Introduction: Problem drinking (PD), defined as hazardous or harmful drinking, constitutes a major health and economic burden worldwide. However, most individuals with PD typically remain untreated for many years as part of the “treatment gap” between prevalence and treatment access. The main objective of this study was to evaluate an unguided, app-based intervention for reducing alcohol consumption, compared to an information control app. Secondary analyses targeted motivation effects, subgroup differences in heavy drinking days, and the proportion of participants with excessive drinking.

Methods: In this two-armed randomized controlled trial (RCT), Swedish-speaking adults seeking help for PD on the Internet were recruited via online ads (n = 576). Eligible participants, defined as those who reported PD without significant comorbid conditions, were randomly assigned to one of two unguided interventions, either the “TeleCoach” app (n = 293) or the information control app (n = 283), and followed up via online questionnaires at six-, 12- and 26-weeks post-recruitment. Participants and researchers were blinded to group assignment at recruitment but not for outcome analyses. The primary outcome was the number of standard drinks consumed per week.

Results: Participants reported drinking a mean of 28 (SD = 18) standard drinks per week at the baseline recruitment measure, and 65% of the participants reported a history of PD for over three years; only 7% of the participants reported less than a year of PD history. Only 26% of the participants had sought help before. A significant within-group reduction in alcohol consumption occurred in both conditions at the six-week follow-up (B = −10.57, SE = 0.83, 95% CI [−12.20, −8.94], p < 0.01; Cohen’s d = 0.69), sustained until the 26-week follow-up (B = −11.44, SE = 0.91, 95% CI [−13.23, −9.65], p < 0.01, Cohen’s d = 0.67), with no significant differences between the two groups. No adverse events were reported.

Conclusions: The findings, although null, nonetheless supported app-based interventions’ feasibility and potential as a scalable digital approach for reaching individuals who have not previously sought help for PD.

Trial registration: ClinicalTrials.gov as NCT03696888, Oct 5, 2018; analysis plan at https://osf.io/wxfqg, on Dec. 18, 2023 prior to analysis.

Objectives: To establish diagnostic prevalences for common mental disorders among students at higher education institutions (HEI's) in Sweden.

Methods: This was a cross-sectional study assessing diagnostic prevalences for 17,948 students at 30-day, 12-month and lifetime timepoints, according to the Diagnostic and Statistical Manual, fifth edition (DSM-5). Sample participants at 15 HEI's answered an online survey 2020-2023 within the World Mental Health International College Student (WMH-ICS) initiative. Diagnoses are reported for Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), Panic Disorder (PD), Bipolar Disorder (BD, any), Alcohol Use Disorder (AUD) and Substance Use Disorder (SUD). Multilevel logistic regression was used to estimate odds ratios in relation to diagnoses of any mental disorder.

Results: Respondents (69.4% women, 25.5 mean age, range 18 to ≥ 36) reported 25.2%, 39.3% and 44.5% prevalences for any mental disorder at 30-day, 12-month and lifetime periods. Odds for any mental disorder were markedly higher for non-binary students and those with non-heterosexual orientation; odds were also higher for students aged 20-29 years, women, heterosexual individuals with same-sex attraction and post-pandemic respondents.

Conclusions: The findings augment existing concern over student mental health. Student mental health services should expand menus for low-threshold treatment interventions, to promote flourishing and resilience.

OBJECTIVE: We examined psychopathological conditions accounting for the highest risk of role impairment among university students.

METHOD: Cross-sectional online survey of first-year students (60 universities, 10 countries) assessing role impairment due to emotional problems in previous 30 days with the 3-item emotional subscale of the VR-36. Cross-tabulations and Poisson regression examined associations between 12 psychopathological conditions (8 probable mental disorders and 4 SITB) and socio-demographics with "significant role impairment" ("most"/"all of the time" in ≥2+ VR-36 items). We used machine learning methods to predict probabilities (risk) of significant role impairment based on the 12 psychopathological conditions. Observed prevalence of significant role impairment was examined within and across the 20 population ventiles to assess risk concentration using sensitivity (SN) and positive predictive value (PPV).

