Suicidal thoughts and behaviors among college students and same-aged peers: results from the World Health Organization World Mental Health Surveys

Trends and factors influencing the mental health of college students in the post-pandemic: four consecutive cross-sectional surveys

Background

The long-term impact of COVID-19 on the mental health and well-being of college students, specifically trends over time after full removal of COVID-19 restrictions, has not been well-studied.

Methods

Four consecutive cross-sectional surveys were conducted in December 2022 (N = 689), March 2023 (N = 456), June 2023 (N = 300), and November 2023 (N = 601) at a university in Sichuan Province, China.

Results

The proportion of students with COVID-19 panic decreased from 95.1 to 77.3% (p < 0.001). The prevalence of moderate anxiety and above decreased from 18 to 13.6% (p < 0.001), and the prevalence of moderate and above depression decreased from 33.1 to 28.1% (p < 0.001), while the prevalence of post-traumatic stress disorder (PTSD) increased from 21.5 to 29.6% (p < 0.005). Further, the proportion of suicidal thoughts increased from 7.7 to 14.8% (p < 0.001). Suicidal thoughts and self-injuries were significantly associated with COVID-19 panic, depression, anxiety, and PTSD. Students who reported being in close contact with COVID-19 patients in the past were more likely to develop PTSD. Further, COVID-19-induced panic was a risk factor for self-injury.

Conclusion

One year after the COVID-19 pandemic, the overall mental health of college students was not optimal. Hence, we can conclude that the long-term impacts of COVID-19 on the mental health of college students may have already occurred. To mitigate this impact and prepare for the next major public health event, strengthening college students' mental health curricula and promoting healthy behaviors among college students should be a priority for universities and education authorities.

Outcomes of Best-Practice Guided Digital Mental Health Interventions for Youth and Young Adults with Emerging Symptoms: Part I. A Systematic Review of Socioemotional Outcomes and Recommendations

Youth-specific digital mental health interventions (DMHI) represent an emerging field of study, and aim to increase access, improve socioemotional outcomes, and, where required, support triage to targeted interventions. However, prior reviews have reported inconsistent findings on the clinical effectiveness of such interventions in young adults (12-25 years). Further, shortfalls remain for the impact of guided interventions based on the mode of delivery and the type of human support personnel (e.g., professional or peer) guiding the intervention. In response, this systematic review, co-designed with Australia's leading mental health organization, aims to assess the effectiveness of guided digital programs in improving youth socioemotional outcomes. Included studies involve young people experiencing mental ill-health, receiving brief (i.e., 1-12 sessions), digitally delivered (at least partially) psychological interventions that were guided or partially guided, tested in a type of experimental study, with a socioemotional outcome. Specific socioemotional outcomes examined were depression, anxiety, stress, wellbeing, mindfulness, and quality of life. A systematic search of the contemporary published and grey literature identified 22,482 records with 32 relevant records published between 2018 and 2023. A narrative synthesis guided integration of findings. Results demonstrated strong evidence for the effectiveness of guided interventions on socioemotional outcomes (i.e., depression, anxiety, stress) yet these effects were short-lived. When factoring in the use of different control groups (i.e., active vs. inactive), inconsistent effects were observed for the socioemotional outcomes of depression, anxiety, and stress. The mode of delivery (i.e., asynchronous, synchronous, combined) and the type of human support personnel did not appear to impact socioemotional outcomes. Results indicate efficacious brief digital interventions for depression and anxiety include refresher/follow-up content, goal setting content, and relapse prevention content. In contrast, poor efficacy is associated with interventions that include homework tasks, self-monitoring, and log-keeping content.PROSPERO, ID CRD42023405812.

Positive and Negative Correlates of Psychological Well-Being and Distress in College Students' Mental Health: A Correlational Study

BACKGROUND

Recognizing the positive or negative effects of students' mental health promotes personal development, well-being, and academic success. Academic life exposes college students to multiple adjustments, demands, and vulnerabilities that can cause stress and mental health problems. This study aims to identify psychological well-being and psychological distress effects on college students' mental health.

METHODS

A correlational study was designed involving a non-probabilistic 560 sample of students (446 women) aged 18 to 41 years (M = 19.6; SD = 1.68). An online self-report questionnaire was used including demographic, relational, academic, and health behaviors variables, and the measures: Mental Health Inventory; Satisfaction with Social Support Scale; Academic Life Satisfaction Scale; and Psychological Vulnerability Scale.

RESULTS

Regression analyses indicate that male students, dating, good academic performance, exercise, sleeping seven hours, satisfaction with social support, and academic life satisfaction were significant correlates (p < 0.05) of psychological well-being, with the last two having great weight in the model. Females, low income, aged 21-24 years, sleeping less than 6 h, moderate psychological vulnerability, and perception of vulnerability were significant (p < 0.05) negative effects of psychological distress.

CONCLUSIONS

This study addresses the positive and negative effects of psychological well-being and distress in college students. Specific mental health promotion and morbidity prevention programs can improve students' mental health literacy and resilience.

Prevalence of university non-continuation and mental health conditions, and effect of mental health conditions on non-continuation: a systematic review and meta-analysis

BACKGROUND

University non-continuation, also termed as university dropout in literature, is a concern for institutions. Elevated stress levels, mental distress, and psychiatric issues affect academic performance and thus may contribute to non-continuation. There is a lack of systematic reviews exploring the link between mental health and university non-continuation.

AIM

This systematic review aims to bridge this gap, by investigating the prevalence of non-continuation and mental health conditions among university students, and the impact of mental health on university non-continuation.

METHODS

Following PRISMA guidelines this review synthesized data from 67 studies, utilising both narrative synthesis and meta-analytic techniques.

RESULTS

The results revealed that the included studies reported a range of university non-continuation rates (5.9% to 43.6%) with a pooled prevalence of 17.9%, 95% CI [14.2%, 22.3%]. The prevalence of mental health concerns among students varied widely (2.2% to 83.6%), with a pooled prevalence of 26.3%, 95% CI [16.0%, 40.0%]. Depression, OR = 1.143 (95% CI [1.086, 1.203] p<.001), stress, OR = 1.413 (95% CI [1.106, 1.805], p=.006), and other mental health conditions, OR = 1.266 (95% CI [1.133, 1.414], p<.001), were associated with higher non-continuation.

CONCLUSION

Some mental health conditions elevate non-continuation risks, and addressing mental health may enhance student retention in higher education.

Prevalence of suicidal thoughts and behaviors among young adults between 2000 and 2021: Results from six national representative surveys in France

The study examines the prevalence of 12-month suicidal thoughts and lifetime suicide behaviors among young adults between 2000 and 2021. Data were drawn from the Health Barometer survey, a cross-sectional survey on a French national representative sample. The 2000, 2005, 2010, 2014, 2017, and 2021 survey waves were pooled to examine time trends in 12-month suicidal thoughts and lifetime suicidal behaviors among respondents aged 18 to 25 (n = 13,326), categorized based on sex and on their occupational status: students, those employed, and those who are neither in employment, education or training (NEETs). The 12-month prevalence of suicidal ideation among young adults in 2021 (6.8 %) is no different from that of 2000 (7.0 %), despite a U-shape curve in between. In contrast, the overall prevalence of lifetime suicide attempts was significantly higher in 2021 as compared to what was observed on average in the previous 21 years. In multivariate models, females and NEETs were overall at greatest risk for suicidal ideation and suicidal behaviors. Additional attention and prevention efforts are needed to reach young adults who are neither in employment, education or training.

Why emotional neglect brings suicidal ideation? The mediating effect of meaning in life and the moderating effect of post-stress growth

BACKGROUND

Emotional neglect during childhood has long-lasting negative effects on individuals, and it is often hidden and unrecognized. Previous research has not fully understood its unique effects on mental health outcomes, especially when considering the co-occurrence with other forms of maltreatment. The meaning-making coping and growth model suggests that individuals achieve positive psychological outcomes by constructively integrating negative experiences into their self-concept, which may be a protective mechanism against the detrimental effects of emotional neglect.

OBJECTIVE

This study aimed to examine the relationship between emotional neglect and suicidal ideation among undergraduates, accounting for the presence of emotional abuse and physical neglect, and to investigate the mediating role of meaning in life and the moderating role of post-stress growth in this relationship.

