e.g., well-being) can alone accurately describe the mental health of a person (Keyes and Michalec, 2010). Instead, the model proposes that mental illness and well-being represent two correlated but differentiated latent continua in defining mental health. More specifically, mental illness and well-being lie on two separate spectra, the first going from absent to present mental illness and the second running from low to high well-being (Slade, 2010). The absence of mental illness, therefore, does not necessarily imply high levels of well-being. Correspondingly, low levels of well-being do not always indicate the presence of mental illness. Further, in this model, mental health is defined as not only the absence of mental illness, not the mere presence of high well-being. Complete mental health (i.e., flourishing) is a result of experiencing low mental illness and high levels of well-being. Incomplete mental health (i.e., languishing), on the other hand, refers to the absence of mental illness symptoms and low reported levels of well-being. Two other conditions are possible within this framework. Incomplete mental illness (i.e., struggling) refers to high levels of well-being accompanied by high mental illness symptoms. Lastly, complete mental illness (i.e., floundering) accounts for low levels of well-being and high mental illness symptoms (Keyes and Lopez, 2002).The Present Study

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Disciplinary Approaches to the Conceptualization of Mental Health/IllnessConceptualizations of mental health/illness are largely dependent on the theoretical and paradigmatic foundations of the disciplines from which they emerge. In this context, the field has progressively evolved through the accumulation of knowledge generated in a diverse range of disciplines in the biomedical, behavioral, and social sciences. Biomedical disciplines are grounded in the medical paradigm focused on disease and (ab)normality and often emphasize dichotomous conceptions of mental health/illness (Scheid and Brown, 2010). Research on mental health and well-being in this domain has been traditionally conducted from a psychiatric perspective, which aims to understand the dysfunctionality in the brain that leads to psychiatric symptoms and to also offer a pharmacological treatment to correct neuronal dysfunctions. Consequently, psychiatrists have historically considered mental health as a disease of the brain (e.g., depression), similar to any other physical disease, caused by genetic, biological, or neurological factors (Schwartz and Corcoran, 2010). While the prevalence of psychiatric approaches to mental health is currently incontestable, the development of other biomedical disciplines has tremendously contributed to the progression of the field in recent decades. For example, Insel and Wang (2010) argue that insights gained from genetics and neuroscience contribute to the reconceptualization of “the disorders of the mind as disorders of the brain and thereby transform the practice of psychiatry.” (1979). In addition to that, other disciplines such as behavioral medicine have made important contributions to the field, although it has recently argued that mental health and behavioral medicine should be as two separate fields (Dekker et al., 2017).Within the behavioral sciences, the study of mental health focuses on the distinct psychological processes and mechanisms that prompt thoughts, feelings, and behaviors (Peterson, 2010). Clinical psychology has the longest tradition in the psychological study of mental health and tends to focus on the assessment and treatment of mental illness and disorders that can alleviate psychological distress or promote positive states of being (Haslam and Lusher, 2011). However, significant contributions to the field have also emerged from other branches of psychology less focused on psychopathology, including personality and social psychology, psychoanalysis, humanistic psychology, and cognitive psychology (Peterson, 2010). Despite the diversity of theories, principles, and methodological approaches to understanding mental health within the behavioral sciences, these disciplines acknowledge that mental health have a biological basis and reside in the social context, and tend to prioritize continuum approaches to mental health (Scheid and Brown, 2010).

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Disciplinary Approaches to the Conceptualization of Mental Health/IllnessConceptualizations of mental health/illness are largely dependent on the theoretical and paradigmatic foundations of the disciplines from which they emerge. In this context, the field has progressively evolved through the accumulation of knowledge generated in a diverse range of disciplines in the biomedical, behavioral, and social sciences. Biomedical disciplines are grounded in the medical paradigm focused on disease and (ab)normality and often emphasize dichotomous conceptions of mental health/illness (Scheid and Brown, 2010). Research on mental health and well-being in this domain has been traditionally conducted from a psychiatric perspective, which aims to understand the dysfunctionality in the brain that leads to psychiatric symptoms and to also offer a pharmacological treatment to correct neuronal dysfunctions. Consequently, psychiatrists have historically considered mental health as a disease of the brain (e.g., depression), similar to any other physical disease, caused by genetic, biological, or neurological factors (Schwartz and Corcoran, 2010). While the prevalence of psychiatric approaches to mental health is currently incontestable, the development of other biomedical disciplines has tremendously contributed to the progression of the field in recent decades. For example, Insel and Wang (2010) argue that insights gained from genetics and neuroscience contribute to the reconceptualization of “the disorders of the mind as disorders of the brain and thereby transform the practice of psychiatry.” (1979). In addition to that, other disciplines such as behavioral medicine have made important contributions to the field, although it has recently argued that mental health and behavioral medicine should be as two separate fields (Dekker et al., 2017).Within the behavioral sciences, the study of mental health focuses on the distinct psychological processes and mechanisms that prompt thoughts, feelings, and behaviors (Peterson, 2010). Clinical psychology has the longest tradition in the psychological study of mental health and tends to focus on the assessment and treatment of mental illness and disorders that can alleviate psychological distress or promote positive states of being (Haslam and Lusher, 2011). However, significant contributions to the field have also emerged from other branches of psychology less focused on psychopathology, including personality and social psychology, psychoanalysis, humanistic psychology, and cognitive psychology (Peterson, 2010). Despite the diversity of theories, principles, and methodological approaches to understanding mental health within the behavioral sciences, these disciplines acknowledge that mental health have a biological basis and reside in the social context, and tend to prioritize continuum approaches to mental health (Scheid and Brown, 2010).

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https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.education.vic.gov.au/Documents/school/teachers/health/mentalhealth/quick-guide-to-student-mental-health-and-wellbeing-resources.pdf&ved=2ahUKEwjpnr2-sab2AhWUslYBHXpJBpwQFnoECAMQAQ&usg=AOvVaw1jIS_gR9QzNiPkGtlkvaxO

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https://journals.sagepub.com/doi/full/10.1177/08295735211001653

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http://unistudentwellbeing.edu.au/student-wellbeing/wellbeing-essentials/

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Enhancing Student Wellbeing for Learning

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Moreover, if one or more of these nutriments is thwarted or denied, we quickly experience negative impacts on wellbeing, performance and motivation ( Deci & Ryan, 2000).

Self-Determination Theory (see READ MORE: SDT in brief, in the right-hand panel) posits that these fundamental psychological nutriments are available to and integrated by individuals when their actions are autonomously motivated (M), as illustrated in the figure above. This makes Autonomous Motivation a key driver of mental wellbeing, or the wellspring of psychological resources. The acronym M-BRAC is used in our learning modules to refer to these five mental health essentials (see READ MORE: M-BRAC explained, in the right-hand panel).

What are autonomous motivations? Doing things that we want to do either because:

We enjoy the activities for their own sake; we find them intrinsically interesting or satisfying, or

We believe the activities are important to achieving valued goals

When we are autonomously motivated to act, we have a sense of owning our actions and of our actions being 'concordant' with our interests and values. This is psychologically nurturing as it facilitates an integrated or coherent (authentic) sense of self.

Autonomous motivations are blunted and our wellbeing is undermined when we feel pressured to act or feel that we are being controlled by others. While external pressures can be energizing, acting in order to please or impress others, or to avoid disappointing them (controlled motivation), is not psychologically nurturing because it does not facilitate a sense of 'being ourselves' and acting in accordance with our true values and interests.

Autonomous motivation is also undermined when we feel that we are not capable of doing what we would like to do, or that our actions do not have any effect. Such beliefs can lead to 'amotivation ' - or a lack of motivation to act intentionally and purposefully. This is another negative psychological state, as amotivated people simple 'go through the motions' without a sense of purpose or meaning.

As a result, some university students may not be intrinsically interested in the courses they are taking. However, initial reasons for enrolling in a course are only part of the picture. Students' motivations for university study are fluid and highly responsive to experiences in the educational environment. Student mental wellbeing will be supported when teaching and learning practices actively engage students' intrinsic interests and communicate the importance and value of the knowledge and skills being developed.

Empirical research shows that goals that have intrinsic or inherent value - such as personal development and growth, helping others, strengthening relationships and contributing to the community - are more psychological satisfying and motivating than 'extrinsic' goals - such as financial rewards, popularity, status and prestige ( Sheldon and Krieger, 2004; 2007; 2015).

As with motivations, students' academic goals are fluid, and influenced by the norms and values in the educational environment. Student mental wellbeing will be supported when teaching and learning practices actively connect -the knowledge and skills students are developing to intrinsic (rather than extrinsic) goals.

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Mental Wellbeing Essentials (Download a transcript of this video) The stressors inherent in a mass higher education system and an increasingly uncertain and challenging employment market cannot be eliminated, only mitigated and managed. To this end, all students can benefit from learning and

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How can I support student well-being? – Flex Teaching

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Duke instructors are known for their concern for students. We encourage instructors to reflect on not only the stressors faced by their students now and how to mitigate their impact on student learning, but also how instructors can practice self-care to maintain their own well-being as they continue…

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https://butterfly.org.au/

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Support for Eating Disorders and Body Image Issues | Butterfly Foundation

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Everyone’s experience of an eating disorder or body image issue is unique and access to care and support is essential.

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ONLINE CLASS I PerDev Lesson No. 12 Mental Health and Psychological Well-Being

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Mental Health and Well-Being in Middle & Late Adolescence - Personal Development for Senior High

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Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom

Department of Psychology, Manchester Metropolitan University, Manchester, United Kingdom

Transitioning into the university environment can be both exciting and stressful for new and returning students alike. The pressure to perform well academically in an increasingly competitive environment, coupled with a vast array of lifestyle changes, can contribute to suboptimal wellbeing. Over recent years, uptake to wellbeing services within universities in the United Kingdom has grown given the concurrent rise in mental health difficulties reported. Higher education students now have to contend with a drastically altered learning landscape, owing to the discovery of novel coronavirus, Sars-Cov-2, otherwise referred to as COVID-19. In the United Kingdom, universities have moved to close their campuses to both students and non-essential staff in an effort to protect them from contracting the virus. The repercussions of these decisions have been monumental for the delivery of teaching, relationships and, importantly, the provision of student services. Ambiguity remains as to how teaching will be delivered for the forthcoming academic year. The uncertainty caused by the pandemic has yet to be considered in terms of student wellbeing and the new, mostly online, environments that students will be expected to navigate without their typical support networks. For the purpose of this paper, the concept of student wellbeing, a population-level term concerned with positive emotions rather than diagnosed mental health conditions, will be considered in relation to the COVID-19 outbreak. The current paper performs a conceptual analysis on student wellbeing in United Kingdom universities with a specific lens on the psychosocial impact of the global COVID-19 outbreak. Given the unprecedented world that students now learn in, considering the impact of the pandemic on psychosocial outcomes delineates the novel challenges that researchers and practitioners must consider when implementing student wellbeing initiatives moving forward.

Introduction

Transitioning into the university environment represents a significant venture in an individuals' life with feelings such as excitement and, conversely, trepidation. Multiple facets converge during this life event that impact almost all elements of an individuals' life. Beyond the obvious change in academic challenge where students are expected to become more autonomous in their studies, individuals may also relocate to another geographical location within the United Kingdom and, sometimes, internationally. This transition denotes a monumental shift in independence. For many new students, complete control over their behavioral choices becomes the norm for the first time with the potential for either positive or negative change ( Mulye et al., 2009). The student solely decides all elements of their life such as diet, exercise, alcohol consumption and drug use. Previous research has illustrated how behavioral choices tend to cluster together in a student population, whether that be maladaptive or optimal behavior ( El Ansari et al., 2018). For example, students who had a poor diet were found to be more likely to order takeaway food, smoke and engage in less physical activity ( Sprake et al., 2018). These suboptimal choices tend to be compounded by the financial restraints felt by students upon entry, imposed by rising tuition fees and limited disposable income. Money and debt worries are described by students as being the main risk factor for exiting their degree prior to completion ( Nevill and Rhodes, 2004), where financial concern can significantly impact upon social functioning ( Jessop et al., 2020). The social implications of becoming a university student can be disruptive to the students' previous support networks. Moving away from pre-existing support networks that include both family and friends can be especially daunting. Forging new social connections can be exceptionally difficult for prospective students and can lead to periods of loneliness or feelings of disconnectedness. Loneliness in university students has been significantly linked to increased stress, anxiety and depression ( Richardson et al., 2017). Synthesizing the above, the university experience presents multifaceted challenges to prospective students and has the potential to negatively impact upon student wellbeing. Despite this, entry levels to universities in the United Kingdom show no sign of waning. Record entry levels of 34.1% for 18 year olds into undergraduate study after year-on-year decreases ( UCAS, 2020) demonstrate that many young adults still strongly consider Higher Education (HE) as a next step in their life. Adding into this already complex intersection of factors impacting upon student wellbeing, the exponential transmission of novel coronavirus COVID-19 has altered the HE landscape monumentally, from teaching delivery to campus closures. This conceptual analysis will illustrate the intricacies of student wellbeing in Higher Education, why universities interest in this concept has increased over recent years, and how COVID-19 has impacted student wellbeing through its' prodigious impact on both physical life and psychological outcomes.

