Open Journal of Social Sciences, 2014, 2, 23-31
Published Online November 2014 in SciRes. http://www.scirp.org/journal/jss
http://dx.doi.org/10.4236/jss.2014.211004
How to cite this paper: Pidgeon, A.M., et al. (2014) Psychosocial Moderators of Perceived Stress, Anxiety and Depression in
University Students: An International Study. Open Journal of Social Sciences, 2, 23-31.
http://dx.doi.org/10.4236/jss.2014.211004
Psychosocial Moderators of Perceived Stress,
Anxiety and Depression in University
Students: An International Study
Aileen M. Pidgeon1, Stephanie McGrath2, Heidi B. Magya3, Peta Stapleton1,
Barbara C. Y. Lo4
1PhD (Clin) Bond University, Gold Coast, Australia
2Bond University, Gold Coast, Australia
3ARNP, University of Florida, Gainesville, US A
4PhD University of Hong Kong, Hong Kong, China
Received Sep te mber 2014
Abstract
Extensive research shows university students experience high levels of stress, which can lead to
the development of mental health problems such as anxiety and depression. Preliminary evidence
supports the role of psychosocial factors such as perceived social support (PSS) and campus con-
nectedness (CC) as protective factors in the development of mental health problems in university
students. However, research conducted on the potential ameliorating effects of social support on
stress applying Cohen and Wills’ (1985) stress-buffering hypothesis produced weak, inconsistent,
and even contradictory results. In addition, little attention has been given to examining the pro-
tective role of CC in the relationships between perceived stress, anxiety, and depression. The cur-
rent study examined the applicability of CC and PSS in buffering the relationships been perceived
stress, anxiety, and depression across an international sample comprised of university students (N
= 206) from Australia, Hong Kong, and the United States. The prediction that CC and PSS would
moderate the relationships between perceived stress, anxiety, and depression was partially sup-
ported. The results indicated CC moderated the relationship between perceived stress and de-
pression but did not moderate the relationship between perceived stress and anxiety. PSS did not
moderate the relationship between perceived stress and depression or the relationship between
perceived stress and anxiety, thus rejecting the stress-buffering hypothesis. These findings sug-
gest less emphasis should be placed on PSS as a protective factor, with universities focusing on
enhancing CC to reduce the high prevalence of mental health problems to promote psychological
wellbeing among students.
Keywords
Perceived Stress, Anxiety, Depression, Psychosocial, Perceived Social Support, Campus
Connectedness, Stress-Buffering Hypothesis, Moderating, Buffering

A. M. Pidgeon et al.
24
1. Introduction
The transition into higher education is a stressful time as university students face multiple stressors such as aca-
demic overload, constant pressure to succeed, competition with peers, and in some countries financial burden as
well as concerns about future career prospects [1]. While many university students adjust effectively to the uni-
versity context, a large proportion of students are adversely impacted by stress and are at risk of developing
mental health problems [2].
The prevalence of mental health issues in university students is of universal concern, with international stu-
dies revealing clinical levels of psychopathology, including anxiety and depression in student populations glo-
bally [2]-[5]. Thus, the mental health of university students has been the subject of increasing focus in recent
years with evidence demonstrating that university students experience higher levels of psychological distress,
including anxiety and depression, in comparison to non-student populations [2] [6]. Moreover, research has
shown approximately 40% of university students with diagnosable mental health conditions do not seek clinical
services or access university support services [7].
Research suggests psychosocial factors such as perceived social support and campus connectedness may play
a protective role in the adverse consequences of perceived stress among university students. Perceived social
support has been shown to be positively associated with psychological wellbeing [8]-[10]. While campus con-
nectedness is a relatively new construct defined as a form of social connectedness and belonging that is specific
to the university context and is also positively associated with psychological wellbeing and adjustment in uni-
versity students [11]. Considering many university students are not seeking professional assistance for psycho-
logical issues, an investigation into the protective role that key psychosocial factors play in promoting psycho-
logical wellbeing and protecting university students from the development of mental health problems is war-
ranted. The current study will examine the protective role of campus connectedness and perceived social support
on the relationships between perceived stress, anxiety, and depression among university student s.