METHODS

A self-reported survey was conducted with 3132 undergraduate students from a university in South China. The survey assessed emotional neglect, emotional abuse, physical neglect, suicidal ideation, post-stress growth, and meaning in life.

RESULTS

Meaning in life partially mediated the relationship between emotional neglect and suicidal ideation. Post-stress growth moderated the association between emotional neglect and the sense of meaning in life, in particular the moderation effect was stronger when emotional abuse was weaker.

CONCLUSIONS

Meaning in life mediated the relationship between emotional neglect and suicide ideation. Post-stress growth moderated the mediation effect such that it was weakened among individual with a higher level of post-stress growth. This study contributes to the understanding of the psychopathological processes following emotional neglect and the development of positive personal changes thereafter.

Validation of the Farsi version of the Suicide Ideation and Behavior Scale

Objective

Suicide ideation and suicide attempts are prevalent in Farsi speaking populations. The present study aimed at validating the Farsi version of the Suicide Ideation and Behavior Scale (SIBS).

Methods

Reliability and validity of the Farsi version of the SIBS were established in a highly burdened Afghan student sample (N = 279). Internal consistency, convergent and discriminant validity were investigated, and confirmatory factor analysis was conducted.

Results

The Farsi version of the SIBS was shown to have a unidimensional structure with excellent internal consistency, as well as good convergent and divergent validity.

Discussion

The results suggest that the SIBS is a brief, reliable, and valid measure of current suicidal ideation and behavior that can be used in Farsi speaking populations.

Suicide ideation among Brazilian college students: Relationship with academic factors, mental health, and sexual abuse

BACKGROUND

Suicide is one of the leading causes of death among youth and its occurrence among college students is a matter of great concern. Challenges of transitional adulting and mental illness increase the likelihood of suicidal cognition in students. The objective of present study was to investigate the prevalence of suicide ideation and associated factors in a representative sample of Brazilian college students (n = 12,245).

METHODS

Data were drawn from a nationwide survey and further subjected to estimate the prevalence of suicide ideation and its association with socio-demographic and academic characteristics. We performed logistic regression analyses upon a conceptual framework, considering individual and academic factors.

RESULTS

The point-prevalence of suicide ideation among college students was 5.9 % (SE = 0.37). In the final regression model, variables associated with the likelihood of suicide ideation were psychopathology, sexual abuse, and academic variables, such as dissatisfaction with the chosen undergraduate course (OR = 1.86; IC95 % 1.43-2.41) and low academic performance (OR = 3.56; IC95 % 1.69-7.48). Having children and religious affiliation were inversely associated with the likelihood of suicide ideation.

LIMITATIONS

Participants were recruited from state capitals, which limited data generalizability to non-urban college students.

CONCLUSIONS

The impact of academic life on the mental health of students should be carefully monitored in in-campus pedagogical and health services. Early identification of poor-performance students with social disadvantages could indicate vulnerable ones who are much in need of psycho-social support.

Study Conditions and University Students' Mental Health during the Pandemic: Results of the COVID-19 German Student Well-Being Study (C19 GSWS)

University students are generally vulnerable to mental health problems. This was exacerbated during the COVID-19 pandemic, when students experienced decisive changes and restrictions in their academic lives. Our study aimed at (a) analysing associations between study conditions and symptoms of depression and anxiety and (b) determining the extent of use and motivation to use student counselling services. The C19 GSWS is a cross-sectional study conducted at five universities in Germany (N = 7203). Descriptive analyses and linear regression models were performed to estimate the associations between study conditions and mental health outcomes. A total of 42.4% of the students felt down, depressed, or hopeless on several days over the past 14 days. Between a third and 44.1% of the students felt burdened by their study conditions. Worse perceived study conditions were associated with higher levels of depressive symptoms and anxiety. Only 7.1% indicated that they had utilised student counselling services, and female gender, enrolment in a bachelor's programme, and having more than 1 reason for utilisation were factors associated with use. The results of our research underline the need for universities to review their study conditions and to provide targeted intervention strategies and counselling services to promote students' mental well-being.

Measuring the Effectiveness of a Multicomponent Program to Manage Academic Stress through a Resilience to Stress Index

In this work, we evaluate the effectiveness of a multicomponent program that includes psychoeducation in academic stress, mindfulness training, and biofeedback-assisted mindfulness, while enhancing the Resilience to Stress Index (RSI) of students through the control of autonomic recovery from psychological stress. Participants are university students enrolled in a program of excellence and are granted an academic scholarship. The dataset consists of an intentional sample of 38 undergraduate students with high academic performance, 71% (27) women, 29% (11) men, and 0% (0) non-binary, with an average age of 20 years. The group belongs to the "Leaders of Tomorrow" scholarship program from Tecnológico de Monterrey University, in Mexico. The program is structured in 16 individual sessions during an eight-week period, divided into three phases: pre-test evaluation, training program, and post-test evaluation. During the evaluation test, an assessment of the psychophysiological stress profile is performed while the participants undergo a stress test; it includes simultaneous recording of skin conductance, breathing rate, blood volume pulse, heart rate, and heart rate variability. Based on the pre-test and post-test psychophysiological variables, an RSI is computed under the assumption that changes in physiological signals due to stress can be compared against a calibration stage. The results show that approximately 66% of the participants improved their academic stress management after the multicomponent intervention program. A Welch's t-test showed a difference in mean RSI scores (t = -2.30, p = 0.025) between the pre-test and post-test phases. Our findings show that the multicomponent program promoted positive changes in the RSI and in the management of the psychophysiological responses to academic stress.

Childhood adversities and suicidal thoughts and behaviors among first-year college students: results from the WMH-ICS initiative

PURPOSE

To investigate the associations of childhood adversities (CAs) with lifetime onset and transitions across suicidal thoughts and behaviors (STB) among incoming college students.

METHODS

Web-based self-report surveys administered to 20,842 incoming college students from nine countries (response rate 45.6%) assessed lifetime suicidal ideation, plans and attempts along with seven CAs: parental psychopathology, three types of abuse (emotional, physical, sexual), neglect, bully victimization, and dating violence. Logistic regression estimated individual- and population-level associations using CA operationalizations for type, number, severity, and frequency.

RESULTS

Associations of CAs with lifetime ideation and the transition from ideation to plan were best explained by the exact number of CA types (OR range 1.32-52.30 for exactly two to seven CAs). Associations of CAs with a transition to attempts were best explained by the frequency of specific CA types (scaled 0-4). Attempts among ideators with a plan were significantly associated with all seven CAs (OR range 1.16-1.59) and associations remained significant in adjusted analyses with the frequency of sexual abuse (OR = 1.42), dating violence (OR = 1.29), physical abuse (OR = 1.17) and bully victimization (OR = 1.17). Attempts among ideators without plan were significantly associated with frequency of emotional abuse (OR = 1.29) and bully victimization (OR = 1.36), in both unadjusted and adjusted analyses. Population attributable risk simulations found 63% of ideation and 30-47% of STB transitions associated with CAs.

CONCLUSION

Early-life adversities represent a potentially important driver in explaining lifetime STB among incoming college students. Comprehensive intervention strategies that prevent or reduce the negative effects of CAs may reduce subsequent onset of STB.

Scoping review of 30 years of suicide prevention in university students around the world: efficacy, effectiveness, and cost-effectiveness

A scoping review of systematic reviews was carried out to identify evidence of efficacy, effectiveness, and cost-effectiveness of universal and selective suicide prevention programs among university students worldwide. Five databases were reviewed using terms in English, Spanish, and Portuguese. The following were the inclusion criteria: systematic review or meta-analysis or meta-synthesis, suicide prevention in college students, evaluation of the efficacy, effectiveness and/or cost-effectiveness of interventions, and peer-reviewed studies. The quality of reviews was assessed. The field of study features three decades of publication in high-income countries. The strategy used, the components of the program, and the target audience to which they are delivered interfere with efficacy. In the psychoeducation strategy, the experiential and didactic components are more efficacious in the knowledge about suicide. And the motivational enhancement component promotes greater self-efficacy in suicide prevention. Programs that take a multimodal approach are effective in increasing short-term attitudes related to suicide and reducing rates of completed suicide. The gatekeeper strategy delivered to peer counselors is the most effective one in the outcomes, including short-term and long-term knowledge about suicide and its prevention and self-efficacy in suicide prevention. A greater number of evaluated studies of gatekeeper interventions were identified, indicating a trend in this research field. No review addressed the effects on subgroups that were classified based on sex, racial or sexual minorities, and special (indigenous) populations. Only one study addressed cost-effectiveness, pointing out that the psychoeducation and gatekeeper strategies have relevant net benefit rates, but the gatekeeper strategy has a higher cost–benefit ratio compared to the psychoeducation strategy. The findings indicate that psychoeducation and gatekeeper interventions tend to be more efficacious when they combine education and skills training to intervene in suicidal behavior. The components of the intervention and the target audience to which it is delivered influence efficacy. Multimodal interventions evaluate completed suicide outcomes, but require greater implementation efforts, in terms of human and financial resources and more time for the evaluation.

