A Thematic Analysis of the Reported Effect Anxiety Has on University Students

Abstract

The number of university students experiencing mental health issues in the UK is increasing and a high number of students are dropping out of university as a result. Literature highlights a lack of knowledge regarding this topic and the significance in educating society. The aim of this qualitative study was to provide further insights as to why students are experiencing anxiety and into help-seeking behavior amongst university students. A thematic analysis was used to analyze a total of 118 blog entries of students discussing the impact of university on mental health. Findings highlighted three main themes: Balancing priorities, Fear of failure, and Critical incidents. These themes are discussed in terms of possible risk factors contributing to students experiencing anxiety while at university. Findings together with recommendations listed in this study offer higher education staff and institutions the opportunity to explore areas of focus and improve university students’ mental health.

Introduction

On a worldwide scale, mental disorders have affected an estimated 25% of the population (Tay et al., 2018). Mental illness can become prominent in all aspects of one’s life. For example, during parenting, pregnancy, difficulty with finances, work, and education (Galson, 2009). The mental health of university students has become a rising public concern (Brown, 2018). The World Health Organization (WHO, 2014, p. 12) defines mental health as “a state of well-being in which every individual realises his or her potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”. There is a significant amount of young adults at uniersity in the UK (Ravenwood et al., 2019). The HESA (2019) reported that, in 2017 to 2018, there were 2,343,095 undergraduate and postgraduate students in UK higher education. According to Wahed and Hassan (2017), an estimated 60% of students dropped out of university because of issues with their mental health.

From 18 to 25 years of age is considered to be a vulnerable time in one’s life and for mental ill health onset and for some young adults, this is when they attend university (Kessler et al., 2007). University is a significant life transition that can be distressing (Gurbuz et al., 2019; Lee & Kim, 2019). For example, moving from home to university accommodation can be overwhelming, as this may be some students first time living away from their family and friends (Laidlaw et al., 2016). Others who are coming straight from a structured school may struggle to adapt to a less structured academic setting (Keeling, 2003). There is also a culture of clubbing and high alcohol consumption at university which many students struggle to adjust to or feel pressured to partake in (Davoren et al., 2015). Research states that the first few months at university and onward may cause psychological distress for those without pre-existing mental health problems (Bewick et al., 2010; Conley et al., 2014; Eisenberg et al., 2007). However, McLafferty et al. (2017) highlight that some students start university with pre-existing mental health difficulties that often worsen at university (Auerbach et al., 2016). As students experience the stress of adapting to a new environment, negotiating a new identity as a student, and learning to transition from adolescence to adulthood by being accountable for their finances, health, and school life (Civitci, 2015; Scanlon et al., 2007). Previous research has found that finance is a contributing factor as students from a low socioeconomic have been found to experience stress, anxiety, and depression due to financial vulnerability (McCloud & Bann, 2019).

According to the Nightline Association (2014), these contributing factors often leads to students experiencing loneliness. Aronin and Smith (2016) found in a recent survey, which was partaken by over 100 students in the UK, that 34% of respondents, aged 18 to 24, felt lonely fairly or very often to almost constantly (Vasileiou et al., 2019). Macaskill (2013) states that, in the UK, the increase in the number of students attending and cuts in university funding has changed the student experience. For example, academic staff time is more demanded and therefore personal support for students is becoming more difficult to obtain. Students are now taught in larger groups, making it more challenging to meet other students and developing a sense of belonging.

According to Cooke et al. (2006), undergraduate students experience high levels of anxiety throughout their university experience. Anxiety disorders are the most frequently experienced mental health condition (Nunn, 2015). It was reported in 2013 that one in nine people worldwide had suffered from an anxiety disorder during that year. Anxiety can make individuals extremely fearful and anxious, this may lead to one attempting to escape from what they may believe to be a threat, for example, social setting or unfamiliar places. Their response to these threats is usually drastic and out of proportion to the actual threat posed (Craske & Stein, 2016).