1.1. Perceived Stress, Anxiety, and Depression
While the literature suggests various risk factors are associated with the development of anxiety and depression,
the positive association between perceived stress, anxiety, and depression has been demonstrated in numerous
studies [12] [13]. High levels of perceived stress increases the risk for an individual to develop anxiety and de-
pression. However, university students worldwide are shown to be a high risk group with prevalence rates being
higher than the general population [14]. Stallman [15] found a significantly higher prevalence of mental health
problems in Australian university students than the general population with 83.9% of students reporting heigh-
tened levels of psychological distress including stress, anxiety, and depression. Eisenberg, Hunt, and Speer [16]
assessed students across 26 United States universities and found 17.3% met the criteria for depression, 7.8%
generalised anxiety disorder, 4.1% panic disorder, and a total of 6.3% reported suicidal ideation. A study con-
ducted by Wong, Cheung, Chan, Ma, and Tang [17] in a sample of university students across 10 universities in
Hong Kong revealed a prevalence of anxiety, depression, and stress with 21% of students experiencing moderate
depression, 41% moderate anxiety, and 27% moderate stress. This research highlights the importance of devel-
oping an understanding of the psychosocial factors that protect students against the adverse effects of perceived
stress.
1.2. Perceived Social Support
Perceived social support has been consistently shown to be positively associated with psychological wellbeing
[8]-[10]. Perceived social support is defined as an individual’s potential access to social support resources, that
is, an individual’s belief that support is available if needed [18]. Perceived social support has been repeatedly
linked to positive psychological and health outcomes [18]. The breadth of research on perceived social support
has led researchers to examine its role in moderating the effects of perceived stress on anxiety and depression [8]
[19] [20]. A moderator is a variable that alters the strength of the relationship between a predictor variable and
an outcome variable [21].
The stress-buffering hypothesis developed by Cohen and Wills [22] suggests perceived social support ameli-
orates the adverse effects of stressful situations. Cohen and Wills’ hypothesis links with Lazarus and Folkman’s
[23] transactional theory of stress in that perceptions of social support may lead an individual to appraise a

A. M. Pidgeon et al.
25
threatening situation as less stressful. Cohen and Wills proposed that perceived social support acts as a protec-
tive psychosocial factor for individuals experiencing high levels of perceived stress. As such, perceived social
support is thought to reduce the adverse effects of perceived stress through the belief that an individual can
access coping resources such as social support if needed [8]. Perceived social support may decrease the expe-
rience of stress by providing a reappraisal of the stressor, thereby reducing the affective, physiological, and cog-
nitive reactions that make up the experience of stress [24]. Since Cohen and Wills’ proposal of the stress-buf-
fering hypothesis, many researchers have tested this process, however the literature contains inconsistent find-
ings. Some studies have demonstrated support for a buffering model of perceived social support consistent with
the stress-buffering hypothesis [25] while others have only found support for a main effect model of perceived
social support [26].
1.3. Campus Connectedness
In comparison to perceived social support, social connectedness is a global construct that encompasses much
more than just perceived interpersonal relations [27]. According to Lee and Robbins [28] social connectedness is
a person’s subjective awareness of closeness with their social world. Social connectedness has been found to be
negatively associated with perceived stress, anxiety, and depression [29] [30]. Therefore, connectedness within a
university context is an important psychosocial variable to examine, as many university students experience
maladjustment issues in adapting to a new social environment upon transitioning into university [31]. Campus
connectedness refers to social connectedness within the university context and has been defined by Lee and
Robbins [28] as a student’s sense of psychological belonging in a university environment. Research demon-
strates that a lack of connectedness in university students has a negative impact on adjustment and psychological
functioning. University students who report low connectedness also report fewer meaningful and supportive re-
lationships with others [31]. Furthermore, university students with low levels of connectedness report higher le-
vels of psychological distress due to their lack of meaningful connections with others [27]. Research has also
demonstrated social connectedness is inversely related to perceived stress, anxiety, and depression in university
students [28]-[30]. This research suggests that university students with higher levels of connectedness have low-
er levels of perceived stress, anxiety, and depression. Additionally, Furthermore, Rude and Burham [32] pro-
posed connectedness should be investigated as a protective factor against depression. It is therefore essential that
students feel connected on campus to ensure they adjust to university life and maintain their psychological well-
being throughout their studies.
