Exploring the mental well-being of higher educational institutions students: a bibliometric analysis

Abstract

Mental health and well-being are vital for the success of students, especially in higher education contexts. The last decade has witnessed a growing concern related to the mental health and well-being of higher education institutions (HEIs) students worldwide. However, the literature related to this research domain remains fragmented and diverse despite the advancement in this domain of research. The present study aims to provide insight into the research conducted in this area in the last two decades, i.e., 1993 to 2023. Scopus database was used to arrive at the key research articles, identified through a thorough keyword string search. Citation and co-citation analysis were conducted to arrive at the results and analysis of the study. The results of the study reveal that the number of documents has shown an upward trend, especially a steep increase since 2020 that indicates the social and economic consequences of COVID-19 have accelerated mental health-related challenges. Also, no country with a low-income economy has contributed to this domain which raises the concerns regarding the health of students residing in developing countries. The co-citation network reveals five clusters that represent key research clusters and emerging trends in mental well-being and HEIs students. The five themes are mental health: an overview; role of higher education institutes in promoting good mental health; stress and depression in students; effect of COVID-19 on mental well-being; and diet and mental well-being. future research opportunities are also discussed.

Keywords:

• Mental well-being
• higher educational institutions (HEIs)
• students
• bibliometric analysis

REVIEWING EDITOR:

• Stephen Darwin, Universidad Alberto Hurtado, Chile

SUBJECTS:

• Higher Education
• Education - Social Sciences
• Teaching & Learning - Education

1. Introduction

The World Health Organization (2022) defines health as,

“a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

The above definition clearly describes that not only physical but also mental health is an integral and indispensable component of the inclusive health of an individual. Mental health is a state of well-being and is more than the absence of mental disorders. It is a fundamental part of health and is ‘fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living, and enjoy life’ (WHO, 2022). Mental Health or well-being is an integral and essential part of an individual’s overall health (Bhugra et al., 2013). According to WHO (2022), good mental health enables individuals to ‘connect, function, cope and thrive’ in a better fashion. Indeed, WHO has classified mental health as a basic human right. The WHO proposition that there can be ‘no health without mental health’ has received wide acceptance around the world and has motivated various stakeholders to dig deep into this domain.

The importance of mental health has also been escalated because of the various challenges posed by the COVID-19 pandemic. A report published by WHO in the year 2022 has described mental health as ‘a growing crisis’. For example, it was estimated that there has been a 25% rise in anxiety as well as depressive disorders in the very first year of the pandemic. Also, mental health services and the treatment gap for mental health conditions have widened. Unfortunately, approximately half the world’s population lives in nations where there is just ‘one psychiatrist to serve 200,000 or more people’ (WHO, 2022). Thus, there is a strong need to integrate mental health and its awareness to various aspects of ‘health and social policy, health-system planning, and delivery of primary and secondary general health care’ (Prince et al., 2007).

The last decade has witnessed a growing concern related to the mental health and well-being of higher education institutions (HEIs) students worldwide as the mental health and well-being of a student impacts the experience, satisfaction, involvement, presence in class, achievement, and future occupational performance directly (Boaden, n.d.). Hernández-Torrano et al. (2020) advocated that mental well-being has been a hot topic of discussion universally due to three interrelated challenges. First, there has been growth in help-seeking behavior among university students around the world. Second, mental well-being is strongly associated with short-term (such as poor academic performance, engagement and attendance) and long-term (such as dropouts and less income) implications. Thirdly, HEIs are perceived as centers that can use a single integrated setting to promote academic, professional, social, health, and other related activities. Thus, HEIs can play a pivotal role in creating an environment for the holistic development of students. HEI’s play an important role in shaping the mind set of students and therefore should have sound practices, policies and interventions in place for sound mental well-being of students.

Unfortunately, the social and economic consequences of COVID-19 have accelerated the mental health-related challenges (Leshner, 2021). The social isolation associated with the pandemic negatively affected the daily life and the well-being of students (Lukács, 2021, Nurunnabi et al., 2020). The study reveals that the lockdown, self-isolation, and social distancing associated with the COVID-19 pandemic are detrimental to the health of individuals and are an area of concern with respect to the health and well-being of students.

According to the ‘Student Academic Experience Survey’ (2021) by Neves and Hewitt (2021), poor mental health is the biggest reason students quit their studies and leave the life-changing golden opportunity that higher education provides them. Poor mental health can be the result of the roadblocks faced by students due to multiple intersectional factors during their academic journey at their institutes and universities (Okoro et al., 2022). Getting admitted to a university program brings a lot of opportunities as well as challenges in the life of a student. During this transition phase, students have to make decisions related to their lives and studies independently, adjust to the new academic environment and demands and interact with people from varied backgrounds and walks of life (Hernández-Torrano et al., 2020). Students often leave their homes for the first time and leave their comfort zones and support networks (Cleary et al., 2011). These changes may be challenging and can affect the mental well-being and health of students enrolled in higher education programs. Past studies have also confirmed the increased probability of experiencing psychological problems (e.g. stress, anxiety, depression, etc.) during adolescence and reaching the peak in early adulthood i.e. around the age of 25 (Kessler et al., 2007). The results of the study by Evans et al. (2018) confirm that graduate students are more vulnerable to depression and anxiety when compared to other strata of the population. This probability can be as high as six times when compared to the general population.

