Flourishing alongside psychiatric symptoms: a qualitative study on dual-continuum mental health in university...

University students' mental health is typically assessed through a deficit-oriented lens that equates symptom absence with well-being. Keyes' 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.

A qualitative descriptive-interpretive study was conducted with seven undergraduate students (six women, one man; ages 19-23) 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' eleven well-being facets with inductively emergent themes.

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' narratives of high flourishing alongside substantial psychiatric burden.

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' mental health trajectories.