Unacceptable Experiences Whilst Attending University and Their Association With Student Mental Health, Well-Being and Academic Outcomes

Introduction: Unacceptable experiences (UEs) are commonly reported by undergraduate students. However, their prevalence and impact have not been rigorously studied. Objectives: To (1) estimate the prevalence of UEs, (2) identify high-risk subgroups, and (3) examine associations with mental health and academic outcomes among undergraduate students attending Queen's University. Methods: Data from the 2021/2022-2023/2024 cycles of the U-Flourish Student Well-Being Survey were collected at the beginning and completion of each academic year. Validated symptom measures included the GAD-7 (anxiety), PHQ-9 (depression), C-SSRS (suicidal thoughts and behaviours), and WEMWBS-7 (well-being). Self-reported UEs included: sexual violence or harassment, physical assault, bullying, hate crimes, and discrimination. Multivariable regression examined associations between UEs and student mental health, and grade-point average (GPA) from linked university data. Results: One-third (28.9%) of students (n=797/2,757) reported an unacceptable experience over the academic year. Sexual violence or harassment and discrimination (15%) were most frequently reported, followed by bullying/harassment (11%), hate crimes (4.6%) and physical assault (3.3%). UEs were highest in students who identified as non-binary gender (49%), 2SLGBTQIA+ sexuality (39%) or had a history of mental illness (41%). These UEs increased the risk of reporting clinically significant anxiety and depressive symptoms by 5-18% and 11-40%, respectively, and Students reporting UEs were also more likely (2-59%) to report having suicidal thoughts and behaviours over the academic year, particularly those who experienced sexual violence (RR:1.59; 95% CI:1.10-2.23). There was evidence that sexual violence, bullying, and hate crimes were associated with lower GPAs among first-year students. Conclusion: UEs are common among undergraduate students and are associated with significant negative mental health and well-being outcomes. Further research is needed to better understand the nature of these UEs and the mechanisms by which they impact student mental health and academic performance. This information is pivotal to develop evidence-informed prevention and early intervention initiatives.