Social and test anxiety are two of the most shared anxiety types experienced amongst students (Farokhi & Tahmassian, 2017). Social anxiety disorder is defined as intense fear in social conditions where one worries, they may experience anxiety symptoms such as sweating or blushing or that something humiliating may occur (Dalbudak et al., 2013). Which may be linked to low self-esteem as self-esteem has been defined as one’s perception of their self-worth and/or whether one accepts and respects oneself (Jung et al., 2018). Self-esteem blossoms as circumstantial or continuous character trait reliant on reassurance and appreciation of others and feelings of adequacy (Mruk, 2006). Many youths usually only gain competence and esteem from family (Hollifield & Conger, 2015). On the other hand, test anxiety is defined as a set of psychological, behavioral, and phenomenological reactions due to worrying about failing an exam or other assessments. Several factors cause test anxiety such as students believing they are incapable of learning what is required for their exam or outside factors such as pressure from others to achieve high grades which increases their level of stress (Duraku, 2017). Auerbach et al. (2016) state that this stress may negatively impact students’ academic performance. However, Richardson (2009) investigated students who were awarded classified honors degrees by UK universities in 2004 to 2005. He found that 65.8% of students with mental health difficulties had been awarded good degrees (first and second class). Therefore, it could be argued that mental health issues do not always prevent students from succeeding academically (Richardson, 2015). According to Bulathwatta et al. (2017), academic achievements and academic grading system cause some students to neglect social activities. This results in students experiencing further emotional problems and issues with social adjustment. Ravenwood et al. (2015) report that during the exam period, libraries within some universities open for 24 hours a day, to allow students to have a quiet environment to study (Ravenwood et al., 2019). However, Coldwell (2013) questions whether 24-hour libraries cause students to create an unhealthy work ethic.

Research considers university students to be a unique subsection of society and are viewed as a particular population experiencing specific issues and emotional reactions (Bulathwatta et al., 2017; Davoren et al., 2015). For example, a majority of students are experiencing relationship problems, issues with their sexual behaviors and are having to learn on their own how to deal with the emotions that come with these issues (Lewis et al., 2012). According to Paterson (2017), these issues amongst other aspects of university life make students vulnerable to trauma. The DSM-5 states that there are different types of traumatic events; car accidents, natural disasters, childhood sexual abuse, rape, and domestic violence. There are further vulnerability factors that leave people traumatized; relationship issues, financial difficulties, job loss, illness, and death of a friend or family member (American Psychiatric Association, 2013). Bulathwatta et al. (2017) highlight that traumatic events affect people differently and that some people face challenges with coping and adapting after a traumatic event (Agaibi & Wilson, 2005).

There is a frequent rate of suicide amongst university students in the UK due to struggles with anxiety, other mental health issues, lack of social support and substance abuse (Bewick et al., 2010; Eskin et al., 2016). It is reported that in 2017, one in 60 deaths were by suicide and were carried out by university students (Eisenberg et al., 2007; Nunez-Mulder, 2018). Suicide is a severe form of psychological distress (Eskin et al., 2016). Suicide is believed to be the leading cause of death in young adults worldwide (Bridge et al., 2006, 2014; Haegerich et al., 2014; Wasserman et al., 2005). The WHO (2018) estimates that by the year 2020, over 1 million people will commit suicide and 10 to 20 times more people will attempt to do so (Bertolote & Fleischmann, 2002).

Donald et al. (2000) highlight that young people rarely seek help; their study reported that 39% of males and 22% of females aged 15 to 24 years old who were surveyed rarely sought help from formal services regarding their mental health (Horgan & Sweeney, 2010). Laidlaw et al. (2016) suggest this could be due to students failing to recognize they are experiencing mental health difficulties or personal stigma (Lally et al., 2013). However, Golberstein et al. (2009) argue that research has shown that stigma does not prevent students from seeking help. Nonetheless, there is still a high amount of stigma that comes with mental illness, and it has been reported that stigma may be a significant contributing factor to why those with mental illness rarely seek help (Bharadwaj et al., 2017; Clement et al., 2015). Berger et al. (2005) provide additional support for this standpoint as their study found that help-seeking for mental health difficulties is frequently delayed because of stigma and that the internet is a method of encouraging people to seek support (Horgan & Sweeney, 2010). Stigma is considered to be a process involving labeling, marginalization, and discrimination against a particular social group (Link & Phelan, 2001).

Less than 29% of universities have a mental health and wellbeing strategy in place for students (Thorley, 2017). The UK Royal College of Psychiatrists (2011) also states that students with moderate mental health difficulties do not always receive treatment due to mental health services focusing more on those with severe difficulties. However, they also identified that there are challenges with students receiving treatment while at university as many students return home for school holidays due to not living where their university is based. However, Gallagher et al. (2008) bring to light that individuals are now seeking help for health-related issues on the internet instead of visiting a healthcare professional. A survey conducted in the UK found that over one in four people preferred to use the internet for therapy and advice regarding their mental health than visiting a doctor (Graham et al., 2000).

