Comorbidity and temporal associations between mental disorders among college students in the world mental health international college student initiative
Por:
Roest AM, de Vries YA, Pozuelo JR, Petukhova MV, Lee S, Sampson NA, Albor Y, Alhadi AN, Alonso J, Al-Saud N, Altwaijri Y, Andersson C, Atwoli L, Auerbach RP, Muaka CA, Báez-Mansur PM, Ballester L, Bantjes J, Baumeister H, Bendtsen M, Benjet C, Berman AH, Bruffaerts R, Carrasco P, Chan SCN, Cohut I, Couder MACD, Crockett MA, Cuijpers P, David OA, Dong D, Ebert DD, Gaete J, Forero CG, Gili M, Gutiérrez-García R, Haro JM, Hasking P, Hunt X, Husky MM, Jaguga F, Langer ÁI, Léniz I, Liu Y, Mac-Ginty S, Martínez V, McLafferty M, Miranda A, Monroy-Velasco IR, Murray EK, Musyoka CM, Nedelcea C, Núñez D, O'Neill SM, Piqueras JA, Popescu CA, Prescivalli AP, Rapsey C, Robinson K, Rodriguez-Jimenez T, Saal W, Siu OL, Stein DJ, Struijs SY, Tomoiaga CT, Valdés-García KP, Vargas-Contreras E, Vigo DV, Wang AY, Wong SYS and Kessler RC
Publicada:
1 sep 2025
Ahead of Print:
20 jun 2025
Resumen:
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.
Filiaciones:
Roest AM:
Department of Developmental Psychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
de Vries YA:
Department of Child and Adolescent Psychiatry, University Medical Center Groningen, Groningen, the Netherlands
Pozuelo JR:
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
Department of Psychiatry, University of Oxford, Oxford, UK
Petukhova MV:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Lee S:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Sampson NA:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Albor Y:
Center for Global Mental Health Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
Alhadi AN:
Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
Alonso J:
Hospital del Mar Research Institute (IMIM), Barcelona, Spain
Department of Medicine and Life Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
Al-Saud N:
Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
Altwaijri Y:
Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
Andersson C:
Department of Criminology, Malmö University, Malmö, Sweden
Atwoli L:
Brain and Mind Institute &Medical College of East Africa, the Aga Khan University, Nairobi, Kenya
Auerbach RP:
Department of Psychiatry, Columbia University, New York, NY, USA
Muaka CA:
Department of Psychology & Counselling, Daystar University, Nairobi, Kenya
Báez-Mansur PM:
Coordinación de Desarrollo Académico y Servicios Educativos, Universidad la Salle Ciudad Victoria, Ciudad Victoria, Mexico
Ballester L:
Hospital del Mar Research Institute (IMIM), Barcelona, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
Bantjes J:
Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa
Department of Psychiatry and Mental Health, University of Cape Town, South Africa
Baumeister H:
Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
Bendtsen M:
Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
Benjet C:
Center for Global Mental Health Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
Berman AH:
Department of Psychology, Uppsala University, Uppsala, Sweden
Bruffaerts R:
Center for Public Health Psychiatry, Katholieke Universiteit Leuven (KUL), Leuven, Belgium
Campus Gasthuisberg, Universitair Psychiatrisch Centrum KU Leuven (UPC-KUL), Leuven, Belgium
Carrasco P:
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
Unit of Medicine, Faculty of Health Sciences, and FISABIO, Universitat Jaume I (UJI), Castelló de la Plana, Spain
Chan SCN:
The Hong Kong University of Science and Technology, Hong Kong SAR
Cohut I:
Career Counseling and Guidance Center, Technical University of Cluj-Napoca, Romania
Couder MACD:
Coordinación de Investigación, Universidad la Salle Noroeste, Ciudad Obregón, Mexico
Crockett MA:
Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
Cuijpers P:
Faculty of Behavioural and Movement Science, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands
DATA Lab, International Institute for Advanced Studies in Psychotherapy and Applied Mental Health, Babe?-Bolyai University, Cluj-Napoca, Romania
David OA:
DATA Lab, International Institute for Advanced Studies in Psychotherapy and Applied Mental Health, Babe?-Bolyai University, Cluj-Napoca, Romania
Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
Dong D:
JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
Ebert DD:
School of Medicine and Health, Department for Sport and Health Sciences, Technical University Munich, Germany
Gaete J:
Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
Centro de Investigación en Salud Mental Estudiantil (ISME), Facultad de Ciencias Sociales, Universidad de los Andes, Santiago, Chile
Forero CG:
Departamento de Medicina, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
Gili M:
Department of Psychology, University of the Balearic Islands (UIB), Palma Mallorca, Spain
Gutiérrez-García R:
Universidad De La Salle Bajío, Campus Salamanca, Mexico
Haro JM:
Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Deu (IRSJD), Sant Boi de Llobregat, Barcelona, Spain
Hasking P:
School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
Hunt X:
Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa
Africa Health Research Institute (AHRI), Durban, South Africa
Husky MM:
Active Team, Bordeaux Population Health Research Center, INSERM U1219, University of Bordeaux, France
Jaguga F:
Department of Alcohol and Drug Abuse Rehabilitation Services, Moi Teaching and Referral Hospital, Eldoret, Kenya
Langer ÁI:
Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
Facultad de Psicología y Humanidades, Universidad San Sebastián, Valdivia, Chile
Léniz I:
Dirección de Salud Mental, Universidad de O'Higgins, Rancagua, Chile
Liu Y:
School of Public Health, Jining Medical University, Jining 272067, Shandong Province, PR China
Mac-Ginty S:
Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
Department of Health Service & Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Martínez V:
Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
ChileCentro de Medicina Reproductiva y Desarrollo Integral del Adolescente (Cemera), Facultad de Medicina, Universidad de Chile, Santiago, Chile
McLafferty M:
Personalised Medicine Centre, School of Medicine, Ulster University, Derry, Londonderry, UK
Atlantic Technological University, Donegal, Ireland
Miranda A:
Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Deu (IRSJD), Sant Boi de Llobregat, Barcelona, Spain
Monroy-Velasco IR:
Facultad de Psicología, Universidad Autónoma de Coahuila, Saltillo, Mexico
Murray EK:
Personalised Medicine Centre, School of Medicine, Ulster University, Derry, Londonderry, UK
Musyoka CM:
Department of Psychiatry, School of Medicine, University of Nairobi, Nairobi, Kenya
Nedelcea C:
Department of Psychology and Cognitive Sciences, University of Bucharest, Romania
Núñez D:
Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
Facultad de Psicología, Universidad de Talca, Talca, Chile
O'Neill SM:
School of Psychology, Ulster University, Coleraine, UK
Piqueras JA:
Department of Health Psychology, Universidad Miguel Hernandez de Elche (UMH), Alacant, Spain
Popescu CA:
Department of Human Sciences, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
Prescivalli AP:
Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Rapsey C:
Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
Robinson K:
School of Psychology, Massey University, Wellington, New Zealand
Rodriguez-Jimenez T:
Department of Psychology and Sociology, Universidad de Zaragoza (UNIZAR), Zaragoza, Spain
Saal W:
Department of Social Sciences, Sol Plaatje University, Kimberley, South Africa
Siu OL:
Department of Psychology, Lingnan University, Hong Kong, Hong Kong SAR
Stein DJ:
SA MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town &Neuroscience Institute, Cape Town, South Africa
Struijs SY:
Faculty of Behavioural and Movement Science, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands
Tomoiaga CT:
DATA Lab, International Institute for Advanced Studies in Psychotherapy and Applied Mental Health, Babe?-Bolyai University, Cluj-Napoca, Romania
Valdés-García KP:
Facultad de Psicología, Universidad Autónoma de Coahuila, Saltillo, Mexico
Vargas-Contreras E:
Facultad de Ciencias Administrativas y Sociales, Universidad Autónoma de Baja California, Mexico
Vigo DV:
Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Wang AY:
Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Wong SYS:
JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
Kessler RC:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Green Submitted, hybrid
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