Mental Health Challenges of Nursing Students in an International University Context

Abstract

 This quantitative cross-sectional study examined the prevalence of depression, anxiety, and stress among nursing students and identified academic, financial, psychosocial, lifestyle, and personal factors associated with psychological distress. Differences by academic year and nationality, as well as coping strategies, were also explored. A total of 147 nursing students (≈80% of the population) participated in the 2025 academic year. Psychological distress and coping strategies were assessed using the DASS-21 and Brief COPE inventories, both demonstrating high reliability (Cronbach’s α = .96 and .91). Data were analyzed using descriptive statistics, Pearson correlation, and multiple regression.
Moderate to extremely severe symptoms were reported by 28.5% of students for depression, 54.3% for anxiety, and 25.1% for stress. Adaptive coping strategies—acceptance, positive reframing, and active coping—were most frequently used, while maladaptive coping was less common. Psychological distress did not differ significantly across academic years; however, nationality was significantly associated with depression and stress, with higher levels among Thai and Asian non-Thai students. Emotion-focused and avoidant coping were positively associated with distress, whereas problem-focused coping showed no significant link. Regression analyses identified heavy academic workload and lack of social support as predictors of depression, workload as a predictor of anxiety, personality traits as a predictor of stress, and pre-existing mental health conditions as the strongest predictor across all outcomes. These findings highlight the need for culturally sensitive interventions that reduce workload, strengthen social support, foster adaptive coping, and enable early identification of mental health concerns among nursing students.