This study will analyze blog entries from students discussing the impact university has on their mental health. Furthermore, an inductive thematic analysis will be used to be able to develop an understanding of the factors which contribute to the deterioration of students mental health. Due to the qualitative take on the current study, no hypotheses are being tested. Instead, this study aims to gather information on what are the reported risk factors contributing to students mental health while studying at university? Further aims of this study are to discover whether gender is a reported factor in experiencing anxiety while at university and why some university students experiencing mental health difficulties may choose not to report their difficulties outside of an online context.

Method

A Qualitative research method was chosen for this study. Qualitative research allows researchers to gain access to hidden population such as vulnerable groups and also investigate human experiences in a personal and social context (Maher & Dertadian, 2018). This provides an understanding of the factors which contribute to one’s experiences (Gelling, 2015).

Qualitative research includes several methods of data collection, interviews, questionnaires, focus groups, observations, and documents (Opie, 2004). Numerous researchers use interviews with a qualitative design in studies involving sensitive topics, as it may be difficult to gain an understanding of these issues using a quantitative approach (Dempsey et al., 2016; Fossey et al., 2002). However, qualitative research design has been critiqued by many researchers to often be inaccurate due to the challenging and unpredictable behavior of participants (Holloway & Wheeler, 2010). Nonetheless, qualitative research allows both researcher and participant to disclose first-hand experiences, making the data collection process quite therapeutic (Eide & Kahn, 2008). As studies involving participants with mental health conditions are considered to be challenging, mainly because they are considered to be vulnerable participants, and both participants and researchers are thought to be at risk of distress or harm from discussions of sensitive issues or past trauma (Biddle et al., 2013). Naturally occurring data were chosen as a method of data collection to avoid such distress and potential harm.

Naturally occurring data is used to investigate and categorize physical source which is usually a written document either in a private or public domain that contains information about a specific phenomenon (Payne & Payne, 2004). Ahmed (2010) states that using naturally occurring data is just as successful as surveys, interviews, and observations in acquiring valuable evidence.

Blogs as a Data Source

The internet has become one of the primary sources for people with mental health problems to gather information and seek support regarding diagnosis, counseling, therapy services, and websites targeting mental health (Hanley et al., 2019). These websites vary from blogs, email lists, and newsgroups (Kummervold et al., 2002). Blogs have become a significant outlet for a large amount of the population as it allows individuals to share both emotional and informational content (Tsai et al., 2018). Blog data is considered to be primary and naturally occurring data which is not able to be influenced or hindered by the researcher unlike other forms of data collection such as interviews (Jones & Alony, 2008). A contributing factor is the Hawthorne Effect; which causes participants to feel as though they must provide the interviewer with data that they believe may benefit the study (Hartley, 2001). However, this is not an issue with blog contents as those submitting blog entries are unaware of the research being conducted when writing (Jones & Alony, 2008). They are also considered to be a valuable source of qualitative data as blogs provide writers with freedom of expression which might not be easily accessible in other forms of media (Hull, 2007).

Ybarra and Eaton (2005) suggested that individuals who may feel suicidal or have depressive symptoms choose to utilize web-based assessments and interventions (Horgan & Sweeney, 2010). Other research has supported this suggestion, as findings have shown that web-based discussion forums are favorable due to the user’s identity being kept anonymous and individuals being able to avoid stigma (Davison et al., 2000).

Data Collection

Search strategy and identification of blogs and/or posts

Blogs were first identified using search terms which were in line with the aims of the study. These were students, mental health, anxiety, and university.

Once the search terms were identified, the blog search engine website was explored to discover relevant blogs. Seven blogs were first recognized, however after thoroughly examining each blog entry to identify whether they met the inclusion criteria, it was found that a few of the blogs were not relevant and did not focus on students’ mental health. Once blogs were narrowed down, the next stage was to select the most valuable blogs to answer the research questions. Three web-based forum blogs were chosen, one from the United Kingdom consisting of 113 blog entries and two from Australia consisting of 15 blog entries.

Inclusion and exclusion criteria of blogs and/or posts

Blogs were eligible for inclusion if they included students discussing their experiences with anxiety and how university contributes toward their experiences. No restriction was placed on blogs which contained entries from both students and graduates. To be able to make a comparison and have a broad understanding of how university students report the impact of university upon their mental health. Similarly, to have a wide range of blogs to choose from, no restrictions were put on a country setting. However, only blogs entries written in English were included.

