International students can face a range of challenges while adapting to life abroad, including separation from familiar support networks, academic pressures, and cultural and linguistic adjustment. The first year of higher education was the focus of the review because experiences during this period can influence long-term well-being and academic success. The authors aimed to map existing research and identify factors associated with students’ mental health and well-being experiences.

The researchers followed scoping-review methodology from the Joanna Briggs Institute and reported the work according to PRISMA-ScR guidelines, incorporating recommendations from Levac and colleagues. Searches covered four electronic databases—MEDLINE, Embase, PsycINFO and CINAHL—as well as the reference lists of included studies. Screening and data extraction were conducted in Covidence.

Descriptive statistics were used to summarize study and student characteristics, as well as the reported outcomes. Associated factors were synthesized through content analysis. This approach allowed the researchers to bring together the findings of studies focused specifically on first-year international students without reducing the evidence to one pooled effect estimate.

The results included nine mental health concerns and three categories of well-being experience. Depression was among the concerns named in the review, while general well-being was among the well-being experiences reported. The studies also identified 31 factors associated with these outcomes.

Host language difficulties were among the factors examined, linking one aspect of the transition to higher education with students’ reported experiences. The direction of the reported relationships was not uniform. The review recorded negative, positive and inconsistent associations between the associated factors and mental health or well-being outcomes.

As a scoping review, the work therefore describes patterns in the evidence rather than demonstrating that any one factor causes a particular outcome. It also does not establish that the same factors affect all first-year international students in the same way. The review’s findings point to areas where the evidence base remains incomplete.

The authors specifically identify studies aimed at developing evidence-based support strategies as an important direction for future research. Overall, the review provides a structured overview of what has been studied about the mental health and well-being of first-year international students. By focusing on this population and stage of higher education, it identifies nine concerns, three well-being experiences and 31 associated factors, while showing why the relationships among them remain complex.

Subject of Research: Scoping review of mental health and associated factors among first-year international students in higher education

Article Title: Mental health experiences and associated factors among first-year international students in higher education: a scoping review

Article References: Rudakova, K., Khalili, A., & Lal, S. (2026). Mental health experiences and associated factors among first-year international students in higher education: a scoping review. BMC Psychology. https://doi.org/10.1186/s40359-026-05206-w

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05206-w

Keywords: international students, first-year students, higher education, mental health, well-being, depression, scoping review, language difficulties, academic pressure, student adaptation, Mental, health

The researchers define “educational involution” as a system in which students and families invest increasing amounts of time, money and effort in academic competition while receiving progressively smaller returns in valued educational outcomes and experiencing greater stress. The study treats this as a structural condition, distinguishing it from academic pressure understood as an individual experience. Jiangsu was selected as a critical case because it is among China’s most educationally competitive provinces. The authors emphasize, however, that interviews with nine participants in three cities cannot establish national prevalence, average effects or trends across China’s diverse regions.

Participants were recruited through stratified and convenience sampling across Changzhou, Nanjing and Taizhou, with additional snowball sampling through researcher networks. The final sample included one student, one parent and one teacher at each of the three school levels, producing nine in-depth interviews. Teachers had at least 10 years of classroom experience, while students attended public primary, secondary or high schools. Interviews were conducted in Mandarin and lasted from 12 to 52 minutes. The lead author, a native Mandarin speaker, translated the recordings. A hybrid thematic approach organized initial coding around the five ecological levels while allowing subthemes to emerge inductively from the transcripts. This design prioritized interpretive depth and contrast among stakeholder roles rather than statistical representativeness.

At the microsystem level—the environments in which children directly participate—participants described a pervasive atmosphere of high pressure. All nine participants acknowledged that educational involution and intense competition were visible or perceptible around them, whether at school, at home or, for teachers, at work. Parents compared their children’s examination results with those of peers during school pick-up and drop-off, in group chats and in private conversations. Some invested heavily in tutoring and additional exercises, while teachers observed that intense attention to test scores could transfer into classroom expectations and peer comparison. Yet the accounts were not uniformly negative: one primary student said competition could improve scores, efficiency and independence, although it came at the cost of leisure time. The study interprets this mixed response as evidence that intense pressure can become normalized, particularly during earlier stages of schooling, even as fatigue and anxiety accumulate.