Although campus connectedness has been found to be negatively associated with perceived stress, anxiety,
and depression, its moderating effect on these relationships is yet to be investigated. A paucity of research exists
in examining the protective role of additional psychosocial characteristics such as campus connectedness, in
moderating (buffering) the relationships between perceived stress, anxiety, and depression in university students.
Further research is required to investigate the dynamic interplay among these variables. The current study will
address the gap in the literature by evaluating the applicability of campus connectedness in buffering the rela-
tionship between perceived stress, anxiety, and depression.
1.4. The Current Study
The purpose of the current study was to examine psychosocial moderators of perceived stress, anxiety, and de-
pression in an international sample of university students. The study also aimed to evaluate Cohen and Wills’
[22] stress-buffering hypothesis of perceived social support, in addition to investigating the role of campus con-
nectedness as a moderator in the relationships between perceived stress, anxiety, and depression. A series of four
moderations were planned to investigate the following hypotheses:
H1. Perceived social support moderates the relationship between perceived stress and depression. Higher le-
vels of perceived social support would buffer the effects of perceived stress on depression.
H2. Campus connectedness moderates the relationship between perceived stress and depression. Higher levels
of campus connectedness would buffer the effects of perceived stress on depression.
H3. Perceived social support moderates the relationship between perceived stress and anxiety. Higher levels
of perceived social support would buffer the effects of perceived stress on anxiety.
H4. Campus connectedness moderates the relationship between perceived stress and anxiety. Higher levels of
campus connectedness would buffer the effects of perceived stress on anxiety.

A. M. Pidgeon et al.
26
2. Method
2.1. Participants
Participants for the current study consisted of 206 university students aged between 18 to 59 years (M = 22.08,
SD = 5.57) including 160 (77.7%) females and 46 (22.3%) males. The sample included university students from
Bond University, Australia, The University of Hong Kong, and The University of Florida. Inclusion criteria re-
quired participants to be aged 18 years and over.
2.2. Measures
Perceived Stress Scale (PSS). The PSS [33] is a 10-item scale designed to measure perceptions of stress.
Four positively stated items require reverse scoring. To calculate a global measure of percieved stress the total
number of items on the scale are summed with higher scores indicating higher levels of percieved stress.
The Depression Scale and Anxiety Scale (DASS-21). The current study used the Depression Scale and An-
xiety Scale from the DASS-21, a short form version of the DASS-42 [34]. Scores for each scale are calculated
through the summation of items. As the DASS-21 is a shortened version of the full DASS-42, the scores for
each of the scales are to be multiplied by two. Higher scores on each scale are indicative of higher scores of de-
pression or anxiety.
Campus Connectedness Scale (CCS). The CCS is a 14-item self report scale designed to measure university
student’s perception of belongingness on the university campus [28]. Eight negatively worded items require re-
verse scoring. The 14-items are summed with higher scores indicative of higher levels of campus connectedness.
Multidimensional Scale of Perceived Social Support (MSPSS). The MSPSS is a 12-item self-report scale
designed to measure how individuals perceive their global social support system across three sources: family,
friends, and significant other [9]. A global measure of perceived social support is obtained by summing the res-
ponses on the 12-items with higher values indicating higher levels of perceived social support.
3. Results
Separate moderated multiple regression analyses were conducted to determine if each of the moderators inte-
racted to buffer the effects of perceived stress on the outcome variables of anxiety and depression. Moderation
effects are assessed through the creation of a statistical interaction term comprised of the predictor variable mul-
tiplied by the moderator variable. Chaplin [35] conducted a comprehensive review of the literature and found
that interaction term effect sizes generally account for between 1% and 3% of the variance in the outcome varia-
ble. Additionally, Evans [36] states moderation effects are so difficult to detect that even interaction terms ac-
counting for 1% of the variance should be considered important. To reduce potentially problematic family wise
inflation the four moderations were conducted within two separate regression models [37]. The first model in-
vestigated whether campus connectedness or perceived social support moderated the relationship between per-
ceived stress and depression. The second model investigated whether campus connectedness or perceived social
support moderated the relationship between perceived stress and anxiety. In each model, university was entered
at Step 1 as a covariate to control for differences between universities on the outcome variables. At Step 2 the
centered predictor and moderators were entered simultaneously, at Step 3 the interaction of the first moderator
and predictor were entered, and at Step 4 the interaction of the second moderator and predictor were entered.
