Mental_health_problems_in_first_generation_university_students_A_scoping_review.pptx

Mental_health_problems_in_first_generation_university_students_A_scoping_review

1. Mental health problems in first‐generation university students: A scoping review Future research should investigate a wider range of factors contributing to mental health problems in first‐generation university students and how these might form the basis of interventions to improve FGS mental health Donna Smith, Ros McLellan 2023

2. Key concepts mental health mental health problem scoping review United States university students United Kingdom higher education mental health disorder statistics FGCS

3. Abstract Abstract Despite growing concern about mental health problems in university students and increasing recognition that first‐generation university students (FGS) may face additional challenges, there has been no previous attempt to map the existing research on FGS mental health. The aim of this scoping review was to elicit current understanding of mental health problems in FGS from the literature. Following database searches and screening, 40 peer‐reviewed articles were included in the scoping review. Findings from these studies were synthesised for: types of mental health problems in FGS; prevalence of mental health problems in FGS compared to continuing‐generation students (CGS); factors associated with mental health problems in FGS; effects of mental health problems on FGS; help‐seeking for mental health problems in FGS; and interventions. Significant gaps were highlighted and recommendations made for future research, particularly outside the United States. True commitment to widening participation demands much more research on mental health problems in FGS to ensure that they thrive not just arrive. Context and implications Rationale for this study The aim of this scoping review was to map the existing international research on mental health problems in first‐generation university students (FGS). Why do the new findings matter? The scoping review synthesises findings from 40 empirical studies published in peer‐reviewed journals, giving valuable insights into mental health problems in FGS and highlighting significant gaps in our understanding. Implications for higher education researchers and universities The findings of the scoping review are a call to action for future research in this field. More studies are needed, particularly outside the United States, using a variety of research designs to gain a more comprehensive understanding of mental health problems in FGS. This research should be prioritised so that universities are provided with evidence‐based recommendations to mitigate and/or address mental health problems in FGS, thereby helping to ensure that they thrive in higher education.

4. Differs from previous work The number of participants for the included studies varied widely, from one (a qualitative case study) to 58,017. Although previous research highlighted the difficulty in comparing results of FGS studies due to huge variability in definitions of FGS used (Spiegler & Bednarek, 2013;

5. Highlights The prevalence of mental health problems in university students worldwide is well-established and extremely concerning The studies included in the scoping review demonstrated that there is a developing body of work on factors associated with mental health problems in first‐generation university students (FGS), those related to family, finance, the university, and sense of belonging Considering the rapid increase in literature in this area in the last few years, it is likely that additional articles that meet the eligibility criteria have since been published. This scoping review is up to date as of July 2021. This scoping review elicited our current understanding of mental health problems in FGS It is concerning that almost all FGS mental health research has been conducted in the United States, mostly using quantitative methods, and Much more research is needed on a wider range of mental health problems, their prevalence in FGS compared to continuing‐generation students (CGS) and how help-­seeking might be improved in FGS Nine of the studies included in the scoping review found that mental health problems were more prevalent in FGS than CGS, whereas eight studies found that there were no significant differences between FGS and CGS Future research should investigate a wider range of factors contributing to mental health problems in FGS and how these might form the basis of interventions to improve FGS mental health