Data Analysis

Thematic analysis is a method used to identify and analyze textual data by exploring, investigating, and reporting patterns within data through generating an array of themes (Clarke & Braun, 2013). This provides the researcher with the ability to answer the study question (Vaismoradi et al., 2016). According to Clarke and Braun (2013), thematic analysis is viewed as theoretically flexible because it can be used within several theoretical frameworks. It is also suitable to use for different research interests and theoretical perspectives because it can be applied to a vast range of research questions and can be used to analyze diverse types of data, from secondary sources such as media to transcripts of interviews.

Inductive thematic analysis was used to analyze the semantic content within the blog entries. Braun and Clarke’s (2006) six stages of thematic analysis was adopted in this study as their guide is straightforward and specifies why each step is essential to the method. This approach is efficient as it focuses exclusively on an individual’s feelings and experiences instead of concentrating on past theories and the study question. It also helps to exclude any bias in the analysis process. The thematic analysis has been carried out using a semantic approach as a result of the high volume of data (Braun & Clarke, 2006).

Three blogs which focused on either current or past university students’ mental health were chosen. A total of 118 blog entries ranging from 200 to 600 words each, were transcribed and combined; the combined data amounted to 204 transcribed pages. Blog entries were first read thoroughly to become familiar with the data, and initial codes were noted on paper. The next step was to organize the initially identified codes based on the collected data, to ensure codes were an accurate representation of participants experiences and the transcript. After sub-themes were created, sub-themes within this study were first acknowledged by recognizing codes which were an accurate representation of reported experiences. Sub-themes were reviewed to discover whether some sub-themes may be interrelated. Sub-themes which were found to be similar were grouped to form subordinate themes. Lastly, the most significant subordinate themes and sub-themes were chosen and renamed to ensure they were comprehensible and answered all the aims of the study. Once it was clear through open coding that there were no new themes present relevant to the topic, saturation was established. This study ensured that data collection reached saturation as failure to do so may impact the quality and hinder the validity of the findings (Fusch & Ness, 2015).

Ethical Considerations

Ethics relate to implementing good practice and avoiding harm, which can be prevented or lessened using suitable ethical principles (Orb et al., 2001). Ethical issues in qualitative research studies are complicated and different compared to issues faced in quantitative research. For instance, how a researcher obtains access to a particular group of individuals may create ethical issues (Carlsson et al., 2017).

For this reason, some ethical considerations were considered to prevent harm and distress. To ensure the study complied with the BPS (2011) code of ethics, an EthOs application was submitted to Manchester Metropolitan University. Informed consent has been acknowledged as an integral part of ethics in research used in various fields. For qualitative researchers, it is vital to identify before the commencement of the study, which data will be collected and how they will be used (Sanjari et al., 2014). Though the blogs used within this study were visible to the public, once the EthOs application was approved, blog owners were contacted to request use of blog entries, they were informed that their involvement is voluntary, the purpose of the study, if they wished to withdraw and reassured that once they withdraw from the study all data collected from their blogs would be destroyed. To ensure confidentiality of both blog owners and blog users, blogs were named as “Blog 1-3” and blog users were renamed as “Anon 1-116.”

Findings

Analysis of the blog entries identified three main themes concerning the reported effect university has on students’ mental health: “Balancing Priorities,” “Fear of failure,” and “Critical incidents.” These themes were chosen due to their prevalence amongst a significant amount of blog entries. All themes are comprised of sub-themes which are different aspects of the key themes identified.

Themes

Balancing priorities

Balancing priorities was found to be a main theme as a majority of blog entries discussed difficulties balancing university priorities such as assignments, exams, and attending lectures with other tasks such as work, socializing, family, and even dedicating time for themselves. Students reported experiencing feelings of isolation and loneliness as a result of this challenge and acknowledged that these feelings caused them to abandon priorities after experiencing burnout.

“I think the hardest part for me is finding a balance; a balance between looking after myself, my mental health, as well as putting my all into my degree and finding time for personal commitments.”—(p. 107, Anon 50)

Culture shock, socializing, and workload were identified as sub-themes as they were significant risk factors contributing toward balancing priorities.

Culture shock

Challenges adjusting to university life were a common factor reported by students. Continuously it was reported that the initial university experience was challenging for students’ mental health.