Family relationships and communication also shaped students’ experience of competition. Teachers associated supportive family environments—including parental patience, attention to children’s interests and a stable marital relationship—with the confidence and academic performance they observed among stronger students. By contrast, some teachers described distress among children from divorced or single-parent households and discussed how controlling or overwhelmed parents could add to a student’s difficulties. Parent-child conversations were also viewed as consequential, with teachers suggesting that some parents lacked the knowledge, confidence or capacity to communicate constructively. These are observations and associations within the interviews, not evidence that family structure causes academic outcomes. The qualitative material instead shows how family interaction was perceived as part of the immediate setting in which involutionary demands were experienced.

The mesosystem, represented by connections between home and school, emerged as a particularly uneven part of the ecology. Teachers generally welcomed parental involvement but distinguished it from excessive involvement that added pressure to students. Communication in the participating schools was described as largely teacher-led: educators communicated assessment information and expectations to families, while parents sometimes remained passive, overly deferential or unsure how to initiate contact. Work-related separation could also leave a missing link, particularly when rural migrant parents lived and worked in another city. Teachers interviewed in the study associated such absences with weaker communication and, in some cases, an interpretation that parents did not value education. The authors propose that this apparent lack of interest may instead reflect structural constraints beyond parental choice, including labor migration and household separation, rather than a simple neglect of children’s schooling.

Two-way communication was portrayed as a more constructive alternative. When parents shared a child’s interests, personality and experiences outside school, teachers described greater trust, useful knowledge and a stronger sense of partnership. By contrast, parents’ exchange of information about other children’s development intensified anxiety and competition. A primary parent explicitly described exchanging examination results with colleagues and friends as a form of educational involution. The study suggests that home-school links can either reinforce or soften performance pressure, depending on their direction and quality. This is an analytical implication drawn from participants’ experiences, not evidence that any single communication model would reduce involution nationwide or produce a measurable improvement in educational outcomes. The mesosystem analysis also raises concerns about unequal visibility: families that remain connected may receive more attention, while those separated from schools risk being further marginalized.

At the exosystem level, participants pointed to school administration and social media as forces that affect students indirectly. Teachers contrasted student-oriented leadership with management focused primarily on discipline, order and safety. A principal’s decisions about school values, routines, resources and policy implementation were described as shaping pressures that students then experienced in classrooms. Digital media exerted a different kind of influence. Parents and teachers encountered educational content through independently operated accounts and recommendation systems on platforms such as WeChat and TikTok. Participants said that repeated exposure to curated material, including other families’ accounts of their children’s achievements, made comparison difficult to avoid and intensified anxiety. One parent said social media made it almost impossible not to compare a child constantly with others, while a teacher described being unable to stop scrolling educational content. The researchers introduce the term “digital exosystem” for algorithmically shaped environments in which children may not participate directly but which affect caregivers and, through them, family behavior. They also note that these platforms provide useful educational information and examples of more aspirational school leadership, making their role complex rather than uniformly harmful.

At the macrosystem level, every participant connected educational involution to the national college entrance examination, the Gaokao, enrolment pressure, traditional cultural values and competition in the labor market. Participants described advanced qualifications as important for securing employment and viewed the examination structure as making intense educational competition appear difficult to avoid. Confucian traditions linking academic achievement to family honor, social mobility and respect for teachers were also invoked. These cultural and institutional conditions were described as making competition appear unavoidable even when individuals recognized its costs. The study additionally places its analysis in a temporal context, noting the expansion of higher education, the credential pressure that can accompany it, and the 2021 Double Reduction Policy, which sought to reduce extracurricular academic burdens. The interviews did not directly evaluate the policy’s implementation or establish whether it had reduced involution, and the authors describe its wider effect as still debatable.

Across school stages, the apparent source of pressure shifted. Primary participants were more likely to describe parental competition, tutoring and packed schedules, whereas secondary and high-school participants emphasized repetitive school timetables, long attendance hours, fatigue and the loss of passion. One secondary teacher described a daily school schedule running from 7:15 a.m. to 6:00 p.m. and linked its repetition to anxiety, fatigue and conflict between short-term examination demands and long-term educational ideals. Because the study was cross-sectional, this pattern represents participants’ perceptions at different developmental stages rather than a tracked change within individual children. The authors conclude that effective responses would need to coordinate family, school, digital and structural influences rather than depend on isolated interventions. They suggest age-sensitive parental involvement, more reciprocal home-school communication, greater attention to digital media, and broader changes to educational assessment and vocational pathways. These are implications proposed by the authors, not interventions tested by the research, and the findings remain exploratory because of the nine-person sample, reliance on researcher networks, focus on one province and limited coverage of regional and digital variation.

