Prevalence of university non-continuation and mental health conditions, and effect of mental health conditions on non-continuation: a systematic review and meta-analysis

Figures & data

Table 1. PICO Search Strategy.

PICO	Search Strategy
Participation (University students)	MeSH term search: Universities, Education, Undegraduate, Graduate Keyword search: Universit* or Tertiary* or higher education or Medical education or University education or Undergraduate education or Graduate education or College student*’ or University student*
Intervention/Exposure (Mental Health)	MeSH term search: Mental health, Mental Disorders, Quality of Life Keyword search: mental illness or mental disorder* or mental ill health or mental health or suicid* or gambling or substance abuse or alcohol* or drug* or psychos?s or depress* or anxi* or nervous or social anxi* or emotional regulat* or psychological distress or emotional distress
Comparison	N/A
Outcome (Dropout)	MeSH term search: Student dropouts, Return to school Keyword search: student dropout* or student drop-out* or student drop out* or student attrition* or student successful rate* or student return to school or student completion rate*

Figure 1. PRISMA Flow Diagram (Page et al., 2021).

Table 2. Summary of the included articles.

Author and year	Country	MH Source	Dropout Record	Sample size	Age (M (SD))	Gender (%)	University level	Prevalence of MH (%)	Prevalence of Dropout (%)	Relationship between MH and Dropout
Aldahmashi et al., 2021	Saudi Arabia	Self-report	University Record	723	18.7 (1.29)	Female: 49.1% Male: 48.5%	Undergraduate: 79.3% Postgraduate: 21.7%	33.1%	19.8%	Mental health diagnosis significantly associated with dropout
Alexander & Haldane,   1980	UK	Self-report	University Record	62	Range: 17-19	Female: 41.9% Male: 58.1%	Undergraduates	66.0%	–	39% of students who dropped out reported having. ‘a great deal’ of mental distress and psychiatric conditions were a contributing factor to dropout
Alschuler & Yarab 2018	USA	Self-report	University Record	7	39 (SD unavailable)	Female: 28.6% Male: 71.4%	–	–	–	Mental health diagnosis, experience more perceived stress, resulting in drop out
Anderson et al. 2020	Australia	Self-report	Self-report	11	>30	Female: 63.6% Male: 18.2% Nonbinary: 18.2%	Undergraduate: 46% Postgraduate: 54%	–	–	Poor mental health associated with dropout
Andersson et al. 2009	Sweden	Self-report/Validated scale	University Record	2032	Range: 22–23	Female: 53.9% Male: 46.1%	–	–	–	High levels of stress were associated with dropout with significance. Mental illness and alcohol use disorder was not significantly related
Arria et al. 2013	USA	Validated Scale	University Record	1145	Range: 17–20	Female: 53% Male: 47%	Undergraduates	76.0%	29.7%	Depression, increased frequency of cannabis use was associated with dropout
Auerbach et al. 2016	USA	Clinical interview	Self-report	2274	Range: 18–22	–	Undergraduates	25.3%	–	Generalised anxiety disorder, PTSD and alcohol dependence were related to dropout, also likely to affect grades and subsequently lead to dropout
Bakker et al. 2021	USA	Validated Scale	Self-report	363	24.0 (6.2)	Female: 91.2% Male: 9.8%	–	–	–	Dropouts less likely to participate in study with significance, distress linked with intention to dropout
Boyraz & Granda 2019	USA	Validated Scale	University Record	894	18.19 (0.45)	Female: 44.4% Male: 55.6%	Undergraduates	11.5%	–	Dropout associated with higher posttraumatic stress and depressive symptoms
Boyraz et al. 2013	USA	Validated Scale	University Record	423	18.42 (1.48)	Female: 65% Male: 35%	Undergraduates	20.6%	–	29.7% of the dropouts were diagnosed with PTSD