Defeat and Entrapment Mediate the Relationship Between Insomnia Symptoms and Suicidal Ideation in Young Adults

AIM

In recent years, there has been a growing interest in understanding the relationship between sleep disturbance and suicide. The current study aimed to advance understanding of the psychological processes driving these relationships by examining whether insomnia symptoms are related to suicidal ideation via perceptions of defeat and entrapment.

METHODS

Young adults (n = 259; 202 students [78.0%], 45 employed [17.4%], 12 unemployed [4.6%]) completed an anonymous self-report survey that was advertised via social media, university participant pools, and fliers. The survey was described as being related to sleep and mood/mental health. Validated measures were used to assess insomnia symptoms, chronotype, defeat, entrapment, suicidal ideation, and affective covariates.

RESULTS

Bivariate associations found insomnia severity to be related to poorer affective outcomes including severity of suicidal ideation. Insomnia and depression were significant independent variables in multiple linear regression with suidical ideation as the dependent variable. The relationship between insomnia and suicidal ideation was mediated by perceptions of defeat and entrapment.

CONCLUSION

Taken together, these findings shed light on the psychological mechanisms linking sleep disturbance and suicidal ideation by highlighting the role of defeat and entrapment. These findings have the potential to improve suicide risk assessment and prevention in young adults experiencing difficulties initiating or maintaining sleep.HighlightsDefeat and entrapment mediate relationship between insomnia and suicidal ideationEvidence for Integrated Motivational-Volitional Model of Suicidal Behavior in community sampleUses validated multi-item suicide measure.

ADHD Comorbidity Structure and Impairment: Results of the WHO World Mental Health Surveys International College Student Project (WMH-ICS)

OBJECTIVE

To examine the prevalence of ADHD and the association of comorbid disorders, and multivariate disorder classes with role impairment in college students.

METHOD

About 15,991 freshmen (24 colleges, 9 countries, WMH-ICS) (response rate = 45.6%) completed online WMH-CIDI-SC surveys for 6-month ADHD and six 12-month DSM-IV disorders. We examined multivariate disorder classes using latent class analysis (LCA) and simulated a population attributable risk proportions (PARPs) of ADHD-related impairment.

RESULTS

About 15.9% had ADHD, of which 58.4% had comorbidities. LCA classified ADHD respondents to pure (42.9%), internalizing (36.0%), bipolar comorbidities (11.3%), and externalizing disorder classes (9.8%). ADHD, comorbidities, and multivariate disorder classes independently predicted severe impairment. PARPs: eliminating ADHD hypothetically reduced severe impairment by 19.2%, 10.1% adjusted for comorbidities, 9.5% for multivariate disorder classes.

CONCLUSIONS

ADHD and comorbid disorders are common and impairing in college students. Personalized transdiagnostic interventions guided by multivariate disorder classes should be explored.

The gendered relationship between illicit substance use and self-harm in university students

PURPOSE

To estimate associations between multiple forms of substance use with self-harming thoughts and behaviours, and to test whether gender is an effect modifier of these associations, both independently and along with perceived risk of cannabis use.

METHODS

Data were drawn from the 2018 Norwegian Students' Health and Wellbeing Study (SHoT 2018). A national sample of n = 50,054 full-time Norwegian students (18-35 years) pursuing higher education completed a cross-sectional student health survey, including questions on past-year self-harm: non-suicidal thoughts of self-harm, non-suicidal self-harm, suicidal thoughts, and suicide attempt. Students reported their frequency of past-year alcohol use (range: never to ≥ 4 times/ week), illicit substance consumption, and perceived risk of cannabis use. The AUDIT and CAST screening tools measured problematic alcohol and cannabis consumption, respectively. We used logistic regression modelling adjusted for age, symptoms of depression and anxiety, and financial hardship (analytic sample range: n = 48,263 to n = 48,866).

RESULTS

The most frequent alcohol consumption category (≥ 4 times/ week) was nearly always associated with more than a two-fold increased likelihood of self-harm. Less frequent alcohol consumption was associated with reduced odds of suicidal thoughts [monthly or less: OR = 0.87 (95% CI: 0.75-1.00), 2-4 times/month: OR = 0.79 (95% CI: 0.69-0.91), and 2-3 times/ week: OR = 0.83 (95% CI: 0.71-0.98)]. Problematic alcohol consumption was associated with most outcomes: odds ranging from 1.09 (95% CI: 1.01-1.18) for suicidal thoughts to 1.33 (95% CI: 1.00-1.77) for suicide attempt. There was evidence of multiple illicit substance by gender interactions: consumption of all but one illicit substance category (other drug use) was associated with all four forms of self-harm for women, but findings among men were less clear. Among men, only one illicit substance category (stimulant) was associated with most forms of self-harm. Women, but not men, who perceived cannabis use as a health risk were more likely to experience non-suicidal thoughts as cannabis consumption increased, and with harmful consumption patterns.

CONCLUSION

Frequent alcohol consumption is associated with increased risk of self-harm and suicidality for young women and men. Associations between illicit substance use and self-harm and suicidality appear stronger in women compared to men.

The influence of diagnosed mental health conditions and symptoms of depression and/or anxiety on suicide ideation, plan, and attempt among college students: Findings from the Healthy Minds Study, 2018-2019

BACKGROUND

Approximately 11% of 18-25 year-olds report thoughts of suicide. Additionally, suicide is the second leading cause of death in college student populations. We sought to evaluate the relationship between diagnosed mental health conditions and current symptoms of depression and/or anxiety and suicidality in the past year.

METHODS

Healthy Minds Study (HMS) 2018-2019 data from 38,757 college students were analyzed. The PHQ-9, GAD-7, and prior mental health condition diagnoses were used to create a suicidality severity index and we determined how these associations varied by race/ethnicity, gender, and sexual orientation. We also assessed non-suicidal self-injury (NSSI) outcomes in the past year.

RESULTS

Students with both a mental health condition diagnosis and current moderate/severe symptoms of depression and/or anxiety had a higher prevalence of NSSI, 10 times the odds (95% CI 9.4-11.5) of suicide ideation, 28 times the odds (95% CI 23.8-33.1) of suicide ideation, with planning or attempt, and 47 times the odds (95% CI 31.1-71.4) of suicide ideation, with planning and attempt, compared to students with none/minimal depression and/or anxiety symptoms and no mental health condition diagnosis.

LIMITATIONS

We could not clinically confirm depression or anxiety diagnoses nor infer causality of associations in this cross-sectional study. Future longitudinal studies are needed to establish temporality.

CONCLUSIONS

Mental health condition diagnoses and moderate/severe symptoms of depression and/or anxiety were strongly associated with suicidality among college students. These findings identify potential opportunities to further understand and address the mental health needs of college students.

Revisiting evidence of primary prevention of suicide among adult populations: A systematic overview

BACKGROUNDS

Primary prevention of suicidal behaviors in the general population is required to interrupt the trend of self-inflicted deaths worldwide. We reviewed the evidence of the efficacy of primary prevention of suicide among the adult population.

METHODS

This is an overview of systematic reviews. We searched PubMed, EMBASE, Scopus, PsycINFO, and Cochrane databases to identify articles on suicide prevention strategies in non-clinical populations. For the purpose of overview, only systematic reviews were eligible. Primary outcomes: The outcomes of the present study were changes in the number of suicide death or suicide behaviors. Two reviewers assessed the methodological quality and the risk of bias of included studies.