Past researchers have attempted to synthesize the knowledge related to basic concepts such as mental disorders (Kessler et al., 2007), perceived barriers, and facilitators in mental health-related help-seeking behavior (Gulliver et al., 2010; Hunt & Eisenberg, 2010) and psychological distress among university students (Sharp & Theiler, 2018). Most of these studies have used traditional content analysis. Mental well-being has been an area of interest for many researchers. The rising number of articles in this domain (demonstrated in Figure 1) shows that it is an important and relevant area of research. There have been numerous definitions of mental well-being (as shown in Table 1). The researchers converge with these definitions. Mental well-being plays an important role in the scholarly environment (Okoro et al., 2022). Discussions around mental well-being prompt academicians, counsellors, administrators, academic advisors and policymakers to design early intervention strategies, provide an inclusive learning environment and take effective measures for the mental well-being of students. In this study, the researchers have used bibliometric analysis which aids in the systematic and objective discovery of various knowledge flows and patterns in the area of research interest. Bibliometric analysis is a well-established method that helps to explore and analyze a large amount of research. It helps to trace how concepts have evolved over a period of time as well as highlights the emerging areas of research. It enables us to unpack the evolutionary nuances of a specific field while shedding light on the emerging areas in that field. The use of Bibliometric analysis reveals important factors that strengthen the contributions of a study in the research area under study (Akhavan et al., 2016). Considering the large volume of research in the area of mental well-being of students in HEIs, bibliometric analysis would provide useful insights into the existing scholarly literature by identifying key sources, countries that have contributed to this area of research, the network maps and thematic evolution over a period of time. The results derived out of bibliometric analysis have implications for strategizing and formulating policies that would help mitigate the negative consequences of poor mental well-being. The following section presents the research question that the present study delves into.

Figure 1. Number of documents year-wise (Source: Scopus).

Table 1. Definitions of mental well-being/mental health (compiled by the author).

S. No	Definition	Reference
1	Mental Health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in.	(WHO, 2022)
2	A dynamic state of internal equilibrium which enables individuals to use their abilities in harmony 231 with universal values of society. Basic cognitive and social skills; ability to recognize, express, and modulate one’s own emotions, as well as empathize with others; flexibility and ability to cope with adverse life events and function in social roles; and harmonious relationship between body and mind represent important components of mental health which contribute, to varying degrees, to the state of internal equilibrium.	(Galderisi et al., 2015)
3	Mental health is the capacity of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections, and personal dignity.	(Public Health Agency of Canada (PHAC), 2006)
4	Mental health is the ability to adapt and self-manage.	(Huber et al.,2011)
5	The state of mental health implies that the individual has the ability to form and maintain affectionate relationships with others, to perform in the social roles usually played in their culture and to manage change, recognize, acknowledge and communicate positive actions and thoughts as well as to manage emotions such as sadness. Mental health gives an individual the feeling of worth, control and understanding of internal and external functioning.	(Bhugra et al., 2013).

1.1. Research questions

Mental health and well-being are vital for the success of students, especially in higher education contexts (Leshner, 2021). Academic literature on mental well-being has received considerable attention in recent years. A study of the Scopus database showed that research has been across multiple disciplines of education, nursing, health care, psychology and sociology, which indicates the multidisciplinary scope of this area of research. In this study, the researchers have attempted to provide a bird’ s-eye view of existing research to identify the journal sources, key countries that have contributed to this domain of research, most cited articles and trending topics. This thematic overview would provide a comprehensive understanding of this diverse area of research.

The current study follows the steps laid down by bibliometric analysis (Donthu et al., 2020) to address the following research questions:

RQ1: How has the literature on mental well-being in students enrolled in HEIs progressed and what are the trends in this domain of research?

This research question will explore Country dynamics, Word dynamics, Source Dynamics, Article Dynamics, and Thematic Map Analysis. This would help to examine the frequency and patterns of citations within literature published in this domain. The sub-research questions for RQ1 are:

• Which are the most influential journals in this area of research?

• Who are the most cited authors and which are the most cited articles?

• Which countries have contributed the most to this area of research?

• What are the trending topics over the period of years?

RQ2: What are the key research areas and emerging trends in the domain of mental health and well-being in HEIs students?

This research question would explore a co-citation analysis through the co-occurrence of author keywords. This would help to identify clusters that would provide valuable information into the intellectual structure of research that would provide direction for future research in this domain.