Boyraz et al. 2016	USA	Validated Scale	University Record	569	18.39 (1.31)	Female: 65% Male: 35%	Undergraduates	–	32.7%	Higher levels of depressive symptoms were predictive of dropout, however high GPA was protective
Cipher & Urban 2022	USA	Self-report	Self-report	170	43.5 (11.4)	Female: 87.1% Male: 12.9%	–	–	30.6%	Dropout was associated with experience of stress
Cohen & Greenberg 2011	USA	Self-report	Self-report	465	–	Female: 78.6% Male: 21.4%	Master’s	–	–	Mental health diagnosis significantly associated with dropout, emotional supports were protective against dropout
Crawford et al. 2022	UK	Self-report	University Record	1152	24.1 (6.8)	Female: 91.1% Male: 8.9%	–	12.5%	12%	Mental health issues contribute to lowers grades and risk dropout unless academic supports are in place.
Cruwys et al. 2021	Australia	Validated Scale	University Record	237	18.73 (SD unavailable)	Female: 53.2% Male: 46.8%)	Master’s	–	11.4%	Better mental health protective against dropout, though not significant
Cvetkovski et al. 2018	Australia	Validated Scale	Self-report	1265	23.33 (9.25)	Female: 59.0% Male: 41.0%	Undergraduates	69.2%	32.9%	No significant relationship between mental health and dropout
Dancot et al. 2021	Belgium	Validated Scale	University Record	464	Range: 18–21	Female: 82.5% Male: 17.5%	Undergraduates	11.5%	21.5%	High levels of state anxiety associated with lower self-esteem, which is associated with dropout
Davis et al. 1971	USA	Clinical interview	Self-report	220	Range: 21–23	Female: 40.45% Male: 59.55%	–	19.5%	–	MH associated with dropout, with only 23% of students with MH diagnosis persisting to completion
DeBerard et al. 2004	USA	Self-report/Validated scale	University Record	204	18.9 (0.95)	Female: 72.1% Male: 27.9%	Undergraduates	18.0%	15.2%	Poor mental health associated with dropout without significance. Increased binge drinking pattern associated with lower GPA, which is associated with dropout with significance
Del Savio et al. 2022	Peru	Self-report	University Record	641	Range: 17–24	Female: 20.75% Male: 79.25	–	–	1.6%	Symptoms of depression and anxiety contribute to dropout with significance
Faas et al. 2018	USA	Self-report/Validated scale	University Record	3507	27.72 (0.14)	Female: 45.8% Male: 54.2%	Undergraduates	11.3%	43.6%	Poor mental health, particularly Depression and Stress more associated with dropout with significance.
Fergusson et al. 2003	NZ	Self-report	Self-report	306	Range: 18–20	Female: 78.6% Male: 21.4%	–	56.2%	24.5%	Increased cannabis use associated with dropout
Fuse-Nagase et al. 2016	Japan	Self-report	University Record	305087	–	–	–	–	–	Schizophrenia less associated with dropout in 2013-2014 than in 1986-1987
Gaultney 2016	USA	Self-report/Validated scale	Self-report	900	18.58 (1.85)	Female: 66% Male: 34%	Undergraduates	–	–	Symptoms of depression and sleep disorder associated with a lower GPA, which was significantly associated with dropout
Hartl et al. 2022	Germany	Validated scale	Self-report	903	22.20 (3.29)	Female: 71.5% Male: 28.5%	–	–	–	Emotional problems and wellbeing may be related to performance problems which contribute to dropout.
Heinrichs et al. 2021	Germany	Self-report	Self-report	14	Range: 22–28	Female: 50% Male: 50%	–	–	–	Mental illness and emotional distress associated with doubts about continuing study, but unclear if direct cause of dropout
Hjorth et al. 2016	Denmark	Validated Scale	University Record	368	Range: 16–29	Female: 51.4% Male: 48.6%	Undergraduates	27.2%	–	Poor mental health is associated with increased frequency of dropout
