Beyond Medical Students: Rethinking Mental Health Support Across Universities

University mental health support should not be designed around the assumption that medical students are automatically the group at greatest risk. Recent evidence from Pakistani university students suggests a more complicated picture: non-medical students in the studied sample reported higher depressive and anxiety symptoms than medical students, while academic discipline itself explained only a small proportion of the differences in mental health scores. The practical message is not that one group has replaced another as the priority. It is that universities need broader, more responsive mental health systems that identify vulnerability wherever it occurs.

Byline: Taimoor Asghar

Why university mental health needs a broader lens

Discussions about student mental health often focus heavily on medicine. There are understandable reasons for this. Medical education can involve demanding examinations, competitive environments, long study hours, clinical responsibilities, exposure to illness and death, and pressure to perform at a consistently high level. These experiences deserve serious attention.

The problem begins when legitimate concern about medical students becomes an assumption that students in other disciplines are comparatively protected. Engineering students may worry about academic competition and employment. Business students may face uncertainty about career progression. Humanities and social-science students can experience financial concerns, family expectations and questions about future opportunities. Students in any programme may be dealing with relationship difficulties, caregiving responsibilities, poor sleep, social isolation, financial insecurity or a previous history of mental health problems.

A university mental health strategy therefore becomes too narrow when eligibility for attention is implicitly determined by the name of a student’s degree programme.

What a Pakistani study found about medical and non-medical students

A recently published cross-sectional study in BMC Psychology provides useful evidence for reconsidering this assumption. The study included 602 undergraduate university students in Lahore, Pakistan: 424 medical students and 178 non-medical students. Participants completed the Patient Health Questionnaire-9 (PHQ-9) and the Depression Anxiety Stress Scales-21 (DASS-21), and the researchers examined both symptom differences and the psychometric performance of the instruments. The full BMC Psychology study on PHQ-9 and DASS-21 symptom profiles among Pakistani university students provides the methodological and statistical details.

The comparison did not support a simple expectation that medical students would necessarily report worse symptoms. Non-medical students had a higher median PHQ-9 score: 10 compared with 9 among medical students. In adjusted analyses, non-medical students also had higher scores on the PHQ-9, DASS depression and DASS anxiety measures. The difference in DASS stress scores was not statistically significant. :contentReference[oaicite:0]{index=0}

These results should be interpreted carefully. This was a cross-sectional study from universities in Lahore, not a nationally representative survey capable of establishing that non-medical students throughout Pakistan have worse mental health than medical students. Cross-sectional data also cannot determine whether academic discipline causes differences in depression or anxiety.

The more important finding for university policy may be the relatively small amount of variation explained by academic discipline. The statistical models reported low R-squared values, ranging from approximately 0.029 to 0.041. In other words, knowing whether someone was a medical or non-medical student provided only limited information about their overall symptom burden. :contentReference[oaicite:1]{index=1}

That is precisely why the study matters beyond a competition over which group is “more depressed.” Degree programme is only one characteristic among many that may shape a student’s mental health.

The wrong question is: Which discipline has the worst mental health?

Universities understandably use group comparisons when deciding how to distribute resources. However, asking which faculty has the worst mental health can encourage an unhelpful zero-sum approach. If medicine receives attention, perhaps engineering is overlooked. If one survey finds higher symptoms in non-medical students, institutions might be tempted to reverse the hierarchy and redirect attention away from medical students.

Neither response follows logically from the evidence.

A better question is: Which students are experiencing clinically meaningful distress, what factors are associated with that distress, and how can the university make appropriate support accessible to them?

This approach treats academic discipline as one possible contextual factor rather than a screening test for vulnerability. It also encourages universities to examine characteristics that may cut across every faculty, including sleep, previous mental health treatment, gender-related differences, financial pressures, social support, disability, academic difficulties and stressful life events.

Mental health risk does not respect faculty boundaries

A university is not simply a collection of academic programmes. It is a community of people navigating a major developmental period while facing overlapping educational, social and economic demands. Two students enrolled in entirely different programmes may have far more in common psychologically than two students sitting in the same lecture hall.