2. Literature review

2.1. Mental well-being-definitions

Various researchers and organizations have defined the term mental well-being in multiple ways. Therefore, a general agreement on one definition is difficult to trace. Also, the terms mental well-being and mental health are being used interchangeably in past literature. Table 1 presents a few definitions of interest for the present study.

The researchers appreciate the diverse perspectives on mental health and would like to conclude that mental well-being is a state of internal awareness and equilibrium. It is the ability to express and cope with stress; this would enable one to channel positive emotions that would enhance one’s self-esteem and self-worth.

2.2. Mental well-being of HEI students

The holistic approach to education encompasses the well-being of learners’ minds, bodies, and spirits i.e. psychological, social and mental aspects (Agrawal & Sharma, 2022). It is important to note that the life of HEI students has its challenges but at the same time, it acts as a bridge for their successful future. In other words, college years inculcate vital professional, vocational, and life skills in students. At the same time during these years, they develop a sense of themselves and their involvement in the world (Ozer & Schwartz, 2020). Thus, these years act as a foundation stone for their future success and accomplishment. Therefore, the well-being of students in higher education is a matter of attention and focus and higher education institutes can play a key role in the holistic development of students enrolled in HEIs. According to Botha et al. (2019), the overall well-being of the student population is reflected in their emotional, psychological, social, spiritual and physical well-being. Also, self-perception of well-being plays a vital role in improving the quality of a university student’s life. A study by Ozer and Schwartz (2020) examined the relationship between ‘academic motivation, features of emerging adulthood, and psychological adaptation to life satisfaction, psychological well-being, and perceived stress among students’ enrolled in a Danish University. The results of the study revealed a direct and positive association of autonomous motivation with life satisfaction, as well as a direct negative association between controlled motivation and psychological well-being. The results underline that not only should vocational competencies be given importance while designing educational curricula, but personal interests and motivation need to be considered equally.

A study of medical student mental health at the University of Liverpool revealed amplified amounts of stress in medical students compared to students from other disciplines. Also ‘perceived stigma surrounding mental health continues to prevent students seeking help over concerns this might have upon academic progress’ (Simpson et al., 2019). Past studies have also explored the impact of COVID-19 on the mental health of students enrolled in HEIs (Kecojevic et al., 2020; Savage et al., 2020; Son et al., 2020). A study conducted on a large sample by Gray et al. (2020) revealed ‘clinically recognizable psychological stress as an after-effect of the pandemic’ in 16 + age group individuals. Another study conducted by Defeyter et al. (2021) on the mental well-being of UK higher education students during COVID-19 revealed that a substantial proportion of UK students face a low level of mental well-being. A cross-sectional study was conducted in Malaysia to examine the impact of COVID-19 on the anxiety level of university students. The study found an increased level of anxiety in students, especially due to financial insecurities, uncertainty in academic performance and future career options, and challenges faced while adopting an online learning environment.

The above discussion clearly indicates that concerns related to the mental health and well-being of HEIs students have increased substantially during the pandemic and post pandemic period. There still exists a stigma which does not permit free conversations around mental well being, It is important for HEI’s to provide an open and inclusive environment that would encourage open dialogue. Capacity building to sensitize stakeholders is also vital. This indicates a strong need for immediate intervention strategies, as the mental well-being of students is imperative for holistic development of students.

3. Research methodology

The present study uses bibliometric analysis as a tool to analyze the data. Bibliometric analysis provides an effective tool to understand and determine knowledge drifts and patterns in a particular area of research (Van Raan, 2014). Also, it aids in shaping future research directions. Pritchard (1969) is credited with the introduction of Bibliometric analysis and referred to it as ‘the application of mathematical and statistical methods to books and other means of communication.’ Since then it has gained acceptance by the academic and research fraternity and is widely used in multidisciplinary research. The popularity of this tool lies in its ease of use, comprehensive and interesting insights it provides related to influential authors, sources, countries, network of collaborations between authors, co-authorship, countries and much more (Donthu et al., 2020).

3.1. Data collection

The vital aspect of bibliometric analysis is data collection. The present study uses the Scopus database to search the relevant documents. Scopus database is one of the renowned databases by Elsevier that was launched in the year 2004. Scopus contains more articles when compared to any other academic database (Veloutsou & Mafe, 2020). Scopus covers over 28 thousand titles from more than 7000 international publishers representing 240 disciplines (Elsevier, 2024). Also, this database is comprehensible and facilitates multiple inclusion and exclusion criteria which are vital for getting a more refined study. Researchers can rely on the quality standards of the documents indexed in the Scopus database as a rigorous peer review and screening process is followed by Scopus-indexed journals. The ease of downloading data and the facility to download multiple information such as the name of the authors and their affiliations, journal name, year of publication, document type, citations received, authors’ keywords, and so on, which smoothens the process of bibliometric analysis made it the first choice for data collection by researchers.

