How do setting-level changes in universities affect mental health and wellbeing? A systematic mixed studies review

Background: Mental ill health is persistent and pervasive in universities, with calls for setting-level change to improve mental health and wellbeing. However, rather than addressing setting-level factors, most research evaluates individual-level change, and most previous reviews privilege quantitative studies. Research on setting- level change remains limited and under-synthesised. Aims: This review addressed three questions: (i) what are the domains of setting-level change evaluated for mental health impacts in universities? (ii) what are the quantified effects of setting-level changes in universities upon student and staff mental health and wellbeing? and (iii) what are the perspectives of students and staff with respect to setting-level changes in universities? Methods: A systematic mixed studies review was conducted. APA PsycINFO, MEDLINE via Ovid, and Web of Science were searched twice - on 19 December 2022 and 20 January 2023 - with 3,643 records returned. Peer- reviewed journal articles reporting qualitative, quantitative, and mixed-methods studies on mental health outcomes, perspectives, and experiences arising from setting-level changes in universities were included. Included studies were critically appraised using the Mixed Methods Appraisal Tool. Findings: Sixteen studies, reported in 18 articles, were included. All studies evaluated setting-level changes in relation to students' mental health and wellbeing; none focused on staff. Two domains of setting-level change were identified: (i) learning and teaching, and (ii) student-focused policy. Studies varied in design and methodological quality. Conclusions: Most setting-level changes modify how students are taught. Further research should prioritise impacts upon staff, employ rigorous study designs, and include comprehensive review of the grey literature.