Comorbidity and temporal associations between mental disorders among college students in the world mental health international college student initiative
- PMID: 40582274
- DOI: 10.1016/j.psychres.2025.116605
Comorbidity and temporal associations between mental disorders among college students in the world mental health international college student initiative
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.
Copyright © 2025. Published by Elsevier B.V.
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.
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