Table 1 Summary of samples and prevalence of included studies (N = 89)
Citation | Country | Sample | Outcome measure | Cut-off score | Overall prevalence | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Â | Â | Sample size | Response rate | Age range | Mean age (SD) | Gender (% Female) | Course or Faculty of study | Year of course | Number of HEIs | Â | Â | Â |
Al-Bahhawi et al. (2018) [41] | Saudi Arabia | 642 | 90.2% | NR | 22.14 (1.7) | 48.9% | Health sciences Other sciences Non-science courses | NR | 1 | DASS-21-A |  ≥ 10 (moderate or above) | 65.7% |
Abdallah & Gabr (2014) [42] | Egypt | 379 | 90.0% | 17–19 yrs | 18.02 (0.26) | 48.0% | Medicine | Yr 1 | 1 | DASS-21-A | NR | 78.4% |
Abdel Wahed et al. (2017) [43] | Egypt | 442 | 88.4% | 17–22 yrs | 20.15 (2.9) | 61.1% | Medicine | Yrs 1–4 | 1 | DASS-21-A |  ≥ 8 (mild and above) | 64.3% |
Abeetha et al. (2018) [44] | India | 323 | 100.0% | 18–22 yrs | NR | 50.5% | Medicine Engineering Arts | NR | 1 | GAD-7 |  ≥ 10 (moderate and above) | 19.0% |
Aboalshamat et al. (2015) [45] | Saudi Arabia | 422 | 64.5% | NR | NR | 53.3% | Medicine Dentistry | Yrs 2–3 | 1 | DASS-21-A |  ≥ 8 (mild and above) | 66.4% |
Al-Khani et al. (2019) [46] | Saudi Arabia | 206: 95 included in analysis | 46.0% | 18–28 yrs | 20.8 (1.95) | 24.0% | Medicine | Yrs 1–5 | 1 | DASS-21-A | NR | 28.3% |
Almhdawi et al. (2018) [47] | Jordan | 838 | 80.7% | 18–41 yrs | 21.3 (1.8) | 77.3% | Allied health professions courses | Yrs 3–4 | 1 | DASS-21-A |  ≥ 7 | 65.3% |
Al-Shamlan et al. (2020) [48] | Saudi Arabia | 523 | 71.1% | NR | 22.4 (0.96) | 54.7% | Medicine | Yrs 4–6 | 1 | GAD-7 |  ≥ 10 (moderate and above) | 31.7% |
Alvi et al. (2010) [49] | Pakistan | 279 | 71.0% | NR | 21.4 (1.41) | 72.4% | Medicine | Yrs 2–5 | 1 | BAI |  ≥ 8 (mild and above) | 47.7% |
Amir Hamzah et al. (2019) [50] | Malaysia | 1631: 1602 included in analysis | 53.0% | 18–25 | 19.5 (0.7) | 72.8% | NR | Yr 1 | 1 | DASS-21-A |  ≥ 8 (mild and above) | 60.4% |
Asif et al. (2020) [51] | Pakistan | 500 | 100.0% | 18–24 yrs | NR | 49.6% | NR | NR | 3 | DASS-21-A |  ≥ 8 (mild and above) | 88.4% |
Auerbach et al. (2016)Â [52] | Australia, Belgium, Germany, Mexico, UK (Northern Ireland), South Africa, Spain, USA | 14,371: 13,984 included in analysis | 45.5% | NR | NR | NR | NR | Yr 1 | 19 | CIDI-SC diagnostic interview | n/a | Lifetime: 18.6% 12Â month: 16.7% |
Awadalla et al. (2020) [11] | UAE | 404 | 80.8% | 17–41 yrs | 19.64 (2.75) | 72.2% | Business Humanities and Social sciences Technological Innovation Communication and Medical Sciences Natural health sciences | Yrs 2–4 | 1 | GAD-7 |  ≥ 10 (moderate and above) | 22.3% |
