Major depressive episode among university students in Southern Brazil

Variables Associated with the Use of Psychotropic Medications by Brazilian University Students

BACKGROUND

University life is a phase of developing personal and professional skills, but it brings challenges such as distancing from family and supporting networks, difficulties with academic tasks, loneliness, new relationships, competitiveness, and social, socioeconomic, and psychological vulnerability, among others. These conditions can lead to the development of illnesses such as anxiety, depression, sleeping disorders, suicide, self-harming, and excessive drug use, including psychotropic medications. Therefore, this study aimed to evaluate the use of psychotropic medications and its association with sociodemographic, academic, behavioral, and health variables in Brazilian university students.

METHODS

A cross-sectional, quantitative research, with a sampling of 524 students from a Brazilian public Higher Education Institution (Federal University of Mato Grosso - UFMT). The collection took place from October 10th to December 30th, 2022. An online questionnaire was applied with sociodemographic and clinical questions-the General Anxiety Disorder Questionnaire-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). The data were descriptively and inferentially analyzed; in the descriptive analysis, the absolute (FA) and relative (FR) frequencies of each category investigated were presented; and for bi- and multivariate analyses, Poisson regression with robust estimation was used.

RESULTS

The participants were at the median age of 22 years old, the majority were female (69.7%), heterosexual (68.1%), with medium/high subjective social status (82.4%) and without being involved in a romantic relationship (54%). The prevalence of psychotropic medication use was 26.1%, considering that 17.5% was not prescribed by a medical professional. The most used class of medications was antidepressants (91 participants), followed by natural medicines (38 participants). Among the segments associated with the use of psychotropic drugs were female individuals, romantic relationships, perception of academic performance by postgraduate students, and previous diagnoses of mental or mood disorders (depression and anxiety).

CONCLUSIONS

The results obtained highlight the importance of research on mental health among university students, especially regarding the use of psychotropic drugs, which must be monitored by a qualified professional. At the university, these data can be important for the development of policies aimed at health and life quality, in addition to contributing to the strengthening of national and international partnerships, and promoting the scientific production in the area.

Depression and Substance Use Among Brazilian University Students During the COVID-19 Pandemic

The prevalence of depression and substance use changed significantly during the COVID-19 pandemic. The present study explored the association between the use of psychoactive substances and depression in Brazilian university students. This cross-sectional study was conducted between 2021 and 2022. A sample of 1271 students were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Hierarchical multivariate logistic regression models were used to assess the association between tobacco use, alcohol consumption, illicit substance use, and depression. Among the participants, 424 (33.4%; 95%CI 30.7-36) screened positive for depression (PHQ-9 ≥ 10). Alcohol was the most consumed substance. Recent use of illicit substances was associated with depression (adjusted odds ratio [aOR] 1.59; CI 1.02-2.50). The pattern of moderate or high-risk tobacco use (aOR 2.11; CI 1.31-3.42), alcohol use (aOR 3.40; CI 2.29-5.06), and illicit substances (aOR 1.82; CI 1.15-2.89) were associated with higher chances of depression in adjusted models. Findings highlight the importance of implementing support for mental health among university students. These policies are crucial for addressing maladaptive behaviors, such as substance use, and for mitigating psychological distress, such as depression, which has been exacerbated during the pandemic.

Co-occurrence of obesogenic behaviors and their implications for mental health during the COVID-19 pandemic: a study with university students

BACKGROUND

The university years are a critical period for young adults, as they are more exposed to obesogenic behaviors and experience stressful situations that compromise their mental health. This study aims to estimate the prevalence of anxiety and depression symptoms and evaluate the association between the combined occurrence of obesogenic behaviors among university students.

METHODS

A cross-sectional study was conducted on students from a public university in Brazil during the COVID-19 pandemic. Data were collected from July to August 2020 using an online questionnaire. The outcome variables (anxiety and depression symptoms) were assessed using the Depression, Anxiety and Stress Scale-21 (DASS-21). The co-occurrence of obesogenic behaviors was measured based on irregular consumption of fruits and vegetables, frequent consumption of ultra-processed foods, physical inactivity during leisure time, and sedentary behavior. A Venn diagram was used for the exploratory analysis. To verify the association between the outcome and explanatory variables, a directed acyclic graph model was constructed, and multivariate logistic regression was performed to calculate odds ratios (ORs) and 95% confidence intervals (95%CIs).

RESULTS

A total of 1,353 students aged 18-24 years participated in this study. Symptoms of anxiety and depression were present in 46.1% and 54.6% of the participants, respectively. The most prevalent combination of obesogenic behaviors was frequent consumption of ultra-processed foods, physical inactivity during leisure time, and sedentary behavior (17.2%). The greater the number of simultaneous obesogenic behaviors, the higher the chance to present symptoms of anxiety [OR: 2.81 (95%CI: 1.77-4.46)] and depression [OR: 3.46 (95%CI: 2.20-5.43)].

CONCLUSION

These findings reinforce the need to take actions to promote mental health in the university environment in conjunction with programs to promote a healthy lifestyle and improve the physical and mental well-being of students.

Analysis of the dimensional structure of the Patient Health Questionnaire-9 (PHQ-9) in undergraduate students at a public university in Brazil

BACKGROUND

The prevalence of mental health-related problems has increased in recent years, especially among young adults, such as university students. Several measurement instruments have been developed to identify individuals at risk for depression, such as the Patient Health Questionnaire-9 (PHQ-9). However, different dimensional structures of the PHQ-9 can make it difficult to interpret and compare research results. To analyze the dimensional structure and convergent validity of the PHQ-9 in university students.

METHODS

This is a cross-sectional study developed with 3163 students enrolled in different courses at a university in southern Brazil. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to identify the most parsimonious and best-fitting model. Convergent validity was verified through the significant relationship (p < 0.05) between theoretically related constructs (sleep quality, alcohol consumption, and physical activity practice).

RESULTS

The EFA resulted in two models (unidimensional and two-dimensional), with better indices for the two-dimensional model. In the CFA, both the unidimensional and the two-dimensional models presented satisfactory fit indices that were higher for the unidimensional model.

LIMITATIONS

The analysis of convergent validity is limited by the absence of a gold standard for comparison.

CONCLUSIONS

This study provided support for the unidimensional structure of the PHQ-9, with adequate convergent validity, among university students.

Mood disorders in higher education in Flanders during the 2nd and 3rd COVID-19 wave: Prevalence and help-seeking: Findings from the Flemish College Surveys (FLeCS)

To examine the prevalence of 12-month mood disorders and receipt of mental health treatment among a volunteer sample of higher education students during the 2nd and 3rd COVID-19 wave in the Flanders region. Web-based self-report surveys were obtained from 9101 students in higher education in the Flemish College Surveys (FLeCS) in Flanders, Belgium. As part of the World Health Organization's World Mental Health-International College Student Initiative, we screened for 12-month mood disorders (major depressive episode (MDE), mania/hypomania), and service use. We used poststratification weights to generate population-representative data on key socio-demographic characteristics. 50.6% of the respondents screened positive for 12-month mood disorders (46.8% MDE, of which 22.9% with very severe impact). Use of services was very low, with estimates of 35.4% for MDE, 31.7% for mania, and 25.5% for hypomania. Even among students with very severe disorders, treatment rates were never higher than 48.3%. Most common barriers for not using services were: the preference to handle the problem alone (83.4%) and not knowing where to seek professional help (79.8%). We found a high unmet need for mood problems among college students; though caution is needed in interpreting these findings given the volunteer nature of the sample. A reallocation of treatment resources for higher education students should be considered, particulary services that focus on innovative, low-threshold, and scalable interventions.

