# Unequal burdens: a scoping review of key social determinants of health affecting wellbeing of international vs. domestic students

## TL;DR

This review compares the wellbeing of international and domestic university students, showing international students face greater challenges like social isolation and food insecurity.

## Contribution

The study systematically compares social determinants of health affecting international and domestic students using a scoping review approach.

## Key findings

- International students report higher levels of psychological distress and social isolation compared to domestic students.
- Food insecurity and housing issues disproportionately affect international students, worsening their mental health.
- Combined social determinants create a cycle of poor wellbeing, especially for international students.

## Abstract

The wellbeing of university students has become a significant concern globally. This scoping review aimed to explore key social determinants of health, such as food insecurity, housing issues, social isolation, and psychological distress and how it affects the overall experiences and wellbeing of university students. The review included studies comparing the experiences of international and domestic students to highlight unique challenges faced by each group.

This scoping review followed the first five stages of Arksey and O’Malley’s framework and used Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. A comprehensive search was conducted across Medline, Scopus, and Web of Science databases, focusing on studies published between 2014 and 2024. The inclusion criteria targeted research on international students in comparison to domestic students addressing food insecurity, housing issues, social support, psychological distress and wellbeing. A total of 23 studies met the inclusion criteria and were assessed for quality using the Joanna Briggs Institute (JBI) critical appraisal tool. Data were extracted and synthesised using a narrative approach.

The review identified that international students are particularly vulnerable to psychological distress due to combined influence of other key social determinants of health. Social isolation was identified as a critical factor, with international students reporting higher levels of loneliness and lack of social support compared to domestic counterparts. Food insecurity significantly impacts both domestic and international students, with international students experiencing higher levels of anxiety and depression due to limited access to affordable food and support networks. Housing issue affect stress and mental health, particularly among international students who face additional barriers such as cultural adjustments and unfamiliarity with local housing markets. The interconnectedness of these factors intensifies their impact, resulting in poorer wellbeing among international students compared to domestic students.

This review highlights the critical need for targeted interventions to address food insecurity, housing issues, social isolation and psychological distress among university students, particularly international students. Comprehensive support systems and tailored policies are recommended, and future research is needed to develop and evaluate solutions for these challenges to improve student wellbeing.

The online version contains supplementary material available at 10.1186/s12889-025-26152-z.