RESULTS: 43,990 students responded to the survey (median age = 19, IQR = 18-23). 27.1 % had significant role impairment due to emotional problems and 65.8 % had at least one psychopathological condition. Students with one or more of these conditions were more likely to have significant impairment than those without (RR = 3.9; 95 %CI: 3.6-4.2). In multivariable analyses, probable Depression and Bipolar disorders were the strongest correlates of significant impairment. Most (69.6 %) of the observed significant role impairment occurred among the roughly 35 % of respondents with highest predicted risk (PPV = 53.2 %).

CONCLUSION: Significant role impairment due to emotional problems is highly prevalent among university students. High risk of significant role impairment concentrates in one third of the students, those with several psychopathological conditions. Assessing these conditions should help identifying highest role impairment risk university students.

BACKGROUND: Addressing the effects of non-compliance with health-related recommendations in pandemics is needed for informed decision-making. This longitudinal study investigated the effects of non-compliance on mental health and academic self-efficacy among university students in Sweden.

METHODS: Baseline assessments were conducted in May 2020, with follow-ups after 5 and 10 months. Students (n = 3123) from 19 universities completed online questionnaires covering compliance, mental health, and academic self-efficacy. Effects of non-compliance were estimated using causal inference and multilevel multinomial regression.

RESULTS: Non-compliant students constituted a minority, but their proportion increased over time. Regarding mental health and academic self-efficacy, few differences were observed between compliant and non-compliant students. When differences were identified, non-compliant students experienced fewer negative effects on mental health and academic self-efficacy than compliant students.

CONCLUSION: The findings may suggest that non-compliance may have involved a trade-off between increased individual freedom and mitigating negative outcomes. Addressing the research gap on non-compliance effects is crucial for informed decision-making and promoting the common good. This may guide strategies balancing individual autonomy and collective well-being during future pandemics.

PRE-REGISTRATION: Center for Open Science (OSF), https://accounts.osf.io/login?service=https://osf.io/37dhm/ .

BACKGROUND: University students show a high prevalence of diverse mental health problems, requiring adaptable interventions to assist them in improving their mental health.

OBJECTIVE: This study aimed to evaluate the feasibility of transdiagnostic internet-delivered cognitive behavioral therapy (ICBT) for anxiety and depression in preparation for a randomized controlled trial. ICBT incorporated 2 innovative approaches to increase precision: user-steered content personalization and within-treatment adaptive modification based on early symptom trajectory.

METHODS: This single-group, open-label study was conducted online in Sweden in the autumn of 2021, recruiting from students who had completed the World Health Organization (WHO) World Mental Health International College Student (WMH-ICS) mental health survey. Participants were eligible if they scored 5-19 on the Patient Health Questionnaire-9 (PHQ-9), or ≥5 on the Generalized Anxiety Disorder-7 (GAD-7), or both. Participants completed an 8-week ICBT program with therapist support. They initially personalized their program by selecting a primary problem orientation, anxiety or depression, and choosing additional elective modules, and could consult their therapist regarding these choices. At midtreatment, stepped care was piloted, in which participants without symptom improvement were randomized to adaptive enhancement of therapist support or to continue treatment as before. The main feasibility outcomes included data on reach and uptake, intervention acceptability, stepped care procedures, and assessment retention up to 6 months. The GAD-7 and PHQ-9 were the primary outcome measures, with changes in scores calculated using mixed effects models.

RESULTS: Of 749 invited students, 55 (7%) completed the study screening, and 28 (4%) were included. The GAD-7 baseline score was 9.5 (SD 4.4), and the PHQ-9 baseline score was 11.2 (SD 5.2). Participants opened 6.2 (SD 2.2) out of the 8 treatment modules. The user-directed personalization yielded 27 unique treatment configurations across 28 participants. At week 4, 16/27 (59%) participants remaining in treatment were randomized in the stepped care procedure. Ratings on self-report measures showed acceptable to good therapeutic alliance and treatment satisfaction. Eleven participants reported increased stress associated with the treatment. Reductions in depression and anxiety symptoms were observed at postmeasurement and 6 months follow-up, with 43% attrition at those times.

