A multilevel perspective on university student mental health: a systematic review of determinants and implications for social inclusion

Abstract

Purpose This study aims to synthesise determinants of university student mental health through a multilevel framework and examine their implications for social inclusion. Design/methodology/approach Following preferred reporting items for systematic reviews and meta-analyses 2020, Scopus was searched to 2 June 2026. Of 8,961 records identified, 132 studies met the eligibility criteria. Determinants were classified across seven analytical levels: Individual, Interpersonal, Academic, Institutional, Socioeconomic, Structural and Digital Environment/Technology. Owing to substantial heterogeneity, findings were synthesised narratively without meta-analysis. Findings Individual determinants were most frequently studied (98/132; 74.2%), but 62 studies (47.0%) examined determinants across at least two levels. Interpersonal support, belonging, institutional accessibility, material security, structural equity and digital safety emerged as contexts for mental health. Seventy-nine studies (59.8%) had direct or contextual relevance to social inclusion, although this represented review-level interpretation rather than direct measurement. The evidence base was dominated by cross-sectional studies, limiting causal inference. Research limitations/implications The predominance of cross-sectional studies, reliance on Scopus and limited institutional and digital evidence constrain causal inference and the comprehensiveness of the evidence base. Future research should prioritise longitudinal and multilevel designs and directly measure social inclusion across diverse higher-education contexts. Practical implications Universities should combine individual-level support with relational, academic, institutional, socioeconomic, structural and digital strategies that strengthen participation and safety. Social implications Student mental health should be addressed as a personal and environmental issue in higher education. Originality/value The review integrates a seven-level determinant framework with a social-inclusion lens, reframing student mental health as embedded within interconnected personal and environmental conditions.