Homel et al. 2014	Canada	Self-report	Census	319	Range: 15–25	Female: 49% Male: 51%	Undergraduates	18.2%	–	Cannabis use disorder associated with dropout
Hunt et al. 2010	USA	Self-report/Validated scale	Census	15800	46 (15)	Female: 56.2% Male: 43.8%	–	50.0%	42.8%	Mania (bipolar I), Antisocial personality traits, alcohol use disorder and other substance use disorders associated with dropout with significance
Ishii et al. 2018	Japan	Clinical interview	University Record	370	18.35 (SD unavailable)	Female: 59.1% Male: 40.9%	Undergraduates	–	–	Duration and severity of mental health diagnoses associated with dropout (particularly, schizophrenia, neurotic disorders, and eating disorders)
Jennison 2004	USA	Self-report	Census	1885	Range: 19–27	Female: 49% Male: 51%	Undergraduates	47.5%	–	Increased frequency and level of alcohol consumption associated with dropout, especially in binge pattern alcohol use and alcohol use disorder
Kahn & Kulick 1975	USA	Clinical interview	University Record	95	18.4 (SD unavailable)	Female: 47.4% Male: 52.6%	Undergraduates	63.2%	–	Heavy substance users are more likely to dropout than nonusers with significance
Kennett & Reed 2009	Canada	Validated Scale	University Record	61	18 (SD unavailable)	Female: 70% Male: 30%	Undergraduates	45.9%	19.7%	State anxiety and mental health is associated with dropout.
Kilstrom et al. 2022	USA	Self-report/Validated scale	Self-report	276	28.5 (6.7)	Female: 74.4% Male: 25.6%	Postgraduate	–	2.2%	Mental health concerns were cited for leaving 50% among dropouts, and major factor for 22.7% of those considering dropping out.
Koh et al., 2022	USA	Validated scale	University Record	3316	17.97 (0.41)	Female: 43% Male: 57%	Undergraduates	–	–	Emotional regulation contributed to GPA, which was negatively associated with dropout for first-generation university students.
Li & Tse 2015	NZ	Self-report	Self-report	15	25.7 (SD unavailable)	Female: 33.3% Male: 66.7%	–	–	–	Gambling addiction associated with dropout
Li et al. 2014	NZ	Self-report	Self-report	15	25.67 (4.79)	Female: 33.3% Male: 66.7%	–	–	–	Gambling addiction associated with poor self-esteem both associated with dropout
Liguori & Lonbaken 2015	USA	Self-report	Self-report	820	19.37 (2.99)	Female: 35.2% Male: 64.8%	Undergraduates	52.9%	19.0%	Binge pattern of alcohol intake associated with dropout in male students
Lockard et al. 2019	USA	Validated Scale	University Record	404	–	Female: 45.7% Male: 54.3%	Undergraduates	–	19.5%	Depression on its own was not associated with dropout, but depression with academic distress associated with dropout
Manze et al. 2022	USA	Self-report	Self-report	38	–	Female: 61% Male: 39%	–	–	18%	Mental health problems are suggested to affect academic achievements, which subsequently contributed to dropout
Martinez et al., 2009	USA	Self-report/Validated scale	University Record	3290	17.96 (0.37)	Female: 53.6% Male: 46.4%	Undergraduates	–	–	Drug use and psychological distress associated with dropout
Martinez et al., 2008	USA	Self-report/Validated scale	University Record	3290	17.96 (0.37)	Female: 53.6% Male: 46.4%	Undergraduates	–	28.1%	Heavy drinking was not significantly associated with dropout
McAnulla et al., 2020	UK	Self-report	University Record	579	Range: 18–31	Female: 71.6% Male: 28.4%	Undergraduates	9.0%	19.2%	Menatally ill health was associated with dropout without significance
McMichael & Hetzel, 1975	Australia	Self-report	University Record	1803	–	Female: 36.$% Male: 63.6%	Master’s	29.3%	6.6%	Serious mental health diagnosis associated with dropout
Meilman et al., 1992	USA	Clinical interview	University Record	77	–	Female: 58.4% Male: 41.6%	–	–	–	Mental health and particularly depression was associated with dropout
