1. Background/Rationale
1.1. Introduction
There is growing worry in the UK about mental health problems affecting university students. Yassin’s (2023) survey shows that mental health problems like depression and anxiety are getting worse. Each year in England, there is a 25% rise among adults who need help for these issues. This worrying thing is also happening in college, where the number of students who say they have mental health problems has increased a lot. Over ten years it went up by 450% (Yassin, 2023). It’s important to understand mental health because it covers feelings, thoughts and social life. It affects many parts of everyday activities such as making choices or dealing with others. It’s important to know that mental health and mental illness are not the same. Mental health is about how well your brain works, while having a mental illness means there is something wrong with it which can make you sick.
Galante et al.’s study (2018) shows that it is very important to help students with their health and happiness because more people are going to college nowadays. Even though mental health problems are less common in first-year college students than in the normal people, it goes up a lot during their second year. The increase in students getting help for their mental health, more than the rise of new college starters, shows the discourse needs to study how students see and feel about getting this support properly. This review looks at what’s been written before, finding gaps and uncertainties. It helps us understand better how to make mental health improvements for university students in the UK effective.
1.2. Scope of the Issue
Mental health problems among UK students at university are shown by a big increase in reports about it. This is up 450% over the last ten years (Yassin, 2023). This worrying pattern shows bigger problems affecting student health. A survey showed that students’ satisfaction with life is 6.5 out of ten, which is much less than the general population’s rating of 7.1 (Yassin, 2023). The importance of this health problem becomes clear when thinking about all the things that cause students to feel unhappier.
Lack of money is a big problem. This includes paying for home costs, extra fees and costly books to study from. 34% students cannot afford the price of their homes while another 39% find that textbooks are too expensive (Yassin, 2023). Also, the worries about students’ mental health also extend to academic productivity. Here, three in four feel worried about their studies and only half are okay with asking questions (Yassin 2023).
Going to university is a big part of growing up, as said by Duffy et al. (2020). This happens with faster brain development and strong reactions to stress. This time, where family is left behind and more work must be doe shows students issues connected to paying for universities costs. It also involves making new friends when not living within reach of their usual supports (Duffy et al., 2020). Going to university is important for personal and community growth, but it’s also a time when serious mental health issues often start. (Duffy et al., 2020)
Sharp and Theiler (2018) show how common mental stress is among college students all over the world. They say people are getting more worried about problems with their minds. More and more students are facing bad mental health issues. 93.7% of people who run counseling centers say that the number is still growing, according to Sharp and Theiler in 2018 (Sharp & Theiler , 2018).
1.3. Literature Review
Looking at what’s been written before shows a confusing situation about how students think and feel when trying to get help for their mental health. The study by Ebert and team in 2019 shows that many students who are going to college for the first year all over the world do not ask for help. Even though many college students have mental problems and think about suicide, only 24.6% say they are sure to get help in the future for any emotional issues they might face. Mindset obstacles, like liking to deal with problems alone and worries about being ashamed, are bigger than physical barriers. This shows an urgent need for special help plans made just for them (Ebert et al., 2019).
Oswalt et al. (2020) give information about how college mental health diagnoses and treatments have changed from 2009 to 2015. There were more cases of different mental health problems found, with anxiety, panic attacks and ADHD having the highest chances. The number of college students going for mental health services got more over time, showing how things are changing when it comes to their mind problems (Oswalt et al., 2020).
Lipson et al. (2019) added a ten-year study of people, focusing on the growing need for mental health help among college students in U.S. The research shows an important increase from 19% to 34%, meaning more young adults are getting treatment since eight years ago. More people started getting help for depression and the risk of suicide. At the same time, it became less shameful to ask for assistance. This data clearly shows an increase in mental health services use at US universities (Lipson et al., 2019).
Lipson and Eisenberg (2018) look at the complicated relationship between mental health and universities results. The research shows how common mental health problems are in college students. It highlights their effect on universities and what people expect from it. One out of four students who have symptoms don’t like their universities experience. Mental health issues can make people unhappy with learning and more likely to quit, the study shows (Lipson and Eisenberg, 2018).
