Mental health and

undergraduate
students in
Pakistan
Applied Business Research – Final
Report

Maryam Akhlaq
ERP 12731
Abstract
The aim of this research is to study the mental health problems arising in undergraduate
students in Pakistan. In this study, we conducted interviews, focus group and had surveys to
discuss not only the issues, but the stigma attached to mental health and how students cope
with them. We identified several factors that cause mental health issues, factors which
worsen or improve them and self-coping mechanisms. We also studies facilities available in
universities and in the country.

This topic is very essential for research because there have been efforts going on for some
years to raise mental health awareness in Pakistan. One of the aims was to get an idea of the
work these campaigns have done and has there been a change in mindset of the people.

This research builds on previous researches and the main findings are that people and society
have been making efforts to improve the mental health situation. There are free facilities
available as well and universities have counsellors for students. However, the problem of
stigma is still a huge barrier and there is still a lot of work needed in that area.

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Table of Contents
Abstract.............................................................................................................................1
1.0 Introduction...........................................................................................................1
1.1 Purpose of the study..............................................................................................................1
1.2 Objectives of the research.....................................................................................................1
1.3 Methodology..........................................................................................................................1
2.0 Literature Review.........................................................................................................0
3.0 Methodology................................................................................................................0
3.1 Surveys..................................................................................................................................0
3.2 Focus Group..........................................................................................................................0
3.3 In-depth interview.................................................................................................................0
4.0 Findings......................................................................................................................1
4.1 Findings from the Survey......................................................................................................1
4.2 Findings from the Focus Group............................................................................................1
4.2 Findings from the In-depth interview...................................................................................4
4.2.1Concept Map.......................................................................................................................5
4.2.2 Codes..................................................................................................................................5
4.2.3 Project Map......................................................................................................................11
4.2.4 Word Cloud......................................................................................................................12
5.0 Data Analysis...............................................................................................................0
6.0 Discussion....................................................................................................................0
7.0 Conclusion...................................................................................................................0
8.0 Appendix......................................................................................................................1
8.1 Observation notes..................................................................................................................1
8.2 Focus group guide.................................................................................................................3
8.3 Focus group summary...........................................................................................................6
8.4 Interview guide....................................................................................................................12
8.5 Interview transcription with self-evaluation.......................................................................14
8.6 Literature map....................................................................................................................26
8.7 Excel sheet of literature matrix...........................................................................................26
1.0 Introduction
1.1 Purpose of the study
The essential purpose of the study was to find out the current situation of mental health
awareness and where do we stand as a society when it comes to helping undergraduate
students. There has been a steady increase in competition amongst students, competition in
the corporate world and above all competition to succeed and be the best. All these factors
are some of the problems that cause stress and anxiety leading to severe mental health
problems. Amidst advancements, we wanted to study how institutes have advanced in this
field.
Being a university student and having faced this situation real time, I wanted to study this
further to get a realistic view of the situation out there.

1.2 Objectives of the research

The objectives of the research are as follows:
 To study the main mental health problems in undergraduate students
 To find out self-coping mechanisms
 To find out the level of support provided by the university
 To find out the level of support provided by family and friends
 To find out the level of support provided by society in general
 The stigma attached to these problems
 The effect of mental health awareness campaigns

1.3 Methodology
This is a qualitative research hence qualitative tools are used to carry out this study.
The proposed methodology is to study previous literature available first. There is a lot of
existing research on mental health, mental health stigma, coping mechanisms and support.
Then for primary research, the tools used will be focus group, in depth interviews and
surveys.
2.0 Literature Review
Mental Health
World Health Organization (WHO) defines mental health as "a state of wellbeing in which
every individual realizes his or her potential, can cope with the normal stresses of life, can
work productively and efficiently, and may contribute to her or his community." 
Mental Distress
Mental distress is typical, expected, and normal response to everyday life stresses. For
example: writing an exam to going to a job interview. It is a sign from your brain to you,
telling you that you simply need to adapt to the surrounding. It is the basis for adaptation and
resilience. In other words, mental distress is a stress indicator to the control center to notify us
that we have an issue that we need to acclimatise to it. 
Stress responses are responsible for resilience and developing new skills. We don't need to
protect young people from this as it builds capacity.
Mental Health Problems
Mental health problems are indicators of stress adaptation or coping skills being challenged
by the stressor's extent. Negative emotions characterize them, challenging cognitions, and
various difficulties with behaviour. These can be severe at times and of either short or long
durations (for example, death of a loved one, loss of a job, etc.) Almost everyone will
experience these states many times during their life.[ CITATION Man15 \l 1033 ]
Mental Illness
The Diagnostic and Statistical Manual, 5th edition, of the American Psychiatric Association
(DSM-5) defines mental illnesses or mental disorders as ‘dysregulation of mood, thought, and
behaviour’. 
Mental Wellbeing
Wellbeing is the condition of being agreeable, sound, or glad.
Mental wellbeing depicts your psychological state – how you are feeling and how well you
can adapt to everyday life. Our mental wellbeing is dynamic. It can change from second to
second, every day, month to month, or year to year. [ CITATION Pom20 \l 1033 ]
Types of mental health
Depression
Depression(Major burdensome Disorder) is a typical and genuine clinical disease that
adversely influences how you feel, the manner in which you think and how you act.
Despondency a disposition state described by trouble or misery sensations of uselessness and
withdrawal from others. Occurrence at least one major depressive disorder (2 weeks duration)
Mania
Mental state described by exceptionally misrepresented action and feelings including rapture,
inordinate energy or peevishness that bring about hindrance in social or word related
working. Actually depression and mania are opposite ends of a continuum that extends from
deep sadness to wild elation, representing the extremes of mood . Whereas depressive
disorders involve only one troubling mood (Depression) those with bipolar disorders
(previously called manic depression). A person experiencing a manic episode is usually
engaged in significant goal directed activity beyond their normal activities. A maniac episode
will generally last 3 to 6 months whereas a depressive episode lasts rather longer,
approximately 6 -12 months without treatment.
Types of depression
Major Depression
This is characterized by the ccurrence of at least one major depressive episode which is
typically two weeks long. The patient has no history of mania or hypomania. This type is
much higher in females and can occur to any individual of age average onset in late 20s. Its
life time prevalence(%) is 14- 16.
Persistent Depressive Disorder
This typically includes depressed mood that has lasted for at least two years with no more
than two months being symptom free. It is much higher in females and often shows up in
childhood or adolescence.
Bipolar Disorder
Somebody with bipolar turmoil, which is likewise now and then called "hyper misery," has
state of mind scenes that range from boundaries of high energy with an "up" mind-set to low
"burdensome" periods. At the point when the patient is in the low stage, you'll have the side
effects of significant melancholy. Drug can help manage your emotional episodes. Regardless
of whether you're in a high or a low period, your PCP may recommend a state of mind
stabilizer, like lithium.
Psychotic Depression
People with psychotic depression have the symptoms of major depression along with
"psychotic" symptoms [ CITATION Coe21 \l 1033 ]
Situational Depression
A depressed mood when you're having trouble managing a stressful event in your life, such
as a death in your family, a divorce, or losing your job. Your doctor may call this "stress
response syndrome." [ CITATION Haa21 \l 1033 ]
Psychotherapy can regularly assist you with getting a time of sadness that is identified with
an upsetting circumstance. [ CITATION Man21 \l 1033 ]
Seasonal Affective Disorder
Seasonal Affective disorder is one of the sorts of burdensome temperaments. In contrast to
other mental issues, it is a state of mind issue that is just restricted to a particular
season/climate of the year[ CITATION Ogu21 \l 1033 ]
People have mood changes and disturbed routines during that specific season. Furthermore,
the American Psychiatric Association has defined this mood disorder as a "winter blue"
because the symptoms usually occur in the months of January & February. However there are
consistently exemptions as certain people face burdensome temperaments in summer as well.

Stress
Stress is the body's response to a challenge or demand.
Any job can be stressful sometimes because even when you love to do what you are working
for. Work stress ( burn-out) can affect mental wellbeing. You may be astonished by how
influenced by work environment stress you are the point at which you have a distressing
morning. When you start the day with planning, good nutrition, and a positive attitude, you

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might find that the stress of your job rolls off your back more easily. In these times of covid-
19 people around the world are working from home and it’s more stressful for people to
manage home and work simultaneously. [ CITATION Dhu21 \l 1033 ]
Mental Health Literacy
[ CITATION Jor15 \l 1033 ]Remember – language is powerful. While these changes in the
words we use may seem small, they reduce the stigma and sensationalism surrounding mental
illness. Being more aware of the terms we use to address and depict psychological instability
goes far to break generalizations and advance a more mindful and educated local area. The
proposal here isn't that we should all become language police. There is a challenge not to
overdo it with censorship, mainly because of mental health stigma's silencing effect. We don't
want to be so frightened of using language around mental illness as to prevent healthy
communication and expression altogether. There's still a need for discussion and
understanding. Thoughtful reflection of the words you use and how you use them is a
good start.
Stigma attached to Mental Health
[ CITATION Rui21 \l 1033 ]Self-stigma: It refers to people with mental illness who internalize
negative stereotypes, leading to shame, social withdrawal, and demoralization. People with
psychological instability may feel they are not commendable or ready to seek after their life
objectives.
Public-stigma: It happens when individuals from the overall population underwrite
pessimistic generalizations and victimize individuals with psychological instability. Social
isolation and impaired social networks, unemployment, education, and housing opportunities.
Stigma and discrimination are typically experienced as social defeat, which in turn is
associated with suicide. [ CITATION OLo21 \l 1033 ]
Structural Discrimination: Cultural guidelines can methodicallly weakness individuals with
psychological maladjustment. Generally insufficient subsidizing of emotional wellness
benefits as contrasted and actual wellbeing administrations, more unfortunate nature of care,
and decreased admittance to psychological well-being administrations.
Cultural stigma
Living in a culture where talking about mental health has been a stigma for years and where
women are subconsciously taught to keep other’s needs before their own, people often tend to
mix self-care with selfishness. [ CITATION Lau07 \l 1033 ]
Stereotypes
Generalizations are particularly productive methods for ordering data about social gatherings.
They are speedy since it creates impressions and assumptions for somebody who has a place
with a generalized gathering. They are social because they represent collectively agreed on
notions about groups of persons. [ CITATION Kee21 \l 1033 ]
Commonly held stereotypes about people with mental illness are that they are:
- [ CITATION Kha11 \l 1033 ]Incompetent (they are incapable of independent living or
real work), and are to be
- Blamed (because of weak character, they are responsible for the onset and
continuation of their disorders).
Coping Mechanisms

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The Digital Era is bringing great advancements in several fields including the field of
psychology. As the world is developing, human brain science is advancing appropriately.
Discussing Human Psychology, feelings are influenced fundamentally by advanced media.
Analysts have begun exploring the effect of online media on passionate prosperity and they
have found some incredible realities [ CITATION Bar21 \l 1033 ] Human beings are social
creatures. We need the friendship of others to flourish throughout everyday life, and the
strength of our associations gigantically affects our psychological well-being and satisfaction.
Believing that people are becoming more empathetic because this connectivity and social
media are allowing them to see other people globally in a way that they’ve never been able to
see before. What is significant is that individuals comprehend the advantages of innovation
and where they need to set up cutoff points. We have those examples of conduct that we as a
whole realize the best approach to focus on ourselves, self-care.  But, we now have to learn
how to do this in this new environment. We have to extend our living space, so to speak, into
the online arenas. Therefore we have to find out the way to set online boundaries. we have to
find out the way to respond things. [ CITATION Sia21 \l 1033 ]
[ CITATION Rui21 \l 1033 ]Give your mind some rest. Do it throughout the day and not just
when you’re done with the day’s tasks. If you have a long day at work, take out five minutes
to pause and give your mind a break. Take deep breaths, meditate, look at photos that have a
special meaning, go for a water break, stretch, or walk round in the corridor. People need
such mental stops to keep working during that day with a filled glass of water as opposed to
an unfilled one.
Changing a troublesome circumstance is additionally one of the methods of self-care. In case
you're worried over work, you need to investigate what elements would assist your work with
getting less unpleasant and what changes your workplace needs. Would it be useful to
separate your assignment into more modest errands? Would it help conversing with your
manager about changing where you sit? Would it help to have a plan for the day or breaks
between errands? Recognizing one's own triggers and miens likewise makes a difference. In
the event that you feel that after a specific point from time your perspective beginning
harming or your garments begin feeling hot, possibly it's an ideal opportunity to change your
shoes or wear lighter garments..[ CITATION Apg21 \l 1033 ]
COVID and Mental Health
The current pandemic is influencing individuals both actually just as mentally.
" It is assessed that the world will be hit by a Mental Health consequential convulsion from
the emergency that is relied upon to be bigger than the actual emergency. "
[ CITATION Sch17 \l 1033 ]Young people are in great stress, as are not aware of the upcoming
future challenges. Adults are facing unemployment that can lead to sadness. Close by
individuals lamenting from the awful and abrupt loss of friends and family from the episode,
the failure to acquire conclusion can bring about indignation and disdain.
Health care worker’s Mental Health is also affected due to this outbreak. Frontline medical
are in danger of unfavorable actual results from COVID as well as mental misery. Noted
before that forefront laborers may create side effects of post-horrendous pressure problem,
despondency, and substance use issues.

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The silver lining in these times of crisis is that we are physically distanced but socially
connected . It's when individuals are associating with their friends and family, investing
energy, gaining experiences, and above all sharing and seeing each other's feelings. No matter
what the stress level is, people are very resilient. They are dealing with their life normal and
the burdens of the World. Utilizing inward strength can assist individuals to get past this time
with a solid psyche. Individuals are utilizing their imagination in the hour of episode for
keeping up their psychological prosperity. Rehearsing fundamental self-care will keep your
invulnerable framework solid and your passionate saves full.
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the Initial COVID-19 Lockdown Period in Israel. Int. J. Environ. Res. Public Health.
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Ogunbode, C. A. (2021). Negative emotions about climate change are related to insomnia
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abnormal psychology, 212.
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wellbeing during the Covid-19 lockdown. Health and Technology, 1-11.