The mechanisms of daily life changed significantly upon the discovery and subsequent exponential transmission of COVID-19. COVID-19 (or Sars-Cov-2) is a novel coronavirus initially discovered in Wuhan, China in late December 2019. Initially reported as a case of "unknown pneumonia", the escalation of worldwide response has occurred rapidly. COVID-19 can cause the infected person to experience a range of respiratory symptoms but the most commonly reported symptoms include a new continuous cough, fever and a loss of taste and/or smell ( NHS, 2020). As COVID-19 has spread across the globe, the World Health Organization declared a Public Health Emergency of International Concern in January 2020 ( World Health Organisation [WHO], 2020). Community transmission has led to an exponential growth in cases both nationally and internationally, bringing with it stringent new measures to curb the virus' impact. Each nation has approached the COVID-19 problem with varying degrees of zeal and a range of targeted interventions normally centered around social distancing. The most utilized approach has been quarantine or, as colloquially described in the United Kingdom, "lockdown." Whilst this has looked different in each of the devolved nations, the core element of "lockdown" has been the reduction in social interaction of all forms, including typical working practices, shopping habits and education. Universities in the United Kingdom, and across the world, have closed their campuses to protect both their student and staff populations. Tertiary students have had to adapt to a completely novel learning experience as a result. COVID-19 poses both direct and indirect threats to student wellbeing; both as a direct contributor toward poor psychological outcomes and as the underpinning reason behind the stark reduction in social contact that students now cope with. Understanding how student wellbeing may operate during the global pandemic and post-COVID-19 is imperative to implementing new and adjusted measures to better support students in their academic journey. This paper will perform a conceptual analysis of 'student wellbeing' as it was first devised prior to COVID-19 and consider the impact of the 'new normal' on student wellbeing moving forward in the Discussion section. General research concerning wellbeing as a concept will first be considered before applying and synthesizing evidence in the tertiary student domain. One of the underlying principles of conceptual analysis is "the belief that to reach some agreement of that kind is a prerequisite for the development of useful (and/or interesting) knowledge..." ( Furner, 2004). The impact of COVID-19 will be considered in alignment with wellbeing and how student wellbeing may be affected by the global pandemic. Scopus and Web of Science were searched for relevant papers, using a range of search terms and relevant variations such as: wellbeing, student, university, tertiary and concept. Online software was also used to identify pertinent articles within the domain.

The Evolving Field of Wellbeing

The concept of wellbeing has been extensively studied with competing arguments to its' true definition. The foundation of wellbeing discussion is embedded in the World Health Organization's (WHO) early definition that health "...is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity' ( World Health Organization [WHO], 1948). Despite early work discussing two separate approaches of the concept (hedonic ( Young, 1952) and eudaimonic wellbeing ( Rogers, 1961), it is now widely accepted that wellbeing is a multidimensional construct ( Wills-Herrera et al., 2009). Derived in part from the eudaimonic approach to wellbeing, early seminal work by Bradburn (1969) stimulated conversation about the construct. Bradburn proposed that wellbeing was ultimately composed of both positive and negative affect. Agreement has been reached that positive and negative affect are not strictly orthogonal but rather two separate constructs that are independent of one another ( Diener et al., 1995). Further research began to elucidate the underpinnings of wellbeing and 'ill-being' as two distinct constructs. 'Ill-being' was found to be driven by worry, somatic complaints and negative affect, coupled with a personal sense of low competence and external factors such as unfavorable socioeconomic factors. Wellbeing, on the other hand, was associated with personality factors such as extraversion, optimism and an overall sense of personal competence ( Headey et al., 1984). With inextricable links to the notion of wellbeing, happiness has also been explored as a core component. Resources, assessment of needs and comparison of life situation, the authors propose, all contribute toward human happiness ( Shin and Johnson, 1978). Additionally, the notion of 'quality of life' was discussed in relation to happiness, whereby it is argued that true quality of life should be defined by the individual. A review of subjective wellbeing (SWB) illustrated to the author key components of the concept:

"...the happy person is blessed with a positive temperament, tends to look on the bright side of things, and does not ruminate excessively about bad events, and is living in an economically developed society, has social confidants, and possesses adequate resources for making progress toward valued goals." ( Diener et al., 1999, p295).

Whilst subjective wellbeing and psychological wellbeing differentiate, a common thread throughout the progression of the wellbeing literature clearly emerges: wellbeing is a multifaceted concept consisting of both internal and external contributors. An individuals' affect, attitude toward life events and general outlook on life, coupled with environmental factors, contributes toward an improved sense of wellbeing. Happiness and positive affect, as a core tenet of wellbeing, has been found to correlate with a multitude of culturally desirable successes in many core aspects of life, such as love, work and health ( Lyubomirsky et al., 2005). The value of truly understanding, striving toward, and maintaining positive wellbeing is critically important to ensuring that individuals' within society thrive and flourish within their own right.

Attention in the United Kingdom has more recently focused upon the concept on a national level. Resulting from a 6-month National Debate, three domains of national wellbeing emerged: individual wellbeing (such as life satisfaction), factors that directly affect individual wellbeing (such as health, relationships, where we work and where we live) and contextual domains (such as the economy and natural environment) ( Beaumont, 2011). This framework concisely captures factors of wellbeing that have been previously discussed within the academic sphere. However, it has drawn criticism for its lack of conceptual depth. The illusion that the framework creates is that each 'domain' is viewed in silo and without interaction with the others. The academic evidence to date refutes this proposition, as research has consistently demonstrated how individuals possess distinct subjective reactions to each of the domains ( Cooper et al., 2011). Evidently, academic findings have yet to be effectively translated into real-world pieces that undoubtedly inform policy and practice within the United Kingdom.

Student Wellbeing: Before COVID-19

The term wellbeing generally alludes to a range of factors in ones' life that contributes toward fulfillment and good physical health. It has a complex role to play as both a predictor of outcomes for students, such as their academic attainment ( El Ansari and Stock, 2010) but also as an outcome in and of itself influenced by a variety of factors ( Kim and Kim, 2017). An updated definition for wellbeing was generated recently, where it was defined as: '...when individuals have the psychological, social and physical resources they need to meet a particular psychological, social and/or physical challenge' ( Dodge et al., 2012). As noted by GuildHE (2018), defining wellbeing within the Higher Education domain is a challenging prospect owing to the plethora of evidence available and the complexity of the concept. This echoes McNaught's (2011) proposition that wellbeing is a deeply personal, existential experience. The term student wellbeing can also be described as a population-level term encompassing positive emotion and the inner capacity for an individual to cope with the challenges of day-to-day life and their academic journey ( Barkham et al., 2019). In recent years, the student wellbeing sphere has started to embrace core tenets of the positive psychology approach.

Positive psychology, as coined by Seligman (2004), denotes a paradigm shift from the previous model of mental ill health that permeated the psychological domain. Rather than an explicit focus on a deficit-based model of mental illness, positive psychology transmutes the perception that we must fix what is deemed as being 'wrong' with an individual. Instead, it posits three central pillars of wellness and wellbeing: positive emotion, positive traits and positive institutions. Emerging from this early work is the PERMA model of wellbeing ( Seligman, 2011):

1. Positive emotion (P): refers to experiencing and retaining a positive outlook, focusing on life's events in a constructive manner.

2. Engagement (E): ensuring the opportunity for genuine engagement both professionally and personally with activities, adopting a state of flow and immersion in certain instances.

3. Relationships (R): possessing and nurturing a range of meaningful relationships with others and reducing the risk of isolation.

4. Meaning (M): feeling as if one is working toward something that transcends oneself, or believing in something that lends meaning to ones' life.

5. Accomplishment (A): whether in a personal or academic capacity, reaching a desired goal will lead to a sense of accomplishment and thus, contribute to a state of flourishment.

Oades et al. (2011) propose a conceptual framework for integrating PERMA concepts into the university environment, addressing areas such as curriculum, social aspects, faculty and residential domains to achieve a positive university. Similar to the early models rooted within the eudaimonic approach, the PERMA domains capture both internal and external components of ones' life reflecting the multifaceted nature of wellbeing. Recent research has demonstrated how each of the PERMA domains can be incorporated into teaching practices successfully, incorporating an innovative approach to supporting student wellbeing ( Matthewman et al., 2018). Moreover, introducing a positive psychology course to students can improve the PERMA domains in turn, as compared to regular psychology students ( Smith et al., 2020). The potential that the PERMA model holds in underpinning student wellbeing and subsequent services provided has yet to be fully realized given its' relative infancy within the student domain.

Pertinent within the student wellbeing literature is the role of resilience and how this contributes to elevated wellbeing. Resilience has been previously defined as:

"...the process of effectively negotiating, adapting to, or managing significant sources of stress or trauma. Assets and resources within the individual, their life and environment facilitate this capacity for adaptation and 'bouncing back' in the face of adversity" ( Windle, 2011, p163).

Being adaptable when faced with a range of challenges is largely determined by the assets and resources an individual holds, along with their life and environment. Conceptual models have been suggested specific to the role resilience has to play in the HE setting. One of note is the notion of a "coping reservoir" in medical students ( Dunn et al., 2008). The authors suggest that each student possesses their own "coping reservoir" that has an internal structure, made up of the individuals' temperament, personality characteristics and preferred coping style. The "coping reservoir" is subsequently impacted by negative and positive inputs that either deplete or replenish the reservoir. This can lead to either positive or negative outcomes reflective of the students' wellbeing, such as resilience or burnout. It is noted however, that wellbeing is a lot more complex than inputs and outputs. Despite this, evidence supporting the "coping reservoir" model has illustrated its' utility ( Heinen et al., 2017). Recognizing resilience as an outcome of optimal wellbeing is important to consider, as resilient individuals tend to cope with stressors more efficiently which is particularly useful in the university environment. Further to this, elements of the 'PERMA' model of wellbeing have been found to significantly predict higher resilience ( Abiola et al., 2017).

Resilience has also been discovered to be an antecedent of student wellbeing. It has been shown to have a positive relationship to subjective happiness as well as negative relationships with anxiety, depression and stress. Critical to developing resilience capability are the assets and resources that students access within the systems that they participate, such as university, home and work ( Turner et al., 2017). This mirrors the ONS' domains of wellbeing fairly well, placing the individual within a particular environment that contributes toward overall wellbeing ( Beaumont, 2011). The role of resilience as an antecedent and outcome of student wellbeing is important to consider and is captured loosely in Barkham et al.'s (2019) working definition, alluding to a students' inner capacity to cope. Interestingly, aside from the notion of a "coping reservoir," this has not been explicitly alluded to in more general models of wellbeing. Whilst individual wellbeing or personal characteristics frequently form the central pillar of wellbeing, it could be suggested that resilience contributes significantly to wellbeing and warrants greater acknowledgment.

Why Are Universities Interested?

