This section presents the key themes and sub-themes that emerged from analyzing the interviews conducted with undergraduate healthcare students, exploring their experiences with mental health challenges (Table 3). The analysis revealed several important themes: academic pressure, social isolation, anxiety, coping mechanisms, fear of failure, and stigma around seeking mental health support. The following subsections provide a detailed exploration of these themes, supported by direct quotes from participants.
Theme 1: academic pressure and stress
Academic pressure was one of the most frequently mentioned challenges. Students described how the demanding curriculum and constant assessments led to overwhelming stress. One participant expressed, “From day one, the stress has been intense. It’s not just about studying; it’s about constantly proving yourself” (Student 6, CDEM).
Another participant noted, “The sheer volume of work is exhausting. There’s always an exam or a deadline. It never ends, and that makes it hard to relax” (Student 11, CHS).
This continuous pressure to excel academically led many students to feel constantly overwhelmed, impacting their mental well-being.
In relation to the onset/time factor of mental health issues, one participant shared, “As I started, it was hard to handle the stress; there was too much pressure from year one. As we are progressing with time, we get accustomed to the stress, but it still sometimes becomes too much, and it gets the better of me” (Student 15, CPH).
Another student echoed this sentiment, stating, “The heavy content during preclinical years was very stressful. Once I started clinical practice, I felt a bit more relaxed, but the pressure during exams is always overwhelming, and as we approach graduation, I feel things get worse” (Student 5, CDEM).
A clinical student from Medicine also stated, “I would rather stay long shifts at night, interacting and dealing with complex patient cases, than sitting an exam” (Student 3, CMED).
Theme 2: social isolation and loneliness
The impact of mental health on personal relationships seemed bidirectional. On one hand, a recurring issue among participants was the sense of social isolation, having implications on their mental health. Students frequently reported feeling lonely, often as a result of the competitive environment. One participant mentioned, “It’s hard to make real friends when everyone is focused on their own success. It feels like you’re alone in this race” (Student 2, CMED). In a similar vein, another student reflected on the competitive nature of their program: “The environment feels very competitive. Everyone has their own groups, and sometimes it’s hard to fit in. This makes me question if I’m in the right place” (Student 14, CPH).
Another student reflected, “I’ve never really had close friends here. I’m always feeling like an outsider, and it’s tough to deal with that kind of loneliness on top of the academic pressure” (Student 7, CNURS). The lack of close social ties often compounded the emotional burden, making it difficult for students to find comfort and support during stressful times.
On the other hand, participants perceived mental health status as a leading factor influencing their personal interactions with family and friends. One student reported, “When I’m stressed and worried, I only feel like crying. I don’t want to see my friends… not even my family, no one should see me weak” (Student 4, CDEM).
Theme 3: anxiety and emotional strain
Anxiety was another key theme that surfaced in the interviews, particularly around exams and academic performance. Students frequently mentioned experiencing elevated levels of anxiety, often feeling consumed by worries about their future. One participant remarked, “Before every exam, I feel like I’m on the edge. It’s not just stress; it’s full-blown anxiety. I can’t sleep, I can’t focus, and I worry about what happens if I don’t pass” (Student 2, CMED).
A similar sentiment was shared by another student, who stated, “The anxiety builds up over time, especially when I start thinking about how every grade counts for my future. It’s exhausting, and sometimes it just becomes too much” ((Student 14, CPH).
Another student mentioned the cumulative impact of anxiety on their well-being: “I overthink a lot, especially when I get a bad grade. It spirals into feelings of inadequacy, making me feel unworthy and depressed” (Student 12, CHS).
Theme 4: coping mechanisms
While some students reported struggling to cope with mental health challenges, others discussed the methods they used to manage their stress and anxiety. However, many students admitted that they did not have well-established coping strategies. One participant shared, “I don’t really have a way to deal with stress. I just keep going, but it’s hard to keep up with everything” (Student 8, CNURS).
Another student added, “I try to distract myself by staying busy with other activities, but it’s more like avoiding the problem than solving it. I still feel stressed even when I’m trying not to think about it” (Student 1, CMED).
Unveiling methods used by students to manage stress and anxiety revealed family and faculty support. One participant stated, “The only coping mechanism for me is my mum and bestie… they understand me and provide me with support I need” (Student 10, CHS). Another student reported, “When I’m stressed, I go to faculty XXX; she provides support and advise. I sometimes cry at her office… which makes me feel better” (Student 6, CDEM). Moreover, a student believed that faith was the best coping mechanism, affirming, “Every time I feel depressed, I pray… my strong belief in God helps me frame my emotions and empowers me… it is that sense of peace” (Student 13, CPH).
Theme 5: fear of failure
The fear of failure emerged as a significant theme, with many students expressing a deep concern about not meeting academic expectations. One participant explained, “I’m constantly afraid of failing, not just because of what it means for my grades, but because it feels like failure would ruin everything I’ve worked for” (Student 4, CDEM).
This fear was exacerbated by the high expectations placed on healthcare students, both by themselves and by external factors. “There’s this pressure to be perfect, and anything less than that feels like failure. It’s not just about passing; it’s about excelling, and that’s a huge burden to carry” (Student 3, CMED).
Another student pointed “I want to make my family proud… failing is not an option for me or them” (Student 15, CPH). This was resonated by a health science student reporting “I worked hard to be here… I cannot see myself disappointing my parents” (Student 12, CHS).
Theme 6: stigma around mental health
Another important theme was the stigma associated with seeking mental health support. Many students expressed hesitation about reaching out for help due to fear of judgment from peers or faculty. One student stated, “I know I need help sometimes, but I don’t want people to think I’m weak or that I can’t handle the pressure. So, I just keep it to myself” (Student 10, CHS).
Another student echoed this sentiment: “There’s this unspoken rule that if you admit to struggling, it might affect how people see you, especially in a field like medicine where you’re expected to be strong” (Student 3, CMED). In addition, a participant also highlighted that stigma prevented them from accessing mental health resources that could potentially alleviate their struggles: “It’s a small college, everyone knows each other… I cannot seek help and be known… they will think I am not capable of pursuing dentistry” (Student 5, CDEM).
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