“a first year experience where nightclub advertising is thrust at you from every angle, you’re suddenly miles away from home in an intense prison-block flat with a hoard of people you don’t know, and you absolutely have to join every society and sports club possible to consider yourself as having “a great uni experience”. To be frank, there are many ways in which university is absolutely terrible for your mental health.”—(p. 224, Anon 110)

Students identified that they struggled with the independence and solitude that came with being at university as it made them feel lonely and was a negative reminder that they were far from home.

“Surprisingly, it wasn’t the first night but the second that I found the hardest. I felt like the only person on campus, which I know was only the musing of an anxious mind, but that didn’t make the thought any less real at the time. It was the first time I’d felt truly lonely. I remember pacing the length of my long corridor from one end to the other, feeling like my chest was on fire. I’d have done anything to keep on walking till I was home.”—(p. 155, Anon 78)

No longer having to follow a structured day initially sounded ideal to many; however, some found the freedom and having to look after themselves to be undesirable. Which caused them to struggle with coming to terms with their transition of leaving home to move to university.

“Moving away from home was hard. I had to learn to look after myself and no longer had the comfort of the routine I was accustomed to back home. My depression worsened and by the end of first year I was considering dropping out.”—(p. 45, Anon 15)

Another aspect of university which students reported to be difficult for them was having to live in student accommodation with strangers. Students mentioned that developing a friendship with those they did not know was both distressing and frightening.

“When my parents left me alone in my new room for the first time I had my first panic attack. I ended up hiding under the bed in floods of tears on the phone to my boyfriend. I didn’t venture into the kitchen for four days because I didn’t know how to start a conversation with all those new faces without hyperventilating. I made every excuse I could think of to not leave my room during Freshers’. My only saving grace was my phone and the contacts I had left behind at home. That was my first real experience with anxiety and how debilitating it can be.”—(p. 209, Anon 103)

Socializing

Socializing was found to be a significant aspect of university; students stated that socializing had both positive and negative effect as it gave them a sense of belonging which reduced feelings of anxiety. However, the necessity to meet new people caused great difficulty for some students.

“The prospect of having to meet new people wasn’t exciting it was terrifying. I had no idea what I was doing, I had no money (which was a worry in itself). This led me to spend every night dragging my uncontrollable body to the bathroom in an attempt to vomit all of my anxiety up. It got to the point for me where I wasn’t just having severe panic attacks on my own, but even at university.”—(p. 166, Anon 83)

This feeling was not limited to social events. Some felt overwhelmed to attend lectures, seminars, and even visiting academic staff and counselors to seek support.

“University life triggered my anxiety on a mass scale. I hated walking past people in corridors, and lectures were strange too, with 100 people in a theatre! I was used to having some kind of a relationship with my teachers, but now they barely knew I existed. By the end of the second month, I was at a breaking point. I couldn’t go home (because that would be a failure in my eyes,) but I was so lonely and unhappy.”—(p. 200, Anon 99)

Workload

It was voiced in several blog entries that the workload while at university was excessive and had a negative impact on mental health. Students reported feeling overwhelmed by the amount of work that is provided to them while at university.

“The overload of work and things to be thinking/worrying about can all get a bit too much and with each year of University I have always experienced that sudden break down, where I just want to cry and give up.”—(p. 82, Anon 36)

Students also stated that they placed value on their assignments and exams and saw them as their main priority. They devoted time to them, sometimes an excessive amount of time and neglect necessities such as eating and sleeping.

“The notion that it is perfectly normal not to eat or sleep to meet deadlines ridiculously placed within a few days of each other is just a small part of the lack of care for students’ mental health at university.”—(p. 223, Anon 110)

Despite the volume of students that disclosed choosing to focus on their studies solely. A large number of students also mentioned that they struggled to find motivation to tackle their assignments. Due to the stress they experienced having to tackle an immense amount of coursework.

“I kept leaving my work to the last minute and doing tasks in a really half-hearted way, making my anxiety symptoms worse.”—(p. 37, Anon 5)

“My dissertation had become such a big deal to me that I was completely overwhelmed. I continued all my other work. Coursework, readings, exam revision, that was all fine but when asked how my dissertation was going, my response was simply, ‘it’s going’. Truthfully, it was going nowhere. I disengaged with my supervisor and buried my head in sand.”—(p. 91, Anon 41)

Fear of Failure

Students recognized that there was pressure to do well psychologically and achieve good grades. Some reported that this brought on both a fear of failure and feeling like they had failed when they did not achieve grades which were considered desirable. This often-discouraged students from seeking help.

