Study Limitations

160 The propensity of stressors to translate into distress and mental disorders is mediated by coping resources of individuals. This study included questions related to a number of coping strategies which students use to counter stress. It was found that spending time with friends and family, internet usage and prayers were often used coping strategies. Some negative coping strategies included smoking, substance use and self-injury. As compared with other studies, the proportion of students using religion as a coping strategy was much higher. Very few students sought professional services to address their mental health issues. This could be due to unavailability of mental health services and even if it was available in some cases, students might not have the required level of awareness to utilize them.

The theoretical framework of this study was based on the stress theory. Stress theory postulates that stressors create stress and their relationship is mediated by contextual factors.

This stress could be transformed into distress and other mental health issues if not managed by the use of coping strategies. The present study has analyzed each of these segments of the stress theory and found them to be linked in the same order as hypothesized. While the study was generally successfully in achieving its stated objectives, limitations were identified throughout the research process which could have restricted the extent to which these results could be generalized. Additionally, the limitations of this study could guide future research not only on mental health but also studies on other subjects conducted in Pakistan. These limitations are discussed in detail in the next section.

161 previous literature which came mostly from Western Europe had implications for this study where cultural factors led to differential responses to certain questions.

 In social sciences, there rarely exists a tool with universal validity. With regard to mental health, the measurement of different issues is substantially influenced by the social setting of respondents. Some significant differences were observed in this study between the results of WHO-5 index and M-BDI although both of these tools measured depression. Being a native citizen of Pakistan, the author thinks that the respondents‟ responses to WHO-5 questions were largely influenced by prevalent norms. The people in Pakistan tend to respond positively to questions about their well-being whether these responses reflect their state of mind or not. Therefore, it is important to rework these tools in light of socio-cultural considerations of the context in which these tools will be employed. As no such observation was made in previous small scale studies in Pakistan, the present study could not consider these cultural influences in terms of modification of tools.

 The measurement of mental health issues was done primarily through Modified Beck Depression Inventory, Perceived Stress Scale of Cohen and WHO-5 well-being index.

All these tools measured perceived prevalence of mental health issues rather than the clinical prevalence. Although this limitation was obvious at the outset, it is important to note that these tools are still indicative of clinical prevalence and do serve as efficient screening resources. This study could have benefitted from a joint venture where students who were found to have the perceived prevalence would be referred to psychiatrists for ascertaining the clinical prevalence. However, such an arrangement was out of the scope of this study for a number of academic, ethical and financial considerations.

 Validity of instruments is substantially dependent on context and all measures of mental health issues are imperfect and prone to cultural influences. There is considerable controversy about whether mental health issues e.g. PS, DS and PWB manifest themselves differently across cultures. While these are important phenomenological issues and their comprehensive debate is beyond the scope of the current study but these influences create varied effect of the measurement of actual prevalence.

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 The cut-off points for different measures of mental health vary across different studies. With the exception of M-BDI, the tools used in this study had no universal cut-off points which could have significant bearing on the prevalence. In view of this, the present study adopted the cut-off points used in studies which were also conducted in non-Western contexts. However, such an adjustment may not be sufficient to account for variations in cut-off points and there is need for further studies to ascertain optimum cut-off points in different contexts.

 As this study was concerned with mental health issues, it only looked at transformation of stress to distress. In theory, the stress could also lead to eustress as well which can have positive health or performance outcomes. However, the eustress was not discussed in this study being beyond its research objectives.

 As is the issue with all cross-sectional studies, this study provides only a snapshot of mental health issues among university students in a specific space and time. The variations in stressors and their subsequent impact on mental health issues over the course of students‟ stay in university could be examined with a longitudinal research design. However, a longitudinal research requires substantial time and funding which makes it mostly unfeasible for PhD research projects.

 This study only considered those academic or non-academic stressors which were related to the university context. It is possible that some students had prior distress and other mental health issues. It could also be the case that some stressors outside the university context had affected their mental health such as early stressful life events. Similarly, the responses of students towards stressors were sought in fixed categories. For instance, it was assumed that a strong dissatisfaction with a relationship was same as a strong dissatisfaction with an exam failure. Both these issues relate to personal life circumstances and subjective experiences of respondents.

It was not possible to accommodate for such differences in a quantitative study design. It is, therefore, recommended that quantitative studies in mental health be complemented with qualitative data.

 Those students who were screened as having psychological issues were not asked about their utilization of mental health services. This discrepancy could have been met if students screened positive for psychological issues were interviewed later to get

163 information about their service seeking behavior. However, this was not an objective of the present study.

 Since the present study had a cross-sectional design, it was not possible to establish a causal relationship between coping strategies and mental health. Since only the already existing mental health condition of respondents was known, it was not possible to ascertain how effective certain coping strategies have been to improve, or in some cases worsen, the mental health issues.

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