6. Summary The prevalence of mental health problems in university students worldwide is well-established and extremely concerning. The scoping review synthesises findings from 40 empirical studies published in peer-­reviewed journals, giving valuable insights into mental health problems in FGS and highlighting significant gaps in our understanding. In addition to specific diagnosable mental health conditions, such as those found in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-­5; American Psychiatric Association [APA], 2013), university students experience more general mental health concerns—­for example, stress (Adams et al, 2016), test anxiety (Janke et al, 2017) and financial distress (House et al, 2020). The deleterious effects of mental health problems on university students have serious consequences for academic success in terms of compromised performance and persistence—for example, a US study found that depression was a significant predictor of lower academic achievement and higher probability of dropping out (Eisenberg et al, 2009). Studies were included if they focused on more general mental ill health concerns and problems not found in the DSM-­5 (APA, 2013)—­for example, distress, stress or test anxiety. The quantitative studies included in the scoping review discussed mental health problems that had been determined using self-­report scales, for example the Depression, Anxiety and Stress Scales (DASS; Lovibond & Lovibond, 1995), rather than diagnostic tests such as the DSM-­5 (APA, 2013). Nine studies included in the scoping review found that FGS had significantly more mental health problems than CGS in terms of stress (Simmons et al, 2018), stress and depression (Stebleton et al, 2014; Stebleton & Soria, 2012), anxiety and depression (Keefe et al, 2020; Kroshus et al, 2021), anxiety and financial stress (Cadaret & Rieder Bennett, 2019), acculturative stress (Corona et al, 2017) test anxiety (Janke et al, 2017) and financial anxiety (Potter et al, 2020). Three studies included in the scoping review demonstrated that family support is a protective factor for FGS mental health in terms of stress (Wang & Castañeda-­Sound, 2008), stress and depression (Suwinyattichaiporn & Johnson, 2020) and stress, anxiety and depression (Jeong et al, 2021). In addition to the psychological effects of mental health problems, several studies included in the scoping review demonstrated the repercussions for FGS academic success. The scoping review may reflect that stress, anxiety and depression are the most prevalent mental health problems in university students generally. Evidence from the studies included in the scoping review was mixed on whether mental health problems are significantly worse in FGS than CGS. Much more research is needed on mental health problems in FGS to ensure that widening participation is not just a laudable aim and that FGS thrive as well as arrive

7. Study subjects 255 Undergraduates N = 2 Undergraduate FGS and educatorN = 198 Latin/x undergraduates FGS and CGS sample (43.4% FGS) N = 255 Undergraduates FGS and CGS sample (19% FGS) N = 174 Undergraduates FGS and CGS sample (46.6% FGS)N = 34 Undergraduates FGS sampleAustralia Qualitative Collaborative, relational autoethnographic analysisUnited States Quantitative In person surveyUnited States Mixed methods: Qualitative—­FGS focus groups and interviews (to formulate a family achievement guilt scale) Quantitative—­online survey (to test the scale)United States Qualitative InterviewsMental health problem(s) studied Stress AnxietyAcculturative stress Depression, anxiety and stress Depressive symptomsDepressive symptomsFinancial distress

8. Study analysis British Education Index Records identified from databases (n = 260): APA PsycINFO (n = 95) British Education Index (n = 2) Embase (including MEDLINE) (n = 3) ERIC (n = 55) PubMed (n = 3) Scopus (n = 50) Web of Science (n = 52) United States Mixed methods, focus groups N = 2 Undergraduate FGS and educatorN = 198 Latin/x undergraduates FGS and CGS sample (43.4% FGS) N = 255 Undergraduates FGS and CGS sample (19% FGS) N = 174 Undergraduates FGS and CGS sample (46.6% FGS)N = 34 Undergraduates FGS sampleAustralia Qualitative Collaborative, relational autoethnographic analysisUnited States Quantitative In person surveyUnited States Mixed methods: Qualitative—­FGS focus groups and interviews (to formulate a family achievement guilt scale) Quantitative—­online survey (to test the scale)United States Qualitative InterviewsMental health problem(s) studied Stress AnxietyAcculturative stress Depression, anxiety and stress Depressive symptomsDepressive symptomsFinancial distress