“On my least productive days I will think: “No way will I get a first-class degree, I am going to fail”. This leads me to feelings of helplessness and hopeless, not recognising that there are grades between first-class and failure.”—(p. 56, Anon 21)

The feeling of failure was not only subjected to grades. Students reported feeling as though they had failed for not achieving tasks that were considered to be significant to their university experience.

“I felt like a failure because I hadn’t gone out and met loads of new people, which is what I was told Freshers’ was all about. I felt like I had missed the prime opportunity to make friends and I had essentially failed. I thought I was the odd one out and was never going to make any meaningful friendships. I also thought that everyone was going to think I was the boring girl who never went out.”—(p. 149, Anon 75)

Expectations and fear of future prospects were identified as sub-themes as they were significant factors relating to students fear of failure.

Expectations

Students reported that they started university with expectations of what they will be capable of. However, these expectations were not solely self-inflicted, students identified that family, friends, and academic staff also held certain expectations for them. Students disclosed that they had great self-expectations when starting university but then their self-worth and confidence was questioned once they were surrounded by other students who either challenged their intelligence or simply seemed more intelligent than themselves.

“Although my grades weren’t bad, I was concerned with the fact that others were doing a lot better than me both academically and in terms of managing their workload. In comparison, I felt like I was failing. By relying on how I compared to others to discern my self-worth, I found myself feeling worthless and eventually this led to difficulties with anxiety and depression. If I hadn’t been so preoccupied with how others were doing and realised that I was doing perfectly fine, my mental wellbeing would have been much better.”—(p. 48, Anon 17)

For some expectations were related to their mental health. Due to the gender and stigma placed onto mental health many questioned whether they should be experiencing anxiety and whether they would overcome their difficulties. A large sum of students were also able to recognize that stigma played a part in refraining from seeking help.

“Fighting the Expectations I think men can be particularly susceptible to this view (due, in large part, to the emotionally repressive barriers to talking about feelings imposed by the ‘rules’ of masculinity – I have posted on this before). I certainly remember having some vague (and false) preconception that, when times are hard, women talk about it and men deal with it on their own.”—(p. 68, Anon 28)

Fear of future prospects

For numerous current students and graduates, university was a steppingstone to achieving jobs or continuing into higher education. However, as students reached the end of their studies, they experienced anxiety about the idea of possibly not reaching these goals.

“Graduation is fast approaching, the unknown, the big bad world and needing to prove my worth to survive. I’m struggling with this thought.”—(p. 95, Anon 44)

Critical Incidents

Students reported either starting university with mental issues or developing anxiety as a result of critical incidents which occurred during or prior to starting university. Hinderances Due to Pre-Existing Mental Health Difficulties and Adverse Life Events And/or Traumatic Events were identified as sub-themes as they were significant factors contributing toward critical incidents

Hinderances due to pre-existing mental health difficulties

Several students reported their pre-existing mental illness hindering their academic and social life. Some felt restricted by their mental health difficulties as it repeatedly made them avoid completing assignments and social activities. As a result, this led students to feel both isolated and lonely.

“I would later be diagnosed with anxiety, depression and ADHD, which would also add to the development of Emotionally Unstable (or Borderline) Personality Disorder. While I won’t go into the details of these disorders, they had a massive effect on my life, particularly in my first year of University. I barely attended anything in my first term and resigned myself to failure. I didn’t submit assignments or make many friends, and mostly just drank alone. I wasn’t in Oxford. I didn’t have three A-Levels. I didn’t have a good relationship with practically anyone. I eventually dropped out of first year entirely.”—(p. 73, Anon 31)

Adverse life events and/or traumatic events

For some students’ university was not the only factor troubling their mental health, a few students had reported challenging factors such as having to cope with bereavement while at university.

“During my first year, my eating disorder developed into bulimia, my depression reached an all-time low, a relationship ended, and my grandfather died. Add all of these things together, and top it off with a healthy dose of two essays a week (plus learning Old English from scratch), and you can see why I struggled.”—(p. 113, Anon 53)

Another factor which was stated was changes in one’s life either before starting university or during their time at university. Some disclosed that they found coping with both changes in their personal life and university to be difficult and as a result developed mental health difficulties.