Universities possess a unique organizational structure that incorporate a multitude of competing agendas concerning knowledge production, subsequent translation into real-world impact and financial stability. Ultimately, concentration must be placed on the university as a viable business and thus, means an increased pressure to run as a for-profit business ( Taylor, 2017). The notion of "student wellbeing" therefore, has competed for resources and funding alongside other organizational factors that are often prioritized highly.

The settings-based approach to health and wellbeing encapsulates how the university setting can be critical in promoting improved student wellbeing. For students, university represents a community where they can thrive and hopefully flourish both socially and academically ( Markoulakis and Kirsh, 2013). Embedding health and wellbeing promoting features within the university setting should be a priority given the unique opportunity that the environment offers to support better behavioral choices. The settings-based approach was initially derived from the World Health Organisation [WHO] (1986), where health was described as: "...created and lived by people within the settings of their everyday life; where they learn, work, play and love." Whilst the university environment in itself shares commonalities with other businesses in industry whereby it employs staff, it also possesses a range of unique roles within its' structure that generates a distinctive culture and mission ( Dooris, 1999). The university environment plays a role as a "future-shaper" of students and is a platform for cultural, social and economic change, rendering it as a perfect setting to integrate health promotion ( Cawood et al., 2010). The health-promoting university, otherwise known as the Healthy Universities initiative, draws upon the settings-based approach to embed health into the organizational structure of the institution and instill health into the daily operation. The Healthy Universities initiative aims to achieve key outcomes by:

* Creating healthy and sustainable learning, working and living environments for students, staff and visitors.

* Integrating health and sustainable development as multi-disciplinary cross-cutting themes in curricula, research and knowledge exchange.

* Contributing to the health, well-being and sustainability of local, regional, national and global communities ( Dooris and Powell, 2012).

The Okanagan Charter (2015) has built upon the idea of health promotion infused within the university setting. By embedding health within campuses, universities serve to enhance the success of their institutions whilst promoting equity, wellbeing and social justice. Ultimately, this will strengthen communities economically, socially and ecologically. Through a recent reconceptualization, it was found that developing a supportive ethos and culture, embedding health, targeting the entire university population, embracing challenges and building a broad understanding of health contributes to the status of being a Healthy University ( Dooris et al., 2019). Similarly, students identified that a whole university ethos, coupled with access to health services, is imperative to the initiative ( Holt et al., 2015). Becoming a Healthy University is intrinsically appealing owing to the clear relationship between wellbeing and academic attainment. Previous research suggests that health, health behaviors and health awareness hold relationships with key determinants of academic attainment, such as perceived importance of achieving good grades ( El Ansari and Stock, 2010). The importance of promoting health within the university environment is therefore high, owing to the subsequent gains achieved resulting from improved wellbeing.

Discussion

The global pandemic has shifted the student wellbeing domain considerably due in part to the extensive pragmatic changes that have been introduced to curb the spread of COVID-19. Education, across the board, has experienced drastic changes to teaching delivery. Transition into online learning has occurred rapidly and has presented a range of novel challenges both to staff and students. As noted by Burki (2020), the utilization of virtual learning may well persist until a suitable vaccine for COVID-19 has been developed. Navigating the vast array of technological platforms now being relied upon for telecommunication (such as Zoom, Skype for Business and Microsoft Teams), as well as becoming fully competent using platforms such as Moodle, also stimulates questions surrounding the pragmatic barriers that students may face when attempting to study, collaborate with peers and submit pieces of work. Computer literacy, for example, is understood to be fairly high with the student demographic ( Link and Marz, 2006). Given that teaching has not been a strictly face-to-face endeavor for some time, it is assumed that students will engage with technology seamlessly and with little difficulty. However, it must be considered that a proportion of the student population will now encounter difficulties with the technology-heavy approach to learning. An individuals' sense of personal competence can contribute to suboptimal wellbeing and a perceived sense of decreased wellbeing should a student feel a loss of capability when it comes to their studies. Universities should strive to provide comprehensive support to their students in terms of navigating their new learning experience and extensive resources to underpin the transition to online learning.

Preliminary work has demonstrated that, even in simulation-based scenarios, it is possible to deliver functionally similar sessions that allow students to attain their educational objectives ( Torres et al., 2020). Fully scoping the requirements for each individual session should be paramount to retaining similarity between an on-campus and online scenario, ensuring that functionality is truly aligned with the objective of each session. However, the authors do note that barriers do occur, with practical elements such as internet speed providing challenges to the learning experience. Conversely, Da Silva (2020) suggests that virtual learning could contribute to greater attendance and participation with sessions, removing the anxiety associated with asking questions in front of course peers. This claim is corroborated by recent student surveys indicating that students value online learning for its flexibility and the ability to study at a time convenient to them ( Lall and Singh, 2020). Interestingly, 10% of students surveyed described the lack of face-to-face contact as one of the main strengths of online learning. This could be linked to the idea of reduced anxiety surrounding learning in general but also highlights the importance of others in conceptual frameworks of wellbeing. The concept of others may not always refer to positive relationships held with others but the presence of social judgment, especially concerning perceived stigma relating to mental health. This is, however, counteracted by 26% of the sample disliking online learning as they are unable to meet with friends. Clearly, the transition to virtual learning and assessment comes with both advantages and disadvantages. The technological move could potentially compromise the notion of Accomplishment, one of the five tenets of Seligman's (2011) PERMA model. Each university has approached assessment differently as a result of the pandemic, deploying novel methods that many students have not experienced before such as open-book examinations. The uncertainty surrounding assessment will inevitably provoke anxiety within the student population. Coupled with this uncertainty is the anxiety of completing assessments in a completely novel fashion, where students may worry that the new forms of assessment used will not truly capture their ability, especially when compared to traditional methods. Graduation ceremonies were not exempt from cancelation, negating a significant life event that celebrates the student's achievements after years of hard work. This also calls into question the notion of Meaning stipulated in the PERMA model. Seligman (2011) posits that a state of flourishment can be attained by working for something that transcends oneself. Research has demonstrated that education and career are one of the main sources of meaning for undergraduate students ( Hill et al., 2013). If students feel as if their work is not meaningful, especially given that their studies will occur in a predominantly isolated fashion, detrimental wellbeing could ensue. Ensuring that students are fully informed of new assessment protocols, as well as moving to celebrate their successes in an engaged way, could potentially mitigate the risk of suboptimal wellbeing in this instance. Institutions and, more importantly, researchers should consider the transition in a balanced fashion to truly understand the role virtual learning has on student wellbeing over the course of the COVID-19 pandemic and beyond.

The environment in which the student now resides and studies will provide unique barriers to a streamlined learning experience. Considering the drastic shift in environment that students have experienced, perhaps the biggest potential contributor to poor student wellbeing is the change in physical location. Currently, all academic content is delivered through technological means whilst campuses remain closed. The impact of this change is significant and far-reaching, deviating from the typical university experience that students have become accustomed to. A lack of physical contact with academic staff, coupled with their reduced capacity associated with the technological shift, has put students under increased pressure to meet deadlines without the typical access to support that they would normally experience. Prior to COVID-19, students may have sought advice by physically meeting with a supervisor or module lead. Staff should, in the wake of the pandemic, consider offering virtual office hours to sustain and promote frequent engagement with students to mitigate the disruption they are experiencing to their studies ( Zhai and Du, 2020). The absence of physical contact is not limited to teaching staff. Students are now faced with a prolonged period of time without their friends and course companions. Where group work and collaborative projects are now a mainstay of many university courses, the opportunity for students to work with fellow students has been reduced and become more challenging. The likelihood that students will experience more frequent and intense feelings of loneliness, anxiety and isolation is high, owing to the disconnectedness many will feel as a result of leaving the university campus ( Zhai and Du, 2020). As previously stated, loneliness has been found to be significantly associated with stress, anxiety and depression in students ( Richardson et al., 2017). In addition to education and career, undergraduate students consider relationships as a main contributor to meaning ( Hill et al., 2013), considered integral to wellbeing according to the PERMA model. The importance of combatting feelings of loneliness should be considered owing to the highly detrimental effect this has on student wellbeing. For many, the university campus is home and moving away due to the COVID-19 pandemic represents a significant upheaval for the individual.

Wellbeing described more generally often stresses the importance of the individuals' lived environment and how this impacts upon individual wellbeing, such as the places that we work and live ( Beaumont, 2011). In this instance, the place where students study, as opposed to work, has evolved considerably. The way in which the lived environment has interacted with how we experience relationships during the pandemic is important to note as access to friends and family has practically ceased due to nationwide restrictions to curb the spread of COVID-19. For some students, the ability to return to the familial home to self-isolate together has been near impossible, especially for international students. There are instances of students remaining in university halls or accommodation throughout the pandemic, living independently but without the social support networks they previously possessed as their cohabiting peers have returned home. The impact that this isolation has on student wellbeing is monumental, as the lived environment and accessibility to social support across the globe has ultimately nullified the possibility of physical contact with loved ones. Thankfully, the digital era that we now live in offers online methods of sustaining regular contact with those within our social networks. Paradoxically, early research suggested that increased engagement with the internet was to the detriment of social relationships, exacerbating feelings of loneliness and depression ( Kraut et al., 1998). The use of social media specifically has been found to have both positive and negative effects on psychosocial wellbeing, identity and belonging in adolescents ( Allen et al., 2014). In current circumstances where physical loneliness may be impossible to avoid, the positive elements of internet use and social media engagement should be considered. As long as social media usage is engaged with as a means to sustain existing relationships and forge new connections, it can be a powerful tool in reducing an individuals' feelings of loneliness ( Nowland et al., 2018). Whilst the lockdown measures continue to persist within the context of the pandemic, the use of social media will be key in maintaining appropriate support networks for students. In the absence of offline social activities, social media could play a crucial role in alleviating feelings of loneliness within the student population. Given the importance that social connectedness and relationships play relative to a students' wellbeing, digital solutions provide a good substitution for face-to-face interaction.

Whilst the COVID-19 pandemic has had pragmatic implications relating to campus closures and a transition to virtual learning, the virus itself creates a degree of uncertainty that is unprecedented. COVID-19, as a novel coronavirus, is being studied at a phenomenal pace with more scientific information becoming readily available with each passing day. Understanding the transmission, prevalence and symptoms of the virus is critical to keeping the virus under control but until that information becomes clearer, ambiguity surrounding the virus is high. Misinformation has been spread exponentially throughout the duration of the pandemic through a variety of mediums. Social media platforms such as WhatsApp have experienced an overwhelming level of viral messages, with one particular message purporting to contain the cure for the virus, which involved mixing garlic and boiling water ( Clarke, 2020). A headline published in the BMJ in late April 2020 ( Wise, 2020) is a prime example of how information can be taken out of context and contribute to elevated public anxiety and fear. The article headline stated: "A third of COVID-19 patients admitted to United Kingdom hospitals die," with a remark added when shared by the BMJ on Twitter that the fatality rate was "on par with Ebola." This information was disseminated widely in the United Kingdom press despite the Ebola claim being factually incorrect when case fatality rates (CFRs) are directly compared - Ebola's CFR is approximately 50%, whereas COVID-19's CFR is around 6.5% with significant underreporting of milder cases ( Winters et al., 2020). Further to this, over 25% of COVID-19 related videos on YouTube were found to contain nonfactual information totaling over 62,000,000 cumulative views ( Li et al., 2020). The infodemic that has ensued has been overwhelming for the general population and for students especially. Amongst the false information being circulated is legitimate scientific knowledge. Many news outlets are providing around the clock coverage of the pandemic and how it is affecting countries and communities across the globe. Accessing and assimilating information relating to COVID-19, whether factual or not, is incredibly easy. For students, relating this to their personal circumstances and how it impacts upon their studies can be detrimental to their wellbeing. Contextual domains are compromised where the economic and educational landscape are now unrecognizable. The unpredictability of the pandemic will undoubtedly contribute to suboptimal mental health outcomes for the general population ( Zandifar and Badrfam, 2020). Tertiary students worldwide are facing unmitigated uncertainty in regard to their studies, ranging from fear of contracting the virus once campuses eventually open to the unknown quantity surrounding the completion of their studies. A range of interventions have been posited thus far to combat the onset of poor mental health outcomes including the provision of online mental health resources, online provision of self-help and counseling services, and the deployment of online surveys to understand the prevalence of poor mental health outcomes ( Rajkumar, 2020). Universities should consider their resources and provision throughout the pandemic and beyond. Not only in terms of content, but in their accessibility to students' from a variety of demographic backgrounds. The negative affect associated with the pandemic has the potential to impact on student wellbeing for the foreseeable future, therefore further research is required to understand what provision would be most suitable for the HE context. The use of newly produced psychometric measures with university students could facilitate greater understanding of the mental health impact of COVID-19, such as the Coronavirus Anxiety Scale ( Lee, 2020) or the Fear of COVID-19 Scale ( Ahorsu et al., 2020).

