A nation’s progress is closely linked to the well-being of its citizens, as those who are mentally healthy are more likely to make a positive impact, engage in meaningful work, and maintain strong social connections (1). However, a significant barrier to mental well-being is Major Depressive Disorder (MDD), which is characterized by persistent symptoms such as feelings of hopelessness, difficulty concentrating, disrupted sleep, low energy, changes in appetite, and, in severe cases, suicidal thoughts or attempts. These symptoms typically last for at least two weeks and occur nearly every day, significantly impairing an individual’s ability to function (Depression-World Health Organization). According to the data of Global Burden of Diseases (GBD) 2019 identified depression and anxiety were identified as the two most disabling mental health conditions, ranking among the top 25 causes of disease burden worldwide. Around 280 million people globally suffer from depression, representing 3.8% of the population, with higher rates in adults (5.0%) and those over 60 (5.7%). The highest prevalence rates are found in Greece, Palestine, and Spain (Institute for Health Metrics and Evaluation). In India, states such as Tamil Nadu, Haryana, Andhra Pradesh, and Maharashtra report notable depression rates, with Tamil Nadu having the highest at 4.45% (Institute for Health Metrics and Evaluation | (healthdata.org).

Although adults and older populations show higher global prevalence, it is critical to study the mental health of college-going students, as they undergo significant developmental and psychosocial transitions that can heighten vulnerability to psychological distress. Academic pressure, career uncertainty, identity exploration, and changing social environments contribute to an increased risk of mental health issues in this age group (2, 3). Moreover, early identification and intervention in this formative period can prevent long-term psychological morbidity. In the Kashmir region, multiple studies have explored depression and anxiety prevalence (4–6), though none have specifically targeted the college-going population. Therefore, this study aimed to fill this gap by examining the prevalence of depression, anxiety, and perceived stress among college students in Kashmir, making it, to our knowledge, the first of its kind in the region.

In the present investigation, the surveyed population comprises 1471 students (male = 575 and female=896) who were included after excluding a certain number of students ( Figure 1 ) using exclusion criteria (see section: Data Cleaning and Analysis). The average age of participants was 21.66 ± 1.94 years, with no significant difference between males (21.63 ± 1.94) and females (21.69 ± 1.95; t = 0.577, p = 0.564). The sample was predominantly rural (61.1%), with 38.9% from urban areas ( Figure 2A ). Most participants were unmarried (92.2%) ( Figure 2B ). Gender distribution across rural and urban settings showed a higher proportion of females in urban areas and more males in rural settings. Regarding socioeconomic background, the majority of students’ guardians reported monthly incomes between ₹10,000 and ₹50,000 ( Figure 2C ), with 37.9% earning below ₹10,000 and 19.0% above ₹51,000. A detailed summary of demographic characteristics and gender-based comparisons is presented in Table 1 .

After analyzing the demographic features, the prevalence of different conditions among the surveyed students was observed using various questionnaires. Depression levels were assessed using the PHQ questionnaire. It was revealed that minimal depression was observed in 22.84% of the total sample ( Figure 3A ). In contrast, moderately severe depression was identified in 18.83% of the sample. Notably, there was a higher prevalence of moderately severe depression among females (21.54%) compared to males (14.61%). Furthermore, it was observed that severe depression was present in 12.5% ( Figure 3A ) of the total sample, with a slightly elevated prevalence among females (13.39%) compared to males (11.13%) ( Table 2 ).

Regarding the anxiety disorder, insights into varying anxiety levels among surveyed students were provided by the GAD-7 questionnaire. Minimal anxiety was reported by 29.56% (n=434) of the students. Moderate anxiety was noted in 20.66% (n=304), with a higher prevalence among females (23.66%) compared to males (16.00%) ( Figure 3B ). Severe anxiety was experienced by 24.26% (n=357) of students, with a slightly higher prevalence among females (27.79%) compared to males (18.78%) ( Table 2 ).

The analysis of the stress among surveyed students using the Perceived Stress Scale unveiled varying stress levels. Among the participants, 201 students (13.66%) reported low stress (0-13), with 101 males (17.56%) and 100 females (11.16%) falling within this category ( Figure 3C ). A majority of students, comprising 988 individuals (67.16%), experienced moderate stress (14-26), including 393 males (68.34%) and 595 females (66.40%). Additionally, 282 students (19.17%) reported high perceived stress (27-40), with 81 males (14.08%) and 201 females (22.43%) experiencing this level of stress ( Table 2 ).

The analysis of variables linked to mental health outcomes highlighted significant associations ( Table 3 ). Gender showed notable relevance with anxiety (OR = 1.68, p = 0.0001) and stress (OR = 1.65, p = 0.0007) ( Figure 4 ). Additionally, correlation analysis unveiled positive relationships between depression and stress score (r = 0.6322), anxiety and stress score (r = 0.6824), and depression and anxiety (r = 0.8064), indicating that higher stress levels correlate with increased depression and anxiety among the surveyed individuals ( Table 4 ).