Azad et al. (2017) [53] | Pakistan | 150 | 30.0% | 17–26 yrs | 20.6 (0.8) | 76.4% | Medicine | Yrs 1–5 | 1 | BAI |  ≥ 22 (moderate or above) | 13.2% |
Azim et al. (2019) [54] | Pakistan | 188 | 70.0% | 18–25 yrs | 21.4 (2.2) | 53.0% | Medicine | Yrs 1–5 | 1 | DASS-21-A |  ≥ 8 (mild and above) | 72.3% |
Ballester et al. (2020)a[55] | Spain | 2118 | 19.0% | NR | 18.8 (1.4) | 72.5% | Arts and Humanities Engineering and Architecture Health Sciences Science Social and Legal Sciences | Yr 1 | 5 | CIDI-SC diagnostic interview | n/a | Lifetime: 19.3% 12Â month: 16% |
Bantjes et al. (2019)a[56] | South Africa | 1407 | 9.7% | NR | NR | 55.2% | NR | Yr 1 | 2 | CIDI-SC diagnostic interview | n/a | Lifetime: 22.6% 12Â month: 20.8% |
Bassols et al. (2014) [57] | Brazil | 232 | 67.4% | NR | 23.1 (3.2) | 49.6% | Medicine | Yrs 1 and 6 | 1 | BAI |  ≥ 10 | 18.5% |
Basudan et al. (2017) [58] | Saudi Arabia | 277: 247 included in analysis | 95.8% | NR | NR | 45.7% | Dentistry | Yrs 2–5 | 1 | DASS-21-A |  ≥ 8 (mild and above) | 66.8% |
Baykan et al. (2012) [59] | Turkey | 193 | 86.9% | 23–31 yrs | 24.5 (1.5) | 44.6% | Medicine | Final year | 1 | DASS-42-A |  ≥ 8 (mild and above) | 50.3% |
Borst et al. (2015) [60] | Netherlands | 951 | 43.0% | 17–40 | 23.0 (2.6) | 71.0% | Medicine | Yrs 1–6 | 2 | BSI-ANG |  > 0.41 | 28.0% |
Bunevicius et al. (2008) [61] | Lithuania | 411 | 92.5% | NR | 21.0 (1.0) | 81.7% | Medicine Humanities | NR | 2 | HADS-A |  ≥ 8 (borderline abnormal and above) | 44.5% |
Cheng et al. (2020) [62] | China | 645 | 88.0% | NR | NR | 55.2% | Science and Technology Literature and History Medicine | NR | 3 | SAS |  ≥ 50 | 25.7% |
Chernomas et al. (2013) [63] | Canada | 437 | 49.5% | NR | NR | 89.0% | Nursing | Yrs 1–3 | 1 | DASS-42-A |  ≥ 10 (moderate and above) | 31.0% |
Cheung et al. (2016) [64] | Hong Kong, China SAR | 661 | 52.6% | 18–30 yrs | NR | 72.5% | Nursing | Yrs 1–4 | 1 | DASS-21-A |  ≥ 10 (moderate and above) | 39.9% |
Cheung et al. (2020) [65] | Hong Kong, China SAR | 9479 | 56.5% | NR | 18.9 (1.5) | 52.3% | Applied Science Business Construction and Environment Health and Social Science Engineering Humanities Design Hotel and Tourism Management | Yrs 1–4 | 1 | DASS-21-A |  ≥ 10 (moderate and above) | 29.1% |
Coker et al. (2018) [66] | Nigeria | 240 | 74.0% | 25–34 yrs | 25.0 (4.5) | 50.0% | Medicine | Yrs 2–6 | 1 | DASS-21-A |  ≥ 8 | 9.5% |
Dalky & Gharaibeh (2019) [67] | Jordan | 600 | 98.3% | NR | NR | 64.7% | NR | NR | 3 | DASS-21-A |  ≥ 10 (moderate and above) | 76.5% |