One of the most important steps in bibliometric analysis is the identification and use of accurate keywords that can retrieve accurate results from the database. For the present study, the researchers deeply examined the literature related to emotional and mental well-being and HEIs. This helps in the identification of relevant keywords for searching. The in-depth literature review revealed some commonly used keywords such as emotional well-being, mental well-being, mental health, psychological well-being, and psychological resilience. The search field ‘title, abstracts and keywords’ was used and Boolean Operators ‘AND/OR’ were applied to the identified keywords. Before deciding on the final keywords, the use of pertinent BOOLEANs was looked at. The first search string was TITLE-ABS-KEY (‘emotion* wellbeing’ OR ‘mental well-being’ OR ‘mental health’ OR ‘psychological well-being’ OR ‘psychological resilience’) AND TITLE-ABS-KEY (‘HEI’ OR ‘higher education* Institut*’). The initial search yielded 554 documents. In the next step the document type was limited to ‘article’, language ‘English Language’, and documents that have been published (Final) and are in ‘Journal’ filters were applied. This resulted in 394 documents. The search was conducted on 16^th October 2023 and the results were retrieved from Scopus in a comma-separated (.csv) file. Table 2 summarizes the search syntax used.

Table 2. Search syntax on Scopus.

Data Source	Search Syntax
Scopus (www.scopus.com)	(TITLE-ABS-KEY (“emotion* wellbeing” OR “mental well-being” OR “mental health” OR “psychological well-being” OR “psychological resilience”)
	AND TITLE-ABS-KEY (“HEI” OR “higher education*) AND
	(LIMIT-TO (PUBSTAGE, “final”)) AND (LIMIT-TO (DOCTYPE, “ar”)) AND (LIMIT-TO (LANGUAGE, "English")) AND (LIMIT-TO (SRCTYPE, "j"))

3.2. Data analysis

Biblioshiny and Vos Viewer were used for the attainment of the results in the study. VOSViewer is a bibliometric visualization tool that displays bibliometric maps that are easily interpretable. The Biblioshiny app is a Bibliometric package of the R-tool software that aids in data analysis, reduction, visualization and mapping. The next section discusses the results of data analysis and is divided into three parts—overview of the results, citation analysis and co-citation analysis.

4. Results and Discussions

The following section provides insight into the result and is split into three parts, i.e., Overview of the Results, Citation Analysis and Co-Citation Analysis. The study findings are discussed with the help of tables, graphs, Biblioshiny outputs and VoS Viewer outputs. To understand the current publication trends and progress of literature in mental health and well-being in students enrolled in HEIs and answer the first research question, the study took into consideration 394 documents published in 264 journals from 1994 to Oct 2023. To answer the second research question, i.e., the key research areas and themes emerging in this research domain, the researchers conducted a cooccurrence of authors’ keyword and co-citation analysis.

4.1 Overview of the results

Table 3 presents an overview of the results. Three hundred ninety-four documents were published in 264 journals from 1994 to 2023 (As on 16^th October 2023). There were 1591 authors from 85 different countries who contributed to this area of research. All the 394 documents are articles published in Scopus-indexed Journals.

Table 3. An overview of Scopus results (Surce: Author Compilation).

Parameters	Results
Time frame	1993–2023 (As on 16^th October 2023)
Sources	Scopus Indexed Journals
Number of Sources	264
Type of documents	Articles published in Scopus-indexed journals
Number of documents	394
Annual growth rate	16%
Number of authors	1591

4.2. Citation analysis

4.2.1. Growth in the number of documents

As depicted in Figure 1, the number of documents published in this area of study started picking up after 2012 and has seen a steep increase since 2020. The trends reveal the increasing interest of researchers in this domain. The sharp increase in the number of documents during and after the pandemic of COVID-19 demonstrates the impact of COVID-19 on the mental health and well-being of the individuals.

4.2.2. Country dynamics

The United Kingdom leads with 94 publications followed by the United States, Brazil, India, and South Africa with 67, 29, 26 and 25 publications respectively. Figure 2 depicts the same in terms of documents and citations received by these documents for the respective countries.

Figure 2. Country dynamics: documents and citations received (Source: Scopus).

The top countries that are publishing in this area are given in Table 4. As per the World Bank, the countries are divided into four different economies for the Financial year 2024 based on their GNI (Gross National Income) per capita in 2022. The four different economies are low-income economies, lower-middle-income economies, upper-middle-income economies and high-income economies. Out of the 12 top countries in terms of the number of publications, five countries are classified as high-income economies, five countries are classified as upper-middle-income economies and two are classified as lower-middle-income economies. There is no country with a low-income economy in the top twelve. Ethiopia is the first country from low-income economies in this list at 27^th position with four publications.

Table 4. Classification of countries as per their economies (Source: World Bank Country Classification).