CONCLUSIONS: This pioneering study of personalized ICBT with adaptive change among university students demonstrated the overall feasibility of the treatment. To enhance the design of a future definitive trial, modifications are necessary to mitigate assessment attrition and reduce treatment-related stress.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05509660; https://clinicaltrials.gov/study/NCT05509660.

Objective: Research in the mental health field has focused on exploration and implementation of digital interventions both in research and society. However, demographic and mental health factors that may influence engagement with research on such interventions have not been explored. This study aims to investigate the relationship between demographics, signs of mental disorders, and interest in participating in an intervention study. Using data collected in the Swedish arm of the World Health Organization’s World Mental Health International College Student (WHO-WMH-ICS) initiative (n = 9140), we conducted a multinomial logistic regression to assess relationships between these factors.

Results: Older age, as well as female and non-binary gender identities, were factors significantly associated with increased interest in the intervention study. Treatment flags, indicating fulfilment of criteria for possible mental disorder diagnosis, were significantly associated with clear interest (“yes” response) in intervention research for five of the 15 treatment flags: depression, general anxiety, social anxiety, panic disorder and self-harm. Possible interest (“maybe” response) was also indicated for four of these, excluding general anxiety. These findings may facilitate a better-informed approach to recruiting student participants for treatment research, enhancing unbiased recruitment practices, reducing treatment gaps, and increasing engagement in digital intervention studies for improved mental health. 

Background: During the COVID-19-pandemic, Swedish higher education institutions shifted to remote teaching to reduce contagion. Among the students, this shift may have involved mental health changes. Such changes in mental health may, in turn, influence academic success.

Purpose: This longitudinal study investigated the effects of mental health changes on academic self-efficacy among university students in Sweden over the course of the pandemic.

Method: Self-reports were collected through online questionnaires. Baseline questionnaires were distributed in May 2020 with follow-ups at 5-months and 10-months post baseline. The longitudinal sample included 2796 students (89,5% of baseline respondents). Taking a Bayesian approach, multilevel multinomial regressions were used to estimate effects, with adaptive intercepts for universities as well as respondents in the longitudinal models.

Results: Reporting worse mental health at baseline, rather than no change, resulted in an observed higher odds of reporting worse academic self-efficacy rather than no change in academic self-efficacy at both follow-ups. Also, reporting a change to worse mental health, rather than no change, at the 5-month follow-up resulted in observed higher odds of reporting worse academic self-efficacy at the 10-month follow-up. A similar pattern was found for students reporting both positive and negative mental health changes, as compared to those reporting no mental health changes.

Conclusions: These findings have implications for the development of easily accessible services that support mental health in order for students, particularly those who experience negative effects on their mental health, to keep up their studies in times of uncertainty.

Purpose: This study investigates associations of childhood adversities (CAs) with lifetime prevalence, 12-month prevalence, and 12-month persistence of mental disorders in a large cross-national sample of university students. Methods: Data came from epidemiologic surveys carried out by the World Mental Health International College Student (WMH-ICS)Initiative across 18 countries (n=60,719). The web-based surveys screened for lifetime and 12-month prevalence and age-of-onset of common DSM-5 disorders (Major Depressive Disorder, Bipolar I/II Disorder, Generalized Anxiety Disorder, Panic Disorder, Posttraumatic Stress Disorder, Alcohol and Drug Use disorders, Attention-Deficit/Hyperactivity Disorder) and five types of CAs (family dysfunction, emotional abuse, physical abuse, sexual abuse, neglect). Multivariable Poisson regression models estimated associations of CA type, number, and frequency with disorders. Results: The majority of incoming students reported exposure to at least one CA (64.9%), including 50.0 % family dysfunction, 42.2 % emotional abuse, 21.2 % physical abuse, 18.8 % neglect, and 5.0 % sexual abuse. Lifetime and 12-month disorders were significantly associated with CAs in multivariable models, although associations with disorder persistence were weaker. Population attributable risk proportions of 12-month disorders associated with CAs were in the range of 40.7–61.0 % for anxiety and mood disorders and 13.5–55.2 % for substance use disorders. Conclusion: Six out of ten university students arrive at university having been exposed to CAs. These students have substantially higher risk of mental disorders than other students, primarily due to associations with lifetime risk rather than persistence. Given the considerable distress and impairment caused by mental disorders, these results underscore the need for primary and secondary prevention efforts.