RESULTS

From the initial 2,315 records, 32 articles met inclusion criteria. Evidence of reduction of suicide-related outcomes was detected, but of small magnitude. Most multicomponent prevention programs were delivered to specific populations, comprising strategies such as restriction to lethal means, educational programs, and gatekeeper training. Means restriction was the single intervention that showed some evidence of individual efficacy in reducing suicide. There is evidence that poor quality of media reporting is related with increasing suicide and better-quality reports could help suicide prevention. Most of the included SRs were of critically-low methodological quality.

LIMITATIONS

Publication bias, reporting bias, study designs, outcome definition and article overlap across studies are the main concerns.

CONCLUSIONS

Multicomponent programs and means restriction have indicated a reduction of suicide rates, mainly in specific populations. There is insufficient evidence to recommend a widespread implementation of suicide primary prevention in the general population.

Covid-19: Repercussions on the mental health of higher education students

ABSTRACT This article aimed to assess the repercussions of Covid-19 and social isolation on the mental health of higher education students in Ceará, Brazil. The sample consisted of 3,691 higher education students taking online classes from June to September 2020, who answered to two instruments: a sociodemographic and situational profile questionnaire concerning the pandemic/social isolation, and the Mental Health Inventory. The results showed that 21.2% of the students had their activities canceled, with no expected return. The majority, 77.2%, reported concern about the death of relatives and acquittances by Covid-19. The overall state of mental health average measured by the inventory was 48.8. This result suggests that students had their mental health affected by the conditions imposed by the pandemic. Therefore, edu- cational institutions should promote strategies to protect the mental health of the student community.

Covid-19: repercussões na saúde mental de estudantes do ensino superior

RESUMO Este artigo teve como objetivo avaliar as repercussões da Covid-19 e do isolamento social na saúde mental de estudantes do ensino superior no Ceará, Brasil. A amostra foi composta por 3.691 alunos do ensino superior participando de aulas on-line no período de junho a setembro de 2020, que responderam a dois instrumentos: um questionário sociodemográfico e situacional referente à pandemia/isolamento social e o Inventário de Saúde Mental. Os resultados mostraram que 21,2% dos alunos tiveram suas atividades canceladas, sem expectativa de retorno. A maioria, 77,2%, relatou preocupação com a morte de parentes e conhecidos pela Covid-19. O estado geral de saúde mental médio, medido pelo inventário, foi de 48,8. Esse resultado sugere que os alunos tiveram sua saúde mental afetada pelas condições impostas pela pandemia. Assim, as instituições de ensino devem promover estratégias para proteger a saúde mental da comunidade estudantil.

Suicidal behaviours and mental health disorders among students commencing college

The increase in psychological disorders and suicidal behaviour in students is a reason for growing concern. Some may start university with pre-existing problems, while others develop problems during this time. It is important to evaluate mental health and wellbeing early, identifying those at risk. The aim of this study was to compare mental health problems and help-seeking behaviour between students in Northern Ireland (NI) and the Republic of Ireland (ROI). Whilst geographically proximate, the institutions span a cross-border region with distinct education and healthcare systems. First-year undergraduate students (n = 1828) were recruited in September 2019 as part of the World Mental Health International College Student Initiative. Suicidal behaviour, mental health and substance disorders were investigated using the World Mental Health- Composite International Diagnostic Interview. Prevalence of disorders was high, with more ROI students experiencing problems than NI students. Students were significantly more likely to experience mental health problems if they were female (p<0.001), non-heterosexual (p<0.0001), and over the age of 21 (p<0.0001). These findings show that many students are starting university with high levels of psychopathology and suicidal behaviour, highlighting the importance of early intervention which may need to be tailored to different student populations.

Testing the Influence of Brooding and Anger Rumination on the Association Between Suicidal Outcomes and BPD Features in Undergraduate Students

Borderline personality disorder (BPD) symptoms and suicidal behaviors are prevalent among undergraduate students. Although rumination contributes to self-destructive behaviors in BPD, less research examines the role of rumination in distinct suicidal outcomes among individuals with BPD features instead focusing more on self-destructive behaviors as a latent variable. The present study examined the main and interactive effects of BPD features and two forms of rumination (brooding and anger) in the prediction of suicide-related outcomes (ideation and attempts) among college students. Participants (N = 181 undergraduate students, overrecruited for BPD features; 55.2% female) reported their lifetime suicide risk, brooding rumination, anger rumination, and BPD features. Brooding rumination and BPD features were associated with suicidal ideation. Anger rumination was not associated with suicide-related outcomes. Findings suggest that brooding rumination is a potential intervention target for suicidal ideation in undergraduate students whereas further research is required to determine the association between anger rumination and suicidal ideation and attempts.

The moderating role of resilience in the relationship between peer pressure and risky behaviors among nursing students

PURPOSE

To examine the moderating role of resilience in the relationship between peer pressure and risky behaviors among nursing students.

DESIGN AND METHODS

A cross-sectional correlational study carried out with 512 students.

FINDINGS

The mean age was 20.90 ± 1.66. Of the students, 82.4% were females 99.0% were single, 71.5% had moderate socioeconomic status. While peer pressure directly made an effect on whole subdimensions for risky behaviors (p < 0.001), resilience had an effect on antisocial behavior, dropout, eating habits, and suicidal tendency (p < 0.001). Moderation was supported as the relationship between peer pressure and substance use varied by resilience level (p < 0.001). PRACTICAL IMPLICATIONS: Students with high levels of resilience are less prone to exhibit some risky behaviors based on peer pressure. Resilience-building strategies should be incorporated into the curriculum.

Informing the study of suicidal thoughts and behaviors in distressed young adults: The use of a machine learning approach to identify neuroimaging, psychiatric, behavioral, and demographic correlates

Young adults are at high risk for suicide, yet there is limited ability to predict suicidal thoughts and behaviors. Machine learning approaches are better able to examine a large number of variables simultaneously to identify combinations of factors associated with suicidal thoughts and behaviors. The current study used LASSO regression to investigate extent to which a number of demographic, psychiatric, behavioral, and functional neuroimaging variables are associated with suicidal thoughts and behaviors during young adulthood. 78 treatment seeking young adults (ages 18-25) completed demographic, psychiatric, behavioral, and suicidality measures. Participants also completed an implicit emotion regulation functional neuroimaging paradigm. Report of recent suicidal thoughts and behaviors served as the dependent variable. Five variables were identified by the LASSO regression: Two were demographic variables (age and level of education), two were psychiatric variables (depression and general psychiatric distress), and one was a neuroimaging variable (left amygdala activity during sad faces). Amygdala function was significantly associated with suicidal thoughts and behaviors above and beyond the other factors. Findings inform the study of suicidal thoughts and behaviors among treatment seeking young adults, and also highlight the importance of investigating neurobiological markers.

When in Doubt … Career Indecision, Mental Wellbeing, and Consultation-Seeking Behaviour-A Qualitative Interview Study among Students and Counsellors

University dropout is often preceded by a phase of doubt whether to continue studying, either in general or just the given subject. Mental health problems might be interrelated with this phase of doubt. Counselling services at German universities could provide help, but do not seem to reach students in need. To explore the phase of doubt and possible (inter-)relationships with mental wellbeing among university students in Germany as well as their consultation-seeking behaviour, a qualitative interview study was conducted (2017–2018). Participants were students casting doubts on their studies (n = 14) and counsellors (n = 16) working with this target group. Examples of reasons for doubts were insufficient information, unfulfilled expectations concerning the subject, subjectively poor study conditions, performance problems, and lacking future perspectives. Mental health problems were subjectively intertwined with doubts, considered as both cause and effect. Counselling services were evaluated as hardly helpful by students and as being in need of improvement by counsellors. Suggestions as how to improve such services comprise a more specific and proactive way to approach students. By considering the phase of doubt before dropout, German universities can improve their support services to be more responsive to students and, thus, prevent dropout and mental health problems.

