Food Insecurity, Housing Issues, and Social Isolation: Key Drivers of Psychological Distress and Wellbeing Among International and Domestic Students

University students face numerous challenges that impact their wellbeing, with food insecurity, housing issues, and social isolation identified as significant key social determinants of health (SDoH). This thesis investigates these key SDoH as key drivers of psychological distress and overall wellbeing through a mixed-methods approach. The study highlights the comparative experiences of international and domestic students, revealing the disproportionate vulnerabilities of international students. This thesis is comprised of three studies: a scoping review, a quantitative study, and a qualitative study. It investigates the relationship between key SDoH - food insecurity, housing issues, and social isolation - and their association with psychological distress and wellbeing among international and domestic university students in higher education. The first study, a scoping review, systematically examined existing literature to identify how key SDoH differentially affect international and domestic students. The second study, a quantitative cross-sectional analysis, explored the prevalence and associations of key SDoH with psychological distress among university students at an Australian university, including a comparative analysis of international and domestic cohorts. The third and final study employed a qualitative approach to explore the lived experiences of students navigating food insecurity, housing issues, social isolation, and wellbeing, offering deeper insights into the unique and shared challenges faced by these groups. The scoping review synthesises findings from 23 studies, demonstrating that international students are significantly more affected by food insecurity, housing issues, and social isolation. Limited access to culturally appropriate food, unstable housing conditions, and reduced social support networks worsen psychological distress among international students compared to their domestic peers. A cross-sectional quantitative survey (n=710) conducted at an Australian university examines the prevalence, interconnections, and predictors of key SDoH and psychological distress. Employing validated instruments, the study finds that international students experience higher rates of food insecurity (61.51% vs. 36.68%), housing issues (57.94% vs. 27.73%), and social isolation (63.89% vs. 53.06%) than domestic students; with social isolation emerging as the strongest predictor of psychological distress in multivariable regression (adjusted OR=7.58, p<0.001). Also, 87.61% of all university students experience psychological distress, whereas international and domestic students have almost similar levels of psychological distress (86.46% and 89.68%). Multivariable logistic regression revealed that these key SDoH are significant predictors of severe psychological distress, with comparable levels of psychological distress between international and domestic students (adjusted OR=0.99, p<0.001). The findings highlight the compounded impact of multiple vulnerabilities, particularly for international students. The qualitative study involved semi-structured interviews (n=18) with university students (9 international, 9 domestic), providing deepened and comprehensive insights into their lived experiences. A thematic analysis identified four overarching themes: 1) current experiences with SDoH; 2) health impacts of food insecurity and social isolation; 3) barriers to accessing support; and 4) coping mechanisms. International students faced compounded difficulties, including cultural adjustment, limited social networks, and unfamiliarity with local systems, while domestic students benefited from proximal familial support. Coping strategies ranged from lifestyle adjustments, such as engaging in physical activities, to utilising institutional and peer support. These findings highlight the interconnected nature of the key SDoH. This thesis highlights the need for targeted interventions addressing food insecurity, housing issues, and social support to reduce psychological distress and improve student wellbeing, particularly for international students. Recommendations include culturally sensitive food assistance programs, affordable housing initiatives, and enhanced institutional support services. Future research should explore intersectional factors influencing key SDoH and their compounded effects on diverse student populations.<p></p>