Country (In order of number of publications in descending order)	Type of economy
United Kingdom	High-income economy
United States	High-income economy
Brazil	Upper middle-income economy
India	Lower middle-income economy
South Africa	Upper middle-income economy
China	Upper middle-income economy
Malaysia	High-income economy
Canada	High-income economy
Australia	High-income economy
Ireland	High-income economy
Turkey	Upper middle-income economy
Ukraine	Lower middle-income economy

4.2.3. Word dynamics

Author keywords are a set of keywords selected by authors that they believe best represent the content in their paper. They are also a tool to help researchers, search engines and indexers find relevant papers. The top five most frequently used author keywords in this area of study are COVID-19, mental health, higher education, student and stress (please refer to Figure 3). It is interesting to note that the top keyword is COVID-19 which first made its appearance in the database in 2020 and emerged as the most frequently used keyword in a database that spans from 1994 to 2023. Mental health was used as an important keyword in the past but gained significance since 2015. Similarly, though student, higher education and stress were important keywords in the area of study they became significant focus areas after the year 2019.

Figure 3. Word frequency over time (Source: Authors elucidation using Biblioshiny).

This is also reflected in the trend topics (Figure 4). There is a visible change and focus on mental health, depression, higher education and students post the pandemic. The pandemic brought sudden, extreme, and accelerating changes in many phases of life. Higher education systems at all levels had to cope with these changes. Many institutes were shut down and they had to re-think teaching-learning tools. Faculty and students had to re-learn and re-imagine university life. Mental and emotional well-being was also one of the areas which got the collective attention of the world.

Figure 4. Trend topics over the years (Source: Authors elucidation using Biblioshiny).

4.2.4. Source Dynamics

As per the Scopus database, articles on the area of study were published in 264 Journals. Table 5 shows the different parameters of the top ten journals. International Journal of Environmental Research and Public Health has published thirty articles on the subject. All other journals have published articles in single digits. As per the Cite score (which is a way of measuring the citation impact of Journals), the Journal of the Academy of Nutrition and Dietetics has a cite score of 6.8. BMC Public Health has an SNIP score of 1.661 in 2022. SNIP or source normalized impact per paper is the ratio of a source’s average citation count per paper and the citation potential of its subject field.

Table 5. Top Journals according to number of articles published.

Sources	Articles	Cite Score 2022	Scimago Journal Rank	SNIP 2022
International Journal of Environmental Research and Public Health	30	5.4	0.828	1.28
Frontiers in Psychology	9	4.5	0.891	1.422
Revista Brasileira De Enfermagem	8	1.5	0.271
Journal of Mental Health Training, Education and Practice	7	1.6	0.323	0.493
Plos One	7	6	0.885	1.253
Frontiers in Education	6	2.3	0.661	1.329
Nurse Education in Practice	5	4.9	0.765	1.334
BMC Public Health	4	6.1	1.307	1.661
Journal of The Academy of Nutrition and Dietetics	4	6.8	1.162	1.45
Nurse Education Today	4	5.5	0.946	1.622

Source: Scopus.

Further using Bradford’s law (Figure 5), it is seen that out of a total of 264 Journals, 28 Journals are in Zone 1 contributing to 131 articles out of 394 articles, 106 journals are in Zone 2 contributing 133 articles and 130 Journals are in Zone 3 contributing 130 articles.

Figure 5. Core sources by Bradford’s Law (Source: Authors elucidation using Biblioshiny).

4.2.5. Article Dynamics

Figure 6 shows the most cited articles in the area of study.

Figure 6. Most cited documents (Source: Scopus).

‘Impacts of COVID-19 Pandemic on Life of Higher Education Students: A Global Perspective’ is the most cited paper with 878 citations (Aristovnik et al., 2020). The paper presents the perspectives of students on how COVID-19 impacted their lives. The paper titled ‘Knowledge, Attitudes, Anxiety and Coping Strategies of Students during COVID-19 Pandemic’ has 261 citations and examines students’ anxiety, coping strategies during the pandemic, and the need to address student’s mental health by Higher education Institutes (Baloran, 2020). The paper titled ‘Psychological Well-being and Academic Experience of University Students in Australia during COVID-19’ also traces the effect of the pandemic on the well-being of postgraduate and undergraduate students (Dodd et al., 2021). The top three papers deal with emotional distress due to the pandemic. Low morale and the rising number of mental health cases among academics were the focus of the paper titled ‘Ableism in Academia: Where are the Disabled and Ill Academic?’ (Brown & Leigh, 2018). Better understanding and need for better policy to monitor and prevent suicide and psychological distress was highlighted in the paper titled ‘Suicidal Behavior and Psychological Distress in University Students: A 12-Nation Study’

4.2.6. Thematic Map Analysis

A thematic map analysis provides a pictorial representation of the different themes based on research in this domain (Figure 7). To understand the themes, 75 author keywords were selected with a minimum frequency for the cluster maintained at 10 per thousand documents. The size of the circle depicted the number of keywords in that cluster. The thematic map has two dimensions- centrality and density. Centrality indicates the importance of the theme in the domain and density measures the theme’s potential to develop sustain and contribute to the domain. ‘Mental health’ was the most prominent with 18 author keywords and 417 cumulative occurrences. ‘Stress’ was the next important cluster with 12 independent author keywords and 12 cumulative occurrences. ‘Diet quality’ with 7 author keywords and 40 cumulative occurrences was in third position. There were nine clusters in total.