Baik et al. (2019) give a important student perspective with respect to improvement of mental health support on university places. They also show how universities can improve mental happiness by taking certain actions. Students give many different ideas, grouped into areas like universities teaching methods, student help services and surroundings. These tips show how universities can work with students better to improve mental health (Baik et al., 2019).
Cheng et al. (2018) looked at how college students think about asking for help, mainly focusing on self-shaming and knowing about mental health problems. The research points out that understanding about mental health is a big factor in deciding to ask for help. It shows the importance of programs meant to fix these knowledge shortfalls and lower self-shaming issues among college students (Cheng et al., 2018).
1.4. Critical Analysis
The study of literature helps the discourse understand better the problems students have with their minds. This includes looking at numbers and ways things are done in detail. Ebert et al. (2019) study shows that college freshmen worldwide don’t want to get mental health help. It gives a complete view of problems in attitudes. Preferring to solve problems alone and fear of shame are big barriers. This shows how important it is to understand mental factors that affect people’s choices in asking for help. But the study mostly uses surveys that people fill out themselves. This can cause issues about possible answer skew and how personal reported feelings might be.
Oswalt et al. (2020) looked at mental health diagnoses from 2009 to 2015. They used a complex math step called hierarchical binary logistic regression, which made their findings strong. However, the study’s use of information reported by people may cause recall bias. This could affect how accurate mental health issues are found out to be. Lipson et al. (2019)’s big study of how things changed over 10 years uses the Healthy Minds Study. This is a survey done online. The big data set gives helpful information, but it could be affected by self-selection bias. This might make the sample not suitable and change how often the discourse can use these findings in other situations.
Lipson and Eisenberg’s (2018) study about how mental health affects universities results gives important information. But, the study’s use of information based on what people say may lead to problems with social desire bias. This can affect how true their answers are. Baik et al.’s (2019) student-focused research gives us detailed qualitative information. But, the personal aspect of student advice and possible variety in reactions from different universities show we should be careful about making wide statements.
Cheng et al.’s (2018) check about self-stigma and learning in mental health uses regression plans. This improves the research’s quality. But the study mostly uses information that people tell about themselves. This could lead to problems because it might make them lie in a way, they think others will like or accept. In short, the research gives helpful information but has some problems. These issues include using data that people talk about themselves and possible unfair ways of looking at things in studies. So, it’s best to be careful when reading those findings.
2. Objectives/Systematic Review Question
2.1. Focused Systematic Review Question
Research Question:
What do UK college students think and feel about getting mental health support and how does this change their happiness, academic performance or retention?
2.2. Question Structure
| Population (P) | Exposure/Outcome (E) | Context (O) |
| University students in the UK, enrolled in higher education institutions | Perceptions and experiences of accessing mental health support services | Impact on overall well-being, academic performance, and retention within the university setting |
Table 1: Research Question Structure
(Source: Researcher)
Type of Question
Qualitative Nature of the Question
The study question uses a method that focuses on the deep feelings and events of students in UK universities when they get help for their mental health. This kind of design is seen as the best way to understand complex stories and different viewpoints about a topic (Murphy, 2017). It helps the researcher get a full picture of the issue in question.
2.3. Objectives
1. To systematically investigate the perceptions that university students in the UK hold with respect to the accessing mental health support services.
2. To investigate the experiences of students with regards to accessing mental health support services.
3. To identify barriers as well as facilitators with regards to accessibility of mental health support services for university students in the UK.
2.4. Philosophical Underpinnings
The study goes along with a constructivist research philosophy. This belief knows that the truth changes for each person and pays attention to how both people who study and those involved make knowledge together (Boon, 2017). The perspective accepts that individuals actively change their life experiences (Kamal, 2019). It knows what they believe is influenced by the world and things around them (Van der Walt, 2020). This matches the nature of research because it tries to understand what students think and say about getting help for mental health problems in a university setting.
3. Methods of Review
3.1. Search Strategy
Relevant Databases:
The search strategy will harness the expansive capabilities of three pivotal databases: Scopus, Medline, and Embase. Each database was carefully picked because it has special strengths and fully covers academic articles about mental health problems among students at universities.