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3.0 Methodology
This is a qualitative research hence all tools used will be to gather qualitative data.
3.1 Surveys
We floated an online survey to get some preliminary primary data. The survey form was
filled by undergraduate students anonymously. From the results of these forms we got
direction to shape our questions for the in depth interviews and focus group.
We shared the form on university groups, with acquaintances in other universities and then
had to filter the responses for undergraduate students only. The main advantage of an online
survey is that there is no interviewer or moderator bias.
3.2 Focus Group
An online focus group was conducted. It was attended by six female students from different
universities. This gave us insights of the mental health problems arising in different
university environments and how different universities in Pakistan are handling mental health
problems amongst undergraduate students. The focus group was conducted online on Zoom
and the identities were not revealed. Talking about the same topic and relating to each other,
the participants provided valuable insights about our topic.
To expand the study, we could conduct more focus groups, probably covering all the major
universities of Pakistan to get a wholistic view of the situation of undergraduate students.
3.3 In-depth interview
An online in depth interview was conducted along the themes which emerged from the focus
group. This was to go in detail and explore the realities related to facilities. The in depth
interview provided a deeper understanding of the topic and gave a chance to explore themes
at an individual level. This provides a chance to explore every minor detail and is less
consuming as there is only one person at a time.
To make this research better, we should conduct at least ten in depth interviews, students
from different universities of Pakistan.
4.0 Findings
4.1 Findings from the Survey
The survey findings were preliminary and gave us an idea that this problem exists and there is
a need for research in Pakistan. It helped us come up with questions for the focus group and
the interview as well. The questions about stigma, facilities, support, self-coping
mechanisms, affordability, etc.
4.2 Findings from the Focus Group
1. Daily Routine
The discussion started with making the participants comfortable and understanding the
average day in an undergraduate’s student life. A busy schedule was identified by most of the
participants for their respective universities. In pre-COVID times, almost all students
described their day to revolve around university. Commuting to and from their campus was
time consuming too. Then waiting in between classes, as some did not have continuous
classes took up time as well. So, to sum it up, the participants were at university from 8 in the
morning till 6 in the evening. Spending 10 hours on campus and counting the travelling time,
most of them did not have time left for any other hobbies or activities.
Once COVID struck and students were having online classes, most participants reported to
have found quite a lot of free time on their hands. This provided them with a great
opportunity to spend time doing activities they would have done had they had time
previously. This included reading, painting, baking, cooking, nail art, freelance work. The
participants were at home all day and some of them enjoyed the time spent with family as
well. Every minute of the day could be utilised as there was no travelling, no waiting in
between for classes. All participants identified a vast difference between their average days
pre-COVID and post-COVID.
2. Daily Interactions
The participants were asked about their daily interactions in the university to gauge their
social status. The insights were quite interesting. The participants said that after COVID
struck, they realized and valued even the meagre interactions they had when going physically
to university. Some participants said that they used to interact with so many people, like
talking to the Rickshaw wala, Careem driver, guards, university staff, professors, classmates
and of course friends. Now some of these interactions are not there completely and others
have been reduced to emails and messages. Then there were short outings with friends,
maybe not a well-planned outing, but small escapades between classes, to a nearby restaurant.
Besides close friends, there are a number of classmates that were on ‘Hi! Hello!’ terms and
tend to exchange a smile or a nod or a wave when seeing them on campus. All these
apparently small, meaningless interactions have been noted now and missed and valued as
well.
Interactions post-COVID have been limited to family members only. Where close friends are
concerned, for several months, no outings were possible hence, contact was via WhatsApp
and phone calls only. Not only for extroverts, even for introverts these interactions were
important and said to have been missing it. Then there were social events at university which
was a source of great fun. There were family gatherings, weddings, parties, which were
missed. Some stated that even though they previously avoided weddings and family
gatherings, they miss them now.
 3. Life Beyond University
The participants all talked of how university and their studies took up most of their time.
When they got home from university, their time was mostly spent studying or doing
assignments. Despite the workload, some of them did take out time for their hobbies or their
passions.
For some, their passions were closely linked to what they were studying, and they pursued
freelance work in similar fields simply because they enjoyed the work. One mentioned that
she worked as a content creator for medical digital magazines and volunteered with student
organisations that raise awareness about medical issues and resources for help-seeking.
Another worked as a freelance editor in her free time.
The participants were involved in various activities like playing sports, singing, exercising,
reading, swimming, baking, cooking, and indulging in nail art. Half of them also talked about
maintaining journals that they regularly write in and that helps them organise and unwind.
Spending time with friends was also a key activity. They regularly made plans to meet in
person or kept in touch regularly over social media. Social media was identified as a key part
of their lives with all of them regularly spending time on various platforms. They used this to
look at memes, connect with friends or even connect with strangers who had similar interests.
An interesting thing mentioned was how it helped them connect to strangers all over the
globe just on the basis of what they felt. One described it as the best way to destress and
unwind as someone else was feeling the same thing and she did not have to explain her
feelings to them.
4. Family Relations
Furthermore, participants were asked to describe their relations with their families. Some of
the participants were very quick to respond while some took relatively greater time. One of
the participants was confused and expressed it was difficult to select three terms to describe.
However, responses led to emergence of some key terms that were used to explain family
relations; Unique – wholesome – unthinkable, Unconditional love – funny – supportive,
Sweet and Sour, Supportive- Caring – Comfortable, Loving- Grateful- Terrible and Meet at
dinner. While it is obvious that relations may not be perfect, these terms were helpful in
analysing how close the participants were to their families. Some made use of positive words
while others described a terrible relation or a limited one where they meet at dinner.
5. Emotions
The participants were prompted to articulate the overwhelming emotions they have
throughout the day. Several emotions were identified while the most significant feeling
expressed as Stress and Anxiety. Few attributed this feeling to excessive workload, exams,
and exhaustion. Participant highlighted that feelings of stress have been increasing over time.
One participant articulated how life doesn’t make sense to her and she is utterly confused
about her emotions. The brain often dwells in the question of “why?” or “why me?” that
initiates a state of anxiety. A participant expressed that the competitive nature of studies was
responsible for added stress.
The participants stated that feeling stressed was something usual. One of them admitted that
she did feel joy and a sense of accomplishment at times. One stated that initially when
university started, she felt exhaustion and suffocation, but with time she adjusted, and
exhaustion evolved into a good type of exhaustion.
One participant expressed that stress forms a creative block and made her feel unworthy at
times and takes up a lot of mental space when one thinks about it. She went on to say that
when she can sort it out on her own. She feels proud but that is not the case always and it
makes her feel overwhelmed.
Another participant described how she felt overwhelmed when she had to complete multiple
tasks in a day, adding to the stress. When the pandemic happened, there was and still is a lot

2
of uncertainty around, and in times like these, stress and anxiety partner up and make you feel
low. There are no clear answers about the future however, appreciation and praise make her
feel happy.
Post-COVID there is an impending sense of doom and death and there are feelings of
sadness. A participant described these waves of emotions and expressed how every day is
like a rollercoaster of emotions.
6. Coping Mechanisms
Based on the emotions described above, they were asked to explain their plan of action when
emotions like stress and anxiety consume them. Here everyone had a different coping
mechanism ranging from keeping to self, penning down, and ranting it out with a trusted
friend to seeking help from a therapist.
One of the participants described her coping mechanism to include eating food, reading,
watching memes, spending time on Tik Tok, and talking to people with similar problems on
Twitter. Another participant laid emphasis on writing down emotions, listening to music,
watching funny videos, and eating sweet however, she said she feels safe keeping things to
herself as sharing leads to a spiral spread of information which she did not like. In addition to
that, a participant said she would first analyse the situation to see what is the worst that could
happen and then laugh it out along with a childhood close friend. She also said she writes
everything in her diary, listens to music and puts her trust in God.
Another mechanism was identified as crying it out and finding peace in sleeping well and
talking to best friends. One of the participants articulated that she reached out to a therapist
who assisted her, but she was inconsistent in her visits and believed that regular visits will be
helpful. It was evident that most of the participants put their trust in someone who they are
close to and would not judge them for what they are going through. For some the trusted
someone was the member of their family while for others was their close circle of friends.
The notable point in this was most participants felt more comfortable in confiding in a friend
than a family member. They said it was because either their friends were going through
similar emotions and hence it was easier to connect and vent. Secondly, family members
often thought that the participant had too many issues. All realised that bottling up emotions,
suppressing them or avoiding them were not a solution and it was best to cope with whatever
mechanism worked best with them.
7. Views on Mental Health
We asked the participants about mental health — what it meant to them and how they
perceived it and it led to a very comprehensive discussion on the topic. Several felt that
mental health was a very loose and broad term, and it needed a proper definition. According
to them, the term involved what it was, the stigma associated with it and the misconceptions
around it.
They also expressed the idea that there is little awareness about the subject and hence a lack
of understanding about what it entails and what should one do when mental health gets
affected. Mental health is often just limited to major disorders like personality disorders and
people believe that treatment becomes a permanent fixture. They also said that anyone who
says their mental health is affected is immediately deemed ‘mad,’ excluding them from social
circles.
Two participants expressed how often the sufferers only need to be heard and that is the way
to solving most of their concerns. But since people are quick to shun them, it becomes
extremely hard to seek help or reach out for it.
While the participants themselves exhibited greater levels of literacy in their conversations,
they stated that older people around them didn’t have the same knowledge and understanding.
They noted that some adults around them needed help and they knew that pointing it out and
suggestions to visit a psychologist will not be taken well at all.

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They were quick to mention that a lot of people dismissed mental health concerns as phases
in life and it was believed that these feelings will go away, and everything will be fine. The
participants, mostly Gen Z, had the idea that everyone goes through phases of life and you
need to identify behavioural patterns and seek help if there is a need. For instance, if someone
gets angry once that is no big deal, however if this behaviour is repeated, it necessitates
seeking help. A few sessions could help you identify underlying causes and improving
behaviour.
During the discussion, it was brought to light that ‘mental health’ is used as a buzz word
today, a lot of people misuse it to suit their own preferences. They said that people would
often blame their toxic behaviour on ‘mental health issues’ and continue to use it as an excuse
for their actions. The participants felt that just by throwing the term around when it suited
them, these people had created a coddle culture. People continue to talk of their failing
mental health and seeking advantages of it rather than going to a counsellor and putting effort
on getting better.
The concept of stigma was also raised. The participants said that due to lack of awareness, the
entire concept of mental health is stigmatised. People wrongly label those who are affected
with concerns and due to the fear of being shunned or being outcasts, people refuse to seek
help. The participants strongly believed that mental health was equally as important as
physical health and taking care of it needed to be normalised.
8. Support and Accessibility of Mental Health Resources
All the participants strongly advocated seeking support and three of them had even sought
support at one time or another.
Support available from university.
The participants admitted that their universities did have counsellors available if they ever
felt the need to talk to someone. However, almost all of them said that there was no proper
system in place. For years in university, they did not know that there were professional
therapists and counsellors available on campus for their support. They also pointed out that
they were not informed of these services and they felt the reason behind this was the stigma
associated with mental health seeking.
Students at medical universities claimed that their teachers and administration had rarely
advertised the presence of an on-campus counsellor. Teachers only intervened and guided
students to seek the counsellor when they felt a certain student needed help. They also added
that mental health awareness seminars and dedicated weeks were held at their universities but
those were mostly student initiatives.
Support from external sources
They believed that as students, they have limited budgets and need more financially feasible
resources. One of them was aware of what affordable, external sources were accessible for
students and people with limited incomes as she had volunteered for NGOs advocating for
better and improved mental health.
4.2 Findings from the In-depth interview
The in-depth interview was transcribed and then using the NVIVO software, codes and
themes were extracted. The themes and codes were linked by creating concept maps and
project maps.

4
4.2.1Concept Map

4.2.2 Codes

Name
Awareness
Considered as
simply thinking too
much
Importance of
mental health
Inability to

5
Name
distinguish emotions
Lack of education
Need to address
mental health issues
Neglected in
Pakistan
Unwillingness
to address the
issues
Coping Mechanism
Cooking
Creative work
Eating favorite food
No action
Paint
Reading
Sleeping
Smoking
Talking to someone
Watching Shows
Writing
Emotions
Anger and
frustration
Dealing with
family and work
issues
Anxiety
Exhaustion
Happiness
Numbing feeling
Overwhelmed

6
Name
Study Pressures
Coping up
with the
workload
Studying
beyond
university
hours
Subjects
requiring
attention
Positivity
Sadness
Stress
Exam times
Suffocation
Impact of COVID
Campus Facilities
restricted
Impact on mental
health
Mental Distancing
Not meeting daily
Social Distancing
Stuck in online
learning mode
Improving the system
Change perceptions
of health experts
Change society
Mental Health
Seminars
Shelter homes
Safe space

7
Name
Meanings of Mental
Health
Anxiety
Depression
Emotional
Imbalances
Feeling low
Interference with
daily activities
Interference with
goals
Lack of motivation
No energy
Mental Health Support
System
Access
Close in
vaccinity
Financial
Feasibility
Family Support
Professional Support
Psychotherapist
s
University Support
Counsellers
Effectivene
ss
Good
resour
ce
Ineffec
tive
C

8
Name
ou
ns
ell
er
s
fo
r
w
ar
d
re
qu
es
ts
to
su
pe
rv
is
or
ra
th
er
th
an
he
lp
in
g
Not
utilize
d
proper
ly
Students
struggling
in
university
Lack
of
open
appoin
tments

9
Name
Talking
and no real
therapy
Faculty
No role in
improving
the system
Student Clubs
Ineffective
Virtual Support
Psychology
Blogs
Pain Points
Expectations
Family Pressures
Responsibilties
Study Pressures
Get good grades
Work Load
Perceptions on Seeking
support
Best time
Interference
with daily lives
Prolong holding
of feelings
Self-harm
Hide about going to
therapy
People perceive as
crazy
Embarassment
Sign of weakness

10
Name
Stigma
Taboo Topic
Toxic society
Unwilling to open
up
Relationships
Family
Parents
Conflicts
Siblings
Closeness
Taking care
of them
Friends
Close circle
Introvert
Schedule
Home
Late Sleeping
Time
Responsibilties
at Home
University
Assignments
Continous
Classes
Early Morning
Extra
Curriculars
Communit
y Service
Limited

