Mental disorder comorbidity and suicidal thoughts and behaviors in the World Health Organization World Mental Health Surveys International College Student initiative

Abstract

Objectives Comorbidity is a common feature of mental disorders. However, needs assessment surveys focus largely on individual disorders rather than on comorbidity even though the latter is more important for predicting suicidal thoughts and behaviors. In the current report, we take a step beyond this conventional approach by presenting data on the prevalence and correlates (sociodemographic factors, college‐related factors, and suicidal thoughts and behaviors) of the main multivariate profiles of common comorbid Diagnostic and Statistical Manual of Mental Disorders (DSM)‐IV disorders among students participating in the first phase of the World Health Organization World Mental Health International College Student initiative. Method A web‐based mental health survey was administered to first year students in 19 colleges across eight countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, United States; 45.5% pooled response rate) to screen for seven common DSM‐IV mental disorders: major depression, mania/hypomania, generalized anxiety disorder, panic disorder, attention‐deficit/hyperactivity disorder, alcohol use disorder, and drug use disorder. We focus on the 14,348 respondents who provided complete data; 38.4% screened positive for at least one 12‐month disorder. Results Multivariate disorder profiles were detected using latent class analysis (LCA). The least common class (C1; 1.9% of students) was made up of students with high comorbidity (four or more disorders, the majority including mania/hypomania). The remaining 12‐month cases had profiles of internalizing–externalizing comorbidity (C2; 5.8%), internalizing comorbidity (C3; 14.6%), and pure disorders (C4; 16.1%). The 1.9% of students in C1 had much higher prevalence of suicidal thoughts and behaviors than other students. Specifically, 15.4% of students in C1 made a suicide attempt in the 12 months before the survey compared with 1.3–2.6% of students with disorders in C2–4, 0.2% of students with lifetime disorders but no 12‐month disorders (C5), and 0.1% of students with no lifetime disorders (C6). Conclusions In line with prior research, comorbid mental disorders were common; however, sociodemographic correlates of LCA profiles were modest. The high level of comorbidity underscores the need to develop and test transdiagnostic approaches for treatment in college students.

Lifetime and 12‐month treatment for mental disorders and suicidal thoughts and behaviors among first year college students

“…As reported in previous WMH‐ICS publications (Auerbach et al, ; Mortier et al, ) and in a prior report in this issue (Auerbach et al, ), around one third of participants met criteria for lifetime mental disorder (mostly major depressive episode [MDE] [21.2%] or GAD [18.6%]—Table ) or reported lifetime STB (mostly suicidal ideation [14.8%]). Approximately one student in five had both STB and mental disorder in their lifetime; whereas approximately half of the students never experienced any mental disorder nor STB.…”

The role impairment associated with mental disorder risk profiles in the WHO World Mental Health International College Student Initiative

“…As described in more detail elsewhere in this issue (Auerbach et al, in press), a majority of respondents (54.8%, ranging from 51.4% in Germany to 60.7 in the United States) were female and most others male (44.7%, range = 38.2% to 51.0%), with the small remaining number defining themselves as either transsexual or “other” (0.5%, range = 0.0% to 1.2%). Most respondents were either 16–18 years of age (51.1%), 19 (25.8%), or 20–21 (12.2%).…”

Introduction to the special issue: The WHO World Mental Health International College Student (WMH‐ICS) initiative

“…The next four papers focus on the initial wave of epidemiological surveys carried out in WMH‐ICS, which consist of surveys in 19 colleges across eight countries that yielded information on more than 14,000 students. The first of these papers, by Auerbach et al (2018), presents an overview of the surveys along with information about the prevalence and basic socio‐demographic distributions of common mental disorders in the surveys. Auerbach and colleagues not only show that mental disorders are widely distributed across the student population but also that they commonly co‐occur and that this co‐occurrence may have profound implications for treatment.…”