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. 2025 Sep:351:116605.
doi: 10.1016/j.psychres.2025.116605. Epub 2025 Jun 20.

Comorbidity and temporal associations between mental disorders among college students in the world mental health international college student initiative

Annelieke M Roest  1 Ymkje Anna de Vries  2 Julia R Pozuelo  3 Maria V Petukhova  4 Sue Lee  4 Nancy A Sampson  4 Yesica Albor  5 Ahmad N Alhadi  6 Jordi Alonso  7 Nouf Al-Saud  8 Yasmin Altwaijri  8 Claes Andersson  9 Lukoye Atwoli  10 Randy P Auerbach  11 Caroline Ayuya Muaka  12 Patricia M Báez-Mansur  13 Laura Ballester  14 Jason Bantjes  15 Harald Baumeister  16 Marcus Bendtsen  17 Corina Benjet  5 Anne H Berman  18 Ronny Bruffaerts  19 Paula Carrasco  20 Silver C N Chan  21 Irina Cohut  22 María Anabell Covarrubias Díaz Couder  23 Marcelo A Crockett  24 Pim Cuijpers  25 Oana A David  26 Dong Dong  27 David D Ebert  28 Jorge Gaete  29 Carlos García Forero  30 Margalida Gili  31 Raúl Gutiérrez-García  32 Josep Maria Haro  33 Penelope Hasking  34 Xanthe Hunt  35 Mathilde M Husky  36 Florence Jaguga  37 Álvaro I Langer  38 Irene Léniz  39 Yan Liu  40 Scarlett Mac-Ginty  41 Vania Martínez  42 Margaret McLafferty  43 Andrea Miranda  33 Iris Ruby Monroy-Velasco  44 Elaine K Murray  45 Catherine M Musyoka  46 Catalin Nedelcea  47 Daniel Núñez  48 Siobhan M O'Neill  49 José A Piqueras  50 Codruta A Popescu  51 Ana Paula Prescivalli  52 Charlene Rapsey  53 Kealagh Robinson  54 Tiscar Rodriguez-Jimenez  55 Wylene Saal  56 Oi-Ling Siu  57 Dan J Stein  58 Sascha Y Struijs  59 Cristina T Tomoiaga  60 Karla Patricia Valdés-García  44 Eunice Vargas-Contreras  61 Daniel V Vigo  62 Angel Y Wang  52 Samuel Y S Wong  27 Ronald C Kessler  4 World Mental Health International College Student collaborators
Collaborators, Affiliations
Free article

Comorbidity and temporal associations between mental disorders among college students in the world mental health international college student initiative

Annelieke M Roest et al. Psychiatry Res. 2025 Sep.
Free article

Abstract

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.

Keywords: College students; Comorbidity; Externalizing; Internalizing; Substance use disorders.

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Conflict of interest statement

Declaration of competing interest RB reports grant funding from Eli Lilly (IIT-H6U-BX-I002). DDE has served as a consultant to/on the scientific advisory boards of Sanofi, Novartis, Minddistrict, Lantern, Schoen Kliniken, Ideamed and German health insurance companies (BARMER, Techniker Krankenkasse) and a number of federal chambers for psychotherapy. He is also shareholder of "GET.ON Institut für Online Gesundheitstrainings GmbH für Gesundheitstrainings online GmbH" (HelloBetter), which aims to implement scientific findings related to digital health interventions into routine care. XH has received grants from Sexual Violence Research Institute, Volkswagen Foundation, Wellspring Philanthropies, Foreign, Commonwealth and Development Office (UK government), PANDA Holding Limited, National Research Foundation of South Africa, Center for Inclusive Policy. XH reports consulting fees from Mastercard Foundation, Missing Billion Initiative, UNICEF, International Food Policy Research Institute and the African Union. Hunt has received funding support to attend conferences from Mastercard Foundation and Charité University (Germany). MMH reports consulting fees from Child Mind Institute, New York. In the past 3 years, RCK was a consultant for Cambridge Health Alliance, Canandaigua VA Medical Center, Child Mind Institute, Holmusk, Massachusetts General Hospital, Partners Healthcare, Inc., RallyPoint Networks, Inc., Sage Therapeutics and University of North Carolina. He has stock options in Cerebral Inc., Mirah, PYM (Prepare Your Mind), Roga Sciences and Verisense Health. DJS has received consultancy honoraria from Discovery Vitality, Johnson & Johnson, Kanna, L’Oreal, Lundbeck, Orion, Servier, Seaport Therapeutics, Takeda, Vistagen, and Wellcome. DVV reports grant support from Health Canada, Canadian Institutes for Health Research, Provincial Health Services Authority and an internal research grant from the University of British Columbia. He received payments from the Canadian Ministry of Health and the Department of Interior Health for projects related to mental health service provision.