Consider a medical student with stable housing, supportive relationships and adequate sleep compared with a business student who works long hours to finance tuition, sleeps five hours per night and has a history of depression. Academic discipline alone would be a poor way of deciding which student might need support.

The same principle operates in reverse. A medical student experiencing persistent depressive symptoms should not be overlooked because a particular dataset found somewhat higher average scores among non-medical students. Population averages describe groups; they do not determine an individual student’s needs.

What the findings suggest about more useful targets

Sleep deserves attention across the university

In the Pakistani study, each additional hour of sleep was associated with a lower PHQ-9 score after adjustment for other variables in the model. Because the research was cross-sectional, this association should not be interpreted as proof that increasing sleep by a specific amount will directly reduce depression scores. Depression itself can alter sleep, and other factors may affect both sleep and mood. :contentReference[oaicite:2]{index=2}

Even with that limitation, sleep is a sensible university-wide health target because irregular schedules, examination preparation, employment and digital habits can affect students from virtually every discipline. Universities can consider whether class schedules, assessment practices, overnight academic culture and awareness campaigns support or undermine healthy sleep routines.

Previous mental health history matters

Prior treatment for depression was the strongest predictor of PHQ-9 scores reported in the study’s adjusted analysis. This does not mean that previous treatment causes later symptoms. More plausibly, a history of treatment can identify students who have previously experienced substantial mental health difficulties and may remain vulnerable to recurrence or continuing symptoms. :contentReference[oaicite:3]{index=3}

For universities, this reinforces the value of continuity of care. Students arriving at university with an established mental health history should be able to learn quickly how to access appropriate services, particularly when moving away from their usual healthcare providers.

Gender-related differences should not be ignored

Female gender was associated with higher scores across the symptom domains examined in the study. This finding identifies a potentially relevant population-level difference in this particular sample, but it should not become another rigid stereotype. Male students and students of any gender may experience serious depression, anxiety or stress, and some may be less likely to disclose distress or seek help. :contentReference[oaicite:4]{index=4}

The policy implication is therefore targeted sensitivity within universal support, not exclusionary services.

Rethinking screening: look at symptoms, not stereotypes

The study also evaluated how the PHQ-9 and DASS-21 performed in the student sample. Internal consistency estimates ranged from 0.82 to 0.88, and measurement invariance across academic discipline was supported. The DASS-21 showed adequate confirmatory factor-analysis fit, although very high correlations between its latent depression, anxiety and stress factors raised questions about how distinctly those subscales operate in this population. :contentReference[oaicite:5]{index=5}

This is a reminder that screening tools are useful but not diagnostic verdicts. A questionnaire can help identify symptom burden and determine who may benefit from further assessment, but a numerical score should be interpreted within clinical and personal context.

For universities considering screening programmes, several principles are especially important:

• Make screening available across faculties rather than only to historically designated high-risk programmes.
• Explain clearly that screening does not provide a psychiatric diagnosis.
• Ensure that students with concerning results have an actual pathway to professional assessment or support.
• Protect confidentiality and explain how information will be used.
• Avoid using mental health scores for academic evaluation, disciplinary action or discriminatory decision-making.
• Provide a clear response pathway for students reporting self-harm thoughts or other urgent safety concerns.

Screening without follow-up can identify problems without helping students address them. Universities therefore need to think about the entire pathway from recognition to assessment, treatment, follow-up and crisis support.

From faculty-specific programmes to a stepped model of support

A practical university mental health system does not require every student to see a psychiatrist. A stepped model can provide different levels of support depending on need.

Level 1: mental health promotion for everyone

The foundation should be universal. All students can receive accessible information about depression, anxiety, stress, sleep, substance use, available counselling services and how to support a struggling peer. Mental health information should be visible during orientation and throughout the academic year rather than concentrated in a single awareness week.

Universities should also make the route to seeking help simple. A student experiencing depression should not need to understand an institution’s administrative structure before finding the correct service.

