Undergraduate university students comprise a sizeable portion of the younger population and go on to wield a considerable degree of influence in society through the key roles adopted in the future as professionals, senior executives and politicians . The latest OECD report showed that 62% of the young adults in OECD countries were enrolled in tertiary education at universities . The health and well-being of this population group is important, not only due to their potential societal influence, but because many lifestyle related attitudes and habits are formed at this stage and persist across the life span [3–6].
Before describing the background literature, it is useful to highlight some definitional issues associated with the literature concerning the health of younger age groups. Various authors have used ‘late adolescent’ and ‘young adults’ in discussing health issues concerning 18–24 year olds [5, 7, 8]. We used the term ‘young adults’ in the current paper. Furthermore, we have used the terms ‘health’ and ‘well-being’ to ensure a more holistic approach, encompassing a spectrum of self-reported physical, emotional and mental health issues .
Much of the research on the health and well-being of university students, including some of the Australian studies, has focused predominantly on self-reported risky health behaviors such as: smoking [10–12]; drug and alcohol use [13–18]; and unsafe sexual activity [19–23]. In comparison studies on self-rated physical health by university students were less common [1, 24–27]. Perhaps the most comprehensive research conducted into the self-rated health of college students was carried out regularly by the American College Health Association. Of the 90,666 students surveyed in 2012, 60.2% rated their health status as excellent or very good, while 31.9% rated it as good . The most common health problems experienced by these students in the past year were allergies (19.7%), sinus infection (17.5%), back pain (12.6%), and strep throat (10.7%). Health conditions which had negatively impacted on their academic performance included: stress (29.0%); sleep difficulties (20.6%); anxiety (20.2%); and upper respiratory tract infections (15.6%). Another recent study found that almost 60% of university students had experienced a health problem in the past month, ranging from allergies and asthma, to severe headaches and insomnia .
With regard to mental health, there was considerable more literature and the available evidence suggested that a significant proportion of young adults suffered from psychological ill health. The most up-to-date data from the global burden of disease study showed that mental disorders accounted for four and five out of the ten leading causes of disability-adjusted life-years (DALYs) globally for 20–24 year olds, and 15–19 year olds respectively [7, 29]. In Australia, the latest data from the national mental health survey reported the 12-month prevalence of any mental health disorder to be 26% amongst the 16–24 year old group . Similar results have been reported from secondary analysis of other Australian national datasets such as the 2007 Household, Income and Labour Dynamics survey in Australia (HILDA), and the 2007–08 National Health Survey . The mental health of young adults is of concern, not only because of the substantial burden of disease, but because adolescence and early adulthood has been linked to onset for a considerable proportion of mental health disorders diagnosed during adulthood, and due to the persistence of mental illness across the life span [7, 29, 32–34].
Research studies focused on university students have found that psychological distress is at least as common amongst university students when compared with their age group in the general population. One recent study conducted in the US by Hafen et al., of 78 first-year veterinary science students found 30% of university students rated above the clinical cut-off for depression , whilst a large study by Eisenberg et al., of 2785 university students in the US found that that 15.6% of undergraduates tested positive for depression and/or anxiety . Studies in Europe have found similar results. In Hungary in 2008, 19% of students reported considerable psychological distress, with female students scoring significantly worse than their non-student peers in this domain . It is believed that whilst some students commence university with a preexisting mental illness, the stressors associated with university and this stage of life can lead to the manifestation of symptoms in this high risk age group [38, 39]. Mental ill-health issues for the university student population can lead to negative outcomes such as: risky health behavior; poor academic performance and attrition; physical illness; antisocial behavior; and suicide . Australian studies involving university students showed a similar pattern [40–43] as found by studies in the US and Europe.
The academic, financial and social challenges associated with university can make this a very stressful time for students [38, 44]. There was considerable research on excessive stress leading to burnout in the workplace [45, 46], however similar studies into university students’ perceptions and experiences of stress and fatigue, and the associated impact on academic performance and quality of life were relatively limited [24, 44, 47]. Of the available studies, a large proportion focussed on impact of stress on medical students [47–49]. A study by Vaez et al., in Sweden compared first year university students with their work peers ; and a US study by Law found that the level of exhaustion experienced by undergraduate business students was similar or higher than that in conventional high-stress and burnout occupations . As mentioned, much of the burnout research in university students centered on medical students. In the US Dyrbye et al.  found 45% of medical students met the criteria for burnout, and further research published in 2008 by Drybye et al.  found burnout in 49.6% of medical students. A recent study from South Australia compared rates of psychological distress in undergraduate university students across four distinct disciplinary areas: medicine, psychology, law and mechanical engineering and found slightly higher levels of distress amongst law students compared to medical students .
As evident from the information above, most of the research on health and well-being of university students has been conducted in the US and other developed countries. We found only 16 published research studies conducted in Australia since 1995 across a variety of databases including Medline and ProQuest [12, 18, 20, 31, 40, 42, 43, 52–61]. An additional two research papers included a systematic review of physical activity across a number of countries ; and a recent paper used secondary analysis of national datasets to assess prevalence and correlates of psychological distress in university students compared to their community peers . Only two of the 16 empirical studies were conducted in a rural setting [53, 57]. Whilst there was little research around the physical health and well-being of Australian university students, even less is known about their utilisation of available health services. One such study found that although university students were well informed when it came to the services available on campus such as health and counselling facilities, this knowledge did not translate to service usage, with many students having never used the services on offer [43, 56].
The aim of the present study was to examine the perceptions of first year undergraduate students studying at a rural university about academic and social stressors and self-rated health. A secondary aim was to examine the accessibility of general practitioners and support services for the students and their peers in a rural university town. Studying as an undergraduate student at a rural campus has its own set of advantages and challenges. The pressures of high-cost accommodation and long-distance commuting of large metropolitan universities are mitigated by being in a smaller rural campus. However, rural communities also have the disadvantage of providing limited anonymity that can be a deterrent from seeking healthcare, particularly in relation to mental health issues.