What’s overlooked in student mental health in South Africa: social connection and sexual wellbeing

Student mental health has become one of the defining challenges facing universities worldwide. In South Africa, these concerns are often framed around reports which point to anxiety, burnout and academic pressure. With this comes the call for expanded student counselling and crisis services.

These concerns are important. Previous research has shown that university students in South Africa face mental health challenges shaped by financial strain, inequality, academic pressure and social stressors. Studies conducted during and after the COVID-19 pandemic have also shown how isolation and loss of support affected students' mental health and wellbeing.

But mental health is not only the absence of distress or illness. It is also the presence of wellbeing: feeling connected to others, being satisfied with one's life overall, and having the ability to manage everyday challenges and participate meaningfully in one's community.

Our recent study suggests that this broader view matters. As psychologists and researchers, we wanted to better understand the factors that help university students flourish.

We surveyed 1,366 students at a public, in-contact South African university to examine what influences student mental health and wellbeing. We looked at structural factors, such as socioeconomic status, food security, financial strain and living conditions. We also examined academic pressures and psychosocial factors. These included life satisfaction, loneliness, sexual wellbeing, and health-related social support (help from friends, family and others to maintain a person's physical and mental health).

The findings suggest that students are more likely to flourish when they experience both material security and psychosocial support, including greater life satisfaction, stronger social support for their health, and lower levels of loneliness.

Coping, but not all thriving

Most students in our study were not languishing, a state characterised by low levels of wellbeing and a sense of disconnection, stagnation, or lack of purpose. But many were also not flourishing, which refers to high levels of emotional, psychological and social wellbeing.

About two-thirds (66%) of participants were classified as having moderate mental health. Just over a quarter (28%) were flourishing, while around 6% were languishing.

This matters because students with moderate mental health may appear to be coping. They may attend class, complete assignments, and continue with their studies. But coping is not the same as thriving.

The distinction is important because flourishing has been associated with stronger psychological functioning, better social relationships, improved academic engagement and greater resilience when facing life's challenges.

For universities, this means student mental health strategies should consider not only how to address and reduce distress, but also what enables students to flourish.

Two different student profiles

One of the clearest findings from our study was that students tended to fall into two broad profiles.

The first group, which we called “Strained and Stressed”, was characterised by greater financial strain, poorer food security, lower life satisfaction, weaker social support for health, and higher loneliness.

The second group, which we called “Resourced and Supported”, had greater material security, stronger psychosocial resources, more health-related social support and higher life satisfaction. These students also reported better mental health outcomes and were less lonely.

This highlights an important reality for South African universities: student wellbeing is shaped by both material circumstances and psychosocial resources. Financial strain, food insecurity and unstable living conditions matter, but so do social connection, support, life satisfaction and the ability to manage one's health.

In other words, student mental health is both a material and relational issue.

Why connection matters

Psychosocial factors showed the strongest associations with mental health in our study. Students who reported greater life satisfaction and social support for health reported better mental health. Loneliness was associated with poorer wellbeing.

This aligns with previous research showing that social connection and belonging are central to student wellbeing.

This does not mean universities should stop investing in counselling and psychological services. These services remain essential, particularly for students experiencing significant distress.

But counselling services alone cannot carry the full burden of student wellbeing. Universities also need to create environments in which students can build meaningful relationships and experience a sense of belonging.

This could be through promoting peer mentoring programmes, student societies, residence-based support, orientation programmes that extend beyond the first few weeks of university, and structured opportunities for students to connect across academic and social spaces.

The overlooked role of sexual wellbeing

One finding stood out because it is rarely discussed in South African higher education research: students who reported higher sexual wellbeing also tended to report better mental health.

Sexual wellbeing is not simply the absence of disease, dysfunction or risk. It includes feeling safe, respected, comfortable and able to exercise agency in intimate relationships.

This is important because much of the South African research on student sexuality has understandably focused on sexual violence and risk. These remain urgent issues.

But our findings suggest that universities should also consider the positive dimensions of sexual wellbeing as part of holistic student health. A student's sense of safety, respect and autonomy in intimate life may be connected to their broader wellbeing.

This does not mean that sexual wellbeing should replace risk-prevention work. Rather, it suggests that student wellness programmes should be broad enough to address both protection from harm and the conditions that allow students to experience dignity, agency and wellbeing.

What universities can do

The findings highlight three priorities.

First, universities must, with the support of government and other relevant agencies, continue addressing the structural barriers that shape student wellbeing. Financial hardship, food insecurity and living conditions remain serious pressures. Support systems such as food programmes, accommodation assistance and academic flexibility are not peripheral to mental health. They are part of the conditions that make wellbeing possible.

Second, universities should invest in and support social networking interventions that create durable social connections among their student communities. Students experiencing greater loneliness are more likely to report poorer mental health. This means that belonging should not be treated as an optional aspect of university life. It is central to the wellbeing of young adults.

Third, universities should adopt a broader view of student wellbeing and implement targeted support interventions which encourage multiple dimensions of wellbeing. Our findings support a “whole-university” approach to health promotion. This integrates student wellbeing across the university ecosystem. Mental health, belonging, academic success, as well as physical and sexual wellbeing, cannot be addressed through disconnected health and support services.

Student mental health is often discussed only in terms of crisis. Our findings suggest that universities should focus equally on the conditions that help students thrive.

For South African universities, this means combining structural support with psychosocial care to create environments where students can flourish – not merely survive, but fully participate in university life and realise their potential.

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

By Jarred H Martin, Senior Lecturer in Clinical Psychology, University of Pretoria And

Jacomien Muller, Lecturer in Psychology, University of Pretoria And

Jolize Joubert van Appel, Lecturer in Psychology, University of Pretoria And

Sonja Nicolene Mostert, Senior Lecturer, University of Pretoria