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.

Introduction: Prior research shows high levels of mental disorder among students in many countries, with potential for internet-based cognitive behavioral therapy (ICBT) to improve mental health. Over 40% of young people in Europe pursue studies in higher education. We report mental disorder diagnostic prevalences for students in Sweden, and preliminary results from a transdiagnostic ICBT trial.

Methods: Students at 15 higher education institutions in Sweden answered an online cross-sectional survey between 2020 and 2023 as part of the World Mental Health International College Student (WMH-ICS) initiative. A sample of 17 948 students provided sufficient data for calculation of Diagnostic and Statistical Manual, 5th edition (DSM-5) diagnoses for Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), Panic Disorder (PD), Bipolar Disorder (BD, any), Alcohol Use Disorder (AUD), Substance Use Disorder (SUD), and any mental disorder for 30-day, 12-month and lifetime periods. About 1200 participants will have been randomized by summer 2025 to guided ICBT, unguided ICBT, or waitlist control crossed over at six months to unguided ICBT.

Results: The proportion of respondents (69.4% women, 25.5 mean age, range 18 to 36) fulfilling criteria for any 30-day, 12-month or lifetime diagnosis was 25.2%, 39.3% and 44.5%, respectively. Odds of mental disorders were higher for several sub-groups based on gender, age, sexual orientation and post-pandemic survey responses. Preliminary post-treatment ICBT trial outcomes for depression and anxiety will be presented.

Conclusions: The prevalence findings augment existing concern over student mental health. ICBT may offer a way forward for augmenting student mental health treatment resources.

Mental health disparities have been reported among sexual minority individuals; minority stress theory posits that such disparities are a result of stigma and discrimination. We estimated the prevalence of mental disorders across sexual orientation groups among first-year college students and whether differences across sexual orientation groups varied by gender and country-level LGBTQ+ (lesbian, gay, bisexual, transgender, queer) social acceptance. Using data (N = 53,175; 13 countries) from the World Mental Health Surveys International College Surveys, we performed multilevel logistic regressions to estimate the associations between sexual orientation (i.e., heterosexual, heterosexual with same-gender attraction [SGA], gay/lesbian, bisexual, asexual, questioning, and other) and five twelve-month DSM-5 disorders (major depressive disorder, generalized anxiety disorder, panic disorder, alcohol use disorder, drug use disorder). Heterosexual students with SGA (AORs 1.30-2.15), gay/lesbian (AORs 1.49-2.70), bisexual (AORs 2.26-3.49), questioning (AORs 1.38-2.04), and "other" (AORs 1.76-2.94) students had higher odds of all disorders compared to heterosexual students with no SGA; asexual students did not. Significant interactions with gender show that the gender difference in prevalence was greater among bisexual individuals for most disorders and among all sexual minorities (except "other") for drug use disorder. Significant interactions with country level LGBT+ social acceptance showed some sexual minority groups had lower odds (AORs 0.83-0.95) of disorder as country-level acceptance increased. These findings provide further evidence of mental disorder disparities across a wide range of sexual orientations and how these disparities vary by gender and societal LGBTQ+ acceptance in students from diverse countries.

BACKGROUND: The college years are a developmentally sensitive period for mental disorder onset. Reliable epidemiological data are critical for informing public health responses. This study aimed to estimate prevalence and socio-demographic distributions of common DSM-5 mental disorders among first-year university students from 77 universities across 18 countries.

METHODS: Data were collected 2017-2023 in the World Mental Health International College Student Initiative with n = 72,288 university students. Online surveys assessed alcohol use, attention-deficit/hyperactivity, bipolar, drug use, generalized anxiety, major depression, panic, and post-traumatic stress disorders with validated screening scales. Socio-demographics included student age, sex at birth, gender modality, sexual orientation, and parent education.

RESULTS: The weighted mean response rate was 20.8%. Data were calibrated for differential response rates by sex at birth and age. 65.2% of respondents screened positive for lifetime mental disorders and 57.4% for 12-month mental disorders. Females had higher prevalence of internalizing disorders and males of substance and attention-deficit/hyperactivity disorders. Older age was associated with lower prevalence of most 12-month but not lifetime mental disorders. Non-heterosexual sexual orientation and identifying as transgender were associated with highest prevalence of most mental disorders. Parent education was for the most part uncorrelated with prevalence.

CONCLUSIONS: Although prevalence might have been overestimated due to the low response rate and possible screening scale miscalibration, results nonetheless suggest that mental disorders are highly prevalent among first-year university students worldwide and are widely distributed with respect to socio-demographic characteristics. These findings highlight the need to implement effective interventions to better support first-year university student mental health.