Scopus:
Scopus is famous because it covers many subjects. It is a great choice because it has lots of articles checked by other experts in different fields. Its open-minded way makes sure we include different opinions and understandings important to the many parts of mental health help in a university. Choosing Scopus is because it goes beyond areas of study, allowing a wide range of research from psychology or sociology to public health (Schotten et al., 2017). This approach that brings together different fields matches with the complex nature of this research question. It helps create a thorough study about looking at beliefs and experiences related to mental health help services (Zhu and Liu, 2020).
Medline:
Medline is a very important database for medicine and healthcare. Medline helps by finding studies that look at the connection between mind health and medical treatments (Lee et al., 2023). These studies explore how university students use mental health services in practice. Medline is included because it realizes that mental health, even though purely social and psychological, has important links with medical and healthcare issues. This database helps to find studies that may look at the connection between medical and mental treatments for university students’ wellbeing.
Embase:
Understanding that mental health is holistic, Embase with its wide-ranging study of medical books and drug research helps fill in the search strategy. It gives a detailed view that helps us look at drug treatments and possible links between mental health care services and medical actions. We chose Embase because it focuses on medical and drug-related literature. It gives a complete view, especially when looking at studies using medicine or treatments for mental health support (Bramer et al., 2016). This is very important to get a detailed look at the different ways mental health services are given in universities.
Use of PEO Framework for Key Terms:
The PEO framework which includes Population, Exposure, and Outcome as the sole elements, will be foundationally used for developing the search terms and keywords. In the context of the element of ‘Population,’ terms such as “university students,” “college students,” and “higher education attendees” will be employed. ‘Exposure’ will include terms such as “mental health support services,” “psychological interventions,” and “counseling programs.” ‘Outcome’ will involve terms related to “perceptions,” “experiences,” and “utilization patterns.”
Boolean Operators:
The researcher will use a search strategy with ‘AND’ to connect words in the same group (like different population terms) and ‘OR’ for synonyms or ideas within that category (such as various exposure or outcome phrases) (Atkinson and Cipriani, 2018). This helps the reviewer find better information. Using Boolean operators in this way helps to make the search more detailed and fairer. It catches research that talks about various parts of PEO relationship at once (Scells et al., 2020).
| Category | Keywords and Search Terms |
| Population | University students, college students, higher education attendees |
| Exposure | Mental health support services, psychological interventions, counseling programs |
| Outcome | Perceptions, experiences, utilization patterns |
Table 2: Search Terms
(Source: Researcher)
3.2. Study Selection
| Criteria | Inclusion | Exclusion |
| Publication Date | Studies published between 2013 and 2023 | Studies published before 2013 |
| Geographical Scope | Studies conducted in the United Kingdom | Studies conducted outside the United Kingdom |
| Population | University students in the UK | Studies focusing on non-university populations |
| Intervention/Exposure | Mental health support services, interventions, counselling programs | Studies unrelated to mental health interventions |
| Outcome | Perceptions and experiences in accessing mental health support services | Studies not addressing perceptions and experiences |
| Study Design | Qualitative research studies | Quantitative research studies |
| Language | Studies in the English language | Studies in languages other than English |
| Publication Type | Peer-reviewed journal articles, conference papers, and dissertations | Grey literature, opinion pieces, and editorials |
Table 3: Inclusion and Exclusion Criteria
(Source: Researcher)
3.2.1. Population
For this systematic review, the population (P) are students at universities in the UK (Campbell et al., 2022). The criteria say the studies must be about students in college, making sure they are on topic for that audience. The geographical setting criteria states that the review should only use studies done in the United Kingdom. This is because it helps the review understand key nuances of UK’s college system better. Rules to exclude involve studies that do not just focus on students from university, and ones done in languages other than English. This careful way to count the people makes sure that the study is accurate and important for university students in UK using mental health services.