“For me, the summer before I started university was the hardest of my life. I lost a lot. My mum had moved half way across the country, my family sold the only home I’d ever known and my friends, destined for universities up and down the country, had to say goodbye. This summer of loss was made only more difficult, by a previous, truly world shattering, loss that occurred during my A-level exams. Four days before my 18th birthday, I lost my big brother to SUDEP (Sudden Unexpected Death in Epilepsy). It was one week before his 22nd birthday.”—(p. 123, Anon 60)

Less Frequent Themes

Social media

Though social media was not a theme, findings brought to light that social media was a contributing factor hindering students’ confidence, mental wellbeing, and university experience. Students acknowledged that the portrayal of other students’ university experience made them question their own. This resulted in some students believing no one else felt how they did, which led to high levels of anxiety, isolation, and students not wanting to seek help.

Discussion

The thematic analysis showed students experienced anxiety due to assignments. Auerbach et al. (2016) also found that assignment related mental health issues were high amongst the student population and affected students’ academic performance and desire to stay in university. This was found to be accurate as students stated the pressure to achieve good grades caused them to experience severe anxiety, made them question their ability, which discouraged them from doing assignments and continuing in university. However, the majority of students identified the pressure did not solely come from university lecturers but was instead mostly caused by self-expectations, fear of disappointing family, and not acquiring future careers. In addition, these feelings were not limited to current students; graduates reported they felt pressured to have their grades and future plans figured out while studying at university and after graduating. Unhealthy work habits were also identified as students stated they neglected necessities such as eating and sleeping due to dedicating an excessive amount of time to their assignments and exams. Furthermore, findings revealed that the lack of support from lecturers caused students to become more anxious about achieving their desired grades.

Similar to Civitci (2015) and Laidlaw et al. (2016) findings that stated that numerous students are leaving the familiar and are somewhat forced to adjust to a new environment, identity, and culture. This study found that a large sum of blog entries acknowledged the first few months at university to be overwhelming because it was some students first time living away from home. Being away from family and friends and having to live with strangers added to some students’ anxiety and made them incredibly lonely as they were subjected to unfamiliar surroundings. A lot of students did not know how to cope with the change which caused a lot of students to suffer from anxiety. Alongside moving out, students found no longer having a routine to be difficult as many had just come from a structured school background and were not confident with the new form of independence that requires them to take on more responsibilities. Moving out has also required the students to form a structure that can aid in managing their responsibilities. This supports Keeling (2003) research which indicated that students coming straight from a structured school environment found it hard to adapt to university life.

Students acknowledged many risk factors causing them anxiety. These risk factors brought to light that there is more to university than academics. This strongly supports Farokhi and Tahmassian (2017) discovery of university students mostly experiencing both social and test anxiety. For some young adults, the lifestyle change was a shock; advertising for social activities was forced onto students before some could become familiar with their new lives. Several students identified social events such as raves and societies as an opportunity to make friends and help adjust to their new student role. However, for others, the thought of interacting and meeting new people was frightening and made them extremely anxious. Also, students also mentioned that they considered lectures and seminars a social environment and were intimidated by the large lecture groups. This supports Macaskill (2013) findings that large class sizes prevent students with the opportunity to socialize with other students and lecturers.

Alcohol was identified as a significant part of the university experience and culture. However, students did not disclose experiencing substance abuse issues instead numerous students stated that they felt pressured to drink, struggled to find other students who did not drink and social activities that did not involve alcohol or clubbing. Davoren et al. (2015) study found that the student population drinks significantly more than non-students and the rest of the public which may result in students developing a substance misuse. This study suggests that this could be due to lack of social options and peer pressure.

Findings also revealed that university was not the cause of some students’ mental health difficulties as some students disclosed that they started university with pre-existing mental health problems and disorders due to previous adverse life events and/or traumatic events. However, those with pre-existing mental health issues stated their experience at university worsened their condition, and also caused them to experience anxiety; due to not wanting to show or disclose with their new friends or other students in general that they had any mental health difficulties. It could be argued that the stigma associated with mental health forces those with existing disorders to keep it secret (Davison et al., 2000). Resulting in university possibly being a harmful experience for those with pre-existing mental health issues, if they feel as though they cannot be themselves. As socializing and friendship is a significant part of university life and students forming a sense of belonging (Davoren et al., 2015; Macaskill, 2013).

Stigma alongside having to interact with a potential counselor or healthcare professional was also found to be a contributing factor to why students did not seek help for their mental health difficulties outside of the internet. Which is in contrast to previous research which suggested stigma did not affect help-seeking behavior in students (Golberstein et al., 2009). However, stigma was not the only reason students refrained from seeking help. Though gender was not a frequently discussed factor amongst students, some students did identify that stigma regarding men rarely experiencing anxiety caused them to refrain from seeking professional help. It was clear from all 120 blog entries that students may prefer blogs and other internet mental health support services over seeking help from university and external services because they allow students to connect with other students or young adults who are experiencing the same issues or have overcome such difficulties, so they can offer relatable and achievable advice.

