Mental health among higher education students continues to be a significant global concern, with numerous studies documenting its impact on student well-being and academic performance. (Auerbach et al., 2016) reported that approximately 20% of college students worldwide develop mental health disorders within their first year of study, including major depression and anxiety disorders. Research across various regions supports this trend. The COVID-19 pandemic has further exacerbated mental health challenges, with notable issues reported in the United States (Lipson et al., 2023), Europe and the United Kingdom (Allen et al., 2022), and Eastern Europe, including Poland and Ukraine (Długosz et al., 2022; Rogowska et al., 2021). Studies from Southern Europe, including Kosovo, Albania, Serbia, and North Macedonia (Arënliu et al., 2021; Hyseni Duraku et al., 2023a; Mancevska et al., 2020; Pilika et al., 2022; Radovanovic et al., 2023), have also noted increased levels of anxiety, depression, and stress among university students. Alonso et al. (2018) also found that university students in multiple countries are experiencing a variety of mental health disorders, such as major depression, generalized anxiety, and panic disorder. Similar trends have been observed in South Africa (Bantjes et al., 2023).

The field of student mental health has evolved significantly over the past few decades, with early research primarily focusing on foundational aspects such as identifying basic stressors and psychological pressures inherent in higher education (e.g., academic workload, transitional stress). These studies, largely based in developed regions, laid the groundwork for understanding the unique mental health challenges students face and were instrumental in establishing university counseling services as the primary support system (Abelson et al., 2022). From the early 2000s onwards, research expanded to incorporate specific at-risk groups, such as first-year and minority students, whose mental health was found to be disproportionately affected due to factors like social isolation, financial strain, and lack of culturally sensitive resources (Stoll et al., 2022). This period also saw a shift toward understanding the institutional and systemic barriers that hinder access to mental health support, such as stigma, inconsistent policies, and varying service quality (Auerbach et al., 2018; Gaebel et al., 2021).

Despite continuous reports on the presence of mental health issues among higher education students across various countries, comprehensive research on the factors contributing to mental health deterioration, including barriers to seeking psychological help, remains limited. Furthermore, previous research has predominantly focused on developed countries, particularly the US, the European Union (EU), and the UK, leaving a gap in the literature concerning developing regions, including Southern Europe (Pilika et al., 2022; Radovanovic et al., 2023; Rogowska et al., 2021). By incorporating new studies from previously overlooked contexts, this contribution builds upon existing evidence and enhances the understanding of factors that need to be considered, as well as the importance of advancing mental health support in higher education. A more evidence-informed approach is essential, not only for improving mental health services but also for guiding the effective use of limited resources in policy development and advocacy (Abelson et al., 2022).

Between 2013 and 2023, the student mental health landscape has been further shaped by global events like the COVID-19 pandemic, which intensified pre-existing mental health challenges and introduced new stressors, including social isolation, remote learning demands, and uncertainty (Riboldi et al., 2023; Allen et al., 2022). Unlike earlier periods, recent studies have increasingly focused on identifying scalable, cost-effective solutions like digital interventions and peer support models to address these challenges across diverse socioeconomic and cultural contexts (Broglia et al., 2023; Özer et al., 2024). Furthermore, the field has witnessed a greater emphasis on systemic reforms, such as policy standardization, data-sharing improvements, and the inclusion of youth in the co-design of mental health services (Lynch et al., 2024; Bantjes et al., 2022). This analysis of historical and recent trends reveals both continuities and shifts, emphasizing the need for further research that not only addresses emerging mental health needs but also integrates the lessons learned from past interventions to enhance student support frameworks globally.

This review highlights the unique challenges vulnerable student groups face and explores the factors that influence student well-being and academic engagement, both in general and in specific periods, such as the recent COVID-19 pandemic. We also analyze barriers to accessing mental health services and provide evidence-based policy recommendations for improving mental health services in higher education. Policymakers, university administrators, mental health professionals, and academic staff can benefit from these insights and use them to develop more effective and inclusive mental health strategies and ensure better support for diverse and vulnerable student populations. These insights can also advance international collaboration to reform educational systems with the goal of protecting student well-being and reforming health systems to focus more on prevention, a proven and promoted approach to public health efficiency (World Health Organization, 2022).