3.2.2. Exposure
In this study, the Exposure (E) is about what UK university students feel and think when using services to help with their mental health (Nash et al., 2017). These studies should talk about how easy it is or not, whether students use these services and what effect they have on students’ well-being in college. The understanding includes any actions, plans or services made to help with mental health issues among college students. The criteria for being included in the study looking at different places in the higher education world like counselling services, outreach efforts or online help. Exclusion are for studies not about the needed risk items or done out of time and location limits set. This helps us check carefully on how university students in UK find help things related to mind health support services.
3.2.3. Outcome
This Outcome (O) in the PEO framework for the current systematic review is about learning how mental health help services affect UK college students’ happiness (Choudhry et al, 2016). The chosen studies must offer information about results of getting mental health help. This includes a better state of mind, universities performance and happiness for the students overall. This includes both good and bad results, making sure we thoroughly check how well the actions work and what impact they have.
3.3. Study Quality Assessment
The systematic review will use the Critical Appraisal Skills Programme (CASP) checklist to rate quality and see if chosen studies made good methods. CASP gives a clear plan to carefully check different study types (Long et al., 2020). This makes sure the researcher looks closely at the proof in all ways and not miss anything. To find out how good a method is, the researcher may follow the CASP checklist for each study. The appraisal will look at things like design of studies and data gathering ways that affect results’ understanding better. The CASP checklist has special rules for different ways of doing research (Buccheri and Sharifi, 2017). This makes it suitable to many types of studies included in a systematic review. This helps with the goal to look at lots of kind of research about how students feel and experience help for mental health services.
The reason the researcher has chosen to use CASP is because it is a well-known and trusted tool for properly assessing research studies (Majid and Vanstone, 2018). The way it’s all-encompassing lets us see both the good and bad parts of each study. This helps to make the conclusions from a systematic review stronger overall. CASP helps make sure reviews are done fairly and clearly (Wang et al., 2020). This makes it more trustworthy to use the studies in a systemic review for making decisions or suggestions (Maeda et al., 2023).
4. Data Extraction
The review process uses a thorough data extraction process to put together details from chosen studies (Munn et al., 2018). An organized table has been made to help with recording important information in multiple studies. This table should consist of important details like study name, year it was written, type of research done, the number of people involved in study, results measured and where the studies are from (Thomas et al., 2020).
The chosen way to get results from research reviews carefully checks each study included. It uses the Critical Appraisal Skills Programme (CASP) checklist. This popular tool makes sure that the quality of a study is checked in an organized and uniform way. The CASP list has rules that are important for different study types (Wang et al., 2020). This makes it work well across many kinds of studies to be added in this review. The researcher wants to stay fair and steady by following a tough way of checking each study’s method quality (Munn et al., 2018).
The table for collecting data has been designed to match the rules of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). These guidelines make reports clearer and complete. Each part in the table has a special job, helping to fully understand all of it. The reason for putting these specific things in is based on how important each part is to answering the questions and goals of the study (Chen, 2017).
| Study Identification | Publication Year | Study Design | Sample Size | Outcome | Country |
Table 4: Data extraction table
(Source: Resarcher)
5. Data Synthesis
For this systematic review, the information will be put together using thematic synthesis as the chosen way to study it. Thematic synthesis is a strong and often used method in qualitative research, very good for carefully examining and bringing together results from different studies (Braun and Clarke, 2022). Since the studies in question will most likely use different types of qualitative research designs, thematic synthesis gives a flexible way to find and study repeated themes or patterns from data (Maguire and Delahunt, 2017).
The way the researcher extracts and extrapolates the main ideas is very important for finding out how UK university students feel and what they think about support services for mental health. This way helps us dig deep into the details of qualitative data. It lets the review process find important themes and patterns about how students interact with counselling services for mental health matters (Herzog et al., 2019). The clear and orderly way thematic synthesis works fits in with the high standard of this review.
By using the thematic analysis approach, the joining together process will include finding important ideas and making descriptions of themes (Castleberry and Nolen, 2018). These go with creating discussions that show what university students think and feel about getting support services for their minds. Understanding themes helps the reviewer see implication in a bigger UK university situation. This lets the systematic review study all different factors that affect how students use mental health help services more carefully (Terry et al., 2017; Clarke and Braun, 2017). In summary, the selected approach matches what the study aims to do and guarantees a thorough blending of qualitative facts.