Delara et al. (2015) [68] | Iran | 171 | 93.4% | 18–37 yrs | 21.6 (3.3) | 79.5% | Health Studies | Yrs 1–4 | 1 | SCL-90-A | NR | 35.7% |
Eisenberg et al. (2007)b[69] | USA | 1181 | 56.6% | NR | NR | 52.8% | NR | NR | 1 | PHQ-A | NR | 2.9% |
El-Gilany et al. (2019) [70] | Egypt | 900 | 81.9% | NR | NR | 53.2% | Medicine | Yrs 1–6 | 1 | SCL-90-A | NR | 12.9% |
Eller et al. (2006) [71] | Estonia | 413 | 80.2% | 19–33 yrs | 21.3 (2.5) | 76.9% | Medicine | Yrs 1–6 | 1 | EST-Q |  ≥ 12 | 21.9% |
El-Matury et al. (2018) [72] | Indonesia | 499 | 80.2% | NR | NR | 59.7% | Health Sciences Social Science and Humanities Science and Engineering | NR | 1 | DASS-21-A | NR | 71.5% |
Fawzy & Hamed (2017) [73] | Egypt | 700 | 100.0% | 18–25 yrs | 21.22 (1.62) | 64.5% | Medicine | Yrs 1–6 | 1 | DASS-21-A |  ≥ 8 (mild and above) | 73.0% |
Fernandes et al. (2018) [74] | Brazil | 205 | 73.0% | 18–50 | 21.8 (3.8) | 81.5% | Nursing | NR | 1 | BAI |  ≥ 8 (mild and above) | 62.9% |
Francis et al. (2019) [75] | Malaysia | 622 | 89.2% | NR | 21.18 (1.53) | 64.8% | Medicine | Yrs 1–5 | 1 | HADS-A |  ≥ 8 (borderline abnormal and above) | 39.7% |
Fortney et al. (2016) [76] | USA | 765 | 31.3% | NR | NR | 66.9% | NR | Yrs 1–2 | 11 | GAD-7 |  ≥ 10 (moderate and above) | 17.6% |
Gaspersz et al. (2012) [77] | Netherlands | 1180 | 52.0% | NR | NR | NR | Medicine | Yrs 1–6 | 1 | BSI-ANG |  > 0.41 | 27.5% |
Ge et al. (2020) [78] | China | 2009 | 80.3% | NR | NR | 51.0% | NR | Yrs 1–4 | 1 | GAD-7 |  ≥ 7 | 12.5% |
Islam et al. (2020) [79] | Bangladesh | 440: 400 included in analysis | 88.0% | 18–23 years | 19.66 (0.88) | 47.8% | Arts and Humanities Mathematical and Physical Sciences Social Sciences Biological Science Business Studies | Yr 1 | 1 | GAD-7 |  ≥ 10 (moderate and above) | 61.0% |
Junaid et al. (2020) [80] | Saudi Arabia | 247 | 90.0% | NR | NR | 31.2% | Medicine | Yrs 2–6 | 1 | BAI |  ≥ 16 (moderate and above) | 39.3% |
Karaoglu & Seker (2010) [81] | Turkey | 290 | 82.8% | NR | 19.0 (1.3) | 44.1% | Medicine | Yrs 1–2 | 1 | HADS-A |  ≥ 10 | 20.3% |
Kebede et al. (2020) [82] | Ethiopia | 273 | 98.5% | NR | NR | 39.4% | Medicine | Yrs 1–6 | 1 | HADS-A |  ≥ 8 (borderline abnormal and above) | 30.1% |
Knipe et al. (2018) [83] | UK (England) | 1139 | 55.6% | NR | NR | 76.4% | Medicine Dentistry Veterinary Sciences | NR | 1 | GAD-7 |  ≥ 10 (moderate and above) | 27.3% |
Kou et al. (2012) [84] | China | 1843 | 90.1% | 17–28 | 21.3 (1.6) | 32.6% | Arts and Social Sciences Sciences Agriculture Engineering Medicine | Yrs 1–4 | 1 | WHO-CIDI diagnostic interview | n/a | Lifetime: 0.5% 12 month: 0.3% 30 day: 0.1% |