11
Name
Interaction

4.2.3 Project Map

4.2.4 Word Cloud

12
13
5.0 Data Analysis
There were three students who were conducting research on the exact same topic. We
discussed our findings of primary research to have more data to analyze. The survey forms
were analyzed using the statistics provided by Google forms in the shape of bar graphs, pie
charts and tables.
The focus group had two observers when it was being conducted. Then a summary was
written by all the three members analyzing the themes and findings and linking themes
together.
For data analysis of in depth interviews, the software NVivo was used to extract codes and
themes. We then created project maps, concept maps and code books to analyze our findings.
The data from both was analyzed and combined to answer the research question.
Since this is a qualitative research, analyses was done using codes. No numerical values were
assigned. It was strictly defined in qualitative terms.
6.0 Discussion
The main mental health problems defined are stress and anxiety leading to depression. This is
caused by pressure and competition at university at the undergraduate level. There is a stigma
related to mental health amongst students and they do not want to reveal that they are facing
such problems or else they will be looked down upon.
Hence, students try to cope themselves. Some do it positively by engaging in hobbies, trying
to pull themselves out. the problem arises when students go to the negative side and may
indulge in activities like drug abuse, self-harming, leading up to suicide.
The university support is present in terms of facilities being provided. However it is not vocal
support and there is a lack of awareness and lack of knowledge of the support available.
Family support varies from individual to individual. Friends may or may not be supportive
but due to stigma students avoid sharing details with people around them.
Societal support is not very high. There is no collective stance on this issue. People may
pretend to support this issue but when it comes to individual cases they back off. Silence on
the matter is often translated as lack of support.
Despite all the awareness over the years, the stigma attached has managed to prevail. We
have no clear view if the stigma is real when concerning university students. Students self-
imagine the stigma are self-conscious of utilizing the facilities available.
To close everything, there is an immense predominance of emotional wellness issues in
college understudies. Understudies have different self-methods for dealing with stress as
well, some certain and some negative. There has been an expansion in the help accessible in
colleges just as in the city too. Loved ones have expanded help because of an increment in
psychological well-being mindfulness. The shame wins however has been limited somewhat.
7.0 Conclusion
To conclude it all, there is a vast prevalence of mental health problems in undergraduate
students. Students have various self-coping mechanisms too, some positive and some
negative. There has been an increase in the support available in universities as well as in the
city as well. Family and friends have increased support due to an increase in mental health
awareness. The stigma prevails but has been minimized to some extent.
The principle psychological wellness issues characterized are pressure and nervousness
prompting misery. This is brought about by pressing factor and rivalry at college at the
undergrad level. There is a shame identified with emotional wellness among understudies and
they would prefer not to uncover that they are dealing with such issues or, in all likelihood
they will be peered downward on.
Consequently, understudies attempt to adapt themselves. Some do it emphatically by
participating in side interests, attempting to haul themselves out. the issue emerges when
understudies go to the negative side and may enjoy exercises like medication misuse, self-
hurting, paving the way to self-destruction.
The college support is available as far as offices being given. Anyway it isn't vocal help and
there is an absence of mindfulness and absence of information on the help accessible. Family
support shifts from one individual to another. Companions might be steady however because
of shame understudies try not to impart subtleties to individuals around them.
Cultural help isn't extremely high. There is no aggregate position on this issue. Individuals
may profess to help this issue however with regards to singular cases they ease off. Quietness
on the matter is regularly interpreted as absence of help.
Regardless of all the mindfulness throughout the long term, the shame joined has figured out
how to win. We have no unmistakable view if the disgrace is genuine while concerning
college understudies. Understudies self-envision the disgrace are hesitant about using the
offices accessible.
8.0 Appendix
8.1 Observation notes
FF - MBBS
MFK
PR- CBM
MA -
RM -
PreCOVID
Physical uni - 6 days a week - hectic. No time for anything else. Life revolves around uni.
After COVID
Online classes, less travelling, lesser exhaustion, but captured in the home.
Interactions: from friends, to rickshaw walas, office members, professors, guards, etc. You
interact with so many people throughout a usual day but COVID has made you realize how
you miss talking to people, people that aren’t your friends or acquaintances necessarily.
Some interact with friends mostly. Going for short outings in between classes.
Other activities:
Some participants had a lot of hobbies they wanted to do, but couldn't take out that much
time. Travelling, then classes all day, catching up with sleep.
Work like tutoring kids, freelance editing, baking, freelance writing.
After COVID, no time wasted in commuting and time spent on campus between classes is
wasted also.
Pandemic has given them time to explore unique hobbies like nail art, cookin, baking, etc.
Describe family in 3 words.
- Meet at dinner
- Unconditional love, funny, supportive
- Sweet and sour
- Supportive, comfortable,
- Loving, grateful, terrible
- Unique, unthinkable,
Overwhelming emotions:
- Anxiety = increases
- Joy and a sense of accomplishment
- First year of uni = suffocation and exhaustion which evolved into a good type of
exhaustion. Stress and anxiety are constant
- Feeling of fulfillment and contentment
- Sometimes things don’t make sense. There are happy and sad moments. Mostly stress
because of competition
- Stress and anxiety causes a creative block - makes you feel unworthy - takes up a lot
of mental space thinking about it. When i am able to sort it, i feel proud of myself.
But then i feel overwhelmed a lot
- Overwhelmed when there are multiple tasks to do in one day - causes stress. This year
is uncertain so with uncertainty, stress and anxiety partner up. What happens next - no

1
 clear cut answers. Financial uncertainties - father facing job insecurity. Praise from
others, being appreciated, makes me happy.
- Try to wear off feelings of sadness and stress by being grateful for the things i have
- Impending sense of doom and death - comes and goes in waves. Entire day is like a
roller coaster.
- Cannot handle exam stress
When you feel these emotions, what do you do to tackle it?
- Maintain a journal, which helps. If its a huge problem, talk to my mom and siblings.
But i like keeping things to myself because if things spread, matters become worse as
everyone has their own opinions and it drags a lot.
- Try to isolate the cause of stress. Think what is the worst that can happen. What is the
best I can do. Do it and leave it to God. If things still don’t work out, I speak to my
childhood friend. Even if she doesn't solve it we can laugh over it. Listen to music,
write to vent. If you don't process your emotions they bubble up inside you and then
burst out unexpectedly.
- Speak to family first obviously. Spent time with family mostly this year. Talk to
friends who have the mental capacity to tackle it. The negativity around me brings me
down. Had to leave social media as well because of the negativity circulating. Food
and reading are escapism mechanisms. Browse through memes and Tik Tok.
- Contact 2 of my closest friends
- Talk to my close childhood friend. Get confused easily and suppress too much so it
gets really hard. Afterwards I rant and try to look for a solution. Talk to someone who
can give me good advice.
- I reached out to a therapist. Was inconsistent. If i do it regularly, it will be nice.
Sleeping and crying are other coping mechanisms. I have been bottling emotions
unconsciously and running away from problems. Haven't done that previously.
Blocking out things.
What does the term Mental Health bring to your mind?
- Noone thinks about the solution. Mental health is being used as a weapon, used to
justify situations and as an excuse. The term itself is so loose that it comes naturally.
It needs more specificity. Just using the term is not enough.
- Mental health is just an understanding.
- Commercialised nowadays. Used to promote stuff. To victimise. There is awareness
but there are disadvantages associated with it.
- A component of well-being like physical health. The reason it is so controversial is
because other people cannot view it as a physical injury. It's not testable. Everyone
has a mental life. How people deal with it is the key. Like sleeping well, having a
good social circle, etc. it is a bit of a stigma because people can translate it to
someone being crazy. There should be support systems. It is not only a drama. There
are serious issues out there that need to be dealt with.
- Need a lot of awareness still because it is equally important like physical health. It is
expensive and healthy on the pocket. If the taboo did not exist, money could be a
great factor again. Some therapists here are unprofessional. Like doctors too. Mental
health mein there are very few people already and half of them are not worth the trust.

2
 - Lack of awareness. People fear to be judged. There is a difference between
psychotherapist, counselor and therapist. There is a lack in society.
Seeking support
- Worked with organizations to list organizations and therapists and doctors who
provide support.
- People don’t recognize that they have a problem. So how ill people seek help.
- People are scared of what people will say. Stigmatized.
Accessibility
- Aman telehealth services (free) and good
- Taskeen
- My university has one therapist - minimal arrangement. But the students did not know
about it. If you refer to a professor then only he can refer to the therapist. Stigma still
exists - don't want classmates to know.
- Insta page - aik aik qadam
- Therapists are available but no awareness cum advertising so that students can utilise.
- No proper system in place. No guided system.
- I reached out to a therapist separately. If i knew something was available at university
i would have definitely availed that.

8.2 Focus group guide

Research Objective
To understand what mental health means to students in Pakistan, how it impacts them and
what they do about it.
Group Members
Abeera Tariq – 13170 – Note Taker
Maryam Akhlaq – 12731 – Note Taker
Yusra Sibtain – 12568 – Moderator
Medium of conducting Focus Group 
Online Zoom Meeting, Wednesday 25th February 2021, 7.30 – 9.00 pm
Introduction
Welcome
Hello Everyone! Thank you for taking out time to join us today to talk about mental health
issues in university going students. My name is _____ and here I am with _____ and _____.
We are all from the Institute of Business Administration. As part of our Application Business
Research course, we are conducting research on the prevalent mental issues in undergraduate
university students and would like to learn more about it with your help. 
Ground Rules 
Before we begin, we would like to tell you that this session is being recorded and we have
your consent for it beforehand. You will remain completely anonymous and this recording
will only be utilized for transcription purposes therefore, we have requested you to be named
as "Participant 1", "Participant 2" and so on. We are reiterating this here so if you have any
objections or concerns, please let us know before we begin the session. 

3
This is how we will go about this session. We would be taking turns to speak, and I will
guide you when it is your turn. You can always raise your hand if you would like to
contribute further to the discussion. Remember there are no right and wrong answers. Please
feel free to share your point of view even if it differs from what others have said. 

Hoping for your cooperation. Please keep yourself muted if you are not speaking to avoid
unnecessary distortions. 
Questions
So, let's begin by introducing ourselves. We have done our part and would like to hear brief
introductions from you. Keeping your name as your initials, we would like to know your age,
your degree and institute name. 

1. Let’s start with what your average day looks like.

2. Now that we know what you od throughout your day, we would love to know what
your average day at university looks like?
(Prompt - who do they interact with on a regular basis? What are these interactions like? Also
probe about Covid and whether that has influence? What influence?) 

3. How is your day like once you get home (from university)?
(Prompts - understand life at home and university work juggle, ask about any part-time jobs
or any jobs that the students may be engaged in, probe about nature) 
(This is an attempt to understand the workload, household, and familial responsibilities the
students may have) (also ask about hobbies, extra-curriculars, any other engagements that
keep them occupied apart from university work or studying)

4. On average how much time do you need to give to your studies beyond university
hours? 
(Prompts- understanding average study time and study load)

5. If you were to describe your relations with your family, can you do it in 3 words.
(Prompt- following up with post university homelife, attempt to understand what they are like
at home vs how they are with friends and peers)

6. We’ve talked about your daily routine and what you usually do every day. As you go
about your day, can you describe any feelings that you experience?
(Prompt - get them to identify as many feelings as they can)
(Probe – which one of these would be frequent or overwhelming? would you categorize them
as positive or negative for you?)

7. Is there anything that you do about any of these feelings? 

4
(Probe – what do you do? Attempt to understand coping mechanism, also gauge, and probe
reasons for why they do these specific things only) (ask whether people around them ger
involved and how? Do they do or say anything? If yes, what do they do? If no, why not?)

8. Who do you talk to when you feel what you described? 

(Know who they put their trust in or if they see a therapist)

9. What comes to your mind when I mention mental health? 

(Probe - after assessing responses, get them to define it)

10. Building up on their responses, ask them about the importance of mental health.
(Probe - maintenance of sound mental health) 

11. How open are you to the idea of talking about mental health?
(assess responses - are they open or not? Who are they most comfortable with, ask why)  

12. Do you know of (or use) any resources for mental health? Which ones? Are they
accessible to you?
(Probe to see if there are any university resources) 

13. Have you ever used any of these resources yourself or do you know of someone who
used them? Would you like to share something about the experience?
(Positive or negative experience, are they likely to endorse it or no)

14. What prompted them to access these resources? Did they stop? When did they stop?
Why?

15. What did people around you or they have to say about seeking help or using
resources?

16. What are your opinions about the mental resources available in Pakistan?
(Probe - availability, accessibility in terms of location and finances, approachability. Would
you wish they were different? How?)

17. What resources do you wish were available for mental health for people? for
students?
(Probe: who do you think can make these available? Who should make these available? How
can it be done?

18. Is there anything you would like to add to the conversation? (probe responses, wind
up discussion)

5
Parting remarks
Thank you so much for joining us today in this discussion. It has been extremely pleasant and
insightful, and it will help us greatly in our research. Thank you once again and goodbye.
8.3 Focus group summary
Introduction

The Focus Group was conducted on Wednesday, 24th Feb 2021 from 7:00 pm – 9:00 pm.
The session was moderated by Yusra Sibtain while Abeera Tariq and Maryam Akhlaq were
note-takers who have shared their notes separately. The discussion revolved around
understanding mental health issues in undergraduate students in Pakistan. We tried to have a
diverse group of participants belonging to different majors and universities.

Focus Group Recording Link

https://drive.google.com/drive/folders/1FUPhUYqMK4zznAETDOrtSQvpJglge1LY

Participant Profiles

Frequency

Gender

Male 0

Female 6

Age

18 or younger 0

19 0

20 1

21 1

22 3

23 1

24 0

25 0

26 0

6
Marital Status

Unmarried 6

Married 0

Institution

IoBM 1

DHA Suffa University 1

Jinnah Sindh Medical University 2

Habib University 1

Karachi Medical and Dental College 1

Degree

BBA 2

Communication and Design 1

MBBS 3

Family Size

1 0

2-3 0

4-5 5

6 and more 1

Total Participants 6

7
Findings

9. Daily Routine

The discussion started with making the participants comfortable and understanding the
average day in an undergraduate’s student life. A busy schedule was identified by most of the
participants for their respective universities. In pre-COVID times, almost all students
described their day to revolve around university. Commuting to and from their campus was
time consuming too. Then waiting in between classes, as some did not have continuous
classes took up time as well. So, to sum it up, the participants were at university from 8 in the
morning till 6 in the evening. Spending 10 hours on campus and counting the travelling time,
most of them did not have time left for any other hobbies or activities.

Once COVID struck and students were having online classes, most participants reported to
have found quite a lot of free time on their hands. This provided them with a great
opportunity to spend time doing activities they would have done had they had time
previously. This included reading, painting, baking, cooking, nail art, freelance work. The
participants were at home all day and some of them enjoyed the time spent with family as
well. Every minute of the day could be utilised as there was no travelling, no waiting in
between for classes. All participants identified a vast difference between their average days
pre-COVID and post-COVID.

10. Daily Interactions

The participants were asked about their daily interactions in the university to gauge their
social status. The insights were quite interesting. The participants said that after COVID
struck, they realized and valued even the meagre interactions they had when going physically
to university. Some participants said that they used to interact with so many people, like
talking to the Rickshaw wala, Careem driver, guards, university staff, professors, classmates
and of course friends. Now some of these interactions are not there completely and others
have been reduced to emails and messages. Then there were short outings with friends,
maybe not a well-planned outing, but small escapades between classes, to a nearby restaurant.
Besides close friends, there are a number of classmates that were on ‘Hi! Hello!’ terms and
tend to exchange a smile or a nod or a wave when seeing them on campus. All these
apparently small, meaningless interactions have been noted now and missed and valued as
well.

Interactions post-COVID have been limited to family members only. Where close friends are
concerned, for several months, no outings were possible hence, contact was via WhatsApp
and phone calls only. Not only for extroverts, even for introverts these interactions were
important and said to have been missing it. Then there were social events at university which
was a source of great fun. There were family gatherings, weddings, parties, which were
missed. Some stated that even though they previously avoided weddings and family
gatherings, they miss them now.

8
 11. Life Beyond University

The participants all talked of how university and their studies took up most of their time.
When they got home from university, their time was mostly spent studying or doing
assignments. Despite the workload, some of them did take out time for their hobbies or their
passions.

For some, their passions were closely linked to what they were studying, and they pursued
freelance work in similar fields simply because they enjoyed the work. One mentioned that
she worked as a content creator for medical digital magazines and volunteered with student
organisations that raise awareness about medical issues and resources for help-seeking.
Another worked as a freelance editor in her free time.

The participants were involved in various activities like playing sports, singing, exercising,
reading, swimming, baking, cooking, and indulging in nail art. Half of them also talked about
maintaining journals that they regularly write in and that helps them organise and unwind.