Figure 7. Thematic map (Source: Biblioshiny).

A maximum number of themes were located in the ‘Basic theme’ quadrant. This quadrant has high centrality and low density which means the themes located in this quadrant are foundational, transversal, and vital for transdisciplinary issues. The theme ‘Student mental health’ has significant relevance, is well developed, and has the potential to structure the research domain if it continues its movement to the quadrant of motor themes. The theme ‘diet quality’ also shows the potential to shape the area of research as it has significant relevance, is well developed, and is located at the border of niche themes and motor themes. Motor themes have high centrality and high density, and themes in this quadrant are well-developed and represent the driving themes. The absence of themes in the quadrant of motor themes signifies that this domain of research needs the focus of academics, researchers and policymakers.

4.2.7. Three field plot

Three field plots were used to understand the relationship between countries, author keywords and sources (refer to Figure 8). The height of the box is proportional to its significance and the width of lines between the nodes is proportional to the number of connections. Among the countries, the United Kingdom is the most active country, and all the top author keywords are used by the authors of the country. This is followed by the USA and Brazil. Mental health and COVID-19 are important keywords. The above observation is in sync with the analysis of Country dynamics and Word dynamics.

Figure 8. Three field plots between Country, Author Keywords and Sources. (Source: Biblioshiny).

4.3. Co-citation analysis

4.3.1. Co-occurrence of authors’ keywords

Co-occurrence is a network that helps to analyze potential relationships between different entities. The co-occurrence of author keywords helps identify the most popular topics covered in the defined area of research and the emerging trends of research. VoS Viewer was used to construct this map. The author keywords are represented by nodes and their size is directly related to the number of times the keyword appears in the documents. The network thus constructed is a representation of the cumulative knowledge of a domain (Figure 9).

Figure 9. Co-occurrence of author keywords network map.

Further, for analysis, we clubbed the exact sounding and exact meaning words together and set the minimum occurrence of keywords to 5. Out of 1080 keywords,32 keywords met this threshold value. Overall, we had 32 keywords divided into 5 clusters with 32 items, 180 links and 611 link strength. The top three keywords according to link strength were: COVID-19, Mental Health and Student.

Cluster 1: Mental health: an Overview

World Health Organisation has defined mental health as ‘a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well work, and contribute to their community’ (WHO, 2022). Higher education Institutes have the potential to be hubs of health promotion. Interestingly, past studies have validated that gender affects the mental health of an individual. Transgender students were found to report more psychological burdens than cisgender students. Compared to male students, female students reported greater psychological distress (Abigail Reid et al., 2023; Anderssen et al, 2020; Bickerdike et al., 2019). The psychological state also influenced body perception directly (Ozalp & Akbulut, 2022). The mental health of faculty and staff is as important as students’ mental health. Challenges in remote teaching during the pandemic were associated with faculty mental health. Female faculty reported greater challenges in remote teaching. Perception of inclusion was an important factor with men more inclined to perceive the work environment as inclusive (Innstrand & Grodal, 2022). Positive health promotion strategies for students included studying, physical activities, social networking, cooking, and listening to music during the pandemic (Oliveira et al., 2022). Mental health interventions can be effective in helping students with their mental health. Among the various intervention tools, some new suggested tools are health promotion software and programs using the positive mental health models (Baldassarini et al., 2022; O’Brien et al., 2020; Sokołowska et al., 2018).

Cluster 2: role of higher education Institutes in promoting good mental health

The well-being of students in higher education has been a matter of attention and focus. Education Institutes can play a key role in the holistic development of young students. Cluster 2 explores the different perspectives on students’ well-being in institutes of higher education. The need was felt to destigmatize mental illness and have differential and inclusive approaches rather than a single model (Lister et al.,2020). Assistive technology helped in areas of competence, adaptability, and self-esteem for students with disabilities (McNicholl et al., 2023). Good relationships, social support and resilient capacity were some factors in promoting good mental health (Moraes et al, 2021; Sousa et al, 2022, Morris, 2021). Studies also found that people bereaved by suicide were less likely to receive informed support and delay in accessing support compared to those who were bereaved by other causes. A strong need for appropriate resources on campus to promote well-being is advocated (Kim & Crowley, 2021; Pitman et al., 2017). Institute environment which encourages frequent and personal interactions were found to be more approachable to students. Universities and Institutes need to adopt methods and allocate resources for a participatory and inclusive approach to promote the mental well-being of students in higher education (Gaddis et al., 2020; Lister et al., 2022).