Racial/ethnic discrimination as race-based trauma and suicide-related risk in racial/ethnic minority young adults: The explanatory roles of stress sensitivity and dissociation

Objective: Drawing on race-based trauma models, the present study examined common reactions to trauma exposure (i.e., stress sensitivity, dissociative symptoms, depressive symptoms), as potential explanatory factors in the relation between racial/ethnic discrimination and suicide-related risk among racial and ethnic minority young adults. Method: A group of racial and ethnic minority (N = 747; 61% women; 63% U.S.-born; 34% Asian American) young adults, ages 18-29 (M = 19.84; SD = 2.22), completed a battery of self-report measures online. Accounting for demographics and other trauma exposures, direct and indirect associations between racial/ethnic discrimination and suicide attempt (SA) through stress sensitivity, dissociative symptoms, depressive symptoms, and suicide ideation (SI) were examined using hierarchical linear regression models and bootstrapping methods. Results: There was a direct association between racial/ethnic discrimination and stress sensitivity, dissociative symptoms, and depressive symptoms, but not SI or SA, after accounting for demographics and trauma exposures. There was also an indirect association between racial/ethnic discrimination and SI and SA through stress sensitivity, dissociative symptoms, and depressive symptoms. Conclusion: Experiences of racial/ethnic discrimination may function as a source of traumatic stress in racial and ethnic minority young adults to confer risk for SI and SA via stress sensitivity, dissociation, and depressive symptoms. Addressing racial/ethnic discrimination may help reduce suicide-related risk by targeting stress-related exposures particularly relevant to racial and ethnic minority young adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Validation of the Persian version of the Positive Mental Health Scale

BACKGROUND

Positive mental health (PMH) is a factor of far-reaching salutogenetic importance. The present study aimed at validating the Persian version of the Positive Mental Health Scale (PMH-Scale).

METHODS

Reliability and validity of the Persian version of the PMH-Scale were established in an Iranian student sample (N = 573). Internal consistency, convergent and discriminant validity were investigated, and exploratory factor analysis was conducted. Furthermore, it was assessed how PMH scores moderate the association between depressive symptoms and suicide ideation/behavior.

RESULTS

The Persian version of the PMH-Scale  was shown to have a unidimensional structure with excellent internal consistency, as well as good convergent and divergent validity. PMH differentiated between participants with higher vs. lower suicide risk. Furthermore, PMH proved to moderate the association between depressive symptoms and suicide ideation/behavior.

CONCLUSIONS

The results suggest that the PMH-Scale is a brief, reliable, and valid measure of subjective and psychological well-being that can be used in Iranian student samples and research settings.

Exploration of Mental Health Issues of Students among University Health Science Academics in Japan

Academic educators in universities are well positioned to detect early signs and symptoms of unexplained behaviour change in students that could be the beginning of mental health issues. The purpose of this research was to explore the attitudes, beliefs, knowledge and practices of university academics in Japan towards health science students with psychological/mental health issues. This study used a qualitative descriptive design. Three focus groups using a semi-structured interview guide were conducted with 15 academics teaching health science students. Data were collected between March to October 2019. Themes revealed three areas of interest: 1) Reflection on mental health issues in Japan with sub-themes "family issues"; "society expectations and changes", and "stigma"; 2) Reflection on students' mental health issues with sub-themes "student behaviors", "staff involvement", "barriers encountered"; and, 3) Potential supports with sub-themes "university assistance", "communication and connection", and "interventions and prevention." The findings provide insight and can benefit student populations across diverse cultural university settings. Further research to investigate academic staff support with early recognition of mental ill-health and ability to provide information and advice to students is warranted. Recommendations include mental health education for academics and for students to encourage healthy university campuses and well-being within the community.

The Impact of Relational Adverse Childhood Experiences on Suicide Outcomes During Early and Young Adulthood

This study aimed at investigating the degree to which relational adverse childhood experiences (ACEs) would affect suicide outcomes during early and young adulthood of Iranian female and male students. In all, 487 undergraduate students (59.2% females) with a mean age of 20.66 ± 1.42 were recruited using a multistage clustering sampling method from eight schools from the fields of humanities, engineering, and basic sciences. Suicide Behavior Questionnaire-Revised form (SBQ-R) was employed for assessing past year suicidal ideation (PYSI, once or more), the meaningful likelihood of future suicide (mLoFS, a score of 2 or more), and suicide risk (SR ≥7). Relational ACEs were assessed in the form of a yes/no question, including caregivers' maltreatment, household relational dysfunction, family loss events, school events, and sexual abuse. Analyses were conducted using Fisher's exact test, chi-square test, and univariate binary logistic regression. The rates of PYSI, LoFS, and SR were, respectively, 37.2%, 44.6%, and 30.8%. The most experienced event was witnessing verbal violence (68.8%) and the least was divorce/separation (6.2%). All the events and domains (except family loss events), the interaction of domains, and cumulative events significantly increased the odds of suicide outcomes, in which females were more affected by all types of relational ACEs. Students whose ethnicity was Azari & Turk and who were studying in humanities or basic sciences showed a higher suicide risk than their counterparts. The study showed that the rates of relational ACEs and suicide outcomes were remarkable, in Iran. Because of the detrimental effects of relational ACEs on suicidality, mostly for females, it is necessary to improve the initiatives promoting child protection and legal support for health professionals to address child abuse. There is also an urgent need for providing young students with supports and effective interventions.

Neurocognitive Functioning in Adolescents at Risk for Suicidal Behaviors

Today, little is still known about the neurocognitive functioning of the individual at risk for suicide in a relevant developmental stage like adolescence. Thus, the main goal of the present work was to analyze the neurocognitive performance of adolescents at high risk for suicide. A total of 1509 adolescents from a stratified random cluster sampling were selected. Adolescents at risk for suicidal behaviors included 83 participants. A comparison group of 83 participants matched by age and gender was also randomly selected from the sample. The Paykel Suicide Scale (PSS) and the University of Pennsylvania Computerized Neurocognitive Battery for children (included 14 tasks assessing five neurobehavioral domains: executive functions, episodic memory, complex cognition, social cognition, and sensorimotor speed) were used. Adolescents at risk for suicide revealed statistically significant impairments across different neurocognitive domains including complex cognition, episodic memory and social cognition. No significant differences were found for Sensorimotor and Executive Function domains. Results found in the present study contribute relevant information about the nature of the neurocognitive impairments associated with suicide and add information in order to deeper comprehend the tentative etiology of suicide thoughts and attempts in adolescents with the aim to establish preventive treatments.

Intervention effect of cognitive behaviour therapy under suicidology on psychological stress and emotional depression of college students

BACKGROUND

The suicide of college students had been a social topic attracting people's attention, and the generation of suicidal ideation was an inevitable link in the psychological process of suicidal behavior. It was the focus of many researches whether the pressure of college students with suicidal ideation can be detected and relieved in time.

OBJECTIVE

The study aimed to analyze the therapeutic effect of cognitive behaviour therapy on psychological stress, depression, and other negative emotions of college students with suicide ideation.

METHODS

114 people from 1,158 college students with suicide ideation in the Wuhan area were divided into an experimental group and a control group in this study. Students in the experimental group were given with the cognitive behaviour therapy, and students in the control group were not intervened in any way. The suicide ideation scale (despair, optimism, and sleep), psychological stress test rating, and self-reporting inventory (somatization, compulsion, interpersonal relationship, depression, anxiety, hostility, terror, delusion, and psychosis) were used to evaluate the objects in the pre-test stage, intermediate-test stage, and the tracking-test stage. The multivariate logistic regression was adopted to analyze the influencing factors of the suicide ideation of the college student.

RESULTS

The suicide ideation of the college student was significantly positively correlated with the psychological stress, depression, interpersonal sensitivity, anxiety, and psychosis (P > 0.05); the total score of suicide ideation, despair, optimism, and sleep in the experimental group were lower than those in the control group (P < 0.05) in the intermediate-test stage and the tracking-test stage (P < 0.05); the psychological stress, depression, and anxiety of the college students in the experimental group in the intermediate-test and tracking-test stage were slighter than those in the control group (P < 0.05); the somatization, compulsion, and interpersonal relationship of students in the experimental group were significantly lower than those in the control group (P < 0.05).

CONCLUSIONS

The psychological stress, depression, interpersonal sensitivity, anxiety, and psychosis were all risk factors for the college student to have suicide ideation. Negative emotions such as psychological stress, emotional depression, and anxiety of the college student with suicide ideation could be improved effectively by cognitive behaviour therapy, and the level of suicide ideation could be reduced finally.