Model 1. At Step 1 of the analysis, university was added to the regression equation and the overall model was
significant, F(1, 194) = 7.59, p = 0.006. University explained a significant 4% of the variance in depression
scores. Thus, university was significantly predictive of depression scores,
β = .19, p = 0.006, such that university
students from Hong Kong had higher depression scores than university students from Australia and the United
States. At Step 2, after controlling for the effects of university, perceived stress, perceived social support, and
campus connectedness were added to the regression equation and the overall model was significant, F(4, 191) =
42.74, p < 0.001. Perceived stress, perceived social support, and campus connectedness accounted for 44% of
the variance in depression, ∆F (3, 191) = 52.44, p < 0.001. At this step, perceived stress was a significant posi-
tive predictor of depression,
β = 0.55, p < 0.001, indicating that a 1 SD increase in perceived stress resulted in a
0.55 SD increase in depression. Perceived social support at this step was a non-significant predictor of depres-
sion,
β = −0.10, p = 0.124. Campus connectedness at this step was a significant negative predictor of depression,
β = −0.15 p = 0.031, indicating that a 1 SD increase in campus connectedness results in a 0.15 SD decrease in

A. M. Pidgeon et al.
27
depression. At Step 3 of the analysis, the perceived stress X campus connectedness interaction term was added to
the regression equation and the overall model was significant, F(5, 190) = 36.33, p < 0.001. Consistent with hy-
potheses, the perceived stress X campus connectedness interaction term was significantly predictive of depres-
sion, explaining an additional 2% of the variance in scores on depression, ∆F(1, 190) = 6.13, p = 0.01. Therefore,
the predictive relationship between perceived stress and depression varied according to campus connectedness.
At Step 4, the perceived stress X perceived social support interaction term was added to the regression equation
and the overall model was significant, F(6, 189) = 30.30, p < 0.001. Inconsistent with hypotheses, the perceived
stress X perceived social support interaction term was non-significantly predictive of depression, explaining no
further variance in scores on depression, ∆F(1, 189) = 0.56, p = 0.4 57. Therefore the predictive relationship be-
tween perceived stress and depression did not vary according to perceived social support (Table 1).
To follow up the significant interaction effect of perceived stress X campus connectedness Dawson’s [38] sim-
ple slope analyses were conducted to assess the nature of the interaction through a comparison of high campus
connectedness scores (+ 1 SD) with low campus connectedness scores (−1 SD). The findings revealed, when
campus connectedness was low, perceived stress was significantly predictive of depression,
β = 0.68, p < 0.001.
At high levels of campus connectedness, perceived stress was significantly predictive of depression,
β = 0.45, p
< 0.001. As such, the nature of the interaction appeared to be that campus connectedness at high levels had a
buffering effect on the relationship between perceived stress and depression as represented by the decrease in
the strength of the positive slope. Therefore, an increase in levels of campus connectedness results in a decrease
in the magnitude of the effect of perceived stress on depression. A graphical representation of the interaction is
displayed in Figure 1.
Figure 1. Campus connectedness moderated the relationship
between perceived stress and depression.
Table 1. Model 1 investigating campus connectedness and perceived social support as moderating the rela-
tionships between perceived stress and depression.
β B SE B 95% CI for B
Constant
4.14
1.10
[1.97, 6.30]
University 0.19 1.55
***
0.56 [0.44, 2.65]
Constant 5.67 0.83 [4.02, 7.30]
Perceived stress 0.55 0.54*** 0.06 [0.43, 0.66]
Perceived social support −0.10 −0.06 0.04 [−0.13, 0.02]
Campus connectedness −0.07 −0.07* 0.03 [−0.13, −0.02]
Constant 5.19 0.84 [3.53, 6.88]
Perceived stress X Campus connectedness −0.13 −0.01** 0.00 [−0.12, −0.00]
Constant 10.71 7.45 [−3.99, 25.41]
Perceived stress X Perceived social support −0.30 −0.00 0.01 [−0.02, 0.02]
Note: N = number of participants. CI = confidence intervals. *p < 0.05, **p < 0.01, ***p < 0.001.

