Student mental health in Pakistan: exam stress, pressure, and when to get help
October 28, 20268 min read
Student mental health in Pakistan is a serious and common concern. A 2021 review of 26 Pakistani studies found that roughly four in ten university students screened positive for depressive symptoms. Exam and entry-test pressure, family expectations, and loneliness all play a part. The good news: stress is manageable, and help works.
This guide is for university and college students aged 18 and over, and for the parents who worry about them. It is general information, not a diagnosis. If anything here sounds like you, the most useful next step is a conversation with someone qualified.
What pressures do students in Pakistan commonly face?
Students in Pakistan face a stack of pressures at once: frequent high-stakes exams, entry tests like the MDCAT, strong family expectations, uncertainty about careers, money worries, and often moving away from home for the first time. Pakistani research consistently names exams and parental expectations among the top stressors.
A 2010 study of 161 first- and second-year MBBS students at CMH Lahore Medical College asked which stressors students felt “often or always”. The top answers were high parental expectations (63%), frequency of examinations (59%), the size of the curriculum (50%), sleeping difficulties (48%), worrying about the future (45%), and loneliness (41%). About a third (35%) named living away from home.
A 2018 study of 283 students at Aga Khan University in Karachi found a similar picture: pressure to pass exams, meeting family expectations of good results, and missing home. Female students in that sample reported higher anxiety and stress scores.
Beyond medicine, the NHS lists exams, coursework deadlines, living with people you do not know, thinking about the future, moving to a new area, and managing a tight budget as everyday sources of student stress. Hostel life in Lahore, Islamabad, or Karachi, far from family, fits squarely on that list.
How common is depression among university students in Pakistan?
Depressive symptoms are common among Pakistani university students. The best pooled estimate, a 2021 meta-analysis of 26 studies and 7,652 students, found that 42.66% screened positive. Individual studies range much higher or lower depending on the city, sample, and screening tool, so treat these figures as a warning light, not a precise count.
The meta-analysis by Khan and colleagues (Frontiers in Public Health, 2021) reported a pooled prevalence of 42.66% (95% CI 34.82–50.89%). Students outside medicine had a higher estimate (53.59%) than medical students (36.90%), though that difference was only borderline. The authors stress that most studies used self-report screening tools rather than clinical interviews, often with non-random samples, and that results “should be interpreted with caution”.
| Study | Sample | Finding |
|---|---|---|
| Khan et al., 2021 (meta-analysis) | 26 studies, 7,652 university students | 42.66% screened positive for depressive symptoms |
| Asif et al., 2020 (Sialkot) | 500 students, three universities, DASS-21 | 75% depression, 88.4% anxiety, 84.4% stress symptoms |
| Shah et al., 2010 (Lahore) | 161 first- and second-year MBBS students | About 67% met the study's cutoff for being stressed |
The Sialkot study (Pakistan Journal of Medical Sciences, 2020) shows how high single-site figures can run, but it is one city and uses a screening scale, not diagnoses. For the wider national picture, see our post on mental health in Pakistan.
When does exam stress become something more?
Exam stress is normal when it rises before a paper and settles afterwards. It has become something more when it lasts for weeks, affects sleep, appetite, and relationships, makes you feel hopeless, or stops you functioning. That is the point to talk to a professional rather than push through alone.
| Usually normal exam stress | Signs it is worth getting help |
|---|---|
| Nervousness that peaks before exams and eases after | Worry or low mood that lasts two weeks or more, regardless of exams |
| A few restless nights before a big paper | Ongoing sleep problems, or sleeping most of the day |
| Feeling busy and stretched | Losing interest in things you used to enjoy; pulling away from friends |
| Some irritability | Panic attacks, constant dread, or being unable to concentrate at all |
| Disappointment after a bad result | Feeling worthless or hopeless, or thoughts that life is not worth living |
The NHS describes signs of stress as feeling irritable, anxious, or worried a lot of the time, being unable to enjoy yourself, sleep problems, trouble concentrating, and snapping at people. It advises getting help if self-help is not working or stress is affecting your life or studies. To tell a hard patch from depression, read signs of depression vs feeling low. If you have sudden surges of fear with a racing heart, see panic attacks: what they are and what to do.
