Student Mental Health in Pakistan: Why Academic Discipline May Matter Less Than We Think

Academic discipline may matter less for student mental health in Pakistan than many people assume. In a 2026 cross-sectional study of 602 university students in Lahore, non-medical students actually reported higher depressive and anxiety symptoms than medical students after adjustment. Yet the more important finding was not simply which group scored higher: academic discipline explained only a small part of the overall variation in mental-health symptoms. Factors such as gender, sleep and previous depression treatment showed meaningful associations that point toward a broader, campus-wide understanding of student wellbeing.

This matters because discussions about university mental health often begin with a simple comparison: Which students are under the most pressure? Medical students are frequently singled out because of demanding examinations, clinical training and heavy workloads. Those pressures are real, but treating academic discipline as the main explanation for psychological distress can obscure the substantial differences that exist among students within the same discipline.

The study, published in BMC Psychology, examined medical and non-medical university students using the PHQ-9 and DASS-21 and applied several statistical and psychometric approaches. Readers can review the published study on depressive, anxiety and stress symptoms among Pakistani university students for the full methods and results. The findings do not prove that one type of education causes better or worse mental health. Instead, they suggest that academic discipline is only one piece of a much larger student mental-health picture.

What the Pakistani university student study found

The study included 602 undergraduate students from universities in Lahore, Pakistan: 424 were medical students and 178 were studying non-medical subjects. Participants completed the Patient Health Questionnaire-9, commonly known as the PHQ-9, and the 21-item Depression Anxiety Stress Scales, or DASS-21.

Contrary to the familiar assumption that medical students would necessarily report greater psychological distress, the non-medical group had a higher median PHQ-9 score: 10 compared with 9 among medical students. The difference was statistically significant in the study’s unadjusted comparison.

The pattern persisted after adjustment for measured characteristics. Non-medical students had higher scores on the PHQ-9 and on the depression and anxiety domains of the DASS-21. The adjusted difference in DASS-21 stress scores, however, did not reach conventional statistical significance.

Those results should not be interpreted as evidence that non-medical education causes depression or anxiety. The research was cross-sectional, meaning exposure characteristics and symptoms were assessed within the same general period rather than followed prospectively over time. Consequently, it can identify associations but cannot establish the direction of causation.

There is also a deeper statistical point. The regression models explained only a modest proportion of the overall variation in symptom scores, with reported R-squared values ranging from approximately 0.029 to 0.041. In practical terms, most of the differences between individual students’ scores remained unexplained by the variables included in those models.

That finding is central to understanding why academic discipline may matter less than we think. A statistically detectable difference between medical and non-medical students does not mean discipline is the dominant determinant of student mental health.

Statistical significance is not the same as explaining student mental health

One of the easiest mistakes when reading comparative research is to turn a group difference into a complete explanation. If Group A has a higher average score than Group B, the natural temptation is to describe membership in Group A as the main problem. Real populations are rarely that simple.

Imagine two large lecture halls, one filled with medical students and another with students from other disciplines. Even if the average depression score differs between the rooms, there may still be enormous overlap between individual students. Some medical students may experience severe distress, while many non-medical students may report few symptoms, and vice versa.

Group averages tell us something about populations. They do not tell us the psychological state of every individual within those populations.

This distinction has practical consequences. A university that limits mental-health programs to the discipline with the highest mean symptom score could overlook large numbers of students who need support elsewhere. Conversely, assuming that every student in a supposedly high-risk course is psychologically unwell would also be inaccurate.

Academic labels are convenient but incomplete

Academic discipline is relatively easy for researchers and universities to measure. Students can be classified as medical, engineering, business, humanities or another category. But many experiences that potentially shape mental health cut across these boundaries.

Students may differ in financial security, family expectations, relationship difficulties, physical health, accommodation, social support, commuting demands, academic confidence, sleep schedules, employment responsibilities, previous mental-health difficulties and countless other circumstances. Two students enrolled in exactly the same degree can therefore have profoundly different psychological experiences.

The Lahore study reinforces this idea by showing that discipline-related differences were present while substantial unexplained variation remained.

Sleep may be one part of the bigger picture

Sleep was one of the notable variables associated with depressive symptoms in the study. Each additional reported hour of sleep was associated with a lower PHQ-9 score in the adjusted model, with a regression coefficient of approximately -0.37.

This finding should be interpreted carefully. Because the study was cross-sectional, it cannot establish that increasing sleep by exactly one hour would produce a predictable reduction in an individual’s PHQ-9 score. Depression itself can disrupt sleep, while inadequate or irregular sleep may also accompany psychological distress. The relationship can therefore be complex and potentially bidirectional.

Nevertheless, sleep deserves attention precisely because it is relevant across academic disciplines. Late-night studying is not unique to medical education. Students in many programs may face examinations, assignments, social demands, employment or irregular routines that compete with sleep.

From a public-health perspective, this makes sleep health a more broadly applicable target than assuming that psychological support should be organized primarily according to degree program.