Kulsoom & Afsar (2015) [85] | Saudi Arabia | 442 | 76.8% | NR | NR | 38.0% | Medicine | Yrs 1–5 | 1 | DASS-21-A |  ≥ 10 (moderate and above) | 63% pre-examination 47% post-examination |
Kumar et al. (2019) [86] | Pakistan | 312 | 69.3% | NR | 22.74 (1.52) | 84.6% | Medicine | Final year | 2 | DASS-21-A |  ≥ 10 (moderate and above) | 73.0% |
Kunwar et al. (2016) [87] | Nepal | 538 | 89.6% | NR | NR | 52.0% | Medicine | Yrs 1–5 | 2 | DASS-42-A | NR | 41.1% |
Liu et al. (1997) [88] | China | 537 | 89.5% | NR | 18.2 (1.8) | 69.0% | Medicine | Yrs 1–3 | 1 | SAS |  ≥ 50 | 12.5% |
Lun et al. (2018) [89] | Hong Kong, China SAR | 1119: 1101 included in analysis | 81.1% | 18–29 | 19.81 (1.48) | 61.9% | NR | Yrs 1–5 | 8 | GAD-7 |  ≥ 5 (mild and above) | 54.4% |
Mahroon et al. (2018) [90] | Bahrain | 307 | 87.7% | NR | NR | 63.2% | Medicine | Yrs 1–5 | 1 | BAI |  ≥ 8 (mild and above) | 51.5% |
Marthoenis et al. (2018) [91] | Indonesia | 266 | 82.0% | NR | 19.7 (1.8) | 51.8% | NR | NR | 2 | GAD-7 |  ≥ 8 | 27.4% |
Milić et al. (2019) [92] | Croatia | 562: 538 included in analysis | 72.2% | 20–31 yrs | NR | 69.2% | Medicine Nursing | NR | 1 | GAD-7 |  ≥ 5 (mild and above) | 56.8% |
Moutinho et al. (2017) [93] | Brazil | 761 | 75.4% | NR | 22.1 (3.3) | 55.8% | Medicine | Yrs 1–6 | 1 | DASS-21-A | NR | 37.2% |
Moutinho et al. (2019) [94] | Brazil | 312 | 54.2% | NR | 21.0 (2.6) | 64.1% | Medicine | Yrs 1–4 | 1 | DASS-21-A |  ≥ 7 (mild and above) | 30.1% |
Mundia (2010)b[95] | Brunei | 68 | 95.9% | NR | 23.6 (6.8) | NR | Education | NR | 1 | DASS-42-A |  ≥ 10 (moderate and above) | 64.7% |
Nahm et al. (2020) [96] | South Korea | 1071: 1063 included in analysis | 32.5% | NR | NR | 48.0% | Veterinary Medicine | Yrs 1–6 | 10 | DASS-21-A |  ≥ 15 (severe and above) | 35.8% |
Nakhostin-Ansari et al. (2020) [97] | Iran | 323 | 64.6% | NR | 23.73 (1.62) | 52.3% | Medicine | All years | 1 | BAI |  ≥ 10 (mild and above) | 38.1% |
Naz et al. (2017) [98] | Pakistan | 129 | 84.9% | 17–21 yrs | 19.0 (NR) | 68.0% | Dentistry | Yrs 1–2 | 1 | DASS-21-A |  ≥ 8 (mild and above) | 41.9% |
Nimkuntod et al. (2016) [99] | Thailand | 213 | 92.6% | NR | 19.51 (2.09) | 56.8% | Medicine | Yrs 1–3 | 1 | DASS-21-A |  ≥ 8 (mild and above) | 25.8% |
Paudel et al. (2020) [100] | Nepal | 618 | 90.7% | 18–29 yrs | 20.39 (1.57) | 62.3% | Engineering Management Law Natural Sciences Health Sciences Education Humanities | NR | NR | DASS-21-A |  ≥ 8 (mild and above) | 46.9% |
Rab et al. (2008) [101] | Pakistan | 87 | 20.0% | 18–23 yrs | 20.7 (1.9) | 100.0% | Medicine | Yrs 1–5 | 1 | HADS-A | NR | 43.7% |
