Contextual influences on mental health in pharmacy education: a comparative study across higher- and lower-middle-income settings

INTRODUCTION: Student mental health has emerged as a major challenge for health professional training worldwide, particularly among students enrolled in often demanding professional programmes such as pharmacy. Although universities increasingly recognise the importance of student wellbeing, less is known about how pharmacy students' mental health experiences are shaped by differing institutional and socio-cultural contexts. This study examines the contextual influences shaping pharmacy students' mental health and help-seeking behaviours across two contrasting pharmacy education contexts: Australia, a high-income country, and Pakistan, a lower-middle-income country. METHODS: A qualitative design was employed using semi-structured interviews with 18 pharmacy students from universities in both countries. An inductive thematic approach was adopted to identify broader thematic patterns across two different cultural and educational contexts. RESULTS: The analysis revealed several interconnected themes influencing students' mental health including academic stressors; personal experiences and well-being; family, peer and social expectations; culture, stigma and attitudes to mental health; awareness and knowledge; coping strategies and support mechanisms; help-seeking behaviour and barriers; and institutional and system-level support. While students across both contexts reported significant academic pressure and emotional strain, notable differences emerged in the availability, accessibility, and perceived responsiveness of institutional mental health support, as well as in cultural attitudes towards help-seeking. CONCLUSION: By examining these experiences across contrasting pharmacy education contexts, this study provides cross-national insights into how institutional environments and socio-cultural factors shape pharmacy students' mental health experiences. The findings highlight importance of developing accessible and contextually responsive strategies to support student wellbeing within pharmacy education.