Gender differences also crossed academic boundaries

In the study’s adjusted analyses, female gender predicted higher symptom scores across the PHQ-9 and all three DASS-21 domains: depression, anxiety and stress. The associations were statistically significant across those models.

This does not mean that every female student is at greater individual risk than every male student, nor does it mean gender itself provides a sufficient explanation for psychological distress. The result describes an average association within this particular sample.

It does, however, illustrate why student mental-health research benefits from looking beyond academic discipline. If symptom patterns are associated with characteristics that occur throughout the university population, organizing mental-health policy solely around individual faculties may miss important cross-cutting needs.

It is also essential not to interpret gender differences as evidence that distress among male students is unimportant. Population averages can coexist with serious mental-health difficulties among members of any gender. Screening, support and referral systems should remain accessible to everyone.

Previous depression treatment was a particularly strong marker

Another important result involved students who reported previous treatment for depression. In the PHQ-9 model, prior depression treatment was associated with an increase of about 4.15 points and was the strongest reported predictor in that model.

The most reasonable interpretation is not that treatment causes higher depression scores. Previous treatment can identify students with a history of clinically important psychological difficulties, and symptoms may recur or persist in some individuals. A cross-sectional study cannot determine the precise sequence behind the association.

For universities, however, the result highlights something more useful than a simple medical-versus-non-medical comparison: mental-health history matters. Students do not arrive at university as psychologically identical individuals whose wellbeing is subsequently determined only by the course they choose.

Some students begin university with previous mental-health difficulties, ongoing vulnerabilities or established care needs. Continuity of support can therefore be relevant regardless of faculty.

What the symptom analysis adds to the story

The study did more than compare total depression and anxiety scores. The researchers also examined individual symptoms using item response theory and symptom network analysis.

Items concerning self-worth, concentration, feeling down and appetite showed relatively high discrimination in the PHQ-9 analysis, while the interest or anhedonia item showed lower discrimination in this sample. In the symptom network analysis, self-worth, concentration and downheartedness emerged among the more central symptoms.

These analyses offer an additional reason to avoid reducing student mental health to academic discipline. Psychological distress is experienced through symptoms, and the pattern of those symptoms may be more informative in some contexts than a student’s faculty label.

Difficulty concentrating, for example, can affect studying regardless of whether a student is learning anatomy, economics, computing or literature. Low self-worth can similarly affect students across academic environments. Understanding these experiences may help universities design support around actual psychological needs rather than assumptions about particular degree programs.

The network findings should nevertheless be interpreted conservatively. The study reported stability coefficients ranging from 0.31 to 0.44, meaning some network estimates were more stable than others. Network centrality should therefore not be treated as proof that targeting one particular symptom will necessarily improve all others.

The PHQ-9 and DASS-21 performed reasonably well, with an important caveat

Because the research also evaluated measurement properties, it provides useful information about how the questionnaires behaved in this Pakistani student sample.

Internal consistency was acceptable to good, with Cronbach’s alpha values ranging from 0.82 to 0.88 across the examined scales. Confirmatory factor analysis of the DASS-21 also produced generally adequate fit statistics, including a comparative fit index of 0.954, Tucker-Lewis index of 0.948 and root mean square error of approximation of 0.052 in the reported model.

However, the latent depression, anxiety and stress factors were extremely highly correlated. Depression and stress correlated at approximately 0.939, while anxiety and stress correlated at approximately 0.949.

This raises an important measurement question. Although the DASS-21 is designed to distinguish related domains, exceptionally high correlations suggest that these constructs may have been difficult to separate cleanly in this sample. Researchers using subscale comparisons in similar populations should therefore pay attention not only to reliability but also to whether the intended dimensions remain empirically distinct.

At the same time, the study supported measurement invariance across academic discipline. This strengthens the interpretation of comparisons between medical and non-medical students because it suggests the scales were operating sufficiently similarly across the two educational groups for those comparisons to be meaningful.

Why medical students may dominate the mental-health conversation

There are understandable reasons why medical students receive substantial attention in research on student wellbeing. Medical education can involve dense curricula, high-stakes examinations, clinical responsibilities, exposure to illness and suffering, competitive environments and demanding professional expectations.

Those realities deserve investigation. The problem arises when a legitimate focus on medical students becomes an implicit assumption that students outside medicine face substantially fewer mental-health challenges.

Non-medical students are not a psychologically homogeneous control group. Their academic demands vary enormously, as do their employment prospects, social environments and personal circumstances. Even the broad category “non-medical” can contain students from very different courses and institutional settings.

The Pakistani findings therefore should not trigger a reverse stereotype in which non-medical students are declared the new universally “higher-risk” group. A better interpretation is that presumed hierarchies of academic stress should be tested rather than accepted.

What universities in Pakistan can learn from these findings

The study supports a broader approach to campus mental health. Instead of assuming that wellbeing resources should follow disciplinary stereotypes, universities can build systems that are accessible across the institution while still allowing additional support for groups with demonstrated needs.

1. Make mental-health services university-wide

Counselling, psychological support, referral pathways and mental-health information should be visible and accessible to students across faculties. A student should not need to belong to a traditionally “high-pressure” discipline before distress is taken seriously.