Spending time with friends was also a key activity. They regularly made plans to meet in
person or kept in touch regularly over social media. Social media was identified as a key part
of their lives with all of them regularly spending time on various platforms. They used this to
look at memes, connect with friends or even connect with strangers who had similar interests.
An interesting thing mentioned was how it helped them connect to strangers all over the
globe just on the basis of what they felt. One described it as the best way to destress and
unwind as someone else was feeling the same thing and she did not have to explain her
feelings to them.

12. Family Relations

Furthermore, participants were asked to describe their relations with their families. Some of
the participants were very quick to respond while some took relatively greater time. One of
the participants was confused and expressed it was difficult to select three terms to describe.
However, responses led to emergence of some key terms that were used to explain family
relations; Unique – wholesome – unthinkable, Unconditional love – funny – supportive,
Sweet and Sour, Supportive- Caring – Comfortable, Loving- Grateful- Terrible and Meet at
dinner. While it is obvious that relations may not be perfect, these terms were helpful in
analysing how close the participants were to their families. Some made use of positive words
while others described a terrible relation or a limited one where they meet at dinner.

13. Emotions

The participants were prompted to articulate the overwhelming emotions they have
throughout the day. Several emotions were identified while the most significant feeling
expressed as Stress and Anxiety. Few attributed this feeling to excessive workload, exams,
and exhaustion. Participant highlighted that feelings of stress have been increasing over time.
9
One participant articulated how life doesn’t make sense to her and she is utterly confused
about her emotions. The brain often dwells in the question of “why?” or “why me?” that
initiates a state of anxiety. A participant expressed that the competitive nature of studies was
responsible for added stress.

The participants stated that feeling stressed was something usual. One of them admitted that
she did feel joy and a sense of accomplishment at times. One stated that initially when
university started, she felt exhaustion and suffocation, but with time she adjusted, and
exhaustion evolved into a good type of exhaustion.

One participant expressed that stress forms a creative block and made her feel unworthy at
times and takes up a lot of mental space when one thinks about it. She went on to say that
when she can sort it out on her own. She feels proud but that is not the case always and it
makes her feel overwhelmed.

Another participant described how she felt overwhelmed when she had to complete multiple
tasks in a day, adding to the stress. When the pandemic happened, there was and still is a lot
of uncertainty around, and in times like these, stress and anxiety partner up and make you feel
low. There are no clear answers about the future however, appreciation and praise make her
feel happy.

Post-COVID there is an impending sense of doom and death and there are feelings of
sadness. A participant described these waves of emotions and expressed how every day is
like a rollercoaster of emotions.

14. Coping Mechanisms

Based on the emotions described above, they were asked to explain their plan of action when
emotions like stress and anxiety consume them. Here everyone had a different coping
mechanism ranging from keeping to self, penning down, and ranting it out with a trusted
friend to seeking help from a therapist.

One of the participants described her coping mechanism to include eating food, reading,
watching memes, spending time on Tik Tok, and talking to people with similar problems on
Twitter. Another participant laid emphasis on writing down emotions, listening to music,
watching funny videos, and eating sweet however, she said she feels safe keeping things to
herself as sharing leads to a spiral spread of information which she did not like. In addition to
that, a participant said she would first analyse the situation to see what is the worst that could
happen and then laugh it out along with a childhood close friend. She also said she writes
everything in her diary, listens to music and puts her trust in God.

Another mechanism was identified as crying it out and finding peace in sleeping well and
talking to best friends. One of the participants articulated that she reached out to a therapist
who assisted her, but she was inconsistent in her visits and believed that regular visits will be
helpful. It was evident that most of the participants put their trust in someone who they are
10
close to and would not judge them for what they are going through. For some the trusted
someone was the member of their family while for others was their close circle of friends.

The notable point in this was most participants felt more comfortable in confiding in a friend
than a family member. They said it was because either their friends were going through
similar emotions and hence it was easier to connect and vent. Secondly, family members
often thought that the participant had too many issues. All realised that bottling up emotions,
suppressing them or avoiding them were not a solution and it was best to cope with whatever
mechanism worked best with them.

15. Views on Mental Health

We asked the participants about mental health — what it meant to them and how they
perceived it and it led to a very comprehensive discussion on the topic. Several felt that
mental health was a very loose and broad term, and it needed a proper definition. According
to them, the term involved what it was, the stigma associated with it and the misconceptions
around it.

They also expressed the idea that there is little awareness about the subject and hence a lack
of understanding about what it entails and what should one do when mental health gets
affected. Mental health is often just limited to major disorders like personality disorders and
people believe that treatment becomes a permanent fixture. They also said that anyone who
says their mental health is affected is immediately deemed ‘mad,’ excluding them from social
circles.

Two participants expressed how often the sufferers only need to be heard and that is the way
to solving most of their concerns. But since people are quick to shun them, it becomes
extremely hard to seek help or reach out for it.

While the participants themselves exhibited greater levels of literacy in their conversations,
they stated that older people around them didn’t have the same knowledge and understanding.
They noted that some adults around them needed help and they knew that pointing it out and
suggestions to visit a psychologist will not be taken well at all.

They were quick to mention that a lot of people dismissed mental health concerns as phases
in life and it was believed that these feelings will go away, and everything will be fine. The
participants, mostly Gen Z, had the idea that everyone goes through phases of life and you
need to identify behavioural patterns and seek help if there is a need. For instance, if someone
gets angry once that is no big deal, however if this behaviour is repeated, it necessitates
seeking help. A few sessions could help you identify underlying causes and improving
behaviour.

During the discussion, it was brought to light that ‘mental health’ is used as a buzz word
today, a lot of people misuse it to suit their own preferences. They said that people would
often blame their toxic behaviour on ‘mental health issues’ and continue to use it as an excuse
11
for their actions. The participants felt that just by throwing the term around when it suited
them, these people had created a coddle culture. People continue to talk of their failing
mental health and seeking advantages of it rather than going to a counsellor and putting effort
on getting better.

The concept of stigma was also raised. The participants said that due to lack of awareness, the
entire concept of mental health is stigmatised. People wrongly label those who are affected
with concerns and due to the fear of being shunned or being outcasts, people refuse to seek
help. The participants strongly believed that mental health was equally as important as
physical health and taking care of it needed to be normalised.

16. Support and Accessibility of Mental Health Resources

All the participants strongly advocated seeking support and three of them had even sought
support at one time or another.

Support available from university.

The participants admitted that their universities did have counsellors available if they ever
felt the need to talk to someone. However, almost all of them said that there was no proper
system in place. For years in university, they did not know that there were professional
therapists and counsellors available on campus for their support. They also pointed out that
they were not informed of these services and they felt the reason behind this was the stigma
associated with mental health seeking.

Students at medical universities claimed that their teachers and administration had rarely
advertised the presence of an on-campus counsellor. Teachers only intervened and guided
students to seek the counsellor when they felt a certain student needed help. They also added
that mental health awareness seminars and dedicated weeks were held at their universities but
those were mostly student initiatives.

Support from external sources

They believed that as students, they have limited budgets and need more financially feasible
resources. One of them was aware of what affordable, external sources were accessible for
students and people with limited incomes as she had volunteered for NGOs advocating for
better and improved mental health.

Limitations

Conducting focus groups allowed to have a deeper understanding of the topic and analyse
participants’ diverse flow of thought. It was noticed that participants often seconded point of
views of other and added more based on their experiences.

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However, few limitations of the focus group were identified. Firstly, we had time constraints
for conducting the focus group which restricted us in the extent of probing into questions.

Secondly, we had a diverse group of participants based on their educational qualifications

however, all were females. It can be said that male students were less keen on participating in
a focus group on mental health. However, since there was only one focus group and a small
number of participants, we cannot make this claim with certainty.

Thirdly, due to Covid-19 we were restricted to conduct a virtual focus group and hence, we
could not observe participants’ body language while they responded to questions.

Conclusion

The general findings we got were that students were aware of what mental health constituted.
Not only that, they were acutely aware, they also kept a check on their emotions and their
own mental health. Moreover, they had mechanisms to help them get over these
overwhelming emotions and feelings.

These students had educated themselves on what mental health meant, and what resources
were available to them. They also sought these resources when necessary and shared them
with people who needed help. They also actively advocate seeking help on social media
platforms.

The participants quickly became comfortable with each other after the initial questions. This
ensured a highly active and hearty discussion about mental health and issues.

8.4 Interview guide

1. Welcome the participant and introduce yourself.

“Hi participant, this is Maryam Akhlaq. I am currently an MBA student at IBA and for a course, I am
conducting a research on mental health issues in undergraduate students of Pakistan. Before we start, I
would like to inform you that this session is being recorded solely for the purpose of transcription and
analysis. Further after this session, I will be recording your contact information in case we need to
contact you later in this research.”

Getting to know the participant

2. So let’s begin, Please briefly tell me about yourself. You may skip your name here and simply
share, your age, the full name of your majors and institute name

Life and Routines

3. Can you walk me through an average day of your life during weekdays? (University)

4. Life at home: Once you are home, how does the rest of the day go like?

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 a. Work, part-time b. Chores
c. Studies

5. Study time: On average how much time you need to spend on your studies beyond university
hours.

6. Extracurricular: Do you participate in extracurricular activities, seminars or clubs at your

university?

7. Any hobbies you have

Social Interactions

8. Interactions: Whom do you interact with in between classes? Has COVID affected
interactions in any way?

9. If you were to describe your relation with your family, could you put it in a few words

10. Has Covid impacted your life in any way?

Understanding mental health of participant

11. While you go about your day, what kind of emotions or feelings do you go through?

1. (Prompt - identify as many feelings as they can)

2. (Probe - Categorize them as positive or negative for you?)

12. Coping: Is there anything you do about any of these feelings?

13. Reactions: What do people around you say/ react when you are going through those feelings?

14. Who do you talk to about it

15. ______, is widely used term these days. What is your view on it? (based on what they refer to

as, depression, stress or anxiety)

16. When do you think one should seek help?

Mental Health Views of Participant

17. What do know about mental health? What are the meanings associated with it a. Importance

b. Awareness

Resources and Support

18. Do you know of any resources for mental health?

19. Have you ever made use of these resources or know anyone who has? Describe experience.

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a. How helpful was it?
20. Why did you feel the need to utilize theses sources and would you revisit if needed?

Perceptions on help-seeking of people

21. What do you people (friends and family) around you think about you seeking help or using these
resources?

University actions

22. Does your university do anything regarding mental health issues?

Views on how support structure could be made better

23. In general, what do you think about mental health resources available in Pakistan?

24. If you were to suggest something, what do u feel in missing in our mental health support

system? What resources you wish were available for students specifically?

a. Any ideas on how to make it possible

25. END: Is there anything think you would like to add to the conversation to close this session?

26. Thanks: Thank you for participating in this session today. It has been

8.5 Interview transcription with self-evaluation

INTERVIEWEE TEXT COMBINED
ABEERA
Okay, so I am almost 20 and my major is social development and policy and I'm from the
batch of 2024 from Habib University. Is there any information that I missed?
Okay. So an average day would be for me to wake up at 6:00 and get ready for university
because my class is at 8:30 and I also need to get my siblings to school. So it starts at six. I
get to university at 8:30 when I have a class, usually from 8 30 to 10 30, and I have a 15
minutes break after that. And then I usually have classes back to back with time from 2 30 to
3 30, where I have lunch and I get off at 6 30 and reach home by 9:00. I have my dinner then.
And I do whatever assignments are left and I sleep around 3:00.
I don't spend much time studying after university because I have to get home and, you know,
take care of dinner and my siblings. So I usually like my siblings go to sleep around 1230 to
one. So I'm usually taking care of them to 1 30. And after that, I'm just too tired to do much.
Yes
I am part of the Habib, I forgot the name of the club. Yeah. The Habib care club so obviously
it is a community service club and so I take part in a bit of community service, but that's not a
regular thing.
I keep a small circle of friends, so they're just two people that I usually meet. So like I eat
with them, I smoke with them and like, that's my usual interaction.

15
Yes it has because like, not everyone can meet daily and, you know campus facilities have
been reduced and controlled a lot and there's a certain distance we have to keep. So it also
creates a kind of a mental distance. So that does affect a lot of interactions, actually.
Yes.
I can't really compare doing COVID times because when COVID started, we were already
about to graduate from college, but the, like we didn't have a graduation ceremony, but be all
ready, were prepared for it to end, but, you know, university was supposed to be a new start.
Right. So and that was really impacted. The bonding and the the extra curricular activities
that we got in college compared to university, these were reduced and they did have an
impact on mental health.
Well, I am close to my siblings because I am usually taking care of them much. I usually
have conflicts with my parents.
In terms of sharing experiences with them? I try to share some of my experiences to them, so
they know, you know, they can differentiate between right and wrong or properly, and they
know the importance, their education. And I just try to coach them on how to interact with
people around them to show kindness and, you know, study and work hard.
Well, it actually depends most of the time, it's just a numbing feeling like nothing. There,
there are no feelings at all, but anger and frustration become a common feeling, especially
when dealing with family issues and work.
It is very overwhelming because each subject requires a lot of attention and a lot of setting
outside of university hours. And well, I have fallen behind in my work a lot.
No, I don't really do anything particular to control them as such.
Well, I think these are words that need to be addressed because when you're even younger,
people are using it, they're using these words for a reason, because there's something that's
causing them to feel this way. So, yeah, I agree. They're big words, but they're using big
words for a reason. So it's an issue that needs to be addressed.
Yeah. I do know few people.
I think a lot of people who struggle with these feelings just particularly think of themselves as
it being a weakness, it is in a way, but they don't want to project it as a weakness. And others
also start viewing them as weak. So they aren't really willing to open up about it, but once
they do it just makes a lot of their actions fall into place.
I think the most important time to seek help about such issues is when it starts interfering
with their daily lives and just, you know, just keeping them in a loop of these feelings for a
little too long.
I see an abnormal mental health as something that just interferes in a person's goals and
motivation and daily activities. So like that, I think that comprises of depression, anxiety, and
other mental health issues. And I think it's a topic that's not much discussed here in our
country. And it's something that's ignored or seen as just, like I said, abnormal and people
aren't just willing to address these issues.
Well, the ones that I know that are on campus are we have two mental health counsellors, but
there's just two of them and it's, they usually don't even have like enough open appointments
because there's so many students struggling and fighting for appointments. And, well, I think
it's a good resource, but it is not being used correctly.
None that I'm aware of.