There are limitations to this piece of work and the evidence synthesized. Mainly, research produced during the COVID-19 pandemic is sparse, varied and conducted within a plethora of different scenarios. Studies have originated primarily from Asia where the epicenter of the COVID-19 pandemic can be traced. Little research has been completed thus far within the United Kingdom specifically as Europe's peak of the pandemic arrived later than in Asia. The vast cultural differences observed, alongside the diverse set of methods deployed to explore the impact of COVID-19, means that it is difficult to extrapolate findings directly into the HE setting within the United Kingdom. Only as time passes and more research is conducted in relation to COVID-19 will more concrete conclusions be available. The long-term impact of the virus on student wellbeing, and wellbeing of the general population, is unknown.

Synthesizing the evidence to date in relation to pre-existing models of wellbeing suggests that the psychological impact of the virus will be far-reaching. Whilst students face an unknown length of time living with uncertainty regarding their studies, research teams should move quickly to understand student wellbeing in these unprecedented times and beyond. Considering the negative implications of COVID-19 is intuitive, however, small victories may emerge. The shift to virtual learning and student services could encourage greater participation now that stigma and peer judgment has been significantly reduced. The collective trauma experienced by the university community during the pandemic must not be underestimated, but the potential to rebuild stronger is now more likely than ever ( Wilton, 2020). The lessons learnt during this period will undoubtedly contribute toward more online services, greater awareness of the impact of loneliness on the student experience and an increased need to diversify services to suit a variety of student demographics.

Author Contributions

DB conducted the analysis and drafted the manuscript. ND and MH reviewed the manuscript and provided feedback prior to submission and formed the Ph.D. supervisory team. All authors contributed to the article and approved the submitted version.

Funding

The lead authors' Ph.D. program is fully funded by a strategic partnership held between Nuffield Health and Manchester Metropolitan University.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Footnotes

References

# data[].attributes.attachment_link.title
Assessing the Impact of the COVID-19 Pandemic on Student Wellbeing at Universities in the United Kingdom: A Conceptual Analysis

# data[].attributes.attachment_link.description
Transitioning into the university environment can be both exciting and stressful for new and returning students alike. The pressure to perform well academically in an increasingly competitive environment, coupled with a vast array of lifestyle changes, can contribute to suboptimal wellbeing.

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Focusing on Student Well-Being in Times of Crisis

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One teacher recommends supporting student safety through three Cs: communication, consistency, and control.

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For most people, mental health issues emerge when they are young — half of all mental disorders emerge by the time people are 14 years old and three quarters by 25 years old – the same period when most people are in education.

As well as increasing a person's opportunity and choices in life, promoting mental health and wellbeing as a core role in education helps students:

flourish in their education journey

build resilience against adversity

develop protective factors from mental ill-health

provide them with skills and confidence to self-seek help for early intervention.

Health and Physical Education Learning Area
Focuses on students enhancing their own and others' health, safety, wellbeing and physical activity participation in varied and changing contexts. The curriculum focuses on supporting students to develop the understanding and skills they require to make healthy and safe choices that will enhance their own and others' health and wellbeing

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5 Steps to Mental Health and Wellbeing: A Framework for Schools and Colleges

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https://www.beyondblue.org.au/who-does-it-affect/young-people/

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Going through tough times? Stress, anxiety and feeling down can affect anyone, and happens to a lot of us at some point in our lives.

We all have good days and bad days. However, if you're feeling sad, down or anxious and these feelings have started to affect your everyday life, then it's important to find out what's going on and how you can manage it.

Over 75% of mental health issues occur before the age of 25, while suicide continues to cause the largest loss of life of young people in Australia. It's never too early to start looking after your mental health and wellbeing so you can be the best version of yourself.

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how does mental health affect young people

# data[].attributes.attachment_link.description
Going through tough times? Stress, anxiety and feeling down can affect anyone, and happens to a lot of us at some point in our lives. We all have good days and bad days. However, if you're feeling sad, down or anxious and these feelings have started to affect your everyday life, then it's important to find out what's going on and how you can manage it.

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https://youtu.be/ZL21LRG4kzc

# data[].attributes.attachment_link.title
Supporting the Mental Health Well-Being of High School Students

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A whole school approach to supporting students' wellbeing and mental health

Schools play a critical role in supporting the mental health and wellbeing of all Queensland state school students. The department's Student learning and wellbeing framework assists schools to implement a whole school approach to supporting students' wellbeing and mental health across the continuum-from universal promotion and prevention approaches to targeted responses to students' mental health concerns.

Educators, parents, and children and young people themselves all have a role to play as part of a whole school approach to supporting the wellbeing and mental health of all Queensland state school students.

Find out specific information about how to support students' wellbeing and mental health.

Information for parents, including:

strategies for supporting your child's wellbeing and mental health

getting support for your child's wellbeing and mental health

responding to traumatic events.

Information for students, including:

supporting your wellbeing and staying safe

looking out for your mental health

where to get support for your wellbeing and mental health.

Information for school staff, including:

departmental resources

providing support

external support agencies.

Coronavirus (COVID-19) and supporting students-advice for parents

The department has developed:

The importance of supporting students' wellbeing for enhancing learning and social and emotional development is well established. Nurturing students' wellbeing in safe, supportive and inclusive school and home environments assists children and young people to be resilient, confident and lifelong learners.

Resilient and confident students not only perform better academically but are more likely to develop and maintain healthy, positive relationships and make responsible lifestyle choices.

​

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Supporting students' wellbeing and mental health

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The importance of wellbeing for learning is well evidenced - students learn best in environments where their social, emotional and physical wellbeing is nurtured.

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https://schools.au.reachout.com/student-wellbeing

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Improving wellbeing and resilience is vital for students to stay mentally healthy. Use ReachOut Schools' resources to support your students wellbeing.

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https://youtu.be/DxIDKZHW3-E

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School During the Pandemic: Mental Health Impacts on Students

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School During the Pandemic: Mental Health Impacts on Students

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Schools also play a role in creating a positive community that enhances a sense of connection and belonging in students. Using a whole school approach, schools can develop a safe and inclusive school environment and promote student mental health and wellbeing. This is best achieved by working in partnership with all members of the school community.

Schools can support students to develop:

social and emotional skills and capabilities that promote life-long mental health and wellbeing

skills to problem-solve and manage the normal stressors of life

healthy relationships and the ability to work cooperatively with others

a sense of autonomy and purpose.

The Schools Mental Health Menu is a list of endorsed programs, staff and resources across 3 tiers of support.

Tier 1 activities form a foundation for Tier 2 and Tier 3. Together, the tiers form layers of support for students. Tier 1 supports remain in place, and schools can add extra supports from Tier 2 and Tier 3 when greater needs are identified.

Tier 1: Universal interventions

Tier 1 Universal interventions help schools to create a positive, inclusive and supportive school climate, building the preconditions for optimal student learning, development and wellbeing. They are the initiatives and programs schools adopt that are good for all students.

Activities can be implemented at a school, year, or classroom level. They are usually delivered by school staff. Community organisations or agencies may be employed to deliver some activities.

Programs include:

adopting a whole school approach to mental health

social and emotional learning

wellbeing animal programs

eating disorders supports

alcohol and drug education

mental health literacy

bullying prevention

local community lead mental health intervention

peer support.

The Schools Mental Health Menu provides a comprehensive information about tier 1 activities (as well as tiers 2 and 3) available to schools.

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School's role in Tier 1 promoting mental health and wellbeing | Victorian Government

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Schools also play a role in creating a positive community that enhances a sense of connection and belonging in students. Using a whole school approach, schools can develop a safe and inclusive school environment and promote student mental health and wellbeing. This is best achieved by working in partnership with all members of the school community.

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https://lifeinmind.org.au/youcantalk

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#YouCanTalk exists to encourage all Australians to have a conversation with a friend, family member or work colleague they're concerned about.

While it can be difficult to talk about suicide, research shows you can have a positive influence on someone who may be considering suicide by initiating a conversation with them and supporting them to seek help.

The main message is you don't need to be a clinician, a GP, or a nurse to check-in with someone you are worried about.

It is OK to let someone know you have noticed they are struggling and ask them if they are experiencing thoughts of suicide.

It is normal to feel worried or nervous about having a conversation with a friend, family member or work colleague who might be experiencing suicidal thoughts, but there are resources available to help you.

Life in Mind is a national digital gateway providing organisations and communities access to suicide prevention information, programs, services, resources and research.

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YouCanTalk exists to encourage all Australians to have a conversation with a friend, family member or work colleague they're concerned about. While it can be difficult to talk about suicide, research shows you can have a positive influence on someone who may be considering suicide by initiating a conversation with them and supporting them to seek help.

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https://youtu.be/kkXgcznvsfw

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Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act, and helps determine how we handle stress, relate to others, and make choices.

Mental health is important at every stage of life, from childhood and adolescence through adulthood. Over the course of your life, if you experience mental health problems, your thinking, mood, and behavior could be affected.

Mental Health Conditions

Mental illnesses are disorders, ranging from mild to severe, that affect a person's thinking, mood, and/or behavior. According to the National Institute of Mental Health, nearly one-in-five adults live with a mental illness.

Many factors contribute to mental health conditions, including:

Biological factors, such as genes or brain chemistry

Life experiences, such as trauma or abuse

Family history of mental health problems

Some mental health topics include:

A Serious Mental Illness (SMI) is a mental illness that interferes with a person's life and ability to function. Despite common misperceptions, having an SMI is not a choice, a weakness, or a character flaw. It is not something that just "passes" or can be "snapped out of" with willpower.

View SAMHSA's Public Message about Serious Mental Illnesses.

Early Warning Signs & Symptoms

Not sure if you or someone you know is living with mental health problems? Experiencing one or more of the following feelings or behaviors can be an early warning sign of a problem:

Eating or sleeping too much or too little

Pulling away from people and usual activities

Having low or no energy

Feeling numb or like nothing matters

Having unexplained aches and pains

Feeling helpless or hopeless

Smoking, drinking, or using drugs more than usual

Feeling unusually confused, forgetful, on edge, angry, upset, worried, or scared

Yelling or fighting with family and friends

Experiencing severe mood swings that cause problems in relationships

Having persistent thoughts and memories you can't get out of your head

Hearing voices or believing things that are not true

Thinking of harming yourself or others

Inability to perform daily tasks like taking care of your kids or getting to work or school

Do you think someone you know may have a mental health problem? Talking about mental health can be difficult. Learn about common mental health myths and facts and read about ways to help you get the conversation started.

Tips for Living Well with a Mental Health Condition

Having a mental health condition can make it a struggle to work, keep up with school, stick to a regular schedule, have healthy relationships, socialize, maintain hygiene, and more.

However, with early and consistent treatment-often a combination of medication and psychotherapy-it is possible to manage these conditions, overcome challenges, and lead a meaningful, productive life.

Today, there are new tools, evidence-based treatments, and social support systems that help people feel better and pursue their goals. Some of these tips, tools and strategies include:

Stick to a treatment plan. Even if you feel better, don't stop going to therapy or taking medication without a doctor's guidance. Work with a doctor to safely adjust doses or medication if needed to continue a treatment plan.

Keep your primary care physician updated. Primary care physicians are an important part of long-term management, even if you also see a psychiatrist.

Learn about the condition. Being educated can help you stick to your treatment plan. Education can also help your loved ones be more supportive and compassionate.