A. M. Pidgeon et al.
28
Model 2. At Step 1 of the analysis, university was added to the regression equation and the overall model was
non-significant, F(1, 194) = 1.81, p = 0.180. University explained a non-significant 1% of the variance in anxiety
scores. Thus, university was non-significantly predictive of anxiety scores. At Step 2, after controlling for the
effects of university, perceived stress, perceived social support, and campus connectedness were added to the
regression equation and the overall model was significant, F(4, 191) = 25.37, p < 0.001. Perceived stress, per-
ceived social support, and campus connectedness accounted for 34% of the variance in anxiety scores, ∆F (3,
191) = 32.93, p < 0.001. At this step, perceived stress was a significant predictor of anxiety,
β = 0.44 p < 0.001,
indicating that a 1 SD increase in perceived stress resulted in a 0.44 SD increase in anxiety. Perceived social
support at this step was a non-significant predictor of anxiety,
β = 0.13, p = 0.063. Campus connectedness at this
step was a significant negative predictor of anxiety,
β = −0.30, p < 0.001, indicating that a 1 SD increase in
campus connectedness resulted in a 0.13 decrease in anxiety. At Step 3 of the analysis, the perceived stress X
campus connectedness interaction term was added to the regression equation and the overall model was signifi-
cant, F(5, 190) = 20.39, p < 0.001. Inconsistent with hypothesis, the perceived stress X campus connectedness
interaction term Therefore, the predictive relationship between perceived stress and anxiety did not vary ac-
cording to campus connectedness. At Step 4, the perceived stress X perceived social support interaction term was
added to the regression equation and the overall model was significant, F(6, 189) = 17.39, p < 0.001. Inconsistent
with hypotheses, the perceived stress X perceived social support interaction term was non-significantly predictive of
anxiety, explaining no further variance in scores on anxiety, ∆F(1, 189) = 1.92, p = 0.168. Therefore the predictive
relationship between perceived stress and anxiety did not vary according to perceived social support (Table 2).
4. Discussion
The aim of the current study was to examine psychosocial moderators of the relationships between perceived
stress, anxiety, and depression in an international level in a sample of university students. It was firstly predicted
that perceived social support would moderate the relationship between perceived stress and depression. Specifi-
cally, perceived social support would buffer the effects of perceived stress on depression, thereby reducing the
strength of the relationship. The results of the moderation analysis did not support hypothesis two, as perceived
social support did not moderate the relationship between perceived stress and depression. These findings do not
support Cohen and Wills’ [22] stress-buffering hypothesis. These results demonstrate perceived social support
does not interact with perceived stress to protect university students from depression thus rejecting a buffering
model of perceived social support.
Hypothesis two, evaluated the role of campus connectedness as a moderator in the relationship between per-
ceived stress and depression. It was hypothesised that campus connectedness would buffer the relationship be-
tween perceived stress and depression, such that higher levels of campus connectedness would decrease the
Table 2. Model 2 investigating campus connectedness and perceived social support as moderating the rela-
tionships between perceived stress and anxiety.
β B SE B 95% CI for B
Constant 5.42 1.07 [3.31, 7.54]
University 0.10 0.74 0.55 [−0.34, 1.82]
Constant 6.50 0.89 [4.75, 8.25]
Perceived stress 0.44 0.42*** 0.06 [0.23, 0.54]
Perceived social support 0.13 0.07 0.04 [−0.00, 0.15]
Campus connectedness −0.30 −0.14*** 0.03 [−0.20, −0.70]
Constant 6.33 0.91 [4.53, 8.13]
Perceived stress X Campus connectedness −0.05 −0.00 0.00 [−0.01, 0.01]
Constant −4.77 8.06 [−20.68, 11.14]
Perceived stress X Perceived social support 0.62 0.01 0.01 [−0.02, 0.01]
Note: N = number of participants. CI = confidence intervals. *p < 0.05, **p < 0.01, ***p < 0.001 .

A. M. Pidgeon et al.
29
strength of the positive association between perceived stress and depression. The results of the moderation ana-
lyses supported this hypothesis. A significant interaction of campus connectedness and perceived stress in pre-
dicting depression was found, with the interaction term accounting for 2% of the variance in depression scores.
Again, this result is consistent with Chaplin’s [35] review of the literature, in which interaction terms generally
account for between 1% to 3% of the variance. The nature of this interaction appeared to be that campus con-
nectedness at high levels buffered the relationship between perceived stress and depression, that is, campus
connectedness reduced the strength of the association between the two variables. However, at low levels of
campus connectedness the positive relationship between perceived stress and depression increased. These results
demonstrate campus connectedness interacts with perceived stress to protect university students from depres-
sion.
