{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:01:12Z","timestamp":1790146872884,"version":"4.0.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>University students\u2019 mental health is typically assessed through a deficit-oriented lens that equates symptom absence with well-being. Keyes\u2019 dual-continuum model challenges this assumption, yet qualitative evidence examining how students in active psychiatric treatment narrate the coexistence of distress and flourishing remains scarce, particularly outside high-income, English-speaking contexts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative descriptive-interpretive study was conducted with seven undergraduate students (six women, one man; ages 19\u201323) receiving outpatient psychiatric care at a university-affiliated clinic in Mexico City. Participants were recruited following a quantitative survey week; those who volunteered for further exploration were interviewed. Semi-structured interviews were triangulated with clinical records and analyzed using reflexive thematic analysis, integrating deductive categories from Keyes\u2019 eleven well-being facets with inductively emergent themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five cross-cutting themes emerged: (a) flourishing and psychiatric symptoms co-occurred instead of alternating; (b) the university functioned as an ambivalent microsystem, simultaneously protective and threatening; (c) vital interest operated as a motivational hinge linking emotional, psychological, and social well-being; (d) peer networks functionally replaced family-of-origin support; and (e) institutional disciplinary processes could profoundly compromise psychological safety in a critical illustrative case. Clinical records were consistent with students\u2019 narratives of high flourishing alongside substantial psychiatric burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Flourishing and psychiatric symptoms can coexist within the same individual and narrative. University mental health services should assess flourishing and symptom severity as complementary but distinct tasks, and attend to ecological and institutional factors, including psychological safety around disciplinary processes, that shape students\u2019 mental health trajectories.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1980855","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:16:05Z","timestamp":1790144165000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Flourishing alongside psychiatric symptoms: a qualitative study on dual-continuum mental health in university students"],"prefix":"10.3389","volume":"17","author":[{"given":"Ingrid","family":"Vargas-Huicochea","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Mental Health, Faculty of Medicine, Universidad Nacional Aut\u00f3noma de M\u00e9xico (UNAM)","place":["Mexico City, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo","family":"Camargo-Cabello","sequence":"additional","affiliation":[{"name":"Universidad de los Andes","place":["Bogot\u00e1, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia Aracely","family":"Tafoya","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Mental Health, Faculty of Medicine, Universidad Nacional Aut\u00f3noma de M\u00e9xico (UNAM)","place":["Mexico City, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaqueline","family":"Cort\u00e9s","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Mental Health, Faculty of Medicine, Universidad Nacional Aut\u00f3noma de M\u00e9xico (UNAM)","place":["Mexico City, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga Marina","family":"Robelo-Zarza","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Mental Health, Faculty of Medicine, Universidad Nacional Aut\u00f3noma de M\u00e9xico (UNAM)","place":["Mexico City, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1037\/abn0000362","article-title":"WHO world mental health surveys international college student project: prevalence and distribution of mental disorders","volume":"127","author":"Auerbach","year":"2018","journal-title":"J. Abnorm. Psychol."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1037\/0022-006X.56.6.893","article-title":"An inventory for measuring clinical anxiety: psychometric properties","volume":"56","author":"Beck","year":"1988","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref3","volume-title":"Manual for the Beck Depression Inventory-II","author":"Beck","year":"1996"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1037\/h0037562","article-title":"The measurement of pessimism: the hopelessness scale","volume":"42","author":"Beck","year":"1974","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1177\/1468794112468475","article-title":"Now I see it, now I don't: researcher's position and reflexivity in qualitative research","volume":"15","author":"Berger","year":"2015","journal-title":"Qual. Res."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1080\/2159676X.2019.1628806","article-title":"Reflecting on reflexive thematic analysis","volume":"11","author":"Braun","year":"2019","journal-title":"Qual. Res. Sport Exerc. Health"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1080\/14780887.2020.1769238","article-title":"One size fits all? What counts as quality practice in (reflexive) thematic analysis?","volume":"18","author":"Braun","year":"2021","journal-title":"Qual. Res. Psychol."