Ramón-Arbués et al. (2020) [102] | Spain | 1074 | 80.0% | NR | 21.73 (5.12) | 71.0% | Health Sciences Communications Architecture and Technology | NR | 1 | DASS-21-A |  ≥ 8 (mild and above) | 23.6% |
Renteria et al. (2020)a[103] | Mexico | 7874 | 79.3% | NR | NR | 53.1% | NR | Yr 1 | 9 | CIDI-SC diagnostic interview | n/a | 12Â month: 11.6% |
Saeed et al. (2018) [104] | Pakistan | 404 | 53.6% | NR | NR | 52.2% | Pharmacy 'Non-pharmacy' | NR | 4 | DASS-42-A |  ≥ 8 (mild and above) | 58.2% |
Sahoo & Khess (2010) [105] | India | 405 | 81.0% | NR | 19.3 (2.8) | 0.0% | NR | Yrs 1–2 | 5 | DASS-21-A MINI diagnostic interview | DASS-21-A: ≥ 8 (mild and above) MINI: n/a | DASS-21-A: 24.4% MINI: 19.0% |
Salem et al. (2016) [106] | Egypt | 300 | 94.0% | NR | NR | 55.7% | Pharmacy Arts | Pharmacy: Yrs 2 + 5 Arts: Yrs 1 + 4 | 1 | DASS-21-A |  ≥ 8 (mild and above) | 45.0% |
Samaranayake et al. (2014) [107] | New Zealand | 1291 | 66.8% | 16 -38 yrs | NR | 63.9% | Medicine Health sciences Nursing Law Engineering Architecture | NR | 1 | GAD-7 |  ≥ 8 | 19.7% |
Samson (2019) [108] | Nepal | 680 | 63.4% | NR | 20.29 (1.65) | NR | Nursing | Yrs 1–4 | 9 | DASS-21-A |  ≥ 10 (moderate and above) | 72.9% |
Savitsky et al. (2020) [109] | Israel | 215 | 88.0% | NR | Yr 1: 23.4 (2.8) Yr 2: 25.1 (2.3) Yr 3: 26.1 (3.0) Yr 4: 27.9 (3.4) | 87.5% | Nursing | Yrs 1–4 | 1 | GAD-7 |  ≥ 10 (moderate and above) | 42.8% |
Serra et al. (2015) [110] | Brazil | 657 | 97.9% | NR | 22.7 (NR) | 61.2% | Medicine | Yrs 1–6 | 1 | BAI |  ≥ 11 (mild and above) | 21.5% |
Shawahna et al. (2020) [111] | State of Palestine (West Bank) | 286 | 67.3% | NR | NR | 60.8% | Medicine | Yrs 1–6 | 1 | BAI |  ≥ 19 (moderate and above) | 46.8% |
Shen et al. (2020) [112] | China | 4882 | 97.5% | NR | 18.7 (NR) | 89.0% | Medicine | NR | 3 | SAS |  ≥ 50 | 19.9% |
Simić-Vukomanović et al. (2015) [113] | Serbia | 1940 | 98.6% | NR | 21.04 (2.23) | 65.2% | Agronomy Economics Engineering Mechanical and Civil Engineering Medical Sciences Education Law Natural Sciences and Mathematics Technical Sciences Teachers Training Philology and Arts Hotel Management and Tourism | Yrs 1–6 | 1 | BAI |  ≥ 8 (mild and above) | 33.5% |
Suarez et al. (2021) [114] | Colombia | 554: 456 included in analysis | 70.0% | 18–25 yrs | NR | 59.2% | Medicine | Yrs 1–6 | 1 | SRQ-20-A |  ≥ 5 | 44.9% |
Syed et al. (2018) [115] | Pakistan | 267 | 100.0% | NR | 19.3 (1.19) | 75.3% | Physiotherapy | Yrs 1–5 | NR | DASS-42-A |  ≥ 8 (mild and above) | 68.5% |
Tabalipa et al. (2015) [116] | Brazil | 262 | 75.7% | NR | 23.0 (3.3) | 56.1% | Medicine | NR | 1 | BAI |  ≥ 8 (mild and above) | 35.5% |