Practice good self-care. Control stress with activities such as meditation or tai-chi; eat healthy and exercise; and get enough sleep.

Reach out to family and friends. Maintaining relationships with others is important. In times of crisis or rough spells, reach out to them for support and help.

Develop coping skills. Establishing healthy coping skills can help people deal with stress easier.

Get enough sleep. Good sleep improves your brain performance, mood and overall health. Consistently poor sleep is associated with anxiety, depression, and other mental health conditions.

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Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act, and helps determine how we handle stress, relate to others, and make choices.

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Schools also play a role in creating a positive community that enhances a sense of connection and belonging in students. Using a whole school approach, schools can develop a safe and inclusive school environment and promote student mental health and wellbeing. This is best achieved by working in partnership with all members of the school community.

Schools can support students to develop:

social and emotional skills and capabilities that promote life-long mental health and wellbeing

skills to problem-solve and manage the normal stressors of life

healthy relationships and the ability to work cooperatively with others

a sense of autonomy and purpose.

The Schools Mental Health Menu is a list of endorsed programs, staff and resources across 3 tiers of support.

Tier 1 activities form a foundation for Tier 2 and Tier 3. Together, the tiers form layers of support for students. Tier 1 supports remain in place, and schools can add extra supports from Tier 2 and Tier 3 when greater needs are identified.

Tier 1: Universal interventions

Tier 1 Universal interventions help schools to create a positive, inclusive and supportive school climate, building the preconditions for optimal student learning, development and wellbeing. They are the initiatives and programs schools adopt that are good for all students.

Activities can be implemented at a school, year, or classroom level. They are usually delivered by school staff. Community organisations or agencies may be employed to deliver some activities.

Programs include:

adopting a whole school approach to mental health

social and emotional learning

wellbeing animal programs

eating disorders supports

alcohol and drug education

mental health literacy

bullying prevention

local community lead mental health intervention

peer support.

The Schools Mental Health Menu provides a comprehensive information about tier 1 activities (as well as tiers 2 and 3) available to schools.

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School's role in Tier 1 promoting mental health and wellbeing | Victorian Government

# data[].attributes.attachment_link.description
Schools also play a role in creating a positive community that enhances a sense of connection and belonging in students. Using a whole school approach, schools can develop a safe and inclusive school environment and promote student mental health and wellbeing. This is best achieved by working in partnership with all members of the school community.

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The only UK charity dedicated to supporting the mental health and wellbeing of teachers and education staff.

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Wellbeing and resilience are important in preventing the onset of mental health problems as well as potentially lessening the severity of existing mental health problems. Wellbeing and resilience are vital to developing efficient problem-solving skills, building and maintaining interpersonal relationships and realistic goal setting, all of which greatly enhance an individual's ability to perform and contribute meaningfully in daily life.

What is wellbeing and resilience?

Good health is about more than just the absence of sickness. Focusing on wellbeing and building resiliency is important in establishing a holistic approach to health, addressing both physical and psychological states.

The World Health Organisation defines wellbeing as "the state in which an individual realises his or her own abilities, can cope with normal stresses of life, can work productively, and is able to make a contribution to his or her own community". Wellbeing involves having positive self image and esteem.

Resilience, which is directly related to wellbeing, is about having the ability to cope with and adapt to new situations. Having a sense of resilience and positive wellbeing enables a person to approach other people and situations with confidence and optimism, which is especially important for young people given the enormous changes that occur with the transition into adolescence and adulthood.
Signs of resilience and wellbeing:

confidence to approach new situations and approach new people

realistic optimism

avoiding constant self-blame

ability to set goals

positive self image and self esteem.

How can students focus on wellbeing and resilience?

In a practical sense developing and improving on setting realistic and achievable goals, problem solving and social skills all contribute to wellbeing and resiliency. Other important skills include identifying and becoming aware of one's own strengths and weaknesses.

1. Setting realistic, achievable and measurable goals is a great way to promote self-efficacy. Setting goals should be motivating. One way to increase motivation (and minimise feeling pressure or 'failure') is to set sub-goals, smaller and achievable related targets.

2. Understanding and avoiding negative self-talk as well as actively practicing positive self-talk, is an important tool for building self-esteem. Self-talk, which is essentially internal reflections on personal ability and/or image, can greatly influence self esteem and perceptions about personal ability.

3. Developing and focusing on interpersonal skills, especially learning how to engage with people from different backgrounds, is a valuable tool for young people that will enhance self esteem and ability to maintain personal and fulfilling relationships.

What can teachers do?

create safe and supportive learning environments

provide consistent guidelines for behaviour

model appropriate responses and behaviours

provide opportunities for goal setting, success, failure and reflection.

ReachOut.com resources on wellbeing and resilience

How to help

Talk to young people about their mental health in terms of building strength and resilience.

Suggest self-awareness and resilience strategies, such as mindfulness meditation. Try the Smiling Mind app.

Recommend ReachOut.com content on resilience and wellbeing.

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Wellbeing and resilience are important in potentially preventing the onset of and lessening the severity of existing mental health problems.

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The Five Ways to Wellbeing - boosting mental wellbeing

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Schools also play a role in creating a positive community that enhances a sense of connection and belonging in students. Using a whole school approach, schools can develop a safe and inclusive school environment and promote student mental health and wellbeing. This is best achieved by working in partnership with all members of the school community.

Schools can support students to develop:

social and emotional skills and capabilities that promote life-long mental health and wellbeing

skills to problem-solve and manage the normal stressors of life

healthy relationships and the ability to work cooperatively with others

a sense of autonomy and purpose.

The Schools Mental Health Menu is a list of endorsed programs, staff and resources across 3 tiers of support.

Tier 1 activities form a foundation for Tier 2 and Tier 3. Together, the tiers form layers of support for students. Tier 1 supports remain in place, and schools can add extra supports from Tier 2 and Tier 3 when greater needs are identified.

Tier 1: Universal interventions

Tier 1 Universal interventions help schools to create a positive, inclusive and supportive school climate, building the preconditions for optimal student learning, development and wellbeing. They are the initiatives and programs schools adopt that are good for all students.

Activities can be implemented at a school, year, or classroom level. They are usually delivered by school staff. Community organisations or agencies may be employed to deliver some activities.

Programs include:

adopting a whole school approach to mental health

social and emotional learning

wellbeing animal programs

eating disorders supports

alcohol and drug education

mental health literacy

bullying prevention

local community lead mental health intervention

peer support.

The Schools Mental Health Menu provides a comprehensive information about tier 1 activities (as well as tiers 2 and 3) available to schools.

# data[].attributes.attachment_link.title
School's role in Tier 1 promoting mental health and wellbeing | Victorian Government

# data[].attributes.attachment_link.description
Schools also play a role in creating a positive community that enhances a sense of connection and belonging in students. Using a whole school approach, schools can develop a safe and inclusive school environment and promote student mental health and wellbeing. This is best achieved by working in partnership with all members of the school community.

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https://journals.sagepub.com/doi/full/10.1177/08295735211001653https://journals.sagepub.com/doi/full/10.1177/08295735211001653

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5 Steps to Mental Health and Wellbeing: A Framework for Schools and Colleges

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Graduate School of Education, Nazarbayev University, Nur-Sultan, Kazakhstan

Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan

Psychological Counseling Center, Nazarbayev University, Nur-Sultan, Kazakhstan

The purpose of this study is to map the literature on mental health and well-being of university students using metadata extracted from 5,561 journal articles indexed in the Web of Science database for the period 1975-2020. More specifically, this study uses bibliometric procedures to describe and visually represent the available literature on mental health and well-being in university students in terms of the growth trajectory, productivity, social structure, intellectual structure, and conceptual structure of the field over 45 years. Key findings of the study are that research on mental health and well-being in university students: (a) has experienced a steady growth over the last decades, especially since 2010; (b) is disseminated in a wide range of journals, mainly in the fields of psychology, psychiatry, and education research; (c) is published by scholars with diverse geographical background, although more than half of the publications are produced in the United States; (d) lies on a fragmented research community composed by multiple research groups with little interactions between them; (e) is relatively interdisciplinary and emerges from the convergence of research conducted in the behavioral and biomedical sciences; (f) tends to emphasize pathogenic approaches to mental health (i.e., mental illness); and (g) has mainly addressed seven research topics over the last 45 years: positive mental health, mental disorders, substance abuse, counseling, stigma, stress, and mental health measurement. The findings are discussed, and the implications for the future development of the field are highlighted.

Introduction

The entrance to the university marks a period of transition for young people. Through this transition, students face new challenges, such as making independent decisions about their lives and studies, adjusting to the academic demands of an ill-structured learning environment, and interacting with a diverse range of new people. In addition, many students must, often for the first time, leave their homes and distance themselves from their support networks ( Cleary et al., 2011). These challenges can affect the mental health and well-being of higher education students. Indeed, there is evidence that a strain on mental health is placed on students once they start at the university, and although it decreases throughout their studies ( Macaskill, 2013; Mey and Yin, 2015), it does not return to pre-university levels ( Cooke et al., 2006; Bewick et al., 2010). Also, the probabilities of experiencing common psychological problems, such as depression, anxiety, and stress, increase throughout adolescence and reach a peak in early adulthood around age 25 ( Kessler et al., 2007) which makes university students a particularly vulnerable population.

The interest in mental health and well-being in university students has grown exponentially in the last decades. This is likely due to three interrelated challenges. First, although university students report levels of mental health similar to their non-university counterparts ( Blanco et al., 2008), recent studies suggest an increase and severity of mental problems and help-seeking behaviors in university students around the world in the last decade ( Wong et al., 2006; Hunt and Eisenberg, 2010; Verger et al., 2010; Auerbach et al., 2018; Lipson et al., 2019). Some researchers refer to these trends as an emerging "mental health crisis" in higher education ( Kadison and DiGeronimo, 2004; Evans et al., 2018). Second, psychological distress in early adulthood is associated with adverse short-term outcomes, such as poor college attendance, performance, engagement, and completion (e.g., King et al., 2006; Antaramian, 2015), and others in the long term, such as dysfunctional relationship ( Kerr and Capaldi, 2011), recurrent mental health problems, university dropout, lower rates of employment, and reduced personal income ( Fergusson et al., 2007). Third, there is a widespread agreement that higher education institutions offer unique opportunities to promote the mental health and well-being of young adults as they provide a single integrated setting that encompasses academic, professional, and social activities, along with health services and other support services ( Eisenberg et al., 2009; Hunt and Eisenberg, 2010). However, the majority of university students experiencing mental health problems and low levels of well-being are not receiving treatment ( Blanco et al., 2008; Eisenberg et al., 2011; Lipson et al., 2019) and, while universities continue to expand, there is a growing concern that the services available to provide support to students are not developing at an equivalent rate ( Davy et al., 2012).

In response to the increasing volume of research on the mental health and well-being of university students, there have been several attempts to synthesize the accumulating knowledge in the field and to provide an illustration of the theoretical core and structure of the field using traditional content analysis of the literature (e.g., Kessler et al., 2007; Gulliver et al., 2010; Hunt and Eisenberg, 2010; Sharp and Theiler, 2018). This study aims to extend the understanding of mental health in university students by providing a bird's eye view of the research conducted in this field in recent decades using a bibliometric approach. Bibliometric overviews provide an objective and systematic approach to discover knowledge flows and patterns in the structure of a field ( Van Raan, 2014) reveal its scientific roots, identify emerging thematic areas and gaps in the literature ( Skute et al., 2019) and, ultimately, contribute to moving the field forward. Accordingly, this study employs several bibliometric indicators to explore the evolution of the field based on publication and citation trends, key actors and venues contributing to the advancement of research on mental health and well-being of university students, and the structure of the field in terms of patterns of scientific collaborations, disciplines underlying the foundations of the field, and recurrent research themes explored in the literature. This is important because, despite significant advances in the field, research on mental health and well-being remains a diverse and fragmented body of knowledge ( Pellmar and Eisenberg, 2000; Bailey, 2012; Wittchen et al., 2014a). Indeed, mental health and well-being are nebulous concepts and their history and development are quite intricate, with a multitude of perspectives and contributions emerging from various disciplines and contexts (see section "Conceptualization of Mental Health, Mental Illness, and Well-Being: An Overview"). Therefore, mapping research on mental health and well-being in university students is essential to identify contributions and challenges to the development of the field, to help guide policy, research, and practice toward areas, domains, populations, and contexts that should be further explored, and to provide better care of students at higher education institutions ( Naveed et al., 2017).