16
Okay. So I went to two sessions with the mental health counsellor. Personally, I didn't feel
they were very effective because when I talked about what was troubling me to the counsellor
and asked her for advice on how I should control my emotions and stuff her answer would
usually be, you know, I'll talk to my supervisor and get back to you. So I didn't think they
were that effective. So I quit taking the sessions. I took two of them.
No I wont. I mean I guess everyone has their own you know ways of coping. So I guess it
would be effective for some people because it's just talking and no real therapy involved, but
it just wasn't, for me, it might be beneficial for someone else. So, yeah.
Well, I usually paint and write to the destress, but like, that's just something I do and it won't
really work for anyone else.
Well, one of my friends was aware of it and I was actually, she who got me to go there.
I think when a person is going to get mental health counseling, other people see them as, you
know, cheating, being crazy. There's this term thats used a lot, "keh pagal ho, "pagal hogaya
hai" "crazy". So, you know, a lot of people see them as someone who's mentally deranged or
retarded. So there's a lot of embarrassment factor involved.
Well, the university faculty hasn't done much or anything visible at all, but there's a club here,
the healthy life club, which is supposed to help deal with these issues. But from the semester
that I spent here, it hasn't been active at all.
Oh, one of the main issues, I think the mental health departments have faced is that a lot of
people who come with them, but to them, that these issues are struggling, struggling with
these issues due to environmental factors, because our society has become that toxic. So I
think mental health departments struggled there because the main way to help these people
would be to change their environment. And there's really no way to do that. And nowhere the
person can, you know, just detach themselves from the environment, especially if that
environment stems from home. So I think that's one of the main issues they face. And another
thing is that society has stigmatized mental health so much, you know, just going to give
mental health therapy as just any sort of you health in general is perceived as it's a taboo
topic. Like even a person going there would have to like hide and not tell people about it. So
the thing that needs to change is society in general and the way our mental health experts
view people who are suffering from these issues.
I think an important facility that needs to be made available to students who are facing mental
issues because of toxic environments is like, you know, shelter homes or a safe space,
something that is not usually seen in our society. I think a safe space or shelter is very
important.
I don't think there's anything I missed. I hope so.
MARYAM
I am Syeda Shamama Chishty. I am currently studying in university of Karachi Department
of psychology. I am in my seventh semester. This is the last year of my graduate studies.
Clinical psychology as a major.
Pre COVID my university's days were like what, the whole week from Monday to Friday it
was a busy week, I would say because we have continuous classes. We have actually a course
distributor for like, according to credit ours. It's like two hours per class. So we have actually,
we have a little interesting courses that is majorly related to psychology, but I guess pre
17
COVID, it was really interactive and interesting to learn new things. Apart from that, the
weekends, were mostly busy with working all the weekday things and sorting assignments
and other related work.
Okay. initially our university was managing online classes, but it was difficult because it's a
government university, and they have their own things to manage. But after a while they
started online classes. Usually it was difficult for us to manage things because we were just
home and we weren't getting any time to study because we didn't short, but our university is
managing out and seeing other students who are actually going to the online platforms and
we weren't able to, but after, I think two months, they actually started the online process. And
while staying home, I would say it was easy, accessible for me at least to get into the online
classes. But obviously the teaching pattern wasn't upgraded, I would say because there was
like zoom or other platforms through it, they were actually giving the classes and there was
nothing, you know, like testing us what we are studying at home or how we getting through
things. So I think it wasn't that good for us, but we had to manage it and then staying at home
is like, no work out at all. We were, we had to just, you know, sedentary lifestyle. We were
just managing our own things to, by our own selves because we weren't having any activity
rather than staying home. And, you know, by managing, we were like writing stuff or making
ourselves comfortable with the new style, but it was hard, I would say.
Okay. I have a part-time work. I work as a freelancer these days, so it's like, when I cme back
home and I actually run a website. So I usually update blogs out there or social media
platforms. So I work with that part. And these are mostly on weekends because on weekdays
it's like university, and then I get back home to work somewhat few works or do some online
work. So usually study time is almost on the weekends, but it's mostly the part-time work that
I do.
I would say five hours because it's, I have, I have an evening class, so it's like from three to
seven, eight. That's the time I spend at university.
Beyond university. Okay. On weekends, I'm actually that learner who wants to get into
different courses, or sometimes I try to learn new as I am majoring in clinical psychology.
There are a lot of things that is related to clinical psychology happening. Especially in these
times, there are a lot of change that is happening here in psychology. So I would say, I
actually spend like five hours a day, I would say yeah. Apart from university and not on the
weekdays, especially it's like in weekdays, like what work I get I study in the morning before
going to university. I will say one, two hours on weekdays and five hours on weekends.
Yes. I would say I am really interested in learning new things. So I look, I almost like attend
every seminar that's happening in my university related to psychology, I would say, and my
university does arrange them, so I try to be there. There are not much clubs I would say. So
I'm not into that, I guess, because I'm like, you know, I spend time with my own self at home,
like doing some creative work, but mostly in university it's like seminars more, both like
within university or if it's outside university, arranging somewhere. So I attend.
Yeah, I was, I was about to mention it earlier because every day it's like before sleeping, I try
to read it can be a book, usually my interest in psychology. So I try to read a book and in the

18
morning I try to read a blog or a news alert. So I like reading, I would say, and writing
sometimes scribbling some interesting topics so I can write on it.
Okay. I have like a very small group, I will say with which I actually interact. I try to like be
around them. I don't interact much, I would say, but so pre COVID, it was like with being
with them, studying with them class sharing notes and stuff. And I would say in the midst of
it when there was COVID situation and we were at home I was also interacting with them
and studying with them. And then you know, because we actually, we had physical exams
after the session, so we were actually focused on, you know, we were like four people. So we
were actually focused on your notes, you're sharing notes or any classes that we missed
online. And after it all, sorry. Now, like after COVID situation we are still, we are like. I
would say four. I'm not that interactive. I would say I like, I like talk talking to those who are
in, you know actually have something to add on the class. So I discuss with them, you know,
what was in your mind when you discuss this question or something? But I would say those,
this little group that I stay with.
Okay. family, like I'm bonded to them. I'm a bit dependable. I love being with them. I don't
know. I just love being at home.
Yeah. I would say it's a bit on my health as well, because staying at home there wasn't
workout thing or, you know, because I'm not university I'll we walk around a lot. So it was, I
think it has affected my health a bit because I wasn't able to walk much or maintain my
schedules. Secondly, I would say, no, it wasn't refreshing at being constantly at home and
how much you will maintain a thing when you know that, you know, it's been like one, two,
three, four months are exceeding. So I would say it has affected a bit of health. I would
mention like the mental wellbeing as well, because I think it has affected me in that way as
well, because I wanted to interact with people, you know, because I had a few circles where I
go and, you know, I, I meet them, have some conversations, we actually designed a
workshop. So it's like the part-time work I do. So I go for them, we have the meetings and
there wasn't anything then there was COVID. So it was all online. And I was stuck with this
online thing at home. Something to be, don't go for the physical thing. I think health and
emotional and physical and mental health, I would say these three things are actually affected
a bit.
Is it related to the COVID part or like general? No general. Okay. So I would say I try to
maintain like being positive and you know, in good emotions. But I think the night that I have
sometimes, like it's nighttime, it's like some bit of emotional, then you're sad in part, but I
think these are true emotions that I usually face aggression or something is like, it happens
rarely in surprising emotion has happened. Rarely as in sadness and happiness, like these two
emotions go around.
I think I, I, as, as mentioned before, I love learning things. So when there's a case study being
discussed in the class or teachers being telling us something new, it actually joys me like, Oh
wow, that's something different to learn. Or maybe I can ask questions to it and there's
something new to it. So I think I like that part. I, it actually enrichens me. Well, that's
something different.

19
Okay. if I feel that way I try to become, you know, revert back to the positive side. I try a lot
for, I think for the negative part, I would say it's mostly the stress part. I think that's a lot
stress or anxiety type thing, because mostly it's like it affects me and then I learned how to
cope with it sometime like, you know, if there is some exam going on or I know that, you
know, it's really stressful, I'm not going to get over it. So I try to maintain myself like, okay,
if I'm getting sad, I was like, I have to make myself feel good. Mostly it's like I read, I would
say, or distract myself from that emotion by the time, because I don't want to feel that
negative. Pardon me? I think that's the thing.
I would say again I read, I guess I majorly, I try to write and I would say music is not much
into my list. It's rare, it's rare. TV, no.
Okay. when I know I would say sad or something. I try not to talk to somebody, at that
moment, so it's mostly it's mostly projected as you know, it could only be she's angry or over
something. I, am not because it's, it's mostly an emotion, like sadness. And I don't want to
talk to someone because I know, you know, maybe I'll hurt someone or something, but when
I'm anxious, the reactions are mostly about a family. They are like, okay. They know them.
And I am like do sometimes I'm stressful about my exams. So then they will get like, this is
the situation that is going on. So they try to help me out with the state that, you know, you'll
make it, you will, you don't worry about it or something even like, I have to say the same
words. Like, don't worry, we'll, we'll make it out. And, you know exams will be good. So
these are the things that I hear.
Okay. That's, that's a question to be answered, but I guess, I don't know. I'd be open to it that
I really share. I feel it's not like I put it to myself, but I think if there's something I am really
distressed about, I pray for it to be honest and I try to keep it to myself. I try to, as I
mentioned that I'm already majoring in studying psychology. I tried to, you know, apply a
few things and get out of it because I know that, you know, it's just the emotion, it's a feeling
I should, you know, observe these things. It's not that I should always overcome these things.
That's okay if I'm feeling that way or by something to share. And maybe sometimes it's like, I
find a person that I know is suitable to a certain situation and we can understand a certain
situation. I share that. But in the new one, it's not like I can share everything single person, I
guess.
Yes, I do believe that depression is a widely used on these days. And people are not aware
about the distinction between loneliness, sadness, depression, grief. They are not clear about
it, especially when they are sad. They feel they're depressed. They, they, they intermix
emotions, grief sadness, because we are aware that depression is not just a bit of sadness or
timely that you're feeling. It's a complete cycle of it and there's like lifespan to it. Period you
are going through and I believe that people should be aware about it, you know, educated
about it, that these are different things. Everything is not like people have this idea of saying
every time like, Oh, I'm depressed. Or, but they should know that no, there's there isn't, you
should identify emotions. It's discriminating between them. And again, that stress or anxiety,
again, stress is different. Anxiety is different integration is different. Agreeing the part that
obviously to your mental health in these all are not good at some that some better meters for
depression, I would say people should identify there.

20
Okay. For me personally, I would say it differs in every age bracket. Secondly, I would say
that for teens and others especially I am interested in child and adolescents. I always believe
that, you know, at that stage people with emotional imbalances that are not capable to
manage their emotions and, you know every time being aggressive or not seeking help even
with their prime resources, they should they should talk about it until the primary resources.
Again, I would say the social support is very important. This part when we say that one
should seek help more about the social support that we have, the family, the surrounding that
we have. So I think for child and adolescents, they should, you know, talk to the primary
resources. And again this should be maintained that primary resources first is your family.
And then to anyone else, because at that time we are more dependent on the peers that you
have. So, and about apart from that to adults and stuff, I would say then the things that are
getting before the things are getting worse, I would say, I always believe this emotional
imbalances people should identify that because it really plays a lot role, especially in adults. I
would say this, you know, there's a part in them that sadness, that hopelessness. And when
they feel, especially, I would mention here that self-harm as well. Can you have any trigger
for that? You should seek help. Again, it's always a boundary to everything. Psychology is
not just abnormality there are parameters, so everyone should see it at the time they have this
line when they are no fine and not fine. These are the differences that people should see
within them when they're not, they should seek help, but again, help the first, firstly is your
primary sources, I would say.
And second is the professional help because these resources can help you identify a lot of
things that you cannot identify yourself because you are this tunnel vision. Then you're not
really sure about the things I think primary sources can help you identify that, you know, this
is the problem, or maybe you can it, and if you don't have really strong connections, you can
definitely see that you're actually basing those emotions that are, you're just identify. What is
that dysfunction in your life? What is this, not just the distress, but the dysfunction that is
making an hurdle in your life that is affecting your daily functioning. If it's affecting your
daily functioning, you need help. You need a professional help. I would say again, there's a
difference when you need a social support and you knew you need professional help. I think
people should identify that. So that's all
Okay. I would answer this firstly I would say it it actually, differs that, you know, a lot is
what is our own potential about things? I would say, yes, we do get support from our peers
because you know, we are studying the same subject. We know how we always have. We
know how much we we actually need listeners. So by listening, I would say the reflective
listening. So I would say we do get support and teach from teachers. I would say yes, few
teachers have been, you know, very they have created impressions on us, like be sitting in the
class. And they always mentioned, I remember in psychopathology, they say this that, you
know don't imagine yourself in the situation. And we smile because we all have some things
in our back. You know, nobody's coming from a very promising situations. Everyone has
their own situational stories, I would say. So we have to manage these things and when we
need help. I guess that's the main step I would say asking others to see each other and, you
know, telling the environmental awareness and support the first step, we should take us,

21
maintain our own things, because if we don't seek help, if don't show them by our behaviors it
doesn't work that, so I think we do get support and we should seek support when we need it.
I would say yes, but I would add here that personally I believe that it was there still lackof
education because people are aware that stress, but you are, they're not aware of what
psychological and physiological change that brings on your body. So I believe that yes,
mental health awareness has taken upstairs. People are more aware about it, but again, it's not
just a trend or something that's going on right now. You know, people need to be educated
about it. As we are aware about stroke and cardiac problems, we should be aware about
mental health problems as well. And there's this great educator on this that I always had this
thing in my mind that, you know, people are aware about the cardiac things more because,
you know, we have stress on that. You know, you, you should emphasis on that, that you
should learn about it and you know, it's not good for your health, but that is something that is
unseen, that just your mental health and people should be focused on it.
And for that people need awareness. But with education psycho-education is very important
to every level. I have this I read this thing somewhere that when, if children get to know
about their mental structures a bit about it, I'm not saying that the whole process, but a bit
about it, maybe it can enrich them then maybe that can bring them to the awareness part that
you don't. We need to work on this as well as we work on our physical health, we should
work on mental health. So I'm this advocate of psycho-education people should be educated
awareness. Yes. Awareness, but education.
Yes. I would say APA American, psychological association. They actually have this whole
blogs articles, and I will save the three. I really like the district part because I believe that
people should learn from there. That what is the real meaning of things, because we, we are
this thing and you know what we listen and we just follow it out. We are not aware about the
exact meaning of a thing related to the mental health. So I believe that there are many
Okay. Okay. You mean that, sorry. Yeah. I believe that there are many clinics I would say, or
psychologist personally, firstly, I would add that there are a lot of psychologists that are
practicing online these days and not just these days. I think the COVID had to bring a change
in society. So I think I would not like to mention the names obviously, but I would say that
mostly are available mainly in a few talk about the hospitals. There are hospitals, definitely
there's all hon there is periods or have organized their own. Our university had their own
counseling centers again. The people also need to be sure what they are, you know, visiting
one, you, when you need a psychologist in, you are in to be visited when you need
counseling, I think that's the difference that they need to learn. So yeah, there are lots of
resources, as I said, I am not able to mention exact names because that's, that's a bias thing.
Yes. many of them, because I usually use this referral things I would say many of people
reach out to me that they need someone to talk to. Usually for my domain, they're mostly
parents because for the child and adolescence park so I actually referred them to the
psychotherapist or emotionally. They are the behavioral therapist as well. I refer to them. So I
think those are very beneficial. And even, even our university teachers, like, you know, make
a list of it to actually know when you need referrals, you should have a catalog of it too. You
can refer people.