How can students deal with exam stress and anxiety?
The strategies with the best support are simple: plan study in manageable chunks, protect regular sleep, take real breaks, move your body, limit caffeine, and talk to someone. None of these remove pressure, but together they lower the emotional intensity and help you think more clearly.
| Strategy | Why it helps | Source |
|---|---|---|
| Break revision into chunks with a written plan | Keeps deadlines manageable and restores a sense of control | NHS: student stress |
| Same bedtime and wake time; phone away before bed; no tea or coffee within 6 hours of sleep | Enough sleep supports mood and energy; caffeine keeps you awake | NHS Every Mind Matters: sleep |
| Regular breaks for rest, friends, or exercise | Prevents burnout; NHS advises making time for relaxation | NHS: tips to reduce stress |
| Exercise, even a brisk 10-minute walk | Can lift mood and reduce the emotional intensity of stress | NHS: exercise for depression |
| Talk to a friend, teacher, or family member | Talking things through can help you find solutions | NHS: tips to reduce stress |
A practical note for Pakistani students: late-night cramming on chai and energy drinks is common, but the NHS specifically flags caffeine and short sleep as things that work against you. And if an entry test like the MDCAT does not go your way, one result is not your whole future. A 2025 study of 101 University of Peshawar students found that family encouragement and emotional support were linked to coping better after medical entry-test failure. If worry is constant rather than exam-linked, our guide to anxiety treatment in Pakistan explains what therapy involves.
How do I talk to my parents about stress or therapy?
Start with what your parents can see, such as poor sleep, trouble focusing, or slipping grades, rather than labels they may not trust. Choose a calm moment, explain what you need, and frame therapy as a practical step to cope better. Many parents respond more openly than students expect.
Family expectations are one of the most-cited stressors in Pakistani studies, so this conversation can feel heavy. You do not need to have it all at once. Our step-by-step guide, talking to parents about therapy, covers what tends to go well, common objections, and your options if the answer is still “no”.
Does my university have counselling services?
Many Pakistani universities and medical colleges have a student counselling or wellbeing office, but availability, staffing, and confidentiality vary a lot between campuses. Check your student handbook, website, or student affairs office. Campus counselling can be a good first step for stress, homesickness, and study problems.
Ask directly how confidential the service is and whether it can refer you on for more specialised care. The NHS notes that students do not need a diagnosed condition to benefit from counselling: stress about work, family or relationship issues, and low mood are all valid reasons to go. If your campus has nothing, or you would rather keep things off campus, private online therapy is another option.
When should a student seek professional help?
Seek professional help if low mood, anxiety, or stress lasts more than two weeks, keeps you from studying or sleeping, or self-help is not making a difference. Seek help urgently if you have thoughts of harming yourself. Getting support early is a sensible step, not a sign of weakness or failure.
This matters because young adults are at real risk. The World Health Organization reports that suicide is the third leading cause of death among 15- to 29-year-olds worldwide. Reaching out early matters.
If you are in crisis right now, contact Rescue 1122, the free Taskeen helpline (0316-8275336), or go to your nearest emergency department. For more numbers, see our list of mental health helplines in Pakistan.
Under 18? Safe Healing serves adults aged 18 and over only. If you are still at school or college and under 18, please speak to a parent or guardian, a trusted teacher, or your family doctor, and use local services or the helplines above.
How can parents support a struggling student?
Parents help most by listening before advising, making it clear their love does not depend on marks, and noticing changes in sleep, appetite, and mood. Treat a request for counselling as a responsible choice. Research from Pakistan links family encouragement and emotional support with students coping better after exam setbacks.