Conceptualization of Mental Health, Mental Illness, and Well-Being: An Overview

This section provides an overview of the different perspectives adopted in the literature to conceptualize mental health, well-being, and other relevant constructs in order to identify the glossary of key terms that will be used in the search strategy to create a comprehensive corpus of documents on mental health and well-being in university students for this bibliometric review.

Perspectives on Mental Health and Mental Illness

There is no general agreement on the definition of mental health. For a long time, the term mental health has been used as a euphemism for mental illness ( Manwell et al., 2015). However, mental health and mental illness are regarded as distinct constructs nowadays and two main perspectives differentiating between mental health and illness are available in the literature. The continuum approach considers that mental health and mental illness are the two opposite poles of a continuum. Thus, there are various degrees of health and illness between these poles, with most of us falling somewhere in between. The categorical approach, on the other hand, represents mental health and illness as a dichotomy. People who manifest mental illness symptoms would belong to that category and labeled correspondingly, while those absent of these symptoms can be considered as mentally healthy ( Scheid and Brown, 2010).

Disciplinary Approaches to the Conceptualization of Mental Health/Illness

Conceptualizations of mental health/illness are largely dependent on the theoretical and paradigmatic foundations of the disciplines from which they emerge. In this context, the field has progressively evolved through the accumulation of knowledge generated in a diverse range of disciplines in the biomedical, behavioral, and social sciences. Biomedical disciplines are grounded in the medical paradigm focused on disease and (ab)normality and often emphasize dichotomous conceptions of mental health/illness ( Scheid and Brown, 2010). Research on mental health and well-being in this domain has been traditionally conducted from a psychiatric perspective, which aims to understand the dysfunctionality in the brain that leads to psychiatric symptoms and to also offer a pharmacological treatment to correct neuronal dysfunctions. Consequently, psychiatrists have historically considered mental health as a disease of the brain (e.g., depression), similar to any other physical disease, caused by genetic, biological, or neurological factors ( Schwartz and Corcoran, 2010). While the prevalence of psychiatric approaches to mental health is currently incontestable, the development of other biomedical disciplines has tremendously contributed to the progression of the field in recent decades. For example, Insel and Wang (2010) argue that insights gained from genetics and neuroscience contribute to the reconceptualization of "the disorders of the mind as disorders of the brain and thereby transform the practice of psychiatry." (1979). In addition to that, other disciplines such as behavioral medicine have made important contributions to the field, although it has recently argued that mental health and behavioral medicine should be as two separate fields ( Dekker et al., 2017).

Within the behavioral sciences, the study of mental health focuses on the distinct psychological processes and mechanisms that prompt thoughts, feelings, and behaviors ( Peterson, 2010). Clinical psychology has the longest tradition in the psychological study of mental health and tends to focus on the assessment and treatment of mental illness and disorders that can alleviate psychological distress or promote positive states of being ( Haslam and Lusher, 2011). However, significant contributions to the field have also emerged from other branches of psychology less focused on psychopathology, including personality and social psychology, psychoanalysis, humanistic psychology, and cognitive psychology ( Peterson, 2010). Despite the diversity of theories, principles, and methodological approaches to understanding mental health within the behavioral sciences, these disciplines acknowledge that mental health have a biological basis and reside in the social context, and tend to prioritize continuum approaches to mental health ( Scheid and Brown, 2010).

Perspectives from the social sciences complement the biomedical and behavioral approaches by considering the influence of social and cultural environments in mental health/illness ( Horwitz, 2010). For example, sociologists are interested in how social circumstances (e.g., level of support available) affect levels of mental health/illness and how social structures shape the understanding and response to mental health issues [see Compton and Shim (2015) for an overview of the social determinants of mental health]. Similarly, medical anthropologists attend to the mental health beliefs and practices that form the cultural repertory within and across populations ( Foster, 1975). Beyond sociology and anthropology, social researchers in the fields of business and economics, family and ethnic studies, and educational research have also played a key role in advancing research on mental health in different directions.

The Importance of the Context in Mental Health

Certainly, most notions of mental health/illness in the literature derive from prevailing psychiatric and psychological traditions developed in Western countries ( Gopalkrishnan, 2018). However, cultural values and traditions do shape how mental health and mental illness are conceptualized across contexts ( Vaillant, 2012). In this regard, Eshun and Gurung (2009) pointed out that "culture influences how individuals manifest symptoms, communicate their symptoms, cope with psychological challenges, and their willingness to seek treatment." (4). Fernando (2019) argued that issues related to the 'mind' developed and are often interpreted very differently in non-Western and Low- and Middle-Income Countries (LMICs). For example, cultures explain the manifestation of certain feelings and behaviors based on a range of motives including biological, psychological, social, religious, spiritual, supernatural, and cosmic. Failure to acknowledge alternative non-Western approaches to mental health and mental illness has resulted in imbalances of knowledge exchange and the permeation of dominating Western narratives into LMICs (i.e., so-called medical imperialism) ( Timimi, 2010; Summerfield, 2013). To address this issue, scholars have advocated for a greater willingness to embrace pluralism in the conceptualization of mental health and illness, which might help people to engage with particular forms of support that they deem to be appropriate for them, and to explore how knowledge and practices developed in LMICs can benefit those living in higher-income countries (i.e., knowledge "counterflow") (see White et al., 2014).

Prioritizing Positive Mental Health: The Science of Well-Being

Despite the diversity of disciplinary and contextual approaches to mental health, current definitions of mental health have two things in common. First, mental health is considered from a biopsychosocial point of view that incorporates biological, psychological, and social factors. Second, mental health implies something beyond the absence of mental illness (e.g., Bhugra et al., 2013; Galderisi et al., 2015). An example is the definition by the World Health Organization which refers to mental health as "a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community" ( World Health Organization, 2004). This definition contributed to substantial progress in research and practice in the field as it expanded the notion of mental health beyond the absence of mental illness and integrated the presence of positive features ( Galderisi et al., 2015).

Research on positive mental health is relatively new but has grown rapidly in the last decades fueled by advocates of positive medicine and psychology, who have argued for a change of paradigm from medical and psychopathological-oriented models of mental health that focus on disorders and illness toward more strength-based approaches, which pay more attention to what is right about people and positive attributes and assets ( Kobau et al., 2011). In this regard, the term mental well-being has been progressively incorporated into the study of mental health to account for the positive aspects of mental health beyond the absence of negative factors. While there is not a universally accepted definition of well-being, two perspectives have dominated the discourses on well-being in the literature: subjective well-being (SBW) and psychological well-being (PWB). SWB is based on hedonic perspectives of pleasure and represents "people's beliefs and feelings that they are living a desirable and rewarding life" ( Diener, 2012). SBW is strongly linked with the idea of happiness and is typically understood as the personal experience of high levels of positive affect, low levels of negative affect, and high satisfaction with one's life ( Deci and Ryan, 2008). PWB is grounded in Aristotelian ideas about eudaimonia, i.e., self-realization, with the ultimate aim in life being to strive to realize one's true potential ( Ryff and Singer, 2008). PWB has been broadly defined as a state of positive psychological functioning and encompasses six dimensions: purpose in life (i.e., the extent to which respondents felt their lives had meaning, purpose, and direction); autonomy (i.e., whether they viewed themselves as living in accord with their own convictions); personal growth (i.e., the extent to which they were making use of their personal talents and potential); environmental mastery (i.e., how well they were managing their life situations); positive relationships (i.e., the depth of connection they had in ties with significant others); and self-acceptance (i.e., the knowledge and acceptance they had of themselves, including awareness of personal limitations) ( Ryff, 1989).

Integrating Mental Health, Mental Illness, and Well-Being

The contribution of positive mental health frameworks to the advancement of the field has been undeniable. However, definitions that overemphasize positive emotions and productive functioning as key indicators of mental health have been recently challenged because of the potential they have to discriminate against individuals and groups that, for example, might not be able to work productively or function within the environment because of individual physical characteristics or contextual constraints ( Galderisi et al., 2015). To address these issues, Keyes has successfully integrated the notions of mental illness, mental health, well-being, and other related terms in the literature into a conceptual framework that allows for a more comprehensive understanding of mental health ( Keyes, 2005, 2007; Keyes and Michalec, 2010). The model argues that neither pathogenic approaches focusing on the negative (e.g., mental illness) nor salutogenic approaches focusing on the positive (e.g., well-being) can alone accurately describe the mental health of a person ( Keyes and Michalec, 2010). Instead, the model proposes that mental illness and well-being represent two correlated but differentiated latent continua in defining mental health. More specifically, mental illness and well-being lie on two separate spectra, the first going from absent to present mental illness and the second running from low to high well-being ( Slade, 2010). The absence of mental illness, therefore, does not necessarily imply high levels of well-being. Correspondingly, low levels of well-being do not always indicate the presence of mental illness. Further, in this model, mental health is defined as not only the absence of mental illness, not the mere presence of high well-being. Complete mental health (i.e., flourishing) is a result of experiencing low mental illness and high levels of well-being. Incomplete mental health (i.e., languishing), on the other hand, refers to the absence of mental illness symptoms and low reported levels of well-being. Two other conditions are possible within this framework. Incomplete mental illness (i.e., struggling) refers to high levels of well-being accompanied by high mental illness symptoms. Lastly, complete mental illness (i.e., floundering) accounts for low levels of well-being and high mental illness symptoms ( Keyes and Lopez, 2002).

The Present Study

In light of the complexity of the constructs of mental health and well-being and the multiple theoretical, disciplinary, and contextual approaches to their conceptualization, this study seeks to map out the terrain of international research and scholarship on mental health and university students for the period 1975-2020. More specifically, this study aims to provide new insights into the development and current state of mental health research in university students by mapping and visually representing the literature on mental health and well-being of university students over the last 45 years in terms of the growth trajectory, productivity, and social, intellectual, and conceptual structure of the field. First, the study describes the development of research mental health and well-being in university students examining the trends in publication and citation data between 1975 and 2020 (i.e., growth trajectory). Second, the study identifies the core journals and the research areas contributing most to the development of the field, as well as the key authors and countries leading the generation and dissemination of research on mental health and well-being in university populations (i.e., productivity). Third, the study outlines the networks of scientific collaboration between authors, and countries (i.e., social structure). Fourth, the scientific disciplines underlying the intellectual foundations of research on mental health and well-being in university settings (i.e., intellectual structure) are uncovered. Fifth, the study elucidates the topical foci (i.e., conceptual structure) of the research on the mental health and well-being of university students over the last 45 years.

Materials and Methods

A bibliometric approach was used in this study to map the literature on mental health and well-being in university students over the last 45 years using metadata extracted from four indexes of the Web of Science (WoS): The Science Citation Index-Expanded (SCI-Expanded); the Social Sciences Citation Index (SSCI); the Arts & Humanities Citation Index (A&HCI); and the Emerging Sources Citation Index (ESCI). Several reasons justified the selection of the WoS database in this study. First, the WoS remains as the standard and most widely used for bibliometric analysis ( Meho and Yang, 2007). Second, the WoS is a multidisciplinary database and includes publications on mental health and well-being emerging from distinctive research areas and disciplines published in more than 20,000 journals ( McVeigh, 2009). Using specialized databases such as PubMed would introduce biases into the search strategy favoring biomedical research disciplines. Still, it is important to note that interdisciplinary databases such as WoS and Scopus discriminate against publications in the Social Sciences and Humanities and publications in languages other than the English language ( Mongeon and Paul-Hus, 2016), so the picture provided by WoS is still imperfect. Third, while other databases might provide wider coverage, WoS includes publication and citation information from 1900. For example, Scopus has complete citation information only from 1996 ( Li et al., 2010). Moreover, Google Scholar provides results of inconsistent accuracy in terms of citations, and citation analyses in PubMed are not available ( Falagas et al., 2008). Fourth, WoS has demonstrated better accuracy in its journal classification system compared to Scopus database ( Wang and Waltman, 2016).