Level 2: targeted support for students facing additional pressures

Some groups may benefit from proactive outreach based on local evidence. These could include students with previous mental health treatment, students experiencing financial hardship, international students, students with disabilities, those undergoing academic remediation or students experiencing bereavement or major life changes.

Targeted support does not require labelling these groups as mentally ill. It means recognising predictable situations in which additional information, flexibility or access to counselling may be valuable.

Level 3: professional assessment and treatment

Students with persistent, severe or functionally impairing symptoms need access to appropriately qualified healthcare professionals. University counselling can play an important role, but institutions should also establish referral relationships with external mental health and medical services when students require care beyond the university’s capacity.

Level 4: crisis pathways

Every institution needs a clearly defined process for urgent mental health situations. Students, faculty members and support staff should know what to do when someone appears to be at immediate risk of harming themselves or others, is severely disoriented, or is experiencing another acute psychiatric emergency. Emergency responses should be handled by appropriate healthcare or emergency services rather than improvised by classmates.

Academic systems themselves deserve examination

Mental health initiatives frequently concentrate on teaching students to become more resilient. Coping skills can be useful, but universities should also examine whether institutional practices create avoidable distress.

Possible areas for review include unnecessarily compressed examination schedules, unclear assessment criteria, inaccessible faculty support, bullying or harassment, excessive administrative barriers, inadequate disability accommodations and timetables that make healthy sleep difficult. Not every source of academic stress can or should be removed; higher education is appropriately challenging. The goal is to distinguish productive academic demands from preventable institutional dysfunction.

This matters because individual-level interventions cannot compensate indefinitely for harmful environments. Telling students to manage stress more effectively is incomplete if the institution has not examined the conditions producing that stress.

Universities should build systems around help-seeking barriers

Having a counselling service does not necessarily mean students will use it. Students may worry about confidentiality, stigma, cost, waiting times or whether their problems are “serious enough.” Some may not know where the service is located. Others may fear that seeking psychological help could affect academic records or future careers.

Universities can reduce these barriers by clearly separating confidential healthcare from academic decision-making, explaining privacy policies in understandable language, offering multiple routes of access and training academic staff to signpost services without attempting to become therapists themselves.

Digital booking, telehealth where appropriate, peer-support initiatives and after-hours information may also expand accessibility, but these services require clear governance and escalation procedures. Convenience should complement, not replace, professional care for students who need it.

What the symptom-level analysis adds

The Pakistani study went beyond total questionnaire scores. Item-response and network analyses suggested that symptoms relating to self-worth, concentration and feeling down were particularly informative or central within the patterns observed, while sleep, appetite and energy appeared as connections between symptom domains in the network analysis. The authors appropriately noted limitations to network stability, so these findings should be considered exploratory rather than a blueprint for clinical intervention. :contentReference[oaicite:6]{index=6}

Still, symptom-level thinking can improve how universities communicate about mental health. Students do not always identify with diagnostic labels such as “depression.” They may instead notice that they cannot concentrate, feel worthless, have lost motivation, are sleeping poorly or are struggling to complete ordinary tasks.

Mental health education can therefore describe recognisable experiences as well as diagnostic terminology. This may help students understand when persistent symptoms deserve attention.

What universities should measure next

Institutions that want evidence-based mental health programmes should collect more than a single annual prevalence number. Useful evaluation questions include:

• Which groups are actually using counselling and psychological services?
• How long do students wait for an initial appointment?
• Which students begin but discontinue support?
• Are students from different faculties equally aware of available services?
• What barriers prevent students from seeking help?
• How often do students require referral to external healthcare services?
• Do students perceive services as confidential and culturally acceptable?
• Are mental health difficulties associated with absenteeism, interruption of studies or other functional problems?

These indicators can reveal inequalities that prevalence surveys alone miss. A faculty could have a moderate average symptom score but very poor access to support. Another could report high distress but also have well-developed help-seeking pathways. Effective policy requires understanding both need and service response.