Perceptions of Study Conditions and Depressive Symptoms During the COVID-19 Pandemic Among University Students in Germany: Results of the International COVID-19 Student Well-Being Study

Background: Results of previous studies examining the impact of the SARS-CoV-1 epidemic in 2003 on university students' mental well-being indicated severe mental health consequences. It is unclear how the current COVID-19 pandemic and the changes in study conditions due to federal regulations affected mental well-being in the German student population. We examined university students' perceptions of study conditions during the COVID-19 pandemic and investigated associations between study conditions and depressive symptoms. Methods: A cross-sectional online survey was conducted in Germany in May 2020 at four universities (N = 5,021, 69% female, mean age: 24 years, SD: 5.1). Perceived study conditions, as well as sociodemographic information, were assessed with self-generated items and the CES-D 8 scale was used to determine depressive symptoms. Associations between perceived study conditions (academic stress and academic satisfaction), in general, and confidence to complete the semester, in particular, and depressive symptoms were analyzed using generalized linear regressions. Results: Fifty-four percent of survey participants felt that the university workload had significantly increased since the COVID-19 pandemic; 48% were worried that they would not be able to successfully complete the academic year; 47% agreed that the change in teaching methods caused significant stress. Regarding depressive symptoms, the mean score of the CES-D 8 scale was 9.25. Further, a positive association between perceived study conditions and depressive symptoms was found (p < 0.001), indicating that better study conditions were associated with fewer depressive symptoms. Results of the generalized linear regression suggest that better student mental well-being was related to higher confidence in completing the semester. Conclusions: This study provides first insights into perceived study conditions and associations with depressive symptoms among students during the COVID-19 pandemic in Germany. Findings underline the need for universities to provide intervention strategies targeting students' mental well-being during the course of the pandemic.

The Hippocratic Risk: Epidemiology of Suicide in a Sample of Medical Undergraduates

In spite of the growing awareness on medical students' mental health in recent years, epidemiologic literature about the topic is scarce, particularly for what concerns suicide. Here, we collected cases of suicides among medical students enrolled at a local University in Italy and compared it to the general population of the same age group. Our sample was collected using records of suicides in the city of Pavia, Italy between the years of 2014 and 2019. This record was cross-referenced with enrolment numbers to the Medical Faculty of the city in order to select cases that involved medical students A time-window of 6 years was chosen for the evaluation. The odds ratio of suicide in medical students in comparison to the general population was of 14.58 (p value at the exact Poisson test <0.001). We then differentiated between native Italians and students from abroad. In this case, an odds ratio of 6.81 was observed (p value at the exact Poisson test 0.011). Our estimated suicide rates exceeded what was previously reported for the general population. We call for a closer attention on mental health in medical students, and an increased effort in collecting objective data on the topic.

Prevalence and risk factors for mental health problems in university undergraduate students: A systematic review with meta-analysis

BACKGROUND

Effective targeting of services requires that we establish which undergraduates are at increased risk of mental health problems at university. We aimed to conduct a systematic review and meta-analysis of the prevalence and risk factors for mental health problems in undergraduates.

METHODS

We searched MEDLINE, PsycInfo, EMBASE and the Cochrane Central Register. Eligible studies were assessed using the Quality of Prognostic Studies checklist and narratively synthesised. Pooled prevalence of depression and suicide-related outcomes, and associated risk factors (odds ratios) were estimated using random-effects meta-analyses.

RESULTS

Sixty-six eligible studies of varying quality were included in a narrative synthesis. The pooled prevalence of depression (eight studies; 13,790 participants) was 25% (95% CI 17%, 35%) and the pooled prevalence of suicide-related outcomes (four studies; 2,586 participants) was 14% (95% CI 0%, 44%). Thirteen studies contributed to meta-analytic syntheses of 12 depression-related and four suicide-related risk factors. Presenting with a current mental health problem, negative rumination, parent separation, experiences of sexual harassment and parental depression significantly predicted depression outcomes. Childhood adversity, baseline mental health problems and financial difficulties significantly predicted suicide-related outcomes.

LIMITATIONS

Student mental health is a heterogeneous research area and is hampered by the use of imprecise terms, both for describing risk factors and mental health outcomes. These inconsistencies limit the extent to which datasets can be meaningfully synthesised.

CONCLUSIONS

This review evidences the importance of a range of risk factors for poor undergraduate mental health. Interventions should be developed to target modifiable risk factors and prevent poor mental health outcomes. Systematic review registration: PROSPERO registration CRD42019144927.

Depression, Suicidal Ideation and Perceived Stress in Italian Humanities Students: A Cross-Sectional Study

Mental health issues are common among university students. Nevertheless, few studies focused on Italian students. This study aimed to assess prevalence and associated factors of perceived stress (PS), depressive symptoms (DS) and suicidal ideation (SI) in an Italian sample. A cross-sectional study was conducted amongst a convenience sample of students in humanities field (2018). Questionnaires were self-administered. Outcomes were assessed through Beck Depression Inventory-II (DS, SI) and Perceived Stress Scale (PS). Multivariable regressions were performed (p-value < 0.05 significant; sample size = 203). DS and SI prevalence was 30.6% and 8.8%. PS median score was 20 (IQR = 11), 87.7% reported moderate/severe PS. DS likelihood was increased by psychiatric disorders family history and not attending first year of course and decreased by not thinking that university hinders personal activities. Chronic disease and higher stress score increased SI probability; good/excellent family cohesion reduced it. Being female, thinking that university hinders resting/relaxing, seeing a psychologist/psychiatrist were positively associated with PS; having no worries about future was negatively associated. A high prevalence of mental health issues was reported, with miscellaneous associated factors that were linked to both private and social aspects. Universities must be aware of this to provide efficient preventive measures.

Interaction between physical activity and problematic mobile phone use on suicidality in Chinese college students

BACKGROUND

Previous research has found a relationship between problematic mobile phone use (PMPU) and suicidality. However, few studies have examined the interaction effects between low physical activity (PA) and PMPU on suicidality among college students. This study aimed to examine the interactions of PA and PMPU and their impact on suicidality in a school-based sample among Chinese college students.

METHODS

Analysis is based on date from two university in China, which recruited 4787 participants. Binomial logistic regression models were used to explore the associations of PA, PMPU with suicidal ideation and suicide attempt, as well as the interaction of PA and PMPU with suicidality.

RESULTS

The prevalence of suicide attempt and suicidal ideation were 3.5 and 7.2%, respectively. Low PA was significantly associated with suicide attempt (OR = 3.48, 95%CI: 2.52-4.81) and suicidal ideation (OR = 1.90, 95%CI: 1.46-2.46). PMPU was significantly associated with suicide attempt (OR = 3.65, 95%CI: 2.66-5.01) and suicidal ideation (OR = 2.83, 95%CI: 2.25-3.54). Interaction analysis indicated that low PA and PMPU were interactively associated with suicide attempt (OR = 9.51, 95%CI: 6.15-14.73, P < 0.001), RERI = 4.85(1.20-8.50), AP = 0.51(0.29-0.73), SI = 2.32(1.34-4.04). There was no additive interaction effects between PA and PMPU on suicidal ideation.

CONCLUSIONS

The findings reveals that the intervention programs of suicide attempt should consider the students PA levels and PMPU.

Facilitators and barriers to supporting young people with eating disorders during their transition to, and time at, university: An exploration of clinicians' perspectives

BACKGROUND

Eating disorders (EDs) are common in student populations and present formidable challenges as to how best to treat and support these young people, especially at points of transition. Yet research exploring these challenges is lacking, particularly from the perspective of those providing treatment and support.

METHODS

A qualitative design was used to explore clinicians' perspectives of supporting students with EDs. Twelve clinicians from a large ED service in the United Kingdom participated in one-to-one semi-structured interviews. Data were analysed using thematic analysis.

RESULTS

Facilitators and barriers to supporting students with EDs fell into four overarching themes: Health System, University, Patient and Carer Factors. Reported facilitators were; ED service awareness, flexibility and resources, university as a motivator, and carer support. Reported barriers were; poor links and communication between institutions, the primary care system, poor university provision for and awareness of EDs, young people's denial and ambivalence, inconsistent implementation of guidelines, and carer anxiety.

CONCLUSIONS

The findings revealed challenges unique to the university transition, including the need for more collaborative working between healthcare and education institutions, improved training of non-specialised ED professionals, and the benefits of a flexible, adapted ED treatment approach specifically tailored to the unique needs of students with EDs.