The primary aim of this narrative review was to explore the factors influencing higher education students’ mental health, including mental health policies, services, and the suitability of higher education practices related to student well-being and mental health support. Given the diversity of the studies and regions covered—ranging from well-researched areas like the US, Europe, and the UK to underexplored regions such as South Africa and Southern Europe—this approach provided the flexibility to capture emerging insights and address significant gaps in the literature (Sukhera, 2022). Moreover, the narrative review method allowed for a thorough integration of the current state of knowledge, while adding new perspectives and offering a context-specific interpretation of the factors shaping mental health in higher education by consolidating various findings into a single review (Rumrill and Fitzgerald, 2001).

This review differentiated over 50 studies to provide a comprehensive overview of mental health issues among higher education students and represent a wide range of regions, including the UK and other Western European countries, several Eastern European countries, the US, Australia, and South Africa. The studies focused on diverse populations within the context of higher education. Study populations included college and university students from different fields, years, and levels of studies: undergraduate, masters, and PhD students (including non-students in the same age range and those who had recently left college without graduating), and service providers for university students. Some of the studies focused on the global population, spanning multiple countries and regions, whereas others made comparisons with the general population.

The review encompassed a wide variety of study designs, including cross-sectional studies, qualitative studies, reviews, critical analyses, conceptual and intervention studies, randomized controlled trials (RCTs), system-level monitoring programs, case studies, systematic reviews, meta-analyses, brief reports, overviews, retrospective analyses, qualitative analyses, bibliometric mapping, parallel mixed-method designs, scoping reviews, and panel studies. We also included research reports conducted by leading health organizations and published project evaluation reports conducted by global mental health initiatives on monitoring the quality of mental health care in different countries.

The sample sizes of the reviewed studies varied significantly. Some studies involved extensive samples, such as a cross-sectional study with 192,202 students across 277 campuses, and others with sample sizes of 13,984 and 14,348 participants. The sample sizes of midrange studies were between 2,006 and 6,452 participants. Qualitative studies typically had smaller sample sizes such as 32 and 18 participants. Specific examples included a case study involving 27 professional staff members and an RCT with 1,200 participants. Table 1 summarizes the main characteristics of the studies.

The reviewed studies consistently indicate that mental health challenges, such as anxiety, stress, depression, and academic-related anxiety, are widespread among university students. These issues significantly affect student well-being, contributing to increased dropout rates, especially among those experiencing multiple mental health disorders (Alonso et al., 2018; Auerbach et al., 2016; Berman et al., 2024; Hyseni Duraku et al., 2023a). The onset of the COVID-19 pandemic further exacerbated these problems, with vulnerable groups such as female students, freshmen, and international students experiencing heightened levels of distress (Arënliu et al., 2021; Bíró et al., 2019; Riboldi et al., 2023).

Several pervasive factors contribute to poor mental health across different regions. Common stressors include academic pressure, financial difficulties, lack of social support, substance use, family separation, and unhealthy sleep habits (Bruffaerts et al., 2018; Nurunnabi et al., 2020; Kish, 2003; Morin et al., 2011, as cited in Abelson et al., 2022; Hyseni Duraku et al., 2023b). Social support is identified as a crucial protective factor; students with adequate support are more likely to seek psychological help, while those lacking such support experience more severe mental health issues (Bruffaerts et al., 2018; Nurunnabi et al., 2020). Additionally, the lack of culturally sensitive services and persistent issues of discrimination further exacerbate these barriers, particularly for ethnic and sexual minority students, making them less likely to seek help (Stoll et al., 2022; Abelson et al., 2022).

Despite a number of globally recognized factors impacting student mental health, the studies reviewed also highlight differences in these factors across countries and among specific groups. For example, in both developed and developing countries, financial stress is frequently reported as a major factor affecting student well-being. However, in the United States, financial issues are predominantly driven by the high burden of student debt (Abelson et al., 2022; Lipson et al., 2023). Moreover, first-generation students in the US, despite facing significant financial hardships that negatively impact their mental health, also tend to use mental health services less frequently compared to continuing-generation students (Lipson et al., 2023). In contrast, in the European context, including the UK, financial difficulties are more closely tied to socioeconomic inequalities (Długosz et al., 2022; Dougall et al., 2023). In Southern Europe, financial challenges are further compounded by broader economic instability, which not only exacerbates mental health issues but also limits students’ access to mental health services (Arënliu et al., 2021). High service costs and limited financial aid options make it difficult for students to seek professional help, worsening their conditions (Arënliu et al., 2021; Hyseni Duraku et al., 2023b).