2. Consider individual risk indicators alongside faculty

Academic program can still be useful information, but it should be considered alongside factors such as previous mental-health history, current symptoms, sleep problems and other relevant circumstances. The study’s low model R-squared values are a reminder that no short list of demographic or educational variables can fully explain individual wellbeing.

3. Include sleep health in student wellbeing initiatives

Universities can provide evidence-informed education about sleep routines, academic scheduling and the consequences of chronic sleep disruption without implying that sleep hygiene alone is a treatment for depression. Students with persistent sleep or mental-health problems may require professional assessment rather than lifestyle advice alone.

4. Build confidential and low-barrier pathways to support

Students experiencing psychological distress may hesitate to seek help for many reasons. Institutions can reduce practical barriers by making pathways straightforward, confidential and clearly communicated. Support systems should also explain what happens after a student asks for help.

5. Evaluate programs rather than relying on assumptions

Universities can collect ethically managed, anonymous or appropriately confidential data to determine which students are using services, where unmet needs exist and whether interventions are helping. Local evidence is particularly important because findings from one university, city or country may not generalize perfectly to another.

What this study cannot tell us

The results are informative, but several limitations prevent overgeneralization.

First, the design was cross-sectional. It cannot establish whether academic discipline, sleep or other measured characteristics caused changes in depression, anxiety or stress.

Second, the sample consisted of students from universities in Lahore. Pakistan has substantial educational, socioeconomic, cultural and regional diversity, so results from this sample should not automatically be treated as national prevalence estimates.

Third, the medical and non-medical groups were unequal in size, with considerably more medical students represented.

Fourth, the PHQ-9 and DASS-21 are self-report symptom instruments. They are useful research and screening tools, but questionnaire scores are not equivalent to a clinician establishing a psychiatric diagnosis.

Fifth, the low explanatory power of the regression models shows that many determinants of student mental health were not captured. This is not necessarily a flaw unique to the study; mental health is influenced by numerous interacting biological, psychological, social and environmental factors that cannot be fully represented in a single survey.

Finally, the publisher identified the available version as an early-access, unedited manuscript at the time of publication, noting that further editorial processing could occur. Readers using exact numerical details for academic purposes should consult the current published version.

A better question than “Which discipline is more depressed?”

Comparing academic groups can identify useful patterns, but the most productive question may not be whether medical or non-medical students are more depressed.

A better set of questions would be: Which students are experiencing significant symptoms? What characteristics and circumstances are associated with those symptoms? Which barriers prevent students from obtaining support? Which campus interventions work, for whom, and under what conditions?

Those questions move the discussion from ranking faculties toward understanding needs.

The Lahore study illustrates why that shift is worthwhile. Non-medical students reported higher depressive and anxiety symptoms in this particular sample, challenging a common assumption about medical education. Yet academic discipline accounted for only a small fraction of the differences between students. Gender, sleep and previous depression treatment were also associated with symptom patterns, while much of the variation remained unexplained.

That is arguably the most useful message for student mental health in Pakistan: psychological wellbeing cannot be read reliably from the name of a student’s degree.

Key implications for student mental health in Pakistan

• Medical students should not automatically be assumed to have worse mental health than students in other disciplines.
• In this Lahore sample, non-medical students reported higher depressive and anxiety symptoms after statistical adjustment, while the adjusted stress difference was not statistically significant.
• Academic discipline explained only a small proportion of overall differences in symptom scores.
• Female gender, sleep duration and previous depression treatment were among the factors associated with symptom levels in the study.
• University mental-health strategies should therefore reach the whole student population rather than relying exclusively on faculty-based assumptions.
• Screening questionnaires can identify symptom burden but should not be confused with individual psychiatric diagnosis.

Looking beyond academic discipline

Student mental health is a university-wide issue, not the property of one profession or faculty. Research comparing academic disciplines remains valuable because it can challenge assumptions and identify patterns worthy of further investigation. But those comparisons become misleading when they are treated as a complete explanation for why students experience depression, anxiety or stress.

The findings from 602 Pakistani university students offer a useful example. The expected hierarchy did not appear: non-medical students reported somewhat higher depression and anxiety scores than medical students. More importantly, however, the statistical models left the overwhelming majority of variation unexplained.

Future research in Pakistan would benefit from broader geographic sampling, longitudinal designs and closer examination of potentially relevant social, financial, academic, behavioural and mental-health factors. Following students over time could help distinguish predictors from consequences and clarify how psychological symptoms evolve during university education.

For universities, the immediate lesson is simpler. Do not wait for a student’s academic discipline to signal that they might need support. Mental-health systems should be accessible across faculties, responsive to individual needs and informed by evidence rather than stereotypes.

Medical disclaimer: This article is for educational and informational purposes only. The PHQ-9, DASS-21 and research findings discussed here do not provide an individual diagnosis or replace assessment by a qualified healthcare professional. Anyone experiencing persistent psychological distress, worsening symptoms, thoughts of self-harm or other urgent mental-health concerns should seek appropriate professional or emergency assistance.