Pakistan needs more cross-disciplinary university mental health research

The Lahore study contributes to an area in which direct comparisons between medical and non-medical students remain valuable. However, one study should be treated as a starting point rather than the final national picture.

Future research would benefit from larger multi-university samples spanning public and private institutions, multiple provinces, different socioeconomic backgrounds and a wider range of academic disciplines. Longitudinal studies could clarify how symptoms change across semesters and whether factors such as sleep, financial stress, examination periods and previous mental health problems predict later outcomes.

Researchers should also investigate help-seeking behaviour. Measuring symptoms tells us how many students may be struggling; studying service use tells us whether institutions are successfully reaching them. Qualitative research could further explain why students avoid counselling, what forms of support they consider acceptable and how family and cultural expectations influence disclosure.

What university leaders can do now

Universities do not need to wait for perfect evidence before improving basic mental health infrastructure. Several reasonable actions follow from the current evidence without assuming that every institution has identical needs:

1. Offer mental health information and access pathways university-wide. Do not restrict attention to medicine or any other single discipline.
2. Use local data. Institutions should evaluate their own student populations rather than assuming findings from another university automatically apply.
3. Create targeted outreach within universal services. Additional attention can be directed to locally identified vulnerable groups without excluding everyone else.
4. Integrate sleep and wellbeing education into prevention efforts. These topics affect students across academic programmes.
5. Build referral pathways. Screening and counselling programmes should connect students with appropriate professional care when necessary.
6. Protect confidentiality. Students need confidence that seeking help will not unnecessarily expose private health information.
7. Evaluate outcomes. Universities should monitor access, waiting times, satisfaction, referral completion and unmet need rather than measuring success by the existence of a counselling office.

The larger lesson: stop treating degree programme as destiny

The most useful interpretation of the emerging evidence is not that non-medical students should now receive attention instead of medical students. It is that mental health vulnerability is distributed across the university population and cannot be reliably inferred from a student’s faculty alone.

The Pakistani study found higher depressive and anxiety scores among non-medical students in its sample, but academic discipline explained relatively little overall variance. At the same time, factors such as gender, sleep and previous depression treatment showed meaningful associations with symptom scores. These findings challenge an overly simple model in which the type of degree becomes a proxy for psychological risk. :contentReference[oaicite:7]{index=7}

Universities should therefore combine universal access with evidence-informed targeted support. Medical students still deserve resources appropriate to the unique pressures of medical education. Non-medical students deserve equivalent recognition that their difficulties may be just as consequential. Students with previous mental health difficulties, persistent sleep problems or substantial psychological symptoms require attention regardless of what appears on their student identification card.

The goal should not be to identify the faculty that “wins” an unfortunate competition for the highest depression score. The goal should be to build a campus where students experiencing distress can be recognised early, reach appropriate support without unnecessary barriers and receive professional assessment when symptoms become persistent, severe or dangerous.

Conclusion

University mental health policy needs to move beyond the idea that certain disciplines are inherently the mental health priority. Evidence from 602 Pakistani university students showed that non-medical students reported higher depressive and anxiety symptoms than medical students in that sample, while discipline accounted for only a small share of the variation in scores. That combination is more informative than either finding alone.

It suggests that universities should retain discipline-specific support where genuine needs exist while building mental health systems that serve the entire student population. Screening, prevention, sleep health, confidential counselling, targeted outreach, professional referral and crisis pathways should be available according to need rather than prestige, stereotype or faculty label.

A student’s programme of study can provide useful context. It should never be mistaken for a complete mental health assessment.

Medical disclaimer: This article is provided for educational and informational purposes and does not diagnose depression, anxiety or any other mental health condition. Screening questionnaires such as the PHQ-9 and DASS-21 do not replace assessment by a qualified healthcare professional. Anyone experiencing persistent or worsening psychological symptoms should consider seeking appropriate professional care. Immediate safety concerns, including imminent risk of self-harm, require urgent assessment through appropriate local emergency or healthcare services.