9. Future work Significant gaps were highlighted and recommendations made for future research, outside the United States. True commitment to widening participation demands much more research on mental health problems in FGS to ensure that they thrive not just arrive. Implications for higher education researchers and universities. The findings of the scoping review are a call to action for future research in this field. More studies are needed, outside the United States, using a variety of research designs to gain a more comprehensive understanding of mental health problems in FGS. This research should be prioritised so that universities are provided with evidence-­based recommendations to mitigate and/or address mental health problems in FGS, thereby helping to ensure that they thrive in higher education. Recourse to existing international research is challenging because there has been no attempt to collect and map the literature in a systemised manner. This paper explores what is known about mental health in FGS from a scoping review of the literature, identifies gaps in knowledge and makes recommendations for further research. A scoping review is the most suitable method for this because it provides a broad overview of FGS mental health research from multiple disciplines (medicine, education, psychology, sociology) and multiple study designs. The aim of the scoping review was to elicit current understanding of mental health problems in FGS from the literature. The following research questions were formulated after consulting existing scoping reviews on mental health problems in other populations: (1) What types of mental health problems in FGS are discussed in the literature? (2)Are mental health problems more prevalent in FGS than CGS?. A further study demonstrated the influence of external personal factors (environmental) on FGS mental health. Miller-­Graff et al (2015) found a significant relationship between FGS status and high childhood exposure to violence, which was associated with greater depression, anxiety, stress and PTSD symptomology. Future studies should employ mixed methods or qualitative designs since straightforward quantitative measurement of mental health problems may not adequately address prevalence concerns. Shields (2002) found no differences in stress levels between FGS and CGS, but valuable insight about the types of stress they experienced came from the qualitative part of the study: whereas FGS felt less prepared for university than CGS, CGS felt greater parental pressure to succeed than FGS. Future research should use longitudinal designs to explain or elaborate on cross-sectional studies. Kroshus et al (2021) demonstrated that FGS had higher depression and anxiety levels at baseline than CGS, but they did not have a bigger increase in depression and anxiety during the first year of university overall. Future research is needed to determine whether these factors are context-­specific since almost all the studies included in the scoping review were in the United States. Before measuring the influence of specific factors on FGS mental health, qualitative work should be carried out to determine what those factors are, according to FGS themselves. Without this we cannot be sure that the factors being studied are those that are most pertinent to FGS. Quantitative studies give little sense of the reality of FGS lives and qualitative studies may redress this. Much more research is needed to investigate the environmental and systemic issues that are associated with mental health problems in FGS—­for example, Miller-­Graff et al (2015) is the only study included in the scoping review on personal environmental factors influencing mental health (exposure to childhood violence). This is extremely concerning and requires urgent further research because it threatens to undermine the aims of access and participation. Recent UK research shows that being first in family to attend university is associated with compromised academic success (performance and persistence) even after controlling for prior educational attainment, socioeconomic status and individual characteristics such as gender, ethnicity or special educational needs (Adamecz-­Völgyi et al, 2020; Henderson et al, 2020). Evidence from the findings of this scoping review suggests that mental health problems may explain compromised FGS academic success. More research is required in this area to ascertain whether efforts to increase help-seeking for mental health problems in university students need to take account of additional barriers faced by FGS. This is important if mental health problems are worse in FGS and their repercussions more serious. More research is needed, in countries outside the United States, using a variety of methodological designs to try to better understand what an effective intervention for FGS mental health might be, based on what the problems are and what contributes to or mitigates them. It is clear that there are significant gaps in our understanding of mental health problems in FGS from the literature and these must be prioritised in future research. It is concerning that almost all studies were carried out in the United States and most used quantitative designs. Further research is urgently needed, outside the United States and utilising a wider variety of methods to obtain a more comprehensive picture of FGS mental health. The rapid increase in research studies (half of the articles included in the scoping review were published in the last 2 years) demonstrates growing recognition that this topic is important and it is hoped that these gaps in our understanding of FGS mental health will be prioritised for urgent research. More research is needed on a wider range of mental health problems (stress, anxiety and depression dominate the literature), their prevalence in FGS compared to CGS (the existing literature is inconclusive) and how help-­seeking might be improved in FGS. Future research should investigate a wider range of factors contributing to mental health problems in FGS (informed by FGS experiences) and how these might form the basis of interventions to improve FGS mental health. This is vital because in addition to deleterious psychological effects, mental health problems negatively impact academic success, both performance and persistence, and thereby undermine the aims of widening participation. Much more research is needed on mental health problems in FGS to ensure that widening participation is not just a laudable aim and that FGS thrive as well as arrive.