References
Atkinson, L.Z. and Cipriani, A., 2018. How to carry out a literature search for a systematic review: a practical guide. BJPsych Advances, 24(2), pp.74-82.
Baik, C., Larcombe, W. and Brooker, A., 2019. How universities can enhance student mental wellbeing: The student perspective. Higher Education Research & Development, 38(4), pp.674-687.
Boon, M., 2017, May. Philosophy of science in practice: A proposal for epistemological constructivism. In Logic, methodology and philosophy of science–Proceedings of the 15th international congress (pp. 289-310).
Bramer, W.M., Giustini, D. and Kramer, B.M., 2016. Comparing the coverage, recall, and precision of searches for 120 systematic reviews in Embase, MEDLINE, and Google Scholar: a prospective study. Systematic reviews, 5, pp.1-7.
Braun, V. and Clarke, V., 2022. Conceptual and design thinking for thematic analysis. Qualitative Psychology, 9(1), p.3.
Buccheri, R.K. and Sharifi, C., 2017. Critical appraisal tools and reporting guidelines for evidence‐based practice. Worldviews on Evidence‐Based Nursing, 14(6), pp.463-472.
Campbell, F., Blank, L., Cantrell, A., Baxter, S., Blackmore, C., Dixon, J. and Goyder, E., 2022. Factors that influence mental health of university and college students in the UK: a systematic review. BMC public health, 22(1), pp.1-22.
Castleberry, A. and Nolen, A., 2018. Thematic analysis of qualitative research data: Is it as easy as it sounds?. Currents in pharmacy teaching and learning, 10(6), pp.807-815.
Chen, C., 2017. Science mapping: a systematic review of the literature. Journal of data and information science, 2(2), pp.1-40.
Cheng, H.L., Wang, C., McDermott, R.C., Kridel, M. and Rislin, J.L., 2018. Self‐stigma, mental health literacy, and attitudes toward seeking psychological help. Journal of Counseling & Development, 96(1), pp.64-74.
Choudhry, F.R., Mani, V., Ming, L.C. and Khan, T.M., 2016. Beliefs and perception about mental health issues: a meta-synthesis. Neuropsychiatric disease and treatment, pp.2807-2818.
Clarke, V. and Braun, V., 2017. Thematic analysis. The journal of positive psychology, 12(3), pp.297-298.
Duffy, A., Keown-Stoneman, C., Goodday, S., Horrocks, J., Lowe, M., King, N., Pickett, W., McNevin, S.H., Cunningham, S., Rivera, D. and Bisdounis, L., 2020. Predictors of mental health and academic outcomes in first-year university students: Identifying prevention and early-intervention targets. BJPsych Open, 6(3), p.e46.
Ebert, D.D., Mortier, P., Kaehlke, F., Bruffaerts, R., Baumeister, H., Auerbach, R.P., Alonso, J., Vilagut, G., Martínez, K.U., Lochner, C. and Cuijpers, P., 2019. Barriers of mental health treatment utilization among first‐year college students: First cross‐national results from the WHO World Mental Health International College Student Initiative. International journal of methods in psychiatric research, 28(2), p.e1782.
Galante, J., Dufour, G., Vainre, M., Wagner, A.P., Stochl, J., Benton, A., Lathia, N., Howarth, E. and Jones, P.B., 2018. A mindfulness-based intervention to increase resilience to stress in university students (the Mindful Student Study): a pragmatic randomised controlled trial. The Lancet Public Health, 3(2), pp.e72-e81.
Herzog, C., Handke, C. and Hitters, E., 2019. Analyzing talk and text II: Thematic analysis (pp. 385-401). Springer International Publishing.
Kamal, S.S.L.B.A., 2019. Research paradigm and the philosophical foundations of a qualitative study. PEOPLE: International Journal of Social Sciences, 4(3), pp.1386-1394.
Lee, J.C., Lee, B.J., Park, C., Song, H., Ock, C.Y., Sung, H., Woo, S., Youn, Y., Jung, K., Jung, J.H. and Ahn, J., 2023. Efficacy improvement in searching MEDLINE database using a novel PubMed visual analytic system: EEEvis. Plos one, 18(2), p.e0281422.