- Ask open questions such as “How are you really doing?” and let silences sit.
- Avoid comparisons with cousins, siblings, or neighbours' children. In the Lahore study, high parental expectations were the single most-reported stressor.
- Talk about plan B early, before results, so a missed merit list does not feel like the end.
- Take warning signs seriously, especially talk of hopelessness or self-harm, and help your child reach a professional.
How Safe Healing can help
Safe Healing connects adults in Pakistan, aged 18 and over, with licensed therapists for private online sessions in Urdu or English, so you can talk from your hostel room or home without anyone on campus knowing. You also get 7 days of follow-up chat with your therapist. A short intake helps match you with someone who works with stress, anxiety, and low mood. Start the intake.
Sources
- Khan MN, Akhtar P, Ijaz S, Waqas A. Prevalence of depressive symptoms among university students in Pakistan: a systematic review and meta-analysis. Frontiers in Public Health, 2021.
- Asif S, et al. Frequency of depression, anxiety and stress among university students. Pakistan Journal of Medical Sciences, 2020.
- Shah M, Hasan S, Malik S, Sreeramareddy CT. Perceived stress, sources and severity of stress among medical undergraduates in a Pakistani medical school. BMC Medical Education, 2010.
- Rehmani N, Khan QA, Fatima SS. Stress, anxiety and depression in students of a private medical school in Karachi, Pakistan. Pakistan Journal of Medical Sciences, 2018.
- Arif U, Khan M, Ullah A. Association of family support in coping with medical entry-test failure stress with educational engagement in Khyber Pakhtunkhwa. Pakistan Journal of Applied Psychology, 2025.
- NHS. Student stress.
- NHS. Counselling for student mental health problems.
- NHS. 10 stress busters / tips to reduce stress.
- NHS Every Mind Matters. How to fall asleep faster and sleep better.
- NHS. Exercise for depression.
- World Health Organization. Suicide fact sheet.
- Taskeen: free mental health helpline (contact page)
FAQ
Frequently asked
How common is depression among university students in Pakistan?
A 2021 meta-analysis in Frontiers in Public Health pooled 26 Pakistani studies covering 7,652 university students and found that 42.66% screened positive for depressive symptoms. These were self-report screening tools, not clinical diagnoses, and the studies varied widely, so the figure should be read as a sign of how widespread distress is rather than an exact count.
How do I deal with exam anxiety?
Break revision into manageable chunks with a written plan, keep regular sleep and wake times, take real breaks, stay physically active (even a brisk 10-minute walk helps), cut down on caffeine, and talk to a friend, teacher, or family member. If anxiety stops you studying, sleeping, or sitting exams, speak to a professional.
Is MDCAT or board exam stress normal?
Some stress before a high-stakes exam like the MDCAT or board exams is normal and can even help you focus. It becomes a concern when it lasts for weeks, disrupts sleep and eating, makes you feel hopeless, or continues long after results. Pakistani research shows family support helps students cope with entry-test setbacks.
What are the signs that student stress has become depression or anxiety?
Warning signs include low mood or loss of interest lasting two weeks or more, constant worry you cannot switch off, sleeping far too much or too little, pulling away from friends, falling grades, panic attacks, or thoughts that life is not worth living. These are reasons to talk to a professional, not proof of a diagnosis.
Can students under 18 use Safe Healing?
No. Safe Healing serves adults aged 18 and over. Students under 18 should involve a parent or guardian and seek help through their school, a family doctor, or local mental-health services. In an emergency, call Rescue 1122 or go to the nearest emergency department.
How can parents support a student who is struggling?
Listen without immediately judging or problem-solving, separate your love from their marks, watch for changes in sleep, appetite, and mood, and treat professional help as a normal step. Research from Khyber Pakhtunkhwa found that family encouragement and emotional support were linked to students coping better with entry-test failure.