Association between anxiolytic/hypnotic drugs and suicidal thoughts or behaviors in a population-based cohort of students

AIMS

To investigate the association between the use of anxiolytic/hypnotic drugs and suicidal thoughts and/or behavior (STB) in students.

METHODS

12,112 participants who completed the baseline questionnaire in the i-Share cohort between April 2013 and March 2017 were included. STB were defined at inclusion as suicidal thoughts over the previous year and/or a lifetime suicide attempt. The use of prescribed anxiolytic/hypnotic drugs over the previous 3 months was measured at baseline and follow-up time points (in 2,919 students). Psychiatric disorders were assessed through validated scales. Multivariate logistic regression models were run using disease risk score.

RESULTS

At inclusion, 25.2% of students had STB and 10.3% used anxiolytics/hypnotics. STB at baseline were associated with a more frequent use of anxiolytics/hypnotics in the previous 3 months, after adjustment for covariates including anxiety, depression, sleep, impulsivity, and substance use. The use of anxiolytics/hypnotics at baseline was not associated with the occurrence, persistence or remission of STB one year later. STB at baseline were associated with a new anxiolytic/hypnotic treatment one year later.

CONCLUSIONS

Anxiolytic/hypnotic drug use was associated with STB in students independently of many risk factors of suicide and most psychiatric disorders that require such treatment, which raises drug safety concerns.

Recruitment of women veterans into suicide prevention research: Improving response rates with enhanced recruitment materials and multiple survey modalities

Women veterans (WV) are the fastest growing veteran subpopulation and recognized to be at increased risk for suicide compared with civilians. Improving engagement (e.g., response rates) of WV in survey research is critical to ensuring valid and generalizable findings, which can inform suicide prevention programs tailored for this population. Many factors are known to influence response rates, yet little is known about ways to optimize survey response rates among WV. Three recruitment cohorts (Waves 1 [W1], 2a [W2a], and 2b [W2b]) of WV were invited to participate in an online survey for a national, mixed-methods study examining suicide risk among WV using reproductive health care services paid for or provided by the Veterans Health Administration. To examine the effects of enhanced recruitment efforts, standard recruitment materials were mailed to all three cohorts, with the additions of: a study flyer aiming to build trust between participants and researchers (W2a, W2b) and a paper survey (W2b). Characteristics of responders and non-responders were compared by wave and across survey modalities. Response rates were significantly higher for groups receiving enhanced (W2a = 17.1%; W2b = 24.6%) versus standard (W1 = 12.2%) recruitment materials. WV residing in rural areas were significantly more likely to respond by paper (37.1%) than online (19.8%). Non-respondents were disproportionately racial and ethnic minorities. Disclosure of sensitive information (e.g., military sexual trauma) did not differ by survey modality. Findings suggest that enhanced recruitment materials improve survey response rates among WV, an important consideration for future research with this population.

Social-Ecological measure of resilience: an adapted measure for Persian-speaking university students

Background: There is no validated instrument for Persian-speaking students to apply the social-ecological resilience theory (SERT), which emphasizes the ecological resources for developing resilience. The study aimed at developing the student social-ecological resilience measure(Student-SERM) in Iran’s context.

Methods: Three separate samples of undergraduates participated in this mixed-methods research from the University of Tehran, Iran. Phase-1 qualitatively explored the resilience features in the university setting, to devise the university-specific subscale (USS). Phase-2piloted the construct validity and reliability of the Student-SERM in 242 undergraduates, who also completed Depression, Anxiety, and Stress Scale (DASS-21). Phase-3, as a cross-validation study, investigated 487 undergraduates, who completed the refined Student-SERM, HospitalAnxiety and Depression Scale (HADS), and three indices screening academic performance, loneliness, and suicide acceptability. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), Pearson’s correlation, and Cronbach’s alpha were performed.

Results: Phase-1 yielded nine items for USS. In phase-2, EFA indicated the construct validity of the main 20-item measure (RMSEA=0.06 and SRMR=0.04) and the nine-item USS (RMSEA=0.07and SRMR =0.04), and the reliability and convergent/divergent validity were confirmed. In phase-3, EFA (RMSEA=0.07 and SRMR=0.04) and CFA (RMSEA=0.07, CFI=0.89, TLI=0.87,and SRMR=0.07) in two separate subsamples and CFA (RMSEA=0.06, CFI=0.92, TLI=0.90,and SRMR=0.06) in the total sample indicated the construct validity of the refined Student-SERM, including family, peer, culture, growth, and USS subscales. The reliability and convergent/divergent validity were also reconfirmed.

Conclusion: The Student-SERM incorporates ecological resources, accounting for the students’resilience. Since the resilience process involves a return to healthy functioning after adversity, further research can examine the application of Student-SERM in high-risk student populations.

Sources of Stress and Their Associations With Mental Disorders Among College Students: Results of the World Health Organization World Mental Health Surveys International College Student Initiative

The college years are stressful for many students. Identifying the sources of stress and their relative importance in leading to clinically significant emotional problems may assist in the development of targeted stress management interventions. The current report examines the distribution and associations of perceived stress across major life areas with 12-month prevalence of common mental disorders in a cross-national sample of first-year college students. The 20,842 respondents were from 24 universities in 9 countries that participated in the World Health Organization World Mental Health International College Student Initiative. Logistic regression analysis examined associations of current perceived stress in six life areas (financial situation, health, love life, relationships with family, relationships at work/school, problems experienced by loved ones) with six types of 12-month mental disorders (major depressive disorder, bipolar disorder, generalized anxiety disorder, panic disorder, alcohol use disorder, drug use disorder). Population attributable risk proportions (PARPs) were calculated to estimate the upper-bound potential effects of interventions focused on perceived stress in reducing prevalence of mental disorders. The majority of students (93.7%) reported at least some stress in at least one of the six areas. A significant dose-response association was found between extent of stress in each life area and increased odds of at least one of the six disorders. The multivariable models that included all stress measures were significant for all disorders (F = 20.6–70.6, p < 0.001). Interpretation of PARPs as representing causal effects of stresses on disorders suggests that up to 46.9–80.0% of 12-month disorder prevalence might be eliminated if stress prevention interventions were developed to block the associations of stress with these disorders.

Suicide among university students: prevalence, risks and protective factors

Background: Research evidence on suicide in Ghana so far has focused mostly on suicide in the adult population and less work on the younger population such as university students and other vulnerable groups such as children, youth and the aged. Aims: This study was conducted to determine lifetime and current prevalence of suicidal ideation or attempts and identify the associated risks and protective factors among university students in Ghana. Methods: Using a cross-sectional design, 1003 university students (507 males and 496 females) with a mean age of 20.5 years (SD = 5.95) were administered questionnaires that measured suicide, psychological distress, self-esteem and subjective wellbeing. Results: We found the following prevalence rates of suicidal behaviours: ideations 15.2%, attempted 6.3%, death wishes 24.3% and suicidal plan 6.8%. Psychological distress was a risk factor for both suicidal ideation and suicidal attempt. Subjective wellbeing was protective of suicide attempt while self-esteem was protective of suicidal ideation. Conclusions: These findings underscore the need for school-based mental health-promoting programmes that enhance young people's self-esteem, reduce psychological distress and boost subjective wellbeing.

Prevention of eating disorders at universities: A systematic review and meta-analysis

BACKGROUND

Eating problems are highly prevalent among young adults. Universities could be an optimal setting to prevent the onset of eating disorders through psychological intervention. As part of the World Mental Health-International College Student initiative, this systematic review and meta-analysis synthesizes data on the efficacy of eating disorder prevention programs targeting university students.

METHOD

A systematic literature search of bibliographical databases (CENTRAL, MEDLINE, PsycINFO) for randomized trials comparing psychological preventive interventions for eating disorders targeting university students with psychoeducation or inactive controls was performed on October 22, 2019.