The methodological approach used in this study is presented in Figure 1 and further elaborated in the following paragraphs.

Search Strategy

To create a comprehensive corpus of documents on the mental health and well-being of university students, three parallel searches were performed, which accounted for the multiple approaches and perspectives that have been used in the field, as identified in the Section "Conceptualization of Mental Health, Mental Illness, and Well-Being: An Overview." All the searches were conducted in the last week of January 2020. The first search aimed at capturing research on mental health broadly and included one single keyword in the topic field: ["mental health"]. The second search was implemented to capture research focusing on pathogenic approaches to mental health. Key terms used in the literature to refer to the negative side of mental health, as well as the most frequent mental health problems experienced by university students, were introduced in this search in the title field: ["mental illness," "mental disorder ∗," "mental distress," "psychological distress," "psychopathology," "depression," "anxiety," "stress," "suicide," "eating disorder ∗," "substance use"]. In the third search, keywords reflecting salutogenic approaches to mental health were input. These included terms related to mental health from a positive mental health perspective (i.e., well-being). These key terms were added in the title field and included the following: ["well-being," "wellbeing," "wellness," "life satisfaction," "happiness," "positive affect," "purpose in life," "personal growth," "self-determination"].

To retrieve research relevant only to higher education students, another set of keywords was imputed in all three searches in the title field. These included: ["university," "college," "higher education," "tertiary education," "post-secondary education," "postsecondary education," "undergrad ∗ student," "grad ∗ student," "master's student," "doctoral student," "Ph.D. student"]. The Boolean operator OR was used between keywords in all the three searches to secure a higher number of relevant hits. Also, asterisks were used as wildcards to account for multiple variations in several keywords (e.g., disorder and disorder-s). All searches were limited to journal articles published between 1975 and 2020 (both inclusive). No restrictions on language were implemented in the search.

The search strategy retrieved a total of 6,356 hits ( n search 1 = 2782; n search 2 = 2814, n search 3 = 760). After the removal of duplicates, 5,561 research articles were finally selected and retained for the study. For each of the documents obtained in the search, the authors extracted metadata about the title of the paper, the year of publication, the journal, the number of citations, and the authors' name, organization, and country. Also, the title, the abstract, the author's keywords, and cited references were retrieved.

Data Analysis Procedures

The corpus of the literature was then analyzed using descriptive and bibliometric approaches to provide an overall picture of the evolution and current state of the research on mental health and wellbeing in university settings. Frequency counts of the number of publications and citations per year were obtained to describe the growth trajectory of research on the mental health and well-being of university students. Rank ordered tables were produced to describe the productivity of the field in terms of core journals and research areas, as well as leading scholars and countries contributing to the development of the field.

Bibliometric analyses in VOSViewer software were implemented to examine and visually represent the social, intellectual, and conceptual structure of the field. VOSViewer is a freely available computer software for viewing and constructing bibliometric maps. In VOSViewer, the units of analysis are journals, publications, citations, authors, or countries, depending on the focus of the analysis. The units of analysis are represented in the maps as circular nodes. The size of the node accounts for volume (e.g., number of publications in the dataset by an author) and the position represents the similarity with other nodes in the map. Closer nodes are more alike than nodes far apart from each other. The lines connecting nodes represent the relationship between nodes and their thickness indicates the strength of that relationship. Finally, the color of the node denotes the cluster to which each node has been allocated. Nodes are clustered together based on relatedness ( Van Eck et al., 2010). The software uses a distance-based approach to constructing the bibliometric maps in three steps ( Van Eck and Waltman, 2014). In the first step, the software normalizes the differences between nodes. In the second step, the software builds a two-dimensional map where the distance between the nodes reflects the similarity between these nodes. In the third step, VOSViewer groups closely related nodes into clusters ( Van Eck and Waltman, 2014).

A series of co-authorship analyses were performed to examine the social structure of research on mental health and well-being in university students. In these analyses, the units of analysis were authors and countries/territories. Each node in the map represents an author or a country/territory and the lines connecting them reflect the relationship between nodes. Clusters represent networks of scientific collaboration, which might be interpreted as groups of authors or countries frequently publishing together (e.g., research groups in the case of authors).

Co-citation analysis of journals was implemented to explore the intellectual structure of the field. Here, the units of analysis were journals in the dataset and the map reflects co-citation relationships between journals. Two journals are co-cited if there is a third journal citing these two. The more times a pair of journals are cited by other journals, the stronger their co-citation relationship will be. Frequently co-cited journals are assumed to share theoretical and semantical grounds. Therefore, in our study, clusters of frequently co-cited journals can be interpreted as disciplines underlying the foundations of research on mental health and well-being in university students.

Finally, a co-occurrence analysis of keywords was used to uncover the conceptual structure of the field. The units of analysis, in this case, were the authors' keywords. The more often two keywords appear in the same record, the stronger their co-occurrence relationship. Clusters of co-occurring keywords represent in this study the topical foci (i.e., knowledge base) that have been addressed in the literature in mental health and well-being in university students in the last 45 years.

Findings and Discussion

Growth Trajectory: Evolution of Publications and Citations in the Field

The developmental patterns of a particular field can be well demonstrated by trends in publications and citations. The 5,561 publications in the dataset have been cited 87,096 times, with an average of 15.6 citations per item. Figure 2 shows the growth trajectory of publication data of research on mental health and well-being in university students from 1975 to January 2020. Overall, the trends demonstrate a gradual increase in the scholarly interest in the mental health of university students over the last 45 years that can be organized in three stages: an emergence stage, in which publications rose slowly (1975-2000); a fermentation stage, with a notable increase in publications in the field (2000-2010); and a take-off stage, during which the number of records published per year in the field has almost risen 10 times (2010-2020). The steady increase of publications in the last 15 years coincides with the first calls for attention on the increase and severity of mental problems and help-seeking behaviors of college students ( Kadison and DiGeronimo, 2004; Evans et al., 2018), potentially indicating a growing interest in exploring the epidemiology of mental disorders and the role of universities in promoting the mental health and well-being of students. A similar pattern has also been observed in a recent bibliometric study examining global research on mental health both in absolute terms and as a proportion of all papers published in medicine and across disciplines, which certainly reflects an increase in the general interest in the field ( Larivière et al., 2013).

Productivity I: Core Journals and Research Areas

In total, 1,560 journals published the 5,561 records included in the dataset. Table 1 presents the ten core journals in the field. The Journal of American College stands out as the main publication venue in the field, accumulating around 5% of the publications in the dataset ( n = 270). Psychological Reports and Journal of College Student Development also stand out, publishing 119 and 102 studies, respectively. The Journal of Counseling Psychology ranks fourth in the list with 83 records. Despite being an interdisciplinary and relatively young journal, Plos One appears in the top five journal publishing research on mental health and well-being in university students.

The top research areas contributing to the publication of research on the mental health and well-being of university students are presented in Table 2. Nearly half of the records in the dataset are published in psychology journals. Another influential research area in the field is psychiatry, which captures almost 20% of the publications. Journals on education and educational research also accumulate a considerable number of publications in the field (15%). Other relevant research areas in the field are connected with health and medicine, including public environmental occupational health, substance abuse, general internal medicine, neurosciences neurology, health care sciences services, and nursing. Finally, the field is also grounded, although to a lower extent, in the publications emerging from journals in the social sciences, family studies, and social work research.

All in all, the productivity analysis for journals and research areas showed that most research on mental health and well-being in university students is disseminated in journals in the "psy disciplines"' (i.e., psychology and psychiatry) ( McAvoy, 2014), which is consistent with previous research on mental health in general populations (e.g., Haslam and Lusher, 2011). However, our findings demonstrated that the volume of research in psychology doubles that of research emerging from psychiatric journals. This contrasts with the findings by Haslam and Lusher (2011), who demonstrated that psychiatry journals had a greater influence on mental health research compared to clinical psychology journals and that psychiatry journals accumulate a higher volume of research and citations on mental health research. This is probably because our study includes publications emerging from all branches of psychology, unlike the study by Haslam and Lusher, which included only journals in the field of clinical psychology. Additionally, mental health services in higher education are typically provided by counseling centers led and staffed by non-medical professionals (e.g., psychologists, social workers, counselors, and family therapists) who tend to adopt developmental models of practice grounded in the behavioral sciences and focused on adjustment issues, vocational training, employment, and other personal needs rather than diagnosis and symptom reduction, more common in the biomedical sciences (i.e., psychiatry) ( LeViness et al., 2018; Mitchell et al., 2019).

Productivity II: Leading Authors and Countries/Territories

The 5,561 publications in the dataset were published by a total of 16,161 authors from 119 countries worldwide. Table 3 shows the researchers with the highest number of publications in the field. D. Eisenberg appears as the most productive researcher, followed by K. Peltzer and S. Pengpid. Authors on the list come from diverse geographical backgrounds. Five of the authors work at three different American universities (University of Michigan, Harvard Medical School, and Boston University), two researchers work at KU Leuven University (Belgium), and two other authors are affiliated to the same two universities in Thailand and South Africa. Other prolific researchers are affiliated with higher education institutions in the Netherlands, Egypt, and Germany.

Countries and territories leading research on mental health and well-being of university students are presented in Table 4. The United States is the indisputable leader in this field, publishing more than half of the records in the dataset. This is nearly 10 times the number of publications produced in China, which occupies the second position in the ranking and accounts for nearly 6% of the volume of research in the dataset. Three predominantly English speaking countries/territories complete the top five of the ranking: Canada (265 records), Australia (254), and England (243). The rest of the countries in the list are situated in Europe (Spain, Germany, Turkey), Western Asia (Iran), Africa (South Africa), and East Asia (Japan), which demonstrates that research on college students' mental health and well-being is a matter of concern in different regions of the world, at least to some extent.

Overall, the productivity analysis for authors and countries indicated that the research of mental health and well-being of university students occurs in a variety of locations around the world, especially in developed countries, and in a very prominent way, in the United States. This is not surprising since it is in those countries where better infrastructures and more abundant resources for research are available ( Wong et al., 2006), and a more lasting tradition in the study of mental health, in general, exists ( Gopalkrishnan, 2018). However, Larivière et al. (2013) found that the productivity of the United States on mental health research has dropped significantly and remained stable in other two English speaking countries (the United Kingdom and Canada) since 1980. On the contrary, the number of publications from European countries and the five major emerging national economies (Brazil, Russia, India, China, and South Africa), has experienced remarkable growth, and collectively account nearly for half of the publications in the field. Still, the predominance of knowledge generated in the developed world today, which tends to be grounded on psychiatric and psychological perspectives, might be eclipsing non-traditional views on mental health and well-being that are popular in other regions of the world and, therefore, limiting the development of effective initiatives that align better with local norms, values, and needs in LMICs ( Timimi, 2010; Summerfield, 2013).

Social Structure: Networks of Scientific Collaboration

Research collaboration is regarded as an indicator of quality research and a means to improve research productivity and academic impact (i.e., citations) ( Kim, 2006; Abramo et al., 2009). In particular, international research collaboration is considered a key contributor to the social construction of science and the evolution of scientific disciplines ( Coccia and Wang, 2016). There is recent evidence that national and international research collaborations have been accelerating in recent years ( Gazni et al., 2012; Wagner et al., 2015), especially in applied fields such as medical and psychological disciplines ( Coccia and Bozeman, 2016). In this study, co-authorship analyses were performed to find out patterns in the scientific collaboration between researchers and countries/territories on the mental health and well-being of university students.