College life represents a pivotal stage in an individual’s academic and personal development. It serves as a bridge between foundational education and professional or higher academic pursuits, promoting not only knowledge acquisition and skill enhancement but also self-awareness and identity formation. However, this transitional period is often accompanied by considerable psychological stress, which can manifest as mental health concerns, including depression, anxiety, and somatic symptoms such as headaches. Among these, anxiety has been identified as particularly prevalent among college students globally (9). In the context of Kashmir, although mental health issues have been investigated within the general population, there is a noticeable gap in research focusing specifically on college students (4–6, 10–12). Addressing this gap, the present study seeks to assess the prevalence of depression, anxiety, and perceived stress among college students in the region, contributing novel insights to an underexplored area of public mental health research.

After utilizing the cross-sectional study method, the study utilized the PHQ questionnaire to assess depression levels among college students, revealing that 18.81% (Male Vs Female: 14.61% Vs 21.53%) experienced moderately severe depression (scores 15-19) and 12.5% of students reported severe depression (scores 20-27) ( Table 2 ). However, the present study found that 12.5% of students reported severe depression, which is somewhat similar to findings from studies conducted in various regions of India and foreign countries (13–20). For instance, in District Amritsar, 13.1% of students reported severe depression (21), while in West Bengal, 6.25% of students experienced severe depression (22). Conversely, some studies have reported contradictory results. For example, in Puducherry, only 0.7% of students were classified as having severe depression, and another 0.7% as having very severe depression (23).

In addition, the present study also revealed that severe depression was slightly more common among female students, with 13.39% affected, compared to 11.13% of male students which was consistent with research indicating higher levels of depression among females compared to males (24–34). Females are more susceptible to mental disorders and report more mental health difficulties than their male counterparts which may be due to certain factors such as academic stress, social pressures, less or no social support, body image, academic performance/stress, peer pressure, professional pressure, financial stress in home, and excessive parental expectations (25, 30, 34, 35). On the other hand, the findings are in contradiction with different studies (22, 23, 36, 37), which found that there is no significant difference between genders. Additionally, some evidence showed that a higher percentage of male students suffered varying degrees of depression than females (35, 38–42). There is a possibility that the gender differences that were found might be attributed to the cultural background of the pupils as well as the socialization process that both genders go through (41).

Anxiety levels, assessed using the GAD-7 questionnaire, indicated that 24.26% of participants reported severe anxiety, with a higher prevalence among females (27.79%) compared to males (18.78%) ( Table 2 ). These findings align with several previous studies that have reported elevated anxiety levels among female students (24, 26, 29, 43–46). However, they also contrast with other studies that found higher anxiety levels in males (47) or reported no significant gender differences (36, 48).

Analysis of perceived stress levels showed that 19.17% of students reported high stress, with a higher prevalence observed among females (22.43%) compared to males (14.08%) ( Table 2 ). The findings are in line with the research (29, 35, 41, 49–51) but in contrast to others (36, 52–54). Gender was found to be significantly associated with anxiety (OR = 1.68, p = 0.0001) and stress (OR =1.65, p = 0.0007), highlighting differing susceptibilities between males and females ( Table 3 ). Furthermore, the study identified positive correlations between depression and stress (r = 0.6322), anxiety and stress (r = 0.6824), and depression and anxiety (r = 0.8064). These correlations suggest that higher stress levels were associated with increased levels of depression and anxiety among the surveyed college students ( Table 4 ). The results were found to be consistent with previous studies (55–57); however, several studies present alternative views on the relationship between gender, stress, anxiety, and depression among college students (24, 25, 58).

One might wonder why college students, in particular, experience such high levels of stress. Kashmir has long been a region marked by political instability, prolonged conflict, and socioeconomic uncertainty, factors that have significantly impacted the psychological well-being of its population. Over the past two decades, there has been a notable rise in psychiatric morbidity, with depression emerging as a particularly widespread concern (11). Beyond the broader geopolitical context, several personal, academic, and social factors also contribute to student stress. These include academic overload, personal medical history, family background of chronic or mental illness, and dissatisfaction with body image or overall life satisfaction, all of which have been associated with increased risk of depression and anxiety (16, 59). Poor family relationships have been specifically linked to depressive symptoms. Moreover, predictors of academic stress among adolescent girls include introverted personality traits, religious affiliation, having an illiterate father, and pursuing academic streams such as commerce (60). These findings underscore that student mental health is influenced by a complex interplay of individual, familial, academic, and sociocultural factors. In a conflict-affected setting like Kashmir, such stressors are likely to be intensified, making it essential to examine the mental health of college students within this unique and sensitive context.

This study highlights the significant mental health challenges faced by college students in Kashmir, with high prevalence rates of depression, anxiety, and stress. The findings underscore the urgent need for targeted interventions within educational institutions to support student well-being. A concrete recommendation is the implementation of on-campus mental health programs, including regular counseling services, stress management workshops, and peer support initiatives. These efforts should be integrated into the academic curriculum to reduce stigma and promote emotional well-being among students.