The WHO World Mental Health International College Student (WMH-ICS) Initiative aims to assess the prevalence of mental disorders among college students worldwide and implement Internet-based interventions to prevent and treat mental disorders. The symposium comprises three presentations by researchers from Sweden and Hong Kong who are part of the worldwide consortium. The first presentation shares the epidemiological findings from 17,948 students at 15 higher education institutions in Sweden. Prevalence for any 30-day, 12-month, and lifetime diagnosis of any mental disorder is 25.2%, 39.3%, and 44.5%, respectively. The very high prevalence calls for readily accessible and highly scalable interventions that can reach a large population of emerging adults. Preliminary findings from a randomized controlled trial comparing guided or unguided Internet-based cognitive behavioral therapy will be presented. The second presentation shares findings from a longitudinal study of 2796 students from higher education institutions in Sweden investigating changes in mental health and academic self-efficacy during the course of the COVID-19 pandemic when college teaching was abruptly changed to online remote mode. Findings showed that worsening of mental health is associated with dampening of academic self-efficacy longitudinally. Implications for timely online support for students to adjust to uncertainties is necessary to promote students’ mental health and academic success. The third presentation shares a series of studies conducted in Hong Kong that systematically examine college students’ preferences and experiences in using online interventions and self-care exercises. Specifically, mixed methods in the format of qualitative interviews and user surveys were used to examine users’ perceived needs and preferences, usability, and acceptability in using digital mental health tools to manage their mental health and build self-care habits. Facilitators and barriers were identified. Then, preliminary findings from a 4-arm randomized controlled trial comparing the relative effectiveness of coach-guided or self-guided transdiagnostic cognitive behavioral therapy, self-guided mindfulness-based intervention with waitlist control in managing depressive and anxiety symptoms will be shared. Insights regarding to prevalence of college students’ mental health challenges, usability and effectiveness of Internet-based interventions, and challenges in uptake and engagement of online interventions among emerging adults will be discussed. The experience of integrating offline counseling services with digital mental health platforms across higher education institutions in Hong Kong will also be shared.

Objective: To investigate the associations of demographic variables, childhood adversities (CAs), and mental disorders (MDx) with onset, transition, and persistence of suicidal thoughts and behaviors (STB) among first-year university students. Method: Poisson regression models within a discrete-time survival framework were constructed using web-based self-report survey data from 72,288 incoming university students across 18 countries (response rate=20.9%; median age=19 years, 57.9% female, 1.4% transgender, 21.0% non-heterosexual). These models examined the associations of four demographic variables, five CAs, and eight MDx with STB outcomes. Results: Lifetime prevalence of suicidal ideation, plans, and attempts was 47.0%, 26.0%, and 9.6%, respectively; 12-month estimates were 30.6%, 14.0%, and 2.3%. In unadjusted analyses, associations were strongest between lifetime onset of suicidal ideation and CAs (RR range 4.4–7.0), particularly parental psychopathology (relative risk [RR]=7.0 [95% CI 6.5–7.7]), followed by MDx (RR range 1.3–3.0). Of the demographic subgroups, transgender students had highest risk of STB (lifetime ideation onset RR=2.4 [2.3–2.6]; ideation-to-attempt transition RR=1.5 [1.3–1.8]). In fully adjusted models, strongest predictors of lifetime ideation onset were emotional abuse (RR=2.1 [1.9–2.2]), major depressive disorder (RR=2.0 [1.9–2.1]), and bipolar disorder (RR=1.8 [1.6–2.0]). Ideation-to-attempt transition remained most strongly associated with panic disorder (RR=1.5 [1.3–1.7]), bipolar disorder (RR=1.4 [1.2–1.7]), and sexual abuse (RR=1.4 [1.2–1.7]). Most predictors were significantly but weakly associated with persistence of ideation and plan, while only physical abuse remained associated with repeated suicide attempts (RR=1.3 [1.0–1.8]). Conclusion: CAs and MDx are strong predictors of both onset of and transition within the STB spectrum, underscoring the importance of implementing early-life prevention interventions.

BACKGROUND: Non-suicidal self-injury (NSSI) is associated with mental disorders, yet work regarding the direction of this association is inconsistent. We examined the prevalence, comorbidity, time-order associations with mental disorders, and sex differences in sporadic and repetitive NSSI among emerging adults.

METHODS: We used survey data from n = 72,288 first-year college students as part of the World Mental Health-International College Student Survey Initiative (WMH-ICS) to explore time-order associations between onset of NSSI and mental disorders, based on retrospective age-of-onset reports using discrete-time survival models. We distinguished between sporadic (1-5 lifetime episodes) and repetitive (≥6 lifetime episodes) NSSI in relation to DSM-5 mood, anxiety, and externalizing disorders.

RESULTS: We estimated a lifetime NSSI rate of 24.5%, with approximately half reporting sporadic NSSI and half repetitive NSSI. The time-order associations between onset of NSSI and mental disorders were bidirectional, but mental disorders were stronger predictors of the onset of NSSI (median RR = 1.94) than vice versa (median RR = 1.58). These associations were stronger among individuals engaging in repetitive rather than sporadic NSSI. While associations between NSSI and mental disorders generally did not differ by sex, repetitive NSSI was a stronger predictor for the onset of subsequent substance use disorders among females compared to males. Most mental disorders marginally increased the risk for persistent repetitive NSSI (median RR = 1.23).

CONCLUSIONS: Our findings offer unique insights into the temporal order between NSSI and mental disorders. Further work exploring the mechanism underlying these associations will pave the way for early identification and intervention of both NSSI and mental disorders.