University students represent an increasingly large segment of the young adult population (OECD, 2019 https://www.oecd.org/education/education-at-a-glance), and they are positioned to become future leaders and influential contributors to societal progress (Abel and Deitz, 2012; Astin, 1993; Eisenberg et al., 2025). The university experience is characterized by numerous personal and contextual transitions, including intensified academic pressures, evolving social relationships, and potential separation from familial support networks, all of which contribute to high perceived stress levels and can adversely affect mental health.

Mental disorders are highly prevalent among university students—including anxiety, depression, and substance-related disorders (Ahmed et al., 2023; Auerbach et al., 2018; Ibrahim et al., 2013; Jenkins et al., 2021; Mason et al., 2025) and are strongly associated with role impairment, adversely affecting academic performance, social interactions, and overall daily functioning (Beiter et al., 2015; Blanco et al., 2008; King et al., 2021). Of particular concern is the high prevalence of non-suicidal self-injury (NSSI) and suicidality, which not only indicate severe psychological distress but also further exacerbate impairment in both academic and social realms (Garlow et al., 2008). Vulnerability to mental disorders among university students has been exacerbated by the COVID-19 pandemic (Browning et al., 2021; King et al., 2023; Zarowski et al., 2024).

Evidence reveals that a considerable proportion of university students experience health-related role impairment, with prevalence estimates ranging from 20 % to 33 % across various studies (Alonso et al., 2018; Eisenberg et al., 2009). While impairment is associated with both physical and mental disorders (Wilks et al., 2020) but mental disorders and, in particular, comorbid mental disorders, are especially important (Alonso et al., 2019). Role impairment among university students is associated with academic challenges—such as declining performance and increased dropout rates (Eisenberg et al., 2009; Misra and McKean, 2000). Predicting risk of role impairment among university students could facilitate preventive actions and avoid poor academic outcomes.

Here we present data on the prevalence and correlates of role impairment associated with emotional problems among university students in 60 universities across 10 countries covering 4 broad world regions who participated in the World Mental Health International College Student (WMH-ICS) surveys. We then examine the extent to which specific psychopathological conditions predict the highest risk of this impairment.