Existing research suggested finance was a contributing risk factor for some students (Andrews & Wilding, 2004). However, findings suggest that that very few students discussed financial difficulties causing them to experience anxiety. In addition, this study does not have a specific demographic or a large sum of students to account for. Therefore, financial difficulties should not be rejected as a possible risk factor.

Limitations of the Study

The study was limited to using a small number of blogs due to challenges acquiring consent from blog owners. Therefore, the findings from this study cannot be applied to all students attending universities. Also, utilizing blogs as a data source was found to be a hindrance in discovering whether gender is a reported factor in experiencing anxiety as gender was unable to be determined unless stated by students. If this study was to be carried out again in the future, it is recommended that a bigger range of blogs are used and a mixed method study including interviews and a survey with statistical analysis is used for generalizability.

Conclusion and Recommendations

The present study suggests that aspects of university study may result in psychological distress. Both academic and social risk factors can lead university students to experience anxiety while at university and after they have left. Themes such as balancing priorities, Fear of failure, and Critical Incidents are likely to increase feelings of distress and reducing a sense of belonging and support. This may negatively affect student’s mental health.

It is recommended that to improve reducing students’ anxieties, higher education institutions make student mental health and wellbeing a priority issue (Thorley, 2017). A successful way for institutions to do this is for them to consider the quality and implications of their student mental health policies and procedures and understand that students needs differ (Soorkia et al., 2011). Universities UK (2015) states that this can be achieved if institutions involve students’ unions and students with mental health difficulties when formulating and implementing mental health-related policies and procedures. They state through doing so institutions will be able to identify faults and be able to improve. Also, by considering risk factors such as academic pressures, financial hardship, and availability of mentoring and support from lecturers; these factors may reduce the number of students wanting to withdraw due to policies offering appropriate provision and support (Royal College of Psychiatrists, 2011).

Primary prevention and early intervention are also believed to be vital regarding lessening students mental health difficulties and the dropout rate (Royal College of Psychiatrists, 2011). Researchers suggest that due to NHS services often having long waiting lists and not always being able to adapt to students’ schedules, universities should explore implementing mindfulness courses as mindfulness has been found to reduce psychological distress during the examination period (Nunez-Mulder, 2018; Royal College of Psychiatrists, 2011). However, Storrie et al. (2010) suggest that the availability and accessibility of services provided by universities and external services should be examined. Also, the government and universities should increase the amount of funding given to students’ mental health and wellbeing services. More resources will allow institutions to develop the quality and availability of these services. However, lower budgets for universities and the NHS will impact what services can be offered (Thorley, 2017).

Additional challenges in tackling students’ mental health difficulties have been discovered. Currently, no national professional grouping for psychiatrists working with students exists. However, there are informal networks that provide peer support and exchange of information to institutions. It is recommended that the royal college of psychiatrists consider establishing a student mental health special interest group to provide an opportunity for services to develop and further research to be conducted. The group could also offer a formal point of contact between the college and higher education institutions bodies (Royal College of Psychiatrists, 2011). To ensure services are working adequately and are sufficiently resourced, services should be assessed regularly, and ongoing client feedback should be carried out (Universities UK, 2015).

Researchers have recognized that alcohol is a significant part of student life and alcohol misuse amongst students is often linked to anxiety (Chandley et al., 2014; Loxton et al., 2015). Therefore, it is recommended for universities to consider how alcohol misuse makes students vulnerable to sexual violence and victimization and also to evaluate ways they encourage drinking culture. For example, offers on alcoholic beverages on campus and “happy hour.” Lastly, further research into risk factors for students, frequent users of social media, those with a current and history of abuse, psychological trauma, and pre-existing mental health difficulties need to be identified as more knowledge and awareness about the academic and social outcomes in students with mental health difficulties is needed (Royal College of Psychiatrists, 2011).

On a worldwide scale, university is believed to be a significant life-changing experience that should hopefully enable young adults with the skills to transition into adulthood and life after university (Gurbuz et al., 2019). However, findings from this study imply that for some students this is not the case. Nonetheless, this may be able to be improved with more understanding of the links between being a university student and mental health issues. There is still a great need for more research and enhanced practice.