Lipson, S.K. and Eisenberg, D., 2018. Mental health and academic attitudes and expectations in university populations: results from the healthy minds study. Journal of Mental Health, 27(3), pp.205-213.
Lipson, S.K., Lattie, E.G. and Eisenberg, D., 2019. Increased rates of mental health service utilization by US college students: 10-year population-level trends (2007–2017). Psychiatric services, 70(1), pp.60-63.
Long, H.A., French, D.P. and Brooks, J.M., 2020. Optimising the value of the critical appraisal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Research Methods in Medicine & Health Sciences, 1(1), pp.31-42.
Maeda, Y., Caskurlu, S., Kozan, K. and Kenney, R.H., 2023. Development of a critical appraisal tool for assessing the reporting quality of qualitative studies: a worked example. Quality & Quantity, 57(2), pp.1011-1031.
Maguire, M. and Delahunt, B., 2017. Doing a thematic analysis: A practical, step-by-step guide for learning and teaching scholars. All Ireland Journal of Higher Education, 9(3).
Majid, U. and Vanstone, M., 2018. Appraising qualitative research for evidence syntheses: a compendium of quality appraisal tools. Qualitative health research, 28(13), pp.2115-2131.
Munn, Z., Peters, M.D., Stern, C., Tufanaru, C., McArthur, A. and Aromataris, E., 2018. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC medical research methodology, 18, pp.1-7.
Munn, Z., Stern, C., Aromataris, E., Lockwood, C. and Jordan, Z., 2018. What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences. BMC medical research methodology, 18(1), pp.1-9.
Murphy, E., 2017. Qualitative methods and health policy research. Routledge.
Nash, S., Sixbey, M., An, S. and Puig, A., 2017. University students’ perceived need for mental health services: A study of variables related to not seeking help. Psychological services, 14(4), p.502.
Oswalt, S.B., Lederer, A.M., Chestnut-Steich, K., Day, C., Halbritter, A. and Ortiz, D., 2020. Trends in college students’ mental health diagnoses and utilization of services, 2009–2015. Journal of American college health, 68(1), pp.41-51.
Scells, H., Zuccon, G., Koopman, B. and Clark, J., 2020, April. Automatic boolean query formulation for systematic review literature search. In Proceedings of the web conference 2020 (pp. 1071-1081).
Schotten, M., Meester, W.J., Steiginga, S. and Ross, C.A., 2017. A brief history of Scopus: The world’s largest abstract and citation database of scientific literature. In Research analytics (pp. 31-58). Auerbach Publications.
Sharp, J. and Theiler, S., 2018. A review of psychological distress among university students: Pervasiveness, implications and potential points of intervention. International Journal for the Advancement of Counselling, 40, pp.193-212.
Terry, G., Hayfield, N., Clarke, V. and Braun, V., 2017. Thematic analysis. The SAGE handbook of qualitative research in psychology, 2, pp.17-37.
Thomas, J., Utley, J., Hong, S.Y., Korkmaz, H. and Nugent, G., 2020. A Review of the Research. Handbook of Research on STEM Education.
Van der Walt, J.L., 2020. Interpretivism-constructivism as a research method in the humanities and social sciences–more to it than meets the eye. International Journal of Philosophy and Theology, 8(1), pp.59-68.
Wang, Y.Y., Liang, D.D., Lu, C., Shi, Y.X., Zhang, J., Cao, Y., Fang, C., Huang, D. and Jin, Y.H., 2020. An exploration of how developers use qualitative evidence: content analysis and critical appraisal of guidelines. BMC Medical Research Methodology, 20(1), pp.1-28.
Yassin, F., 2023. Student Mental Health Statistics UK 2021. The Wave Clinic. [online] Available at: https://thewaveclinic.com/blog/student-mental-health-statistics-uk-2021/#:~:text=A%202021%20survey%20from%20the,this%20number%20is%2025%25%20higher.
Zhu, J. and Liu, W., 2020. A tale of two databases: The use of Web of Science and Scopus in academic papers. Scientometrics, 123(1), pp.321-335.