Two years into the pandemic, the health consequences of COVID-19 are increasingly understood to impact both physical and mental wellbeing alike. Across countries, from the US to the UK, Australia and China, reports of depression, anxiety, stress, and loneliness have increased.

Student mental health: A population in peril

University students experience mental health symptoms at levels that are disproportionately high in comparison to the general population. Rates of a number of complaints – from depression to suicidal ideation and alcohol abuse – are up to three times higher among student populations. Similarly worrying reports indicate that students often feel hesitant about seeking mental health support, particularly those that may need it the most. Given the already perilous state of student mental health, there is every reason for concern about how students are managing in the global turmoil of a pandemic.

International students: A vulnerable subgroup

Within the greater student population, international students may be especially at risk of mental health complaints. International students face many additional stressors to those faced by domestic students: they may be subject to additional financial stress resulting from studying abroad, and they are removed from their usual social support systems and may struggle to integrate into a new culture and establish new friendships. Being an international student may also hinder more practical aspects of student life, such as attaining affordable housing, an issue that has been repeatedly discussed in the Dutch media in the past year. Given all the additional stressors faced by internationals, they may also be harder hit by the mental health consequences of the ongoing pandemic.

Student mental health and COVID-19

To find out how the pandemic is affecting the mental health of Leiden University students, and whether international students may be especially affected by the current situation, we collected data from two cohorts of Leiden University students in early 2020 and 2021. A total of 374 students filled in our survey, which covered mental health complaints ranging from academic stress and depressive symptoms to anxiety, post-traumatic stress, and sleep complaints.

Comparing mental health outcomes between March 2020 (i.e., the early, “acute” stage of the pandemic) and March 2021 (i.e., the extended, “chronic” stage of the pandemic), we observed increased reporting of depressive symptoms, academic stress, and loneliness in the 2021 cohort. Notably, twice the number of students reported moderate-to-severe depressive symptoms and severe loneliness in 2021 as in the previous year.

When comparing international and Dutch students, we also observed increased symptom reporting across many domains among internationals: in both cohorts, international students experienced more depressive symptoms, suicidal ideation, anxiety, post-traumatic stress, and loneliness than domestic students. For example, while 12% of Dutch students met criteria for probable post-traumatic stress disorder (PTSD), the rate among international students was 30%. Loneliness was reported by 25% of international students, in comparison to 9% of Dutch students.

While we observed more mental health complaints among international students overall, our expectation that the pandemic would have a greater impact on the mental health of these students was not supported. When we examined the symptom trajectories of Dutch and international students, differing patterns emerged: while international students consistently reported higher levels of symptoms than domestic students across cohorts, the levels remained relatively stable from 2020 to 2021. Among Dutch students, on the other hand, rates of many complaints (such as depressive symptoms and suicidal ideation) almost doubled from 2020 to 2021.

Supporting our students

Mental health complaints are high among students in general, and both domestic and international students have been affected by the pandemic, as is also shown by research conducted by the RIVM. The higher rates of symptoms observed in international students make this group particularly vulnerable.

As of October 2021, international students make up 23% of all students at Dutch universities – and this number is predicted to increase steadily in the upcoming years. Universities should ensure that in introducing new initiatives to enhance the wellbeing of all their student populations, they pay particular attention to the needs of international students.