},{"key":"ref9","doi-asserted-by":"crossref","DOI":"10.4159\/9780674028845","volume-title":"The Ecology of Human Development: Experiments by Nature and Design","author":"Bronfenbrenner","year":"1979"},{"key":"ref10","first-page":"37","volume-title":"International Encyclopedia of Education","author":"Bronfenbrenner","year":"1994"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1080\/13645570701606028","article-title":"The role of gender, environment and individual biography in shaping qualitative interview data","volume":"12","author":"Broom","year":"2009","journal-title":"Int. J. Soc. Res. Methodol."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1446","DOI":"10.1097\/ACM.0000000000000427","article-title":"Reframing medical education to support professional identity formation","volume":"89","author":"Cruess","year":"2014","journal-title":"Acad. Med."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1097\/ACM.0000000000000913","article-title":"Amending miller's pyramid to include professional identity formation","volume":"91","author":"Cruess","year":"2016","journal-title":"Acad. Med."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1508992","DOI":"10.3389\/fmed.2024.1508992","article-title":"Psychological safety in health professions education: insights and strategies from a global community of practice","volume":"11","author":"Dong","year":"2025","journal-title":"Front. Med."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"350","DOI":"10.2307\/2666999","article-title":"Psychological safety and learning behavior in work teams","volume":"44","author":"Edmondson","year":"1999","journal-title":"Adm. Sci. Q."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e101","DOI":"10.3989\/ris.2018.76.3.16.179","article-title":"La influencia de la situaci\u00f3n y el entrevistador en la expresi\u00f3n de la identidad personal","volume":"76","author":"Escobar","year":"2018","journal-title":"Rev. Int. Sociol."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1023\/B:JOBA.0000007455.08539.94","article-title":"Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale","volume":"26","author":"Gratz","year":"2004","journal-title":"J. Psychopathol. Behav. Assess."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"207","DOI":"10.2307\/3090197","article-title":"The mental health continuum: from languishing to flourishing in life","volume":"43","author":"Keyes","year":"2002","journal-title":"J. Health Soc. Behav."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1037\/0022-006X.73.3.539","article-title":"Mental illness and\/or mental health? Investigating axioms of the complete state model of health","volume":"73","author":"Keyes","year":"2005","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1037\/0003-066X.62.2.95","article-title":"Promoting and protecting mental health as flourishing: a complementary strategy for improving national mental health","volume":"62","author":"Keyes","year":"2007","journal-title":"Am. Psychol."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1002\/jclp.20741","article-title":"Evaluating the psychometric properties of the mental health continuum-short form (MHC-SF)","volume":"67","author":"Lamers","year":"2011","journal-title":"J. Clin. Psychol."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1177\/1049732315617444","article-title":"Sample size in qualitative interview studies: guided by information power","volume":"26","author":"Malterud","year":"2016","journal-title":"Qual. Health Res."},{"key":"ref23","first-page":"1","article-title":"Prevalencia de trastornos mentales y uso de servicios: Resultados de la Encuesta Nacional de Epidemiolog\u00eda Psiqui\u00e1trica en M\u00e9xico","volume":"26","author":"Medina-Mora","year":"2003","journal-title":"Salud Ment."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"201","DOI":"10.24875\/gmm.24000369","article-title":"Barreras para la atenci\u00f3n de la salud mental de estudiantes de medicina","volume":"161","author":"Qui\u00f1ones-Robles","year":"2025","journal-title":"Gac. Med. Mex."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1086\/297818","article-title":"Does conversational interviewing reduce survey measurement error?","volume":"61","author":"Schober","year":"1997","journal-title":"Public Opin. Q."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int. J. Qual. Health Care"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"100527","DOI":"10.1016\/j.lana.2023.100527","article-title":"Transforming mental health for pandemic recovery and social development: recommendations from the PAHO high-level commission on mental health and COVID-19","volume":"22","author":"Trianni","year":"2023","journal-title":"Lancet Reg. Health Am."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1007\/s10433-010-0168-y","article-title":"Language differences in qualitative research: is meaning lost in translation?","volume":"7","author":"Van Nes","year":"2010","journal-title":"Eur. J. Ageing"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1007\/s11469-020-00380-3","article-title":"Seeking psychiatric attention among university students with mental health problems: the influence of disease perception","volume":"20","author":"Vargas-Huicochea","year":"2022","journal-title":"Int. J. Ment. Health Addict."},{"key":"ref30","first-page":"27","article-title":"Deseabilidad social y g\u00e9nero: el efecto del sexo del entrevistador(a) sobre las respuestas del encuestado(a)","volume":"11","author":"Verge","year":"2009","journal-title":"Metodol. 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