The current study advances scholarly understanding about perceived impact of a range of contextual determinants on common mental health conditions among Canadian university students. Across 19 exposure items, students rated several (i.e. family expectations, family conflict, social exclusion, feeling judged, finding desired employment, paying tuition fees and GPA) as having a moderate negative impact on their overall sense of wellbeing. In our final analysis with depression, anxiety and stress as outcomes, we grouped these determinants to family, interpersonal, social, socioeconomic and political factors with the aim of assisting policy makers in developing programs at the points of leverage. We found several of these factors were significantly associated with one or more of the three mental health conditions and are discussed in detail with suggestions for practical implications.
Family and social factors and GPA were positively associated with depression while political factors and self-rated health were negatively associated with moderate/severe depression levels. Notably, family factor was also significantly associated with moderate/sever anxiety scores. Some of these associations have been previously reported for Canadian students with depressive symptoms, such as academic workload, and limited social support [7, 27], but the impact of family-related factors has not been studied well for Canadian students. Our study makes a unique contribution by highlighting the significance of considering factors of family conflict, obligations and expectations to better understand and promote student mental health. This is an important area given that studies from other high-income countries also report such patterns. For example, the recent WHO college student survey in high income countries  reported significantly higher odds of common mental disorders among students with family problems, and a Finnish study  reported significant association of these disorders with parental divorce, death, and low parental education. Another unique aspect of our study is the inclusion of social factor which examined in a composite manner the potential negative impact ensuing from one’s sexual orientation or feelings of social exclusion and discrimination based on race, gender and ethnicity. The results show that the social factor was significantly associated with students’ moderate/severe depression and stress; a finding not previously documented through a composite measure. In terms of political factors, its negative association found in our study with depression may indicate that people with moderate/severe depression are less concerned about political news and events; perhaps a consequence of reduced interest and engagement among people with depression. The significant association of the students’ self-rated health and the moderate/severe depression scores also highlights the impact of compromised mental health on participants general health. Overall, these findings suggest a need to enhance supportive environment and activities of engagement for students to alleviate symptoms of depression and anxiety. These may include evidence-based programs on coping and stress management for depression, anxiety and stress for university students [7, 29].
Socioeconomic factor in our study (employment, working conditions, paying tuition, commuting, and access to housing and health services) was also a strong predictor of moderate/sever scores of anxiety. Conceptually, this finding is in alignment with other studies that report lack of sufficient income or financial hardship as associated with anxiety [6, 8, 13, 30, 31]. However, the composite variable in our study also included commuting, housing and access to services which could be important sources of worries for students in addition to financial hardship. The urban university from where the sample was recruited is at the north of Toronto and often called a ‘commuter’ university. These findings are suggestive that commuting adds hardship for students and investments in affordable campus residence may alleviate some of their mental stress. The university programs could also enhance efforts in experiential learning so that student’s uncertainty and stress about their future prospects and employment could be reduced; an area that needs further development and research.
Participant age was also a significant predictor of moderate/severe anxiety score in the final model. The age range was wide in our study and we found significant association of younger age (25 and below) with anxiety which might be an indication of the uncertainty younger students feel and experience about their studies and their future compared to older students who might be enrolled for continuing-education after establishing themselves in a career. However, anxiety could also be related to year-of-study (for which we did not have data) indicating more anxiety in the initial years as reported by others [8, 13, 32, 33]. In either case, the finding lends support to directing more resources towards working with younger students.
Finally, the prevalence rates of depression, anxiety and perceived stress are also notable in our study being 39.5%, 23.8%, 80.3% respectively. The prevalence of depression and anxiety are somewhat similar to those reported by Chernomas et al.  for Canadian students. However, the prevalence of perceived stress is high in our sample compared to the above-mentioned study (38%) but more consistent with the findings of the Canadian college survey (60.6%) , and similar to another Canadian study reporting rate of 82% . It is possible that students experiencing stress at the time of the study were more likely to participate leading to some overestimation; nonetheless, the high rate is notable. Considering that chronic stress could affect cognitive functioning and lead to the development of various psychopathologies including burnout, depression and PTSD , this alarmingly high level of perceived stress in the studied sample calls for immediate attention by the educators and health planners to curb the risk of full-blown clinical disorders. In this context, our investigation on multiple contextual determinants as correlates of depression, anxiety and stress could be utilized to develop a holistic and proactive approach towards reducing personal, family and community-based stressors. Such a comprehensive program for students’ mental health would benefit from intersectoral collaborations to leverage resources especially when universities are struggling to provide mental health services .
The study is not without limitations. The survey was conducted as a baseline survey among students selected for a larger trial. The parent trial tested an online mindfulness intervention and the study flyer and announcements described the study as a trial on mindfulness approaches for well-being including mental and physical health; this might have increased the likelihood of participation of students experiencing stress, anxiety or depression. Such a situation might bias the results towards overestimation of prevalence rates of these conditions. However, it was not possible to avoid this due to the nature of the study. The study did not find gender differences in the prevalence of the three mental health outcomes, probably because the sample was largely composed of female students (75%) with only 37 males. Information on year of study—which could be another predictor of the mental health conditions as reported in the literature—was not collected. As any cross-sectional survey relying on self-reporting, the findings should be interpreted with information bias in mind. The sample size was also not sufficient to analyze all of the measured contextual determinants individually, and the grouping in the multivariate analysis might have diluted the effect of some of those factors. Nonetheless, the study is a first step in examining the perceived impact of multiple determinants of these mental health conditions among the university students and has produced valuable results that could help respond to existing problems.