22
Yes. Yes. I would say yes. There's a great change in view of peoples that they actually share
that, you know, it was really helpful for their child and it was it was good to hear that. Hmm.
I think it's when you refer, you are actually aware of things that you notice. The second
person has the ability to gay to the client. And I've seen that every time I refer, I I'm very
concerned about what's next what's happened when you visit the them. And when I get good
feedback from them to make a use of it
Okay. I will add here to be really honest that people are still have this perception with them
that if you're visiting psychologist, you might have some or merely a severe issue with you.
And as you said, it's crazy that element that we have at it with the people. But I think there is
as I am learning things that, you know, let people stay in front of me, I'll correct them that no,
this is not the right thing to say and seeking help is not that wrong. But I think people still
stigma that we say that we're still saying that, you know, visiting a psychologist or a
psychiatrist, that there might be an issue, a severe issue, that mental health disorder, that
person is seeking help. But yeah, there is, I wouldn't deny that part.
Again by resources, you mean the professionals?
Okay. I would say that in these times of sense when I entered into this university course, I
doubt that time. There wasn't much about an R like in a society where I was in Pakistan, but
now we have actually leveled it up. Not just the psychiatry part, but psychologists as well, a
therapist. And the basic part is that we are now having people that are actually specializing in
a particular age span. Like if I was dealing with child's, I got beside child psychological
issues that the person is also specialized in that part. So I think this is changing in our, in our
country that we are getting people who are specialized in that. And then I would say that we
have a lot of integrative counseling counselors around us that that are actually expedience in
counseling and therapy. So I think, yes, we are leveling up in Pakistan, but still there are a lot
to make because not just the part that we are in pleasing the numbers with the psychologist
part, but we actually need people who can, are ready to seek help because that's the issue that
we have because we don't visit a psychologist until we have we don't visit to hospital until we
have some physical illness.
Okay. I think councilors, firstly, I would say spell your counseling. I have a highlighter
because they need to be here at the time. Especially when you graduate from your high
school. I think that's the time when we actually need carrier counseling and actually very
helpful if we get it that time, because now that I'm studying it, I know how helpful it is. So I
believe that first step would be to add a carrier counselors around the state. Secondly, I would
say psychologists because within university level as well, it can be education counselor, a
psychologist to help students. But we, we need that. We need that a lot, I would say.
Now the whole thing that I want to add is again, to like as these talk about mental health and
I'm really like that we talk, discuss it today and because it actually opened up more
dimensions in it, but I really want to highlight that awareness, mental health awareness is
very important, but education is also really important to educate people that move, why do
they need help? What is the issues? And you know that it's not bad to seek help. It's all videos
all the way out of it. You have a physical illness and you visit a doctor and you sought that
out. Same as if you have a prognosis, because it tells like all this, this or this, I got sorted out.

23
There's always a way out of it. There's always, Oh wait, just make the world and learn about
things.
Don't just decide that things like, you know, this is bad, this is not right for us. It will help
you out. There's no danger. And I believe that there aren't a lot of mental practices that people
are scared of it. And psychologists are not mind readers. They actually help you get through
those signs that you were actually been. You want to seek out that I would say, seek help and
just focus on yourself. And you know, you can build yourself, you can move on to suffocate
yourself. This part that, you know, we don't need help. And you know, we are enough for us.
No, everyone needs a social support. You can stand against that.
Thank you so much for having me. Thank you.
YUSRA
Okay. I'm 23 and I'm currently a senior at IBA. I'm majoring in accounting and finance.
Sure. Just give me a second. What an average day looks like is basically, I have classes in the
mornings that stretch to the afternoon sometimes and I am a TA for a course, and I have been
TA for the last five or so semesters. It's pretty much a part of my day now. And apart from
that, I also give tuitions to 2 kids. Those happen somewhere around the evening and, I live
with my family, there are meals, lunches and dinners with them and that's about it.

Hmm. For work, I would probably say like around three hours, two to three hours a day six or
so hours for studies and, around two hours for myself.
Not at the moment, but I have been part of the arts and photography society in the past, and I
am a campus ambassador for Unilever as well.

My me-time would mostly include watching movies and TV shows and just doing whatever I
feel like doing, honestly, there is no set thing.

I'm mostly with a very close friend circle of mine. Most of my time is spent with them. We're
either in classes or we're just hanging out, but it's mostly with a particular set of people.
Okay. They're mostly positive and very cordial, you know, like asking about how they've
been doing or how I've been doing. Most professors remember me as well, because I
generally tend to do well in classes. They remember who I am and, a bit apart my fellow
students as well. I'm not really a person who has a huge social circle because I have a very
limited set of friends. As for everyone else, it's more of like a hi hello, and how they've been
doing and that's about it.
Hm sure. I have two brothers, two younger brothers, and I'm the only daughter in the family.
It's of course, like it's a very positive relationship with my family. I'm the oldest as well. I'm
close to my parents, I would say closer than both my brothers are to them.
Healthy, I'm more of a confidant for people most of the time and I'm like the mom figure of
the group.
It has my father is currently not working and a big reason for that is the pandemic. I have not
been able to meet my husband in over a year because of the pandemic and well, that, that's it.
And I haven't been able to go to campus for over a year. And haven’t had those interactions
as we used to have with my friends, which I feel is very important for me because I'm not the

24
kind of person who can stay at home for a long period of time. I need to get out more that had
really impacted my life as well, because I was mostly stuck at home.
I have a history of anxiety and depression in my family. And I feel like I've never gotten
myself checked professionally or been diagnosed, but pretty sure that I have it in myself as
well. You know, sometimes, mostly like it's happy, happy, but quite a lot of the times it goes
the other way as well. And I, over time I've learned how to handle those mood swings. Now
it's mostly under control, but it's been a wild journey.
I do things that make me happy, that would include cooking or watching some of my favorite
TV shows and just giving time to myself you know, just being nice to myself and letting
myself feel whatever I'm feeling. That usually helps make me feel better.
I did use to write at first, like when I was in school, but I let go of that habit for some reason.
I feel like it just doesn't help anymore. I can't write in it as freely as I used to back then, but I
talked to a couple of close people that I have, I usually rant and take it out all out. And I'm
mostly feeling better after that or I pray, honestly, that's my saving grace.
Mostly friends.
They're mostly very open to it. Like, I, I have a very, very limited set of people that I actually
opened up properly to. And well, my husband tops the list now, but earlier it obviously wasn't
like that because he wasn't there in my life. But I have a very particular set of people who I
actually open up fully to. they're always open to it. They know the kind of person that I am,
they know what I go through on a daily basis or what, what triggers my emotions mostly.
They understand and they help me. They helped me understand more, more of the situation
and, if solutions are needed, then they give a solution or just make me feel better in general.
Mental health to me refers to mostly how I feel about how I feel on the inside, you know, it's
very important to me to be feeling good about myself and about my surroundings, because if,
if there is something wrong, it just takes a toll on my daily life, right. Or it takes a toll on how
I'm feeling. But more than that, it also takes a toll on me physically as well, starting with
headaches or general fatigue or something like that. It just takes a toll overall. It's very, very
important.
It's not like I haven't sought external support. I have been to a couple of therapy sessions over
the years, but I never really went for clinical testing mostly because of a certain taboo that
exists in society. Maybe I feel like people won't understand and I've never really taken a stand
for this on my own, which I probably should have, but I haven't.
It was good, but it wasn't enough. I felt like it wasn't bringing out the results that it probably
should have been. I wasn't really feeling like it was helping. Then I stopped. This was, this
was 2018. I had gone to the IBA therapists.
Honestly in my case just probably like the elders understanding that it's okay to not be feeling
good at times, or it's okay to not be okay and safe and that it's a thing and it's not like I was
going crazy.
Definitely. Because, the eldest daughter always has this responsibility of being responsible
and I'm happy and to everyone I'm all put together, you know? But I don't think anyone
knows that it might be very different inside. there's this perception of the fact that I'm
supposed to be a positive person. I'm supposed to be responsible. I should have it altogether
because I'm getting good grades. Everything is fine, blah, blah, blah. But it doesn't really
have to be like that, you know?

25
No. No one knew.
I probably wasn't proud of it.
At that point? It was very difficult to actually admit that I was going through something. No
one knew. I, I think like, I, don't even remember, honestly, I probably told like one friend or
but no, I, I genuinely didn't reveal it, but I felt like it was something very personal.
We have the Saya health thing if I'm not wrong which has online therapy sessions. And apart
from that I know that we have like therapists at hospitals and you can always reach out to
them. But, apart from that, not really.
I wanted to keep it a secret, especially from my family. And this was the only way I could do
it.
One, you know, there's a perception of me always being put together and maybe they
wouldn't understand the fact that I just needed to see someone for a while maybe, or that I
merely needed help sorting out things. The inherent reason behind this was like the largely
general stigma that we have.
Definitely. elaborate on the fact that there is a stigma in society for visiting therapists? I knew
if, if my parents, for example, knew of the fact that I was going to see a therapist, they would
either freak out and not understand what was going on, or to just think that I'm thinking too
much in between, or, you know, this was just about my head. But apart from that as well, I
know than, people in general would never see going to a therapist as, as something that
people should actually be doing because of the fact that they think [inaudible] that they're not
correct inside or something like that. There is a perception as well. If someone accepts the
fact that their mental health is not right and tries to talk about it, they're seen as being an
attention seeker.
It has actually. It has, because back then I would never dream of telling my mother about the
fact that I actually went to a therapist, but now I feel like it actually, you know, talk to her
about it. I have actually, my mom now knows that I've taken external help at the time when I
needed it. Just an example of a person in my life who for one was not accepting of the idea
but now she has.
I'm not sure, honestly, but maybe the fact that it's being normalized now, like it should have
been in a way, like, obviously there's a long way to go, but the change has started to take
place.
Hmm. I feel like, what I've been noticing in my brother. So far, because he's in university as
well, is the fact that there is, there can be a lot of pressure from the parents in terms of
academics because there is not always a 4.0 that everyone can achieve and, not every
program or degree can give you that kind of a GPA. If you're you have a very specialized
field, something related to electronics or anything of that sort, it's not necessarily that you
get the best grades to actually be doing well in school. I feel like that perception of, not doing
well, if you don't have a good grade, also adds to a lot of problems and stress in
undergraduate students, especially.

26
8.6 Literature map

8.7 Excel sheet of literature matrix

Citation Purpose, Theory, Research Major Study Study Make
rationale, framewo methods, finding limitatio implicati note of
research rk sample, s, ns, gaps ons for how this
question variables contrib that research, research
utions remain practice, is linked
policy to other
studies
reviewed

27
Jorm, A. F. The benefits To Qualitati The Using While a Following
(2015). Why of a general provide ve, We choice national broad the
we need the health a develope betwee survey concept findings
concept of literacy specific da n broad data, we may be from our
“mental health focus, example, reliable and were useful 1995
literacy”. Hea which can I again scoring domain able to for some survey,
lth be applied turn to system - show purposes the
communicatio across the for these specific that , it will Australia
n, 30(12), health evalu- open- concept quality be n
1166-1168. domains. ation of ended s of of inapprop governme
Using the Mental responses health respons riate in nt has
concept of Health based on literacy es was others. also
mental First Aid a mental is not generall For supported
health training. health an y poor example the
literacy as We have first aid either/o , if a national
an example, defined action r one. It commun mon-
this article mental plan. depend ity itoring of
argues that health s on the survey is mental
there are first aid aims of investiga health
also major as “the a ting literacy,
advantages help project. health with
of a offered literacy subseque
domain- to a across a nt surveys
specific person number in 2003
approach. developi of and 2011.
ng a domains This
mental , a broad monitorin
health concept g has
problem may be shown
or appropri substan-
experien - ate. tial
cing a improvem
mental ents in
populatio
n mental
health
literacy
since
1995,
with gaps
between
public
and
professio
nal views
considera
bly
reduced

28
 (Reavley
& Jorm,
2011).
Manwell, L. Lack of We 50 46% of Small The Our
A., Barbic, S. consensus propose people respond sample survey results
P., Roberts, on the a with ents size found suggest
K., Durisko, definition of transdo expertise rated dissat- that any
Z., Lee, C., mental main in the the isfaction practical
Ware, E., & health has model of field of Public with use of a
McKenzie, K. implications health to mental Health current definition
(2015). What for research, inform health Agency definitio of health
is mental policy and the from 8 of ns of will
health? practice. develop countries Canada mental depend on
Evidence This study ment of complete (PHAC health. the
towards a new aims to start a d an , 2006) There epistemol
definition an compreh online definiti was no ogical and
from a mixed international ensive survey. on as consens moral
methods , def- They the us framewor
multidisciplin interdiscipli inition identified most among k through
ary nary and capturin the preferre this which it
international inclusive g all of extent to d, 30% group on was
survey. BMJ dialogue to the which 4 stated a developed
open, 5(6). answer the subcomp current that common , and that
question: onents of definition none of definitio the
What are health: s were the 4 n. mental
the core physical, adequate definiti and social
concepts of mental and what ons domains
mental and the core were may be
health? social concepts satisfac differenti
health. of mental tory ally influ-
health and enced
were. A only than the
qualitativ 20% physical
e said the domain.
thematic WHO
analysis (2001)
was definiti
conducte on was
d of their their
responses preferre
. The d
results choice.
were The
validated least
at a preferre
consensu d
s meeting definiti
of 58 on of

29
 clinicians mental
, health
researche was the
rs and general
people definiti
with on of
lived health
experienc adapted
e. from
Huber
et al
(2011).
Schaefer, J. We review In the Participa Our Nonethe we aim It has
D., Caspi, A., epidemiolog absence nts are results less, a to been
Belsky, D. ical of prior members suggest limitatio encoura repeatedl
W., evidence research of the that the n of the ge y
Harrington, indicating or theory Dunedin compar Dunedin research demonstr
H., Houts, R., that most on Multidisc atively Study is ers to ated that
Horwood, L. people will enduring iplinary few that it shift individual
J., ... & develop a mental Health individ was not scientifi s with
Moffitt, T. E. diagnosable health, and uals originall c inquiry severe,
(2017). mental we Develop who y from an persistent,
Enduring disorder, selected ment manage designe exclusiv or
mental health: suggesting from our Study to d to e focus recurrent
Prevalence that only a data set (DMHD avoid study on the mental
and minority measure S), a 4- such predicto etiology disorders
prediction. Jo experience s decade, conditi rs of of differ
urnal of enduring available longitudi ons endurin mental from
abnormal mental to us that - nal owe g mental illness individual
psychology, 1 health. This have the investigat their health, toward s without
26(2), 212. minority has best ion of extraor because investiga such
received publishe health dinary no one tion of disorders
little d and mental anticipat the in
empirical evidence behavior health ed that etiology multiple
study, base as in a to an it would of ways.
leaving the importan complete advanta be so enduring This well-
prevalence t risk birth geous rare as mental establishe
and factors cohort. persona to be an wellness d finding
predictors of for lity interesti . Just as was
enduring mental style ng research confirmed
mental disorder. and phenoty on the in our
health lack of pe. As a predictor study:
unknown. family result, s and Table 3
history our correlate shows
of investig s of that Study
disorde ation specific members
r, but was mental diagnosed
not to con- disor- at 3

30
 childho strained ders has waves
od by our contribut had more
socio- set of ed childhood
econom pre- substanti risk
ic existing ally to factors
privileg early the across
e, life risk predictio each
superio factors n, domain
r for preventi compared
health, mental on, and to both
or high disorder treatmen Study
intellig , t of members
ence. suggesti these with
ng that conditio endur- ing
studies ns, so mental
with too health and
richer might Study
sets of research members
early- on the diagnosed
life, pre- at 1–2
mental- dictors waves.
health- of
promoti enduring
ng mental
factors health
are provide
needed. insight
into how
clini-
cians
and
policym
akers
can
promote
its
spread
in order
to
reduce
both
societal
burden
and
individu
al
suffering
.