Subject of Research: An exploratory qualitative study of how students, parents and teachers experience educational involution across Jiangsu’s school ecosystems.

Article Title: Exploring educational involution: a qualitative study of stakeholders’ perspectives in Jiangsu Province, China

Article References: Jia, X., Garvis, S., & Nakar, S. (2026). Exploring educational involution: a qualitative study of stakeholders’ perspectives in Jiangsu Province, China. Frontiers in Education, 11, Article 1872580. https://doi.org/10.3389/feduc.2026.1872580

Image Credits: AI Generated

DOI: 10.3389/feduc.2026.1872580

Keywords: educational involution, Jiangsu education, academic pressure, parental anxiety, school competition, social media algorithms, home-school communication, ecological systems theory, Gaokao examination, China, Exploring, educational

The most alarming signal in the accumulating evidence concerns mental health. Recent large-scale surveys of Chinese secondary school students have documented substantial prevalence of depressive and anxiety symptoms, with a 2023 BMC Psychiatry study led by Chen and colleagues identifying a range of associated factors that place enormous numbers of teenagers at risk. A systematic review and meta-analysis published in the Journal of Affective Disorders had already estimated the pooled prevalence of depressive symptoms among secondary school adolescents in mainland China at a level that clinicians describe as a silent epidemic. More recent network analyses, including a 2024 study in General Psychiatry, have mapped how suicidal ideation interlocks with depression and anxiety symptoms among Chinese adolescents, revealing that these conditions are not isolated diagnoses but densely connected webs of distress in which one symptom can amplify and sustain another. For a country where academic competition is intense and psychological support services remain unevenly distributed, the researchers argue, these findings represent a public health emergency in slow motion.

The mechanisms behind this mental health burden are becoming clearer, and they implicate the structure of adolescent daily life itself. Data from the China Family Panel Studies, analyzed by Zhou and colleagues in the International Journal of Environmental Research and Public Health, show that short sleep duration and high academic pressure are both independently associated with depressive symptoms, and that the two frequently compound each other. Chinese adolescents face some of the longest study hours in the world, and the encroachment of schoolwork on sleep has become a defining feature of the teenage years. Meanwhile, sedentary behavior has emerged as a risk factor extending beyond physical health: a 2024 study in Frontiers in Psychiatry reported a relationship between sedentary behavior and non-suicidal self-injury among Chinese adolescents, suggesting that prolonged inactivity may be intertwined with psychological suffering in ways that traditional clinical screening does not capture.

Screens occupy a central place in this shifting risk landscape. A systematic review by Hale and Guan in Sleep Medicine Reviews established that screen time displaces sleep among school-aged children and adolescents, and subsequent research has linked device-specific screen use to physical inactivity and poor eating habits. Studies of problematic internet use, including work published in Psychiatry Investigation, have highlighted gender differences in how adolescents engage with digital platforms and how that engagement spirals into addiction-like patterns. The viewpoint’s authors note that online gambling addiction in mainland China has itself become a recognized clinical challenge, documented in General Psychiatry, adding a further dimension to the digital threats confronting young people. In an era when smartphones reach virtually every teenager, the boundary between technology as a tool and technology as a hazard has become a central battleground for adolescent health policy.

Alongside the mental health crisis, a metabolic one is unfolding. Evidence from seven national school surveys conducted between 1985 and 2019, published in The Lancet Public Health by Song and colleagues, documents persistent and shifting inequalities in thinness and obesity among Chinese children and adolescents. The double burden of malnutrition, where underweight and obesity coexist and often co-occur within the same communities and even the same families, means that nutrition policy cannot be reduced to a single target. A 2026 cross-sectional study from Hangzhou, published in BMJ Paediatrics Open, reported on the prevalence and risk factors of overweight and obesity among children and adolescents in that city, reinforcing the picture of a population whose energy balance has been upended by dietary transition and declining physical activity.

The downstream metabolic consequences are already measurable in pediatric populations. A large-scale cross-sectional study published in Pediatric Diabetes found notable prevalence of impaired fasting glucose among children and adolescents in urban China, pointing to early dysregulation of glucose metabolism that could seed a future epidemic of type 2 diabetes. Hypertension, long considered an adult disease, has been mapped nationally: a systematic review and modelling study in The Lancet Child and Adolescent Health estimated the national, regional, and provincial prevalence of childhood hypertension in China, revealing widespread elevated blood pressure in pediatric populations. These findings carry profound implications, because hypertension and impaired glucose metabolism established in adolescence tend to track into adulthood, converting childhood risk into decades of cardiovascular and metabolic disease.

