Association between mental health and social pressure among undergraduate students in Karachi, Pakistan: an analytical cross-sectional study

Mental health disorders have been identified as a leading cause of disability and premature mortality globally. Social pressure has been associated with mental health issues such as depression, anxiety, and stress. This study assessed the association between social pressure and mental health outcomes among undergraduate students in Karachi, Pakistan. A cross-sectional study was conducted among 460 undergraduate students aged 18–25 years, recruited using non-probability purposive sampling, and enrolled in engineering, medicine, and humanities degree programs across three universities in Karachi, Pakistan. Data was collected using a self-administered questionnaire. Participants’ mental health was assessed using the DASS-21 scale, and social pressure was measured using a composite variable encompassing academic, financial, family, and peer-related pressures. Data was analyzed using STATA version 17, applying ordinal logistic regression. Institutional ethical approval and necessary permissions were obtained prior to data collection. A sample of 400 undergraduate students from three universities in Karachi was analyzed, with a higher proportion of females (n = 270; 67.5%) and a mean age of 21.1 ± 0.10 years. For every five-unit increase in social pressure, the odds of moderate to severe depression symptoms increased by 67% (OR = 1.67; 95% CI: 1.29–2.16) among medical students and by 42% (OR = 1.42; 95% CI: 1.13–1.79) among engineering students. The odds of moderate to severe anxiety symptoms increased by 25% (OR = 1.25; 95% CI: 1.12–1.39) among medical students and by 23% (OR = 1.23; 95% CI: 1.01–1.50) among engineering students for every five-unit increase in social pressure. For stress, each five-unit increase in social pressure was associated with a 41% increase in the odds of moderate to severe stress symptoms (OR = 1.41; 95% CI: 1.24–1.59). Students living in joint family systems had higher odds of moderate to severe stress symptoms (OR = 2.38; 95% CI: 1.03–5.49). The findings suggest that medical and engineering students have higher odds of moderate to severe depression, anxiety, and stress symptoms as compared to students enrolled in humanities programs. Further research is needed to better understand the contextual factors contributing to mental health challenges among university students in low-resource settings like Pakistan.