31
Apgar, D., & Developing A The Student The Undergr College
Cadmus, T. coping and capstone sample s sample aduate students
(2021). Using self-care course consists reporte is a social experienc
Mixed strategies bridges of 19 d that small work e
Methods to has always the senior they undergr students disproport
Assess the been transitio undergra experie aduate experien ionately
Coping and important n from duate nced student ced high
Self- for social educatio social stressor cohort losses levels of
regulation work n to work s in at a due to stress and
Skills of students as employ students every single COVID- are at risk
Undergraduat they prepare ment, enrolled aspect universi 19 in all for stress-
e Social Work for work with a in a of their ty which aspects related
Students that can take focus on capstone lives was of their mental
Impacted by a experien course at due to conveni biopsych and
COVID-19. C psychologic tial a COVID ently osocial physical
linical Social al, learn- northeast -19. selected, functioni health
Work Journal, emotional, ing ern uni- When limiting ng, disorders
1-12. mental, and activities versity discussi the challeng
physical toll aimed at during ng the potentia ing their
and promotin Spring biologi l ability to
adversely g 2020, the cal generali cope.
impact their assessme semester impacts zability
health and nt, just prior of of
well-being. integrati to their COVID results.
on, graduatio -19,
scholars n. student
hip, s
identity overwh
develop elm-
ment, ingly
and agreed
applicati that
on intangi
ble
losses,
speci
cally
regardi
ng their
daily
routine
s, had
been
particul
arly
challen
ging.
Coelho, S. J. The This was A cohort A total The The Studies

32
D. C., Simões, objective of a study of 1603 limitatio M.I.N.I have
V. M. F., this study longitudi was adolesc ns of question addressed
Batista, R. F. was to nal study carried ents this naire the
L., Ribeiro, C. investigate with data out with were study can be associatio
C. C., Lamy, whether collected 1603 evaluat compris used in n between
Z. C., Lamy- there is an from a adolesce ed in e the clinical cesarean
Filho, F., ... & association birth nts from 2016 retrospe practice birth and
Bettiol, H. between cohort 18 to 19 and c- tive and the
(2021). Birth birth by study in years old 50.2% collectio research developm
by cesarean cesarean the city who were n of ent of
section and section and of São participat males, perinata mood
mood the Luís, ed in the 62.4% l data, disorders,
disorders developmen MA, third self- which such as
among t of mood Brazil. phase of reporte may depressio
adolescents of disorders a birth d have led n and
a birth cohort (depression cohort having to bipolar
study in and bipolar study in brown/ measure disorder,
northern disorders) in São Luís, mixed ment which are
Brazil. adolescents. MA, in skin bias condition
Brazilian 2016. color, (memor s with
Journal of and y) and complex
Medical and 59.9% lack of etiology
Biological had a informat yet to be
Research, family ion on completel
54(1). income mood y
betwee disorder understoo
n 1 and s among d
4 adolesce
minimu nts’
m relatives
wages. and the
lack of
different
iation
between
elective
and
emergen
cy
cesarean
birth.
Haasbroek, The aims Autism The Twenty One of Howeve Relevant
H., & and spectrum types of out of the r, this articles
Morojele, N. objectives disorder participa the 26 biggest research were
(2021). A of this has often nts studies limitatio paper sought
Systematic systematic been included found ns of intends through a
Literature literature assumed from the were these to carefully
Review on the review were to be a primary from studies incorpor structured

33
Relationship to explore protectiv studies Europe has been ate a process in
Between the e factor are adults an that they vari- ety which
Autism relationship against and countri were of, and seven
Spectrum between substanc adolesce es. mostly updated databases
Disorder and substance e use, nts. A Only perform research were
Substance Use use and yet the significa six out ed in using searched
Among Adults ASD extent of nt of the first- various (Springer
and concerning substanc indicatio 26 world database Link,
Adolescents.  potential e use in n that studies countrie s, some Research
Review comorbidity this this were s, with of which Gate,
Journal of , prevalence, populati populatio perfor Europea are Cengage
Autism and types of on has n is more med in n different Learning,
Developmenta substances been susceptib other countrie from Journal of
l Disorders, 1- used, social difficult le to parts of s having those Autism
20. or to substance the most of used by and
environment determin use and world the Arnevik Develop
al causes of e as related such as studies and mental
substance limited disorders the done. Helversc Disorders,
use, genetic research was USA hou PubMed,
and has been found, (4), Medline
neurological done on yet this China and Psych
vulnerabiliti these may only (1) and Info) for
es and interacti remain Austral full-text
lastly, ng true for ia (1). scholarly
potential variables adults. Apart literature
prevention, . from which had
treatment China, been
and care. it is published
evident between
that the 2009 and
given 2019.
studies
came
from
develop
ed
countri
es,
where
people
general
ly have
a
higher
quality
of life
and
more

34
 access
to
healthc
are
compar
ed to
develop
ing
countri
es
(Lake
and
Turner
2017).
Colli, A., The aim of Followin 65 Both we did Future Since
Gagliardini, this work g psychoth positive not studies literature
G., & Gullo, was to Vygotski erapy and focus on should suggests
S. (2021). investigate j’s sessions negativ the be that the
Countertransf the (1987) were e CT impact focused Psychody
erence relationship theory of rated by feelings that on the namic
responses between the zone two seemed therapist interacti Interventi
mediate the therapists’ of different to play s’ inter- on ons
relationship techniques proximal raters a ventions between Rating
between (supportive/ develop each with crucial have on therapist Scale
patients’ expressive ment, the role in the s’ CT, (PIRS)
overall intervention supporti Psychody the patients, their can
defense level – ve namic relation or on intervent categorize
functioning ESIL), intervent Interventi ship the ions and a
and therapists’ therapists’ ions may ons betwee (short the percentag
interventions. countertrans be seen Rating n and long outcome e of in-
Psychotherapy ference as Scale and therapis term) of the session
Research, 1- (CT) and commun the ts’ outcome session interventi
14. patients’ ications Defense interve . and of ons
defense situated Mechanis ntions the ranging
level of on a ms and treatmen from
functioning lower Rating patients t. 91%–
(ODF). level of Scale. ’ ODF. 93% for
the Clinician cognitive
patients’ s used sessions
zone of the to 98%–
proximal Therapist 100% for
develop Response psychody
ment, Question namic and
while naire to psychoan
expressi provide alytic
ve informati sessions (
intervent on on
ions are their CT.

35
 on a The 65
higher sessions
level. referred
to 65
clinicians
(25 =
females,
40 =
males; 38
=
psychody
namic,
27 =
cognitive
). More
than half
of the
patients
(n=40;
61.5%)
had a
diagnosis
of
personali
ty
disorder.
Among
clinical
disorders
the most
frequent
were
mood (n
= 12) and
anxiety
disorders
(n = 11).
Five
patients
had no
diagnosis
. Results:
Four CT
responses
(parental;
positive;
criticized
;

36
 overinvol
ved)
complete
ly
mediated
the
relations
hip
between
patients’
ODF and
therapists
’ ESIL,
while no
effect
resulted
in
relation
to
overwhel
med,
helpless,
sexualize
d and
disengag
ed CTs.
No effect
of
theoretic
al
orientatio
ns on
mediatio
n
pathways
was
found.
Rognli, E. B., The benefits To Qualitati The Using While a Following
Bramness, J. of a general provide ve, We choice national broad the
G., & von health a develope betwee survey concept findings
Soest, T. literacy specific da n broad data, we may be from our
(2021). focus, example, reliable and were useful 1995
Smoking in which can I again scoring domain able to for some survey,
early be applied turn to system - show purposes the
adulthood is across the for these specific that , it will Australia
prospectively health evalu- open- concept quality be n
associated domains. ation of ended s of of inapprop governme
with Using the Mental responses health respons riate in nt has

37
prescriptions concept of Health based on literacy es was others. also
of mental First Aid a mental is not generall For supported
antipsychotics health training. health an y poor example the
, mood literacy as We have first aid either/o , if a national
stabilizers, an example, defined action r one. It commun mon-
antidepressant this article mental plan. depend ity itoring of
s and argues that health s on the survey is mental
anxiolytics. P there are first aid aims of investiga health
sychological also major as “the a ting literacy,
Medicine, 1- advantages help project. health with
10. of a offered literacy subseque
domain- to a across a nt surveys
specific person number in 2003
approach. developi of and 2011.
ng a domains This
mental , a broad monitorin
health concept g has
problem may be shown
or appropri substan-
experien - ate. tial
cing a improvem
mental ents in
populatio
n mental
health
literacy
since
1995,
with gaps
between
public
and
professio
nal views
considera
bly
reduced
(Reavley
& Jorm,
2011).
Mangweth- Lack of We 50 46% of Small The Our
Matzek, B., consensus propose people respond sample survey results
Rupp, C. I., on the a with ents size found suggest
Vedova, S., definition of transdo expertise rated dissat- that any
Dunst, V., mental main in the the isfaction practical
Hennecke, P., health has model of field of Public with use of a
Daniaux, M., implications health to mental Health current definition
& Pope, H. G. for research, inform health Agency definitio of health

38
(2021). policy and the from 8 of ns of will
Disorders of practice. develop countries Canada mental depend on
eating and This study ment of complete (PHAC health. the
body image aims to start a d an , 2006) There epistemol
during the an compreh online definiti was no ogical and
menopausal international ensive survey. on as consens moral
transition: , def- They the us framewor
associations interdiscipli inition identified most among k through
with nary and capturin the preferre this which it
menopausal inclusive g all of extent to d, 30% group on was
stage and with dialogue to the which 4 stated a developed
menopausal answer the subcomp current that common , and that
symptomatolo question: onents of definition none of definitio the
gy. Eating and What are health: s were the 4 n. mental
Weight the core physical, adequate definiti and social
Disorders- concepts of mental and what ons domains
Studies on mental and the core were may be
Anorexia, health? social concepts satisfac differenti
Bulimia and health. of mental tory ally influ-
Obesity, 1-7. health and enced
were. A only than the
qualitativ 20% physical
e said the domain.
thematic WHO
analysis (2001)
was definiti
conducte on was
d of their their
responses preferre
. The d
results choice.
were The
validated least
at a preferre
consensu d
s meeting definiti
of 58 on of
clinicians mental
, health
researche was the
rs and general
people definiti
with on of
lived health
experienc adapted
e. from
Huber
et al

39
 (2011).
Dhungana, S., We review In the Participa Our Nonethe we aim It has
Koirala, R., epidemiolog absence nts are results less, a to been
Ojha, S. P., & ical of prior members suggest limitatio encoura repeatedl
Thapa, S. B. evidence research of the that the n of the ge y
(2021). indicating or theory Dunedin compar Dunedin research demonstr
Quality of life that most on Multidisc atively Study is ers to ated that
and its people will enduring iplinary few that it shift individual
association develop a mental Health individ was not scientifi s with
with diagnosable health, and uals originall c inquiry severe,
psychiatric mental we Develop who y from an persistent,
disorders in disorder, selected ment manage designe exclusiv or
outpatients suggesting from our Study to d to e focus recurrent
with trauma that only a data set (DMHD avoid study on the mental
history in a minority measure S), a 4- such predicto etiology disorders
tertiary experience s decade, conditi rs of of differ
hospital in enduring available longitudi ons endurin mental from
Kathmandu, mental to us that - nal owe g mental illness individual
Nepal: a health. This have the investigat their health, toward s without
cross- minority has best ion of extraor because investiga such
sectional received publishe health dinary no one tion of disorders
study. BMC little d and mental anticipat the in
Psychiatry, empirical evidence behavior health ed that etiology multiple
21(1), 1-11. study, base as in a to an it would of ways.
leaving the importan complete advanta be so enduring This well-
prevalence t risk birth geous rare as mental establishe
and factors cohort. persona to be an wellness d finding
predictors of for lity interesti . Just as was
enduring mental style ng research confirmed
mental disorder. and phenoty on the in our
health lack of pe. As a predictor study:
unknown. family result, s and Table 3
history our correlate shows
of investig s of that Study
disorde ation specific members
r, but was mental diagnosed
not to con- disor- at 3
childho strained ders has waves
od by our contribut had more
socio- set of ed childhood
econom pre- substanti risk
ic existing ally to factors
privileg early the across
e, life risk predictio each
superio factors n, domain
r for preventi compared
health, mental on, and to both
or high disorder treatmen Study

40
 intellig , t of members
ence. suggesti these with
ng that conditio endur- ing
studies ns, so mental
with too health and
richer might Study
sets of research members
early- on the diagnosed
life, pre- at 1–2
mental- dictors waves.
health- of
promoti enduring
ng mental
factors health
are provide
needed. insight
into how
clini-
cians
and
policym
akers
can
promote
its
spread
in order
to
reduce
both
societal
burden
and
individu
al
suffering
.
Ogunbode, C. Developing A The Student The Undergr College
A., Pallesen, coping and capstone sample s sample aduate students
S., Böhm, G., self-care course consists reporte is a social experienc
Doran, R., strategies bridges of 19 d that small work e
Bhullar, N., has always the senior they undergr students disproport
Aquino, S., ... been transitio undergra experie aduate experien ionately
& Lomas, M. important n from duate nced student ced high
J. (2021). for social educatio social stressor cohort losses levels of
Negative work n to work s in at a due to stress and
emotions students as employ students every single COVID- are at risk
about climate they prepare ment, enrolled aspect universi 19 in all for stress-

41
change are for work with a in a of their ty which aspects related
related to that can take focus on capstone lives was of their mental
insomnia a experien course at due to conveni biopsych and
symptoms and psychologic tial a COVID ently osocial physical
mental health: al, learn- northeast -19. selected, functioni health
Cross- emotional, ing ern uni- When limiting ng, disorders
sectional mental, and activities versity discussi the challeng
evidence from physical toll aimed at during ng the potentia ing their
25 countries. and promotin Spring biologi l ability to
Current adversely g 2020, the cal generali cope.
Psychology, impact their assessme semester impacts zability
1-10. health and nt, just prior of of
well-being. integrati to their COVID results.
on, graduatio -19,
scholars n. student
hip, s
identity overwh
develop elm-
ment, ingly
and agreed
applicati that
on intangi
ble
losses,
speci
cally
regardi
ng their
daily
routine
s, had
been
particul
arly
challen
ging.
Pomerleau, S. The This was A cohort A total The The Studies
(2020). objective of a study of 1603 limitatio M.I.N.I have
Mental Illness this study longitudi was adolesc ns of question addressed
Awareness in was to nal study carried ents this naire the
the State of investigate with data out with were study can be associatio
New whether collected 1603 evaluat compris used in n between
Hampshire. there is an from a adolesce ed in e the clinical cesarean
association birth nts from 2016 retrospe practice birth and
between cohort 18 to 19 and c- tive and the
birth by study in years old 50.2% collectio research developm
cesarean the city who were n of ent of
section and of São participat males, perinata mood