Tayefi et al. (2020) [117] | Iran | 560 | 95.0% | NR | 21.2 (5.3) | 55.4% | Medicine Health Sciences Allied Health Professions courses | Yr 1 | 1 | BAI |  ≥ 8 (mild and above) | 28.7% |
Teh et al. (2015) [118] | Malaysia | 397 | 92.3% | 18–24 yrs | 21.9 (2.2) | 63.2% | Medicine | NR | 1 | DASS-21-A |  ≥ 10 (moderate and above) | 55.4% |
Torres et al. (2017) [119] | Ecuador | 1110: 1092 included in analysis | 99.7% | 17–24 yrs | 18.3 (1.1) | 53.7% | Legal and Social Sciences Economic Sciences Arts and Humanities Technological Sciences Health sciences | Yr 1 | 1 | PHQ-A | NR | 0.02% |
Umeh & Bangirana (2016) [120] | Uganda | 387 | 31.5% | 18–34 yrs | 21.24 (2.34) | 40.3% | Agriculture and Environmental Sciences Business and Management Sciences Computing and Information Sciences Education and External Studies Engineering, Design, Art and Technology Natural Sciences Humanities and Social Sciences Veterinary Medicine, Animal Resources and Biodiversity | Yr 1 | 1 | GAD-Q-IV |  ≥ 5.7 | 28.9% |
Van Der Walt et al. (2019) [121] | South Africa | 473 | 35.2% | NR | NR | 68.7% | Medicine | Yrs 1–6 | 1 | HADS-A |  ≥ 8 (borderline abnormal and above) | 45.9% |
Van Venrooij et al. (2017) [122] | Netherlands | 433 | 33.0% | 17–33 yrs | 21.2 (2.0) | 75.5% | Medicine | Yrs 1–6 | 1 | SQ-48-ANXI | NR | 29.1% |
Verger et al. (2010) [123] | France | 1723 | 71.0% | 18–24 yrs | 19.4 (NR) | 62.5% | Medicine University technology institutes Law Economics and Management Literature and Social Sciences Sciences Physical Education and Sport Sciences | Yr 1 | 6 | CIDI-SF diagnostic interview | n/a | 12 month: 2.2% |
Wang et al. (2020)b[124] | China | 39,725 | 80.0% | 16–50 yrs | NR | 54.3% | Medicine Science Engineering Literature | NR | 4 | SAS |  ≥ 50 | 8.1% |
Wege et al. (2016) [125] | Germany | 592: 590 included in analysis | 73.4% | NR | 21.13 (3.91) | 70.0% | Medicine | Yr 1 | 1 | GAD-7 |  ≥ 10 (moderate and above) | 1.9% |
Wong et al. (2006) [32] | Hong Kong, China SAR | 7915 | 27.5% | NR | NR | 62.7% | NR | Yr 1 | 10 | DASS-42-A |  ≥ 10 (moderate and above) | 41.2% |
Wörfel et al. (2016) [126] | Germany | 1707: 1683 included in analysis | 19.0% | NR | 23.29 (3.72) | 73.1% | Linguistics and Cultural Sciences Law, Economics and Social Sciences Engineering Human and Health Sciences Natural Sciences and Mathematics Art, Music, and Science of Art | Yrs 1–5 | 2 | GAD-2 |  ≥ 3 | 16.3% |
Zeng et al. (2019) [127] | China | 544 | 89.9% | 17–24 | 20.2 (1.2) | 97.4% | Nursing | Yrs 1–3 | 4 | DASS-21-A |  ≥ 8 (mild and above) | 41.7% |