Mortier et al., 2018	Belgium	Clinical interview	Census	2274	Range: 18–12	Female: 78.6% Male: 21.4%	Master’s	11.4%	30.9%	Suicidal thoughts and behaviours were associated with dropout
Okasha et al., 1985	Egypt	Clinical interview	University Record	79292	–	Female: 39.3% Male: 60.7%	Undergraduates	3.1%	5.9%	Mental health diagnosis associated with academic difficulties and dropout
Oseguera et al., 2022	USA	Validated scale	Self-report	129	–	Female: 58.9% Male: 41.1%	–	–	–	Higher levels of depressive symptoms are correlated with university dropout
Pritchard & Wilson, 2003	USA	Self-report/Validated scale	Self-report	218	19.67 (2.09)	Female: 57.8% Male: 42.2%	Undergraduates	–	–	Emotional health associated with GPA, which was predictive of retention. No clear relationship with dropout
Ramsdal et al., 2018	Norway	Clinical interview	University Record	14	Range: 28–25	Female: 50% Male 50%	Undergraduates	–	–	Students who dropped out were more likely to report mental health diagnoses
Richardson, 2010	UK	Self-report	University Record	132588	–	Female: 56.7% Male: 43.3%	–	83.6%	36.5%	Those with mental health disability were more likely to dropout
Richardson, 2014	UK	Self-report	University Record	196405	–	Female: 60.5% Male: 39.5%	–	2.2%	35.3%	Those with mental health disability were more likely to dropout
Ruban et al., 2013	Denmark	Self-report	Self-report	1056	21.45 (SD unavailable)	Female: 64.9% Male: 35.1%	Undergraduates	33.0%	19.7%	No clear association between mental health and dropout
Samlan et al., 2021	USA	Validated Scale	University Record	297	Range: 18–19	Female: 66.6% Male: 33.4%	Undergraduates	–	–	Mental health diagnosis not associated with dropout, but academic distress associated with dropout
Sujan et al., 2023	Bangladesh	Self-report	Self-report	436	23.41 (1.26)	Female: 35.3% Male: 64.7%	Undergraduates: 97.7% Postgraduates: 2.3%	54.9%	39.9%	Students who misuse psychoactive substances are more likely to have dropout from university.
Tamin, 2013	UK	Self-report	University Record	1319	–	Female: 80% Male: 20%	Undergraduates	21.1%	13.7%	No significance between mental health diagnosis and dropout
Thomas et al., 2021	USA	Self-report/Validated scale	University Record	9904	Range: 18–24	–	Undergraduates	34.3%	16.7%	Depressive symptoms associated with dropout and Anxiety symptoms protective from dropout, both with significance
Vest et al., 2020	USA	Self-report/Validated scale	Self-report	130	29.4 (5.7)	Female: 23.1% Male: 76.8%	–	36.2%	12.3%	Anxiety, depression and PTSD associated with dropout with significance
Wainipitapong & Chiddaycha, 2022	Thailand	Validated scale	University Record	914	18 (SD unavailable)	Female: 47.3% Male: 52.7%	Undergraduates	9.3%	1.5%	Mental health problems during university was significantly associated with dropout
Willoughby et al., 2020	UK	Validated Scale	University Record	1017	19 (0.93)	Female: 71.1% Male: 28.9%	Undergraduates	26.3%	–	Struggling students more likely to dropout and to use substances, have depressive symptoms, and higher levels of stress
Yates, 2012	USA	Self-report	University Record	1188	–	–	Undergraduates	–	–	Late dropout associated with mental health
Zając et al., 2023	Australia	Medical Record	University Record	652139	–	–	–	13.1%	15%	Students receiving treatment for mental health are more likely to dropout

Figure 2. The forest plot of the effect sizes of mental health outcomes on dropout among university students.

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Data availability statement

Data from this systematic review is available in the supplementary materials.