Cluster 3: Stress and depression in students

Cluster 3 explores the various factors of depression and stress. Stigma and judgment by others were perceived as barriers to seeking help for mental well-being. Challenges were rather universal with ethnicity not being a determining factor of anxiety and depression (Cho et al., 2021; Simjee et al, 2021). Financial aid, academic performance, career preparedness, perceived stress and resilience were some of the identified predictors for stress and depression among students (Catling et al., 2022; Sun, 2022). Vitamin D deficiency was also associated with depression and anxiety. While a study supports the role of dieticians in the management of patients suffering from anxiety and depression, another study found no association between diet quality, BMI and mental health problems (Forsyth et al., 2015; Prasath et al., 2022; Sharifan et al., 2023). Exploring the transdisciplinary dialogue between ecology, design, and public to promote and create an environment for positive mental health and well-being has also been discussed (Azhar et al., 2023; Kiers et al., 2023).

Cluster 4: effect of COVID-19 on mental well being

COVID-19 was a once-in-a-century pandemic that disrupted all facets of life globally. The education sector too faced challenges. Cluster 3 explores the challenges faced by higher education during the pandemic. Faculty, staff and students dealt with various barriers and challenges. Some challenges faced by faculty were adapting to the new digital technology, worsening mental health, struggling with imposed restrictions, and increased workload. Similarly, students also struggled with the shift to online education. Lack of professional and social experiences due to restrictions and isolation led to lowered mood and loneliness in some students (Augusto et al., 2023; Knight et al., 2021; Winters et al., 2023). International students struggled on many fronts. While local students had their families with them, international students faced practical, academic and psychological challenges along with hesitation to seek help (Al-Oraibi et al., 2022). While the pandemic affected all, in a study done on a global scale, it was found that female, full-time, first-level students and students with financial problems struggled with their emotional lives during the pandemic (Aristovnik et al., 2020). Lack of infrastructure and an unconducive learning environment also affected the mental health of students belonging to the vulnerable group especially in least developed and developing nations (Jafar et al., 2022). Online learning was identified as a potential to help access education for all but information overload, perceived technical skill requirements and lack of social interaction were some of the identified difficulties (Conrad et al., 2022; Voitovska et al., 2023). The importance of timely and proper communication was also identified as a potential tool that can increase inclusivity and awareness of mental well-being (Blake et al., 2021).

Cluster 5 diet and mental well-being

Cluster 5 explores the role of diet in mental well-being. The lower number of physician visits for depression was directly associated with a high-quality diet. Similarly, good diet quality had a direct positive relation with the ability of individuals to cope with adversity. Dietary interventions for economically disadvantaged pregnant women also indicated improvement in mental health (Wang et al., 2023). In contrast, significant negative relations between dietary quality and mental health indicators were found in another study for female college athletes (Christensen et al., 2021; Lutz et al., 2017; Marozoff et al., 2020). Higher education level was also a positive predictor of healthy eating index (Pisegna et al., 2021).

5. Discussion and conclusion

The primary aim of the present study was to understand the progress of the literature and current publication trends in the domain of mental health and well-being in students enrolled in HEIs. In order to fulfil this objective, the study delves into the literature from the past two decades using bibliometric analysis as an approach to analyse the data. The topic has become important as the last decade has witnessed a growing concern related to the mental health and well-being of HEIs students worldwide. The rising number of articles in this domain clearly indicates the importance and relevance of this topic in research. To answer the first research question the study took into consideration 394 documents that were published in 264 journals from the year 1994 to Oct 2023. The number of documents has shown an upward trend especially a steep increase since 2020. The sharp increase in the number of documents i.e. from 38 in the year 2020 and 106 in the year 2022 demonstrates the impact of COVID-19 on the mental health and well-being of individuals and growing concern. The United Kingdom leads with 94 publications, followed by the United States and Brazil with 67 and 29 publications, respectively. Interestingly, out of the 12 top countries in terms of the number of publications, five countries are classified as high-income economies, five countries are classified as upper-middle-income economies, and two are classified as lower-middle-income economies. There is no country with a low-income economy in the top twelve. This also reiterates the concern shown by WHO (2022) in their report titled “World Mental Health Report: Transforming Mental Health for All” where they have highlighted the strong need for awareness and insufficiency related to mental health-related programs and professionals in substantial proportional of the world population. This also presents concerns regarding the health of students residing in poor countries as no or negligible attention is paid to the mental health and well-being of students. This also outcries the need for researchers, especially from high-income economies and upper-middle-income economies, to collaborate with authors from low-income economies.