Background: Mental disorders are highly prevalent among students worldwide. This study aims to examine comorbidity and temporal associations between mental disorders among students. Methods: The study included 72,288 students from 18 countries as part of the World Mental Health International College Student (WMH-ICS) Initiative, with cross-sectional data collected between 2017 and 2023. Screening for common DSM-5 disorders was conducted using validated screening measures. Latent variables were examined using exploratory principal axis factor analysis on a correlation matrix among the lifetime mental disorders. Based on age-of-onset information, multivariable poisson regression models were used to examine associations of prior disorders with the first onset of other disorders. Results: 27.0 % of students screened positive for only one lifetime disorder, 17.1 % for two, 10.9 % for three, and 10.6 % for 4+ disorders. In the factor analysis, three latent variables were found, comprising: internalizing disorders (generalized anxiety disorder, major depressive episode, post-traumatic stress disorder, and panic disorder), substance use disorders (drug use disorder and alcohol use disorder), and externalizing disorders (attention deficit/hyperactivity disorder and mania/hypomania). Prior internalizing and externalizing disorders were associated with the subsequent first onset of all other disorders with risk ratios ranging from 1.5–7.5. Substance use disorders were less consistently associated with the subsequent first onset of other disorders, but alcohol use disorder was associated with the first onset of drug use disorder and vice versa. Conclusions: Mental disorder comorbidity is common among students, and students with disorders across the internalizing and externalizing spectrum have an increased risk of future mental disorder comorbidities.

Background: This study explored eating disorders (ED) prevalences, comorbidity of ED with other mental disorders, and risk factors for ED among university students. ED included binge eating disorder (BED), bulimia nervosa (BN), or other specified feeding and eating disorders (OSFED). Methods: A total of 3425 first-year university students in Sweden completed an online survey covering a range of criteria for psychiatric diagnoses, within the World Mental Health International College Student (WMH-ICS) initiative. Pearson’s χ2 -tests were used to compare algorithm-based diagnostic prevalences for eating disorders and other comorbid psychiatric disorders between three groups: students with ED with or without other comorbid psychiatric disorders (A), students with psychiatric disorders but no ED comorbidity (B), and students with no psychiatric disorders (C). Multinomial logistic regression was used to calculate between-group comparisons of odds ratios for independent risk factors, where group B served as the reference group for comparisons with groups A and C. Results: Of the total sample, 75% had at least one psychiatric disorder and 28% had at least one lifetime ED diagnosis. Students with ED (group A) reported higher prevalences for comorbid anxiety disorders, depression, suicidal behavior, and non-suicidal self-injury compared to students with psychiatric disorders but no ED (group B). Group A participants exhibited a higher risk of hazardous drinking, were more likely to have received medical treatment, and to identify as bisexual. Compared to group B, students with no psychiatric disorders (group C) were more likely to report better mental and physical health, but less likely to engage in hazardous drinking, and to have sought mental health treatment. Conclusions: A large proportion of students with ED had additional psychiatric disorders, indicating that individuals with ED suffer from multiple mental health problems. It is crucial that student health services acquire competency to offer effective ED assessment and treatment.