Hypothesis three, in accordance with Cohen and Wills’ [22] stress-buffering hypothesis examined whether
perceived social support moderated the relationship between perceived stress and anxiety. It was predicted per-
ceived social support would buffer the relationship between perceived stress and anxiety. This hypothesis was
not supported, as the interaction term of perceived social support and perceived stress in predicting anxiety was
non-significant. These findings do not support the stress-buffering hypothesis.
Hypothesis four, which investigated whether campus connectedness moderated the relationship between per-
ceived stress and anxiety, was not supported. It was predicted that campus connectedness would buffer the rela-
tionship between perceived stress and anxiety. The interaction of campus connectedness and perceived stress in
predicting anxiety was non-significant. To date no additional research has been conducted investigating the role
of campus connectedness in moderating the relationship between perceived stress and anxiety. These findings
demonstrate campus connectedness does not interact with perceived stress to provide a protective effect on an-
xiety. Although previous research supports associations among these variables, the results of the current study
did not support a buffering model and only demonstrate support for a main effect model of campus connected-
ness on anxiety [29]. The findings from the current study suggest campus connectedness appears to make a
beneficial contribution in reducing anxiety regardless of perceived stress levels. Although only one of the cur-
rent study’s four moderation analyses was significant, the results of the analysis demonstrating campus connec-
tedness buffers the relationship between perceived stress and depression are noteworthy. The results make a
valuable contribution to the body of knowledge and increase our understanding of the potential protective role of
campus connectedness in preventing university students with high levels of perceived stress from the develop-
ment of depression.
A number of limitations are noted with the current study. Firstly, the study did not control for social desirabil-
ity biases and it is possible this may have influenced participants’ responses. Future studies should consider the
inclusion of a social desirability scale to avoid potential confounding of results. Another limitation of the current
study was that a general measure of perceived stress was used and therefore it may not have fully encapsulated
the unique stressors university students encounter. Future studies could use a measure of perceived stress that
specifically assesses the stressors university students’ experience. As the current study is the first to date to in-
vestigate the moderating role of campus connectedness, it is suggested future research is conducted to gain a
further understanding of its protective utility in buffering the relationship between perceived stress, and depres-
sion. In addition, the moderating effects of variables such as resilience or optimism could be investigated to de-
termine whether they can be fostered as protective factors in the university context.
The results from this study offer a valuable contribution to the literature in furthering our understanding of the
utility of psychosocial factors in protecting university students on an international level from the adverse conse-
quences of high levels of perceived stress, including the development of anxiety and depression. Cohen and
Wills’ [22] stress-buffering hypothesis was not supported within the current sample, suggesting that less empha-
sis should be placed on the protective role of perceived social support on perceived stress, anxiety, and depres-
sion among university students. However, the results from the current study provide support for both a main ef-
fect and buffering model of campus connectedness. Therefore, increasing campus connectedness in university
students will result in deceases in levels of both depression and anxiety. Furthermore, recognising that psy-
chosocial factors such as campus connectedness may protect university students from the development of stress-
induced depression adds to the emerging body of literature surrounding connectedness within the university
context. To reduce the high prevalence rates of mental health problems in university students, it seems likely
that facilitating campus connectedness would provide positive outcomes for the mental health of university stu-
dents. Future research should be directed towards examining the effectiveness of preventative programs and in-

A. M. Pidgeon et al.
30
terventions that promote campus connectedness. Universities should remain committed to promoting campus
connectedness in university students through the development of programs and activities that promote student
diversity, cultural unity, and belonging, such as interest groups [30].
The present study has important implications for higher education, as findings indicate that university students
who are more connected have lower levels of perceived stress, anxiety, and depression. These findings demon-
strate it is important for students to become involved in and feel a part of their university communities in order
to be protected against the effects of stress and, consequently, the occurrence of psychological distress. With the
knowledge that campus connectedness buffers the relationship between perceived stress and depression, univer-
sity students with higher levels of campus connectedness may be protected from the adverse effects of stress and
the development of depression. The current study has provided insight into the benefits of increasing campus
connectedness in university students internationally to promote psychological wellbeing and adjustment. This
awareness should be used to initiate programs for universities in Australia, Hong Kong, and the United States to
reduce the prevalence rates of mental health problems in university students.
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