42
 the Luís, ed in the 62.4% l data, disorders,
developmen MA, third self- which such as
t of mood Brazil. phase of reporte may depressio
disorders a birth d have led n and
(depression cohort having to bipolar
and bipolar study in brown/ measure disorder,
disorders) in São Luís, mixed ment which are
adolescents. MA, in skin bias condition
2016. color, (memor s with
and y) and complex
59.9% lack of etiology
had a informat yet to be
family ion on completel
income mood y
betwee disorder understoo
n 1 and s among d
4 adolesce
minimu nts’
m relatives
wages. and the
lack of
different
iation
between
elective
and
emergen
cy
cesarean
birth.
Keen, B., & The benefits To Qualitati The Using While a Following
Gainsbury, S. of a general provide ve, We choice national broad the
(2021). health a develope betwee survey concept findings
Perceptions of literacy specific da n broad data, we may be from our
young adults’ focus, example, reliable and were useful 1995
problematic which can I again scoring domain able to for some survey,
technology be applied turn to system - show purposes the
use among across the for these specific that , it will Australia
Australian health evalu- open- concept quality be n
youth domains. ation of ended s of of inapprop governme
professionals. Using the Mental responses health respons riate in nt has
Cyberpsychol concept of Health based on literacy es was others. also
ogy: Journal mental First Aid a mental is not generall For supported
of health training. health an y poor example the
Psychosocial literacy as We have first aid either/o , if a national
Research on an example, defined action r one. It commun mon-
Cyberspace, this article mental plan. depend ity itoring of
15(1). argues that health s on the survey is mental

43
 there are first aid aims of investiga health
also major as “the a ting literacy,
advantages help project. health with
of a offered literacy subseque
domain- to a across a nt surveys
specific person number in 2003
approach. developi of and 2011.
ng a domains This
mental , a broad monitorin
health concept g has
problem may be shown
or appropri substan-
experien - ate. tial
cing a improvem
mental ents in
populatio
n mental
health
literacy
since
1995,
with gaps
between
public
and
professio
nal views
considera
bly
reduced
(Reavley
& Jorm,
2011).
Lauber, C., & Lack of We 50 46% of Small The Our
Rössler, W. consensus propose people respond sample survey results
(2007). on the a with ents size found suggest
Stigma definition of transdo expertise rated dissat- that any
towards mental main in the the isfaction practical
people with health has model of field of Public with use of a
mental illness implications health to mental Health current definition
in developing for research, inform health Agency definitio of health
countries in policy and the from 8 of ns of will
Asia. practice. develop countries Canada mental depend on
International This study ment of complete (PHAC health. the
review of aims to start a d an , 2006) There epistemol
psychiatry, an compreh online definiti was no ogical and
19(2), 157- international ensive survey. on as consens moral
178. , def- They the us framewor

44
 interdiscipli inition identified most among k through
nary and capturin the preferre this which it
inclusive g all of extent to d, 30% group on was
dialogue to the which 4 stated a developed
answer the subcomp current that common , and that
question: onents of definition none of definitio the
What are health: s were the 4 n. mental
the core physical, adequate definiti and social
concepts of mental and what ons domains
mental and the core were may be
health? social concepts satisfac differenti
health. of mental tory ally influ-
health and enced
were. A only than the
qualitativ 20% physical
e said the domain.
thematic WHO
analysis (2001)
was definiti
conducte on was
d of their their
responses preferre
. The d
results choice.
were The
validated least
at a preferre
consensu d
s meeting definiti
of 58 on of
clinicians mental
, health
researche was the
rs and general
people definiti
with on of
lived health
experienc adapted
e. from
Huber
et al
(2011).
Siani, A., & We review In the Participa Our Nonethe we aim It has
Marley, S. A. epidemiolog absence nts are results less, a to been
(2021). ical of prior members suggest limitatio encoura repeatedl
Impact of the evidence research of the that the n of the ge y
recreational indicating or theory Dunedin compar Dunedin research demonstr
use of virtual that most on Multidisc atively Study is ers to ated that

45
reality on people will enduring iplinary few that it shift individual
physical and develop a mental Health individ was not scientifi s with
mental diagnosable health, and uals originall c inquiry severe,
wellbeing mental we Develop who y from an persistent,
during the disorder, selected ment manage designe exclusiv or
Covid-19 suggesting from our Study to d to e focus recurrent
lockdown. that only a data set (DMHD avoid study on the mental
Health and minority measure S), a 4- such predicto etiology disorders
Technology, experience s decade, conditi rs of of differ
1-11. enduring available longitudi ons endurin mental from
mental to us that - nal owe g mental illness individual
health. This have the investigat their health, toward s without
minority has best ion of extraor because investiga such
received publishe health dinary no one tion of disorders
little d and mental anticipat the in
empirical evidence behavior health ed that etiology multiple
study, base as in a to an it would of ways.
leaving the importan complete advanta be so enduring This well-
prevalence t risk birth geous rare as mental establishe
and factors cohort. persona to be an wellness d finding
predictors of for lity interesti . Just as was
enduring mental style ng research confirmed
mental disorder. and phenoty on the in our
health lack of pe. As a predictor study:
unknown. family result, s and Table 3
history our correlate shows
of investig s of that Study
disorde ation specific members
r, but was mental diagnosed
not to con- disor- at 3
childho strained ders has waves
od by our contribut had more
socio- set of ed childhood
econom pre- substanti risk
ic existing ally to factors
privileg early the across
e, life risk predictio each
superio factors n, domain
r for preventi compared
health, mental on, and to both
or high disorder treatmen Study
intellig , t of members
ence. suggesti these with
ng that conditio endur- ing
studies ns, so mental
with too health and
richer might Study
sets of research members

46
 early- on the diagnosed
life, pre- at 1–2
mental- dictors waves.
health- of
promoti enduring
ng mental
factors health
are provide
needed. insight
into how
clini-
cians
and
policym
akers
can
promote
its
spread
in order
to
reduce
both
societal
burden
and
individu
al
suffering
.
Ruiz, B., Developing A The Student The Undergr College
Ceccolini, C. coping and capstone sample s sample aduate students
J., Shah, B. self-care course consists reporte is a social experienc
B., Crump, F., strategies bridges of 19 d that small work e
Girgis, R. R., has always the senior they undergr students disproport
Brucato, G., ... been transitio undergra experie aduate experien ionately
& Corcoran, important n from duate nced student ced high
C. M. (2021). for social educatio social stressor cohort losses levels of
Stigma and work n to work s in at a due to stress and
coping students as employ students every single COVID- are at risk
experiences in they prepare ment, enrolled aspect universi 19 in all for stress-
Latinx for work with a in a of their ty which aspects related
individuals at that can take focus on capstone lives was of their mental
clinical high‐ a experien course at due to conveni biopsych and
risk for psychologic tial a COVID ently osocial physical
psychosis. al, learn- northeast -19. selected, functioni health
Early emotional, ing ern uni- When limiting ng, disorders
Intervention in mental, and activities versity discussi the challeng

47
Psychiatry. physical toll aimed at during ng the potentia ing their
and promotin Spring biologi l ability to
adversely g 2020, the cal generali cope.
impact their assessme semester impacts zability
health and nt, just prior of of
well-being. integrati to their COVID results.
on, graduatio -19,
scholars n. student
hip, s
identity overwh
develop elm-
ment, ingly
and agreed
applicati that
on intangi
ble
losses,
speci
cally
regardi
ng their
daily
routine
s, had
been
particul
arly
challen
ging.
Khalily, M. T. The This was A cohort A total The The Studies
(2011). objective of a study of 1603 limitatio M.I.N.I have
Mental health this study longitudi was adolesc ns of question addressed
problems in was to nal study carried ents this naire the
Pakistani investigate with data out with were study can be associatio
society as a whether collected 1603 evaluat compris used in n between
consequence there is an from a adolesce ed in e the clinical cesarean
of violence association birth nts from 2016 retrospe practice birth and
and trauma: a between cohort 18 to 19 and c- tive and the
case for better birth by study in years old 50.2% collectio research developm
integration of cesarean the city who were n of ent of
care. section and of São participat males, perinata mood
International the Luís, ed in the 62.4% l data, disorders,
journal of developmen MA, third self- which such as
integrated t of mood Brazil. phase of reporte may depressio
care, 11. disorders a birth d have led n and
(depression cohort having to bipolar
and bipolar study in brown/ measure disorder,
disorders) in São Luís, mixed ment which are

48
 adolescents. MA, in skin bias condition
2016. color, (memor s with
and y) and complex
59.9% lack of etiology
had a informat yet to be
family ion on completel
income mood y
betwee disorder understoo
n 1 and s among d
4 adolesce
minimu nts’
m relatives
wages. and the
lack of
different
iation
between
elective
and
emergen
cy
cesarean
birth.
Bar-Zeev, Y., The aims Autism The Twenty One of Howeve Relevant
Shauly, M., and spectrum types of out of the r, this articles
Lee, H., & objectives disorder participa the 26 biggest research were
Neumark, Y. of this has often nts studies limitatio paper sought
(2021). systematic been included found ns of intends through a
Changes in literature assumed from the were these to carefully
Smoking review were to be a primary from studies incorpor structured
Behaviour and to explore protectiv studies Europe has been ate a process in
Home- the e factor are adults an that they vari- ety which
Smoking relationship against and countri were of, and seven
Rules during between substanc adolesce es. mostly updated databases
the Initial substance e use, nts. A Only perform research were
COVID-19 use and yet the significa six out ed in using searched
Lockdown ASD extent of nt of the first- various (Springer
Period in concerning substanc indicatio 26 world database Link,
Israel. Int. J. potential e use in n that studies countrie s, some Research
Environ. Res. comorbidity this this were s, with of which Gate,
Public , prevalence, populati populatio perfor Europea are Cengage
Health, 18, types of on has n is more med in n different Learning,
1931. substances been susceptib other countrie from Journal of
used, social difficult le to parts of s having those Autism
or to substance the most of used by and
environment determin use and world the Arnevik Develop
al causes of e as related such as studies and mental
substance limited disorders the done. Helversc Disorders,

49
 use, genetic research was USA hou PubMed,
and has been found, (4), Medline
neurological done on yet this China and Psych
vulnerabiliti these may only (1) and Info) for
es and interacti remain Austral full-text
lastly, ng true for ia (1). scholarly
potential variables adults. Apart literature
prevention, . from which had
treatment China, been
and care. it is published
evident between
that the 2009 and
given 2019.
studies
came
from
develop
ed
countri
es,
where
people
general
ly have
a
higher
quality
of life
and
more
access
to
healthc
are
compar
ed to
develop
ing
countri
es
(Lake
and
Turner
2017).
Böge, K., The aim of Followin 65 Both we did Future Since
Hahn, E., this work g psychoth positive not studies literature
Strasser, J., was to Vygotski erapy and focus on should suggests
Schweininger, investigate j’s sessions negativ the be that the

50
S., Bajbouj, the (1987) were e CT impact focused Psychody
M., & relationship theory of rated by feelings that on the namic
Karnouk, C. between the zone two seemed therapist interacti Interventi
(2021). therapists’ of different to play s’ inter- on ons
Psychotherapy techniques proximal raters a ventions between Rating
in the (supportive/ develop each with crucial have on therapist Scale
Kurdistan expressive ment, the role in the s’ CT, (PIRS)
region of Iraq intervention supporti Psychody the patients, their can
(KRI): level – ve namic relation or on intervent categorize
Preferences ESIL), intervent Interventi ship the ions and a
and therapists’ ions may ons betwee (short the percentag
expectations countertrans be seen Rating n and long outcome e of in-
of the Kurdish ference as Scale and therapis term) of the session
host (CT) and commun the ts’ outcome session interventi
community, patients’ ications Defense interve . and of ons
internally defense situated Mechanis ntions the ranging
displaced-and level of on a ms and treatmen from
Syrian refugee functioning lower Rating patients t. 91%–
community. I (ODF). level of Scale. ’ ODF. 93% for
nternational the Clinician cognitive
Journal of patients’ s used sessions
Social zone of the to 98%–
Psychiatry, proximal Therapist 100% for
00207640219 develop Response psychody
95219. ment, Question namic and
while naire to psychoan
expressi provide alytic
ve informati sessions (
intervent on on
ions are their CT.
on a The 65
higher sessions
level. referred
to 65
clinicians
(25 =
females,
40 =
males; 38
=
psychody
namic,
27 =
cognitive
). More
than half
of the
patients

51
 (n=40;
61.5%)
had a
diagnosis
of
personali
ty
disorder.
Among
clinical
disorders
the most
frequent
were
mood (n
= 12) and
anxiety
disorders
(n = 11).
Five
patients
had no
diagnosis
. Results:
Four CT
responses
(parental;
positive;
criticized
;
overinvol
ved)
complete
ly
mediated
the
relations
hip
between
patients’
ODF and
therapists
’ ESIL,
while no
effect
resulted
in
relation

52
 to
overwhel
med,
helpless,
sexualize
d and
disengag
ed CTs.
No effect
of
theoretic
al
orientatio
ns on
mediatio
n
pathways
was
found.
O’Loughlin, Developing A The Student The Undergr College
C. M., & coping and capstone sample s sample aduate students
Ammerman, self-care course consists reporte is a social experienc
B. A. Stigma strategies bridges of 19 d that small work e
as a predictor has always the senior they undergr students disproport
of mental been transitio undergra experie aduate experien ionately
health important n from duate nced student ced high
treatment- for social educatio social stressor cohort losses levels of
seeking work n to work s in at a due to stress and
behavior students as employ students every single COVID- are at risk
among those they prepare ment, enrolled aspect universi 19 in all for stress-
with a history for work with a in a of their ty which aspects related
of suicidality. that can take focus on capstone lives was of their mental
a experien course at due to conveni biopsych and
psychologic tial a COVID ently osocial physical
al, learn- northeast -19. selected, functioni health
emotional, ing ern uni- When limiting ng, disorders
mental, and activities versity discussi the challeng
physical toll aimed at during ng the potentia ing their
and promotin Spring biologi l ability to
adversely g 2020, the cal generali cope.
impact their assessme semester impacts zability
health and nt, just prior of of
well-being. integrati to their COVID results.
on, graduatio -19,
scholars n. student
hip, s
identity overwh
develop elm-

53
 ment, ingly
and agreed
applicati that
on intangi
ble
losses,
speci
cally
regardi
ng their
daily
routine
s, had
been
particul
arly
challen
ging.

54