In Southern Europe, cultural stigmas surrounding mental health are more pronounced, and family-oriented values often increase reluctance to discuss mental health issues openly, further discouraging help-seeking behaviors (Hyseni Duraku et al., 2023a). In contrast, in the U.S. and the UK, discrimination based on race, gender, and sexual orientation serves as a significant barrier to accessing mental health services. Students of color and LGBTQ+ students face unique challenges related to marginalization and a lack of culturally competent support (Abelson et al., 2022; Stoll et al., 2022). In Turkey, limited awareness about digital mental health solutions reduces their potential effectiveness, highlighting the need for improved digital literacy and engagement (Özer et al., 2024). These regional variations underscore the importance of tailoring mental health interventions to address specific socioeconomic and cultural conditions unique to each context (Quimby and Agonafer, 2023). Furthermore, as recommended by the reviewed studies, involving students in the design and implementation of mental health programs is essential to ensure that these services are relevant and meet the actual needs of the student population (Lynch et al., 2024).

The findings also reveal several barriers to accessing quality mental health services for university students worldwide, yet these barriers differ depending on the context. While common obstacles include shortages of mental health personnel, high service costs, and fragmented healthcare policies, these issues are particularly problematic in low- and middle-income countries (de Lima et al., 2021; Kovess-Masfety et al., 2016). Additionally, higher education institutions face challenges such as inconsistent well-being assessments and a lack of standardized data-sharing systems, which hinder effective mental health support (Abelson et al., 2022; Dodd et al., 2021). However, such services are more widely available in the U.S. compared to many European countries, where access remains limited (Hyseni Duraku et al., 2023a; Hyseni Duraku et al., 2023b).

Similarly, methodological issues observed in the reviewed studies can impact the generalizability of findings and the identification of influential factors and prevalence rates among young adults and higher education students. The reviewed studies utilize diverse methodological approaches, including randomized controlled trials, cross-sectional studies, and qualitative research, each with distinct strengths and limitations. For instance, randomized controlled trials, like those conducted by Berman et al. (2024), provide robust evidence on intervention efficacy. However, cross-sectional studies that rely on self-reported data may introduce biases, especially in assessing symptoms such as anxiety and depression (Ebert et al., 2019a,b). Additionally, inconsistencies in the definitions and measurements of mental health outcomes, such as prevalence rates, complicate comparisons across studies (Bruffaerts et al., 2018). Moreover, the geographic focus of most studies is concentrated in high-income regions like the U.S., Europe, and Australia, leaving emerging regions such as Southern Europe and South Asia underrepresented (de Lima et al., 2021). This lack of data from diverse geographical contexts limits the global generalizability of the findings and highlights the need for more inclusive research to better capture the mental health needs of university students worldwide. Therefore, standardizing well-being measures across educational institutions is recommended to ensure consistent and comparable data, which are crucial for effective policy-making (Bramesfeld et al., 2016; de Lima et al., 2021). Furthermore, beyond addressing methodological issues, preventive measures integrated into broader public health strategies can facilitate early identification and intervention, particularly among young adults at critical stages of mental health development (Alonso et al., 2018). Strengthening international collaboration is also vital for bridging service gaps, improving data collection, and sharing best practices globally, thereby contributing to more comprehensive mental health strategies (Abelson et al., 2022; Hernández-Torrano et al., 2020).

The findings from the current study highlight the importance of identifying key personal, cultural, and academic factors that affect students’ well-being, which should inform evidence-based mental health strategies. A comprehensive, inclusive, and multifaceted approach is essential to address the diverse mental health needs of university students, as emphasized in this review. This holistic strategy should involve policy reforms, culturally sensitive interventions, stronger social support systems within universities, and a focus on preventive care and digital innovations. Universities must take a proactive role in fostering environments that promote well-being and offer accessible mental health services. Moreover, international collaboration is crucial for sharing knowledge, developing best practices, improving research methodologies, and addressing global disparities in student mental health care. By implementing these changes, higher education institutions, along with nations, can build a more supportive, accessible, and effective global mental health framework.