Figure 3 demonstrates collaborative ties among authors who published at least 5 articles in the dataset ( n = 179). The map shows the existence of multiple productive collaborative networks of five or more researchers contributing to the development of the field. The largest collaboration network (red cluster) represents an international research group composed of 15 scholars affiliated to universities in the United States, Belgium, and Netherlands. This cluster groups some of the leading scholars in the field, including R. P. Auerbach, R. Brauffaerts, R. C. Kressler, and P. Cuijpers. Moreover, researchers in this cluster lead The WHO World Mental Health International College Student (WMH-ICS) Initiative, a large scale international project aimed at promoting the mental health and well-being of college students around the world through generating epidemiological data of mental health issues in university students worldwide, designing web-based interventions for the prevention and promotion of mental health, and disseminating evidence-based interventions ( Cuijpers et al., 2019). The second biggest cluster (green) represents an intra-national research network that includes 10 researchers from eight different higher education institutions in the United States. The dark blue cluster represents an institutional collaborative network, including nine researchers from the School of Public Health, Puerto Rico. Other prominent clusters in the map represent collaborative research networks between eight (olive color) and seven researchers (turquoise, violet, orange, and mellow mauve). This contrasts, however, with the limited collaboration that exists between clusters. Only four of the clusters on the map demonstrate some kind of scientific collaboration in the field (light blue, pink, brown, and yellow).

Cross-country collaboration networks in mental health and well-being of university students study are presented in Figure 4. Research collaborations between countries with 20 or more publications were considered in this analysis ( n = 45). The United States occupies the central position of the map and shares collaborative ties with all other countries/territories, forming a cluster together with China, South Korea, and Taiwan. Overall, the results suggest that international collaborations in the field are framed to a large extent by cultural, linguistic, and geographical proximity. For instance, the largest cluster (red) is formed by two European countries (Spain and Portugal) and other South American countries with whom they share historical and cultural backgrounds. Other European countries form the purple cluster. Similarly, the blue cluster clearly brings together predominantly English-speaking countries and territories, while the green cluster agglomerates a range of Asian countries.

Collectively, the results of our study suggest that research collaboration in the field of mental health and well-being in university students remains relatively scarce and localized to date. The social structure of the field at the author level could be described as an archipelago formed by a large number of islands (research groups) of different composition and size but with few bridges connecting them, which suggests a relatively fragmented research community. Moreover, while the existence of international collaborative networks was evident in the analysis, they seem to be formed within national borders, between researchers in neighboring countries/territories, or between countries that share cultural, linguistic, and historical heritages. This may be due to the important role that cultural and traditional values play in the conceptualization of mental health and well-being across contexts ( Eshun and Gurung, 2009; Vaillant, 2012; Fernando, 2019). Also, language differences, divergent cross-national institutional and organizational traditions, and increased costs of extramural collaboration, have been found to complicate the formation and continuity of research partnerships in health research ( Hooper et al., 2005; Freshwater et al., 2006). Nevertheless, limited within- and between-country research collaboration arguably poses challenges to the development of a field in terms of lost opportunities to challenge assumptions taken for granted and move toward fresh perspectives, push boundaries in methods and techniques, meet diverse groups of people from differing cultures and get immersed in those cultures, share information, resources, and skills, and address common mental health problems through the pooling of resources ( Rolfe et al., 2004; Freshwater et al., 2006).

Intellectual Structure: Disciplines Underlying the Foundations of the Field

Interdisciplinarity is considered as a valuable approach to address the complex and multidimensional nature of health and well-being ( Mabry et al., 2008). Buckton (2015) argues that the integration of medical, psychological, and social sciences have contributed to generate "new insights into theory, practice, and research in mental health and development." (3). To examine the disciplines underlying research on the mental health and well-being of university students, a journal co-citation analysis was performed. In this analysis, only journals with at least 50 citations were considered ( n = 593). The nodes on the map represent journals and their size reflects the number of co-citation relationships with other journals. Colors account for journal clusters, which agglutinate journals with higher co-citation relationships and stronger semantic connectedness. Clusters were interpreted and labeled accounting for the WoS categorization of the journals with the highest co-citation links within each cluster. For example, if the Journal of Personality and Social Psychology, the Journal of Counseling Psychology, and Personality and Individual Differences clustered together, this group was interpreted as the personality, social, and counseling psychology cluster.

In general, the findings of this study suggest that research on mental health and well-being in university students is interdisciplinary, to a certain extent, and mainly emerges from the convergence of research conducted in the behavioral and biomedical sciences, as it has been suggested elsewhere ( Schumann et al., 2014; Wittchen et al., 2014b). More specifically, the map shows that the research in the mental health and well-being of university students is constructed through the integration of knowledge generated in five interconnected disciplines (see Figure 5). To the left of the map, the red cluster integrates journals on personal, social, and counseling psychology. To the right, the blue cluster represents the contribution of psychiatric journals to research to the formation and development of the field. At the top, the yellow cluster groups journals on substance abuse and issues related to alcohol consumption, addiction, and interpersonal violence. At the bottom of the map, journals covering topics on eating behaviors, sleep, and other issues related to physical health converge on the green cluster. At the center of the map is the purple cluster, which includes journals in the area of clinical psychology and behavioral therapy.

More broadly, the findings suggest that biomedical sciences contribute to a large extent to the composition of the field. Psychiatric research emerged in our study as an obvious building block in the study of university students' mental health and well-being, which is not surprising considering the historical contributions of biomedical disciplines to mental health research ( Schwartz and Corcoran, 2010). Within the behavioral sciences, personality and social psychology, which explores processes and mechanisms through which social phenomena influence mental health and well-being ( Sánchez Moreno and Barrón López de Roda, 2003), appears as a key discipline underlying the foundations of the field. Surprisingly, clinical psychology journals occupy a central position in the map and demonstrate co-citation relationships with journals from all other clusters but make up the most dispersed network and account for a considerably lower volume of co-citation relationships in the field. This suggests that clinical psychology journals are more subordinate to journals in other disciplines in terms of citations flows, and ultimately, play a less unique role in research on the mental health and well-being of university students, as suggested by Haslam and Lusher (2011). Interestingly, research arising from the social sciences (e.g., sociology and anthropology) does not seem to make a distinctive contribution to the intellectual structure of the field, which suggests that the influence of social contexts and cultures on university students' mental health and well-being (e.g., inequality, social norms, public policies, cultural beliefs, and values) is an underexplored research area. Still, the density of co-citation network relationships within and between clusters is particularly noteworthy, considering the lack of common language between disciplines, the absence of a shared philosophy of practice on mental health, and the tensions between medical, psychological, and social explanations of mental distress ( Bailey, 2012).

Conceptual Structure: Topical Foci Addressed in the Literature Over the Last 45 Years

The topical foci of research on the mental health and well-being of university students during the 1975-January 2020 period are presented in Figure 6. The map offers a visual representation of the co-occurrence analysis of author keywords of all the publications included in the dataset. Only the most frequently occurring keywords (25+ occurrences) were considered in the analysis ( n = 84). Items that were not related to others and do not belong to the existing clusters were excluded. The size of the nodes indicates the occurrence of author keywords in the dataset and the thickness of edges represents the co-occurrence strength between pairs of keywords.

The most frequent keywords in the dataset, excluding students' descriptors (e.g., college students and university students), refer to common mental health challenges experienced by university students such as depression ( n = 612), anxiety ( n = 353), and stress ( n = 341). Salutogenic-related keywords such as well-being and life satisfaction occurred less often ( n = 138, n = 113, respectively), suggesting that pathogenic approaches to the exploration of mental health issues in higher education are more widespread. More broadly, seven general themes seem to summarize the topical foci of interest in the field of mental health and well-being of university students over the last 45 years. First, there has been a general interest in positive mental health, as denoted by frequently co-occurring key terms such as well-being, self-esteem, life satisfaction, social support, emotional intelligence, and happiness (red cluster). Second, mental disorders stand as another theme widely addressed in the literature, with a special emphasis on depression, anxiety, and to a lesser extent, suicide and suicidal ideation (green cluster). A third topical area in this field has been substance abuse, most predominantly alcohol consumption (blue cluster). The fourth theme reflects college counseling for mental health, including interventions and protective factors such as mindfulness, stress management, spirituality, and help-seeking (yellow cluster). Other topics reflected in the map are mental illness stigma (purple), stress (e.g., psychological distress and coping) (light blue), and mental health measurement (orange).

Conclusion

This study provides a comprehensive overview of the research on university students' mental health and well-being in the last 45 years using bibliometric indicators. In general, the results reveal interesting trends in the evolution of the field over the last four decades and promising scientific patterns toward a better understanding of the mental health and well-being of university students internationally. First, the interest in the mental health and well-being of university students has grown in the last decades and in a very significant way during the last 10 years, indicating that this area has not still reached its maturity period and will continue developing in the future. Second, research in the field is relatively interdisciplinary and emerges from the convergence of research conducted in several disciplines within the behavioral and biomedical sciences. Third, research in this field is produced by a community of productive researchers coming from several regions around the world, most notably in the United States, which secures a generation of scholars that will continue shaping the field in the years to come. Fourth, over the last 45 years, researchers have been able to address a multitude of research topics in the field, including positive mental health, mental disorders, substance abuse, counseling, stigma, stress, and mental health measurement.

However, this study also identified some issues that could be hindering the development of the study of the mental health and well-being of university students. For example, the research available overrepresents theoretical and disciplinary approaches from the developed world. Additional studies on the field from developing economies and LMICs are needed to provide a more comprehensive picture and ensure a fair representation of the multiple perspectives available in the field. Such studies would inform administrators and practitioners on how to broaden and enrich available programs and initiatives to promote mental health and well-being in higher education contexts in order to offer alternative forms of support that university students find appropriate for their social and cultural values. Moreover, the research community contributing to the development of the field is relatively fragmented. There are multiple research groups but little research collaborations between them and, at the international level, these connections tend to be limited by geographic, cultural, and language proximity. In this context, more actions like the WMH-ICS Initiative could provide a partial solution to this problem by strengthening national and international research partnerships and facilitating knowledge exchange across regions. Also, special issues in the core journals in the field inviting cross-cultural studies on the topic could contribute to promoting research collaboration across regions and research in less represented countries. The field would also benefit from a greater volume of research from the social sciences and humanities exploring the influence of social, cultural, economic, and educational factors on the conceptualization, manifestation, and experience of mental health and well-being. Moreover, more studies emerging from disciplines such as sociology, anthropology, business, and education, would likely increase the permeability of positive mental health concepts into the field and contribute to the promotion of salutogenic approaches to the study of mental health and well-being of university students.

This study has several limitations. First, publications were retrieved only from the WoS database, which limits the generalizability of the findings. Second, WoS provides stronger coverage of Life Sciences, Biomedical Sciences, and Engineering, and includes a disproportionate number of publications in the English language ( Mongeon and Paul-Hus, 2016). This could partially explain the low number of publications emerging from the Social Sciences, the Arts, and the Humanities, and research conducted in non-English speaking countries in the present study. Third, only journal articles were retrieved for analysis, excluding other relevant publications in the field such as reviews, book chapters, and conference proceedings. Future studies could replicate the findings of this study using alternative databases (e.g., Scopus and PubMed) or a combination of them, as well as different filters in the search strategy, to provide an alternative coverage of research conducted in the field. Nevertheless, we believe that the bibliometric approach used in this study offers novel insights about the development and current status of the field and some of the challenges that undermine its progression.

Data Availability Statement

The datasets generated for this study are available on request to the corresponding author.

Author Contributions

DH-T and LI contributed to conception and design of the study, organized the database, and performed the statistical analysis. DH-T, LI, and JS wrote the first draft of the manuscript. NL, AC, AA, YN, and AM wrote the sections of the manuscript.

Funding

This research was funded by the Nazarbayev University Faculty-Development Competitive Research Grants Program (Reference Number 240919FD3902).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Footnotes

References

LeViness, P., Bershad, C., Gorman, K., Braun, L., and Murray, T. (2018). The Association for University and College Counseling Center Directors Annual Survey. Available online at: https://www.aucccd.org/assets/documents/Survey/2018%20AUCCCD%20Survey-Public-June%2012-FINAL.pdf (accessed February 24, 2020).
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# data[].attributes.attachment_link.title
Mental Health and Well-Being of University Students: A Bibliometric Mapping of the Literature

# data[].attributes.attachment_link.description
The purpose of this study is to map the literature on mental health and well-being of university students using metadata extracted from 5,561 journal articles indexed in the Web of Science database for the period 1975-2020.