The authors frame these converging threats as a mismatch between health needs and health systems. China’s pediatric infrastructure, they argue, was largely built around infectious disease, infant mortality, and acute pediatric care, and it excelled at those tasks. But non-communicable diseases now dominate the health needs of Chinese youth, and interventions designed for younger children or for adults do not automatically transfer to adolescents, whose developmental stage, autonomy, and health-seeking behaviors are distinctive. A systematic review in BMJ Paediatrics Open examining implementation factors of non-communicable disease policies and programmes for children and youth in low- and middle-income countries found that translating policy into effective programs remains a persistent weakness, and the authors suggest China is no exception to this global pattern.

There are also grounds for scientific optimism that the authors highlight. The same journal recently published work using integrative metabolomics and machine learning to identify biomarkers of adolescent social anxiety disorder, demonstrating that cutting-edge molecular and computational tools can be directed at conditions that were previously assessed only through subjective questionnaires. Such approaches promise earlier detection and more precise stratification of risk, but the authors caution that technological innovation must be matched by investment in the mundane infrastructure of adolescent health: school-based screening, trained counselors, affordable psychological services, and parental education. Biomarkers alone will not help teenagers who cannot access care, and the viewpoint emphasizes that research advances must feed directly into policy rather than remaining confined to academic journals.

The call to action articulated by He, Xiao, Zhou, and Qiu is deliberately broad. It asks for national attention to adolescent mental health as a priority equal to physical disease, for school and family environments that protect sleep and limit harmful sedentary screen exposure, for nutrition and physical activity policies that address both underweight and obesity, and for surveillance systems capable of tracking rapidly changing adolescent health needs across China’s vast regional inequalities. It also asks pediatricians themselves to evolve, moving beyond the treatment of childhood illness toward the promotion of lifelong health trajectories that begin in the teenage years. The paper was funded by the Guangzhou Health Science and Technology Project, and the authors state that the funder played no role in the design or content of the manuscript. As China’s adolescents confront a world of academic pressure, digital saturation, and obesogenic environments, the message from Guangzhou is unambiguous: the systems that saved their lives as infants must now be reinvented to protect their futures as adults.

The timing of the viewpoint reflects a broader recalibration in global child health thinking. For much of the twentieth century, pediatric progress was measured in survival metrics, and China’s dramatic reductions in infant and child mortality stand among the most celebrated achievements in public health history. Yet as mortality has fallen, morbidity has migrated toward conditions that are chronic, cumulative, and behavioral in origin, which resist the single-dose interventions, such as vaccination campaigns, that served the previous era so well. Adolescent health occupies an awkward institutional middle ground: too old for pediatric services oriented toward early childhood, too young for adult medicine, and frequently overlooked by both.

The developmental science underlying this argument is well established. Adolescence is a period of profound neuroplasticity, during which reward circuitry matures ahead of regulatory control, heightening sensitivity to stress, sleep deprivation, and the persuasive design of digital environments. This makes the teenage years both a period of heightened vulnerability and a window of unusual opportunity, since health behaviors related to diet, activity, sleep, and substance use established during adolescence tend to persist across the life course. Interventions delivered in this window can therefore yield returns that compound over decades, a point the authors implicitly invoke when they urge pediatricians to think in terms of lifelong health trajectories.

The regional heterogeneity of China adds a further layer of complexity. With enormous variation in income, urbanization, and access to services across provinces, a uniform national policy risks being simultaneously too weak for high-burden areas and poorly matched to others. The authors’ emphasis on surveillance systems capable of tracking changing needs reflects this reality: without granular, regularly updated data on adolescent mental health, nutrition, and cardiometabolic risk, policymakers cannot direct resources where they are most needed, and the gap between evidence and action will continue to widen.

Subject of Research: A call to action on emerging physical and mental health challenges among adolescents in China.

Article Title: Emerging challenges and call to action for adolescent health in China

Article References: He, J.-R., Xiao, W.-Q., Zhou, W.-H., & Qiu, X. (2026). Emerging challenges and call to action for adolescent health in China. World Journal of Pediatrics. https://doi.org/10.1007/s12519-026-01074-x

Image Credits: AI Generated

DOI: 10.1007/s12519-026-01074-x

Keywords: adolescent health, China, mental health, depression, obesity, sleep duration, screen time, academic pressure, childhood hypertension, public health policy, noncommunicable diseases, World Journal of Pediatrics