To answer the second research question, i.e. key research areas and emerging trends the researchers conducted keyword analysis. The keyword analysis reveals the most frequently used author keywords in this study area. These are COVID-19, mental health, higher education, student, and stress, respectively. It is interesting to note that the top keyword is COVID-19, which first appeared in the database in 2020 and emerged as the most frequently used keyword in a database spanning from 1994 to 2023. It clearly indicates the negative consequences of COVID-19 on the mental health of the individuals. The lockdown, self-isolation, and social distancing associated with the COVID-19 pandemic have proved to be detrimental to the mental health of individuals and are an area of concern even in this post-COVID world. The keyword analysis also reveals that mental health or well-being topics are very pertinent in the present era and need discussions and necessary steps to mitigate the problem, especially because of the peculiar role played by mental well-being in the scholarly environment (Okoro et al., 2022). The students enrolled in the HEIs constitute the future workforce of any nation, and therefore, their well-being needs adequate invention. Well-being needs to be holistic or follow a 360-degree approach, i.e. in terms of emotional, psychological, social, spiritual, and physical well-being.

The result of the co-citation network reveals five clusters that represent key research clusters and emerging trends in mental well-being and HEIs students. The five themes are mental health: an overview; role of higher education institutes in promoting good mental health; stress and depression in students; effect of COVID-19 on mental well-being; and diet and mental well-being. The cluster Mental Health: An Overview presents a birds-eye view of the mental health domain. Also, the researchers summarize that mental well-being is a state of internal awareness and equilibrium. The second cluster, Role of Higher Education Institutes in promoting good mental health, highlights that higher education institutes have the potential to be the hubs of health promotion. The third cluster, Stress and Depression in Students, explores the various factors related to depression and stress. The cluster highlights that stigma associated with mental health, as well as judgment by others, act as barriers to seeking help in mental well-being. Also, these challenges are universal. The fourth cluster, Effect of COVID-19 on Mental Well-Being, highlights the challenges faced by higher education during the pandemic and its impact on mental well-being. Cluster Five, i.e., Diet and Mental Well-Being, touches on vital aspects, i.e., diet in mental well-being.

6. Implication of the study

The concerns related to the mental health and well-being of HEIs students are omnipresent and thus call for intervention strategies from both the academic fraternity as well as policy-makers. The study calls for more discussions and exchange of dialogue around mental well-being. Academicians, counsellors, administrators, academic advisors and policymakers should work together to spread necessary awareness and to design early intervention strategies. Policy-makers can implement policies, mandates, and interventions at various levels and for HEIs. HEIs can allocate certain mental health resources and try to create an environment where students are free and open to exchange dialogue on this issue. Thus, providing an inclusive learning environment and taking effective measures for the mental well-being of students is imperative for the holistic development of students.

7. Limitations and opportunities for future research

The study presents the extant state of literature and an insight into the research conducted on the mental health and well-being of HEI students in the last two decades. However, despite its contribution, the study has limitations that must be acknowledged. The researchers have used only one database (Scopus) for data collection which is the primary limitation of the present study. The use of one database avoids duplicity; however, it may lead to the likelihood of not including some significant papers related to the area of study. This limitation also leads to future research options where two or more databases can be used to explore this domain or compare the output of two varied databases. Also, for the present study, bibliometric analysis can be done via a wide array of techniques. For example, a factorial map of the most frequent keywords can be used. Similarly, co-term network visualization can also be used to create a co-term map. Forthcoming researchers can implement techniques other than those used in the present study that may help gain better and fresh insight into this field.

Additional information

Author contributions statement

This is to state that all three authors have contributed extensively to this research article. Dr Sonica Rautela, Dr Nehajoan Panackal and Dr Adya Sharma worked together for brainstorming on idea generation. The initial keyword identification and Scopus database search were done together which helped in the conception and design of work. This is to confirm that the 3 authors have equally contributed and are equally accountable towards the 4 points:

• Substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; and

• Drafting the work or reviewing it critically for important intellectual content; and

• Final approval of the version to be published; and

• Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability

The study is based on data that has been directly sourced from the Scopus database.

Additional information

Notes on contributors

Sonica Rautela

Dr. Sonica Rautela is an Assistant Professor at Symbiosis Centre for Management Studies, Pune, India. Her interest areas include Social Media, New Product Development and Open Innovation. She has published research papers in the Scopus indexed and ABDC listed journals and presented paper in national and international conferences.

Adya Sharma

Dr. Adya Sharma, a dedicated professional with more than 20 years of experience is a Ph.D., NET qualified, double Post Graduate, and an alumnus of St Stephens College. She brings with her rich practical experience from the corporate world that perfectly blends with theory and enhances academics. She has also been connected to the industry as a corporate trainer. An avid researcher, she has many case studies to her credit which are based on real-time events. She has also written research papers in reputed journals including Scopus indexed journals and has authored chapters in books. She is also the editor of the book titled 'Marketing Techniques for Financial Inclusion and Development’ by IGI Global.

Nehajoan Panackal

Dr. Nehajoan Panackal is a faculty in Symbiosis Centre for Management Studies, Pune. Her research interests are in the area of sustainability, human resource management, behavioural economics and business administration which has translated into publications in journals that are Scopus indexed and ABDC listed.