RESULTS

Twenty-seven studies were included. Thirteen (48.1%) were rated to have a low risk of bias. The relative risk of developing a subthreshold or full-blown eating disorder was incidence rate ratio = 0.62 (95% CI [0.44, 0.87], n _c = 8, numbers-needed-to-treat [NNT] = 26.08; standardized clinical interviews only), indicating a 38% decrease in incidence in the intervention groups compared to controls. Small to moderate between-group effects at posttest were found on eating disorder symptoms (g = 0.35, 95% CI [0.24, 0.46], NNT = 5.10, n _c = 26), dieting (g = 0.43, 95% CI [0.29, 0.57], NNT = 4.17, n _c = 21), body dissatisfaction (g = 0.40, 95% CI [0.27, 0.53], NNT = 4.48, n _c = 25), drive for thinness (g = 0.43, 95% CI [0.27, 0.59], NNT = 4.23, n _c = 12), weight concerns (g = 0.33, 95% CI [0.10, 0.57], NNT = 5.35, n _c = 13), and affective symptoms (g = 0.27, 95% CI [0.15, 0.38], NNT = 6.70, n _c = 18). The effects on bulimia nervosa symptoms were not significant. Heterogeneity was moderate across comparisons.

DISCUSSION

Eating disorder prevention on campus can have significant, small-to-moderate effects on eating disorder symptoms and risk factors. Results also suggest that the prevention of subthreshold and full-syndrome eating disorders is feasible using such interventions. More research is needed to identify ways to motivate students to use preventive eating disorder interventions.

ANTECEDENTES

Los trastornos de la conducta alimentaria son altamente prevalentes entre los adultos jóvenes. Las universidades podrían ser un entorno óptimo para prevenir la aparición de trastornos alimentarios a través de la intervención psicológica. Como parte de la iniciativa World Mental Health-International College Student, esta revisión sistemática y meta-análisis sintetiza datos sobre la eficacia de los programas de prevención de trastornos alimentarios dirigidos a estudiantes universitarios. MÉTODO: Una búsqueda bibliográfica sistemática de datos bibliográficas (CENTRAL, MEDLINE, PsycINFO) para ensayos aleatorios que comparaban intervenciones preventivas psicológicas para trastornos alimentarios dirigidos a estudiantes universitarios con psicoeducación o controles inactivos fue realizada hasta el 22 de octubre de 2019.

RESULTADOS

Se incluyeron 27 estudios. Trece (48,1%) fueron calificados como de bajo riesgo de sesgo. El riesgo relativo de desarrollar un trastorno de la conducta alimentaria subclínico (parcial) o completo fue IRR = 0.62 (95% CI [0.44, 0.87], n_c = 8, NNT = 26.08; sólo entrevistas clínicas estandarizadas), lo que indica una disminución del 38% en la incidencia en los grupos de intervención en comparación con los controles. Se encontraron efectos pequeños a moderados entre los grupos en la post-prueba en los síntomas del trastorno alimentario (g = 0.35, 95% CI [0.24, 0.46], NNT = 5.10, n_c = 26), dieta (g = 0.43, 95% CI [0.29, 0.57], NNT = 4.17, n_c = 21), insatisfacción corporal (g = 0.40, 95% CI [0.27, 0.53], NNT = 4.48, n_c = 25), impulso por delgadez (g = 0.43, 95% CI [0.27, 0.59], NNT = 4.23, n_c = 12), problemas de peso (g = 0.33, 95% CI [0.10, 0.57], NNT = 5.35, n_c = 13) y síntomas afectivos (g = 0.27, 95% CI [0.15, 0.38], NNT = 6.70, n_c = 18). Los efectos sobre los síntomas de la bulimia nervosa no fueron significativos. La heterogeneidad fue moderada en las comparaciones. DISCUSIÓN: La prevención de los trastornos de la conducta alimentaria en el campus universitario puede tener efectos significativos, de pequeños a moderados, sobre los síntomas del trastorno alimentario y los factores de riesgo. Los resultados también sugieren que la prevención de los trastornos alimentarios subclínicos o parciales y síndromes completos es factible utilizando tales intervenciones. Se necesita más investigación para identificar formas de motivar a los estudiantes a usar intervenciones preventivas para los trastornos de la conducta alimentaria.

Effectiveness of Zhong-Yong thinking based dialectical behavior therapy group skills training versus supportive group therapy for lowering suicidal risks in Chinese young adults: A randomized controlled trial with a 6-month follow-up

BACKGROUND

Dialectical behavior therapy (DBT) is a first-line treatment for the prevention of suicide. Zhong-Yong thinking could be viewed as a Chinese way of dialectical thinking, has long been a culturally dictating thinking style in China. To enhance cultural adaptability, we integrated Zhong-Yong thinking into DBT group skills training and examined its efficacy in suicidal prevention compared with a supportive group therapy and a wait-list group in high-risk suicidal Chinese college students.

METHODS

A total of 97 suicidal participants were randomized to either Zhong-Yong thinking based DBT group skills training (DBT_ZYT , n = 33), or supportive group therapy (SGT; n = 32), or wait-list group (WL; n = 32). DBT_ZYT was a 12-week program based on Zhong-Yong thinking instead of dialectical thinking, coaching participants mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. Supportive group therapy was a 12-week program aiming at improving interpersonal effectiveness and emotion regulation skills. Outcome measures were assessed at pre- and post-treatment and 6-month follow-up.

RESULTS

At post-treatment measures, the levels of suicidal ideation, hopelessness, psychache symptoms, and general psychopathology had significantly decreased in both intervention groups; at the 6-month follow-up measures, the intervention effects were better maintained in the DBT_ZYT group rather than in the SGT group. Specifically, DBT_ZYT was more effective in relieving participants' long-term obsessive-compulsive, anxiety, hostility, phobic, psychotic, and additional symptoms.

CONCLUSIONS

Zhong-Yong thinking not only could integrate with DBT skills training in Chinese young adult population, but also has special strength in enhancing DBT's efficacy.

Suicide and associated psychosocial correlates among university students in Taiwan: A mixed-methods study

BACKGROUND/PURPOSE

The trend of suicide rates among young adults has been increasing worldwide. The study aimed to identify the suicide risks and associated psychosocial factors in a large university in Taiwan.

METHODS

This is a mixed-methods study using both questionnaire survey and two open-ended questions for the exploration of qualitative data. An online survey was conducted between two periods of the same semester in 2018 to collect different sources of stress and other suicide correlates. The measurement scales included the 9-item Concise Mental Health Checklist, the University Stress Screening Tool in Taiwan and the Chinese Maudsley Personality Inventory. The participants were required to fulfill two open-ended questions about stress experience and depressive symptoms in the previous month in the end of the questionnaire, which was analyzed using thematic analysis.

RESULTS

A total of 857 university students were recruited (67.9% female participants). Over a quarter of participants were under poor mental health status and more than 60% experienced stressful events in the prior year. A higher suicide risk and neurotic trait was noticed compared to the general public. These results were consistent with the qualitative findings.

CONCLUSION

While identifying several risk factors that cumulatively conduced to higher suicide risks, neuroticism served as a key element in the increased suicide risk among the university students. Suicide prevention strategies for university students should highlight stress management for those with neurotic trait and early suicide risk identification.

Associations Between Social Capital and Depressive Symptoms Among College Students in 12 Countries: Results of a Cross-National Study

Introduction

A mental health crisis has hit university campuses across the world. This study sought to determine the prevalence and social determinants of depressive symptoms among university students in twelve countries. Particular focus was placed on the association between social capital and depressive symptoms.

Methods

A cross-sectional study was conducted among students at their first year at university in Europe, Asia, the Western Pacific, and Latin and North America. Data were obtained through a self-administered questionnaire, including questions on sociodemographic characteristics, depressive symptoms, and social capital. The simplified Beck's Depression Inventory was used to measure the severity of depressive symptoms. Social capital was assessed using items drawn from the World Bank Integrated Questionnaire to Measure Social Capital. Multilevel analyses were conducted to determine the relationship between social capital and depressive symptoms, adjusting for individual covariates (e.g., perceived stress) and country-level characteristics (e.g., economic development).

Results

Among 4228 students, 48% presented clinically relevant depressive symptoms. Lower levels of cognitive (OR: 1.82, 95% CI: 1.44-2.29) and behavioral social capital (OR: 1.51, 95% CI: 1.29-1.76) were significantly associated with depressive symptoms. The likelihood of having depressive symptoms was also significantly higher among those living in regions with lower levels of social capital.

Conclusion

The study demonstrates that lower levels of individual and macro-level social capital contribute to clinically relevant depressive symptoms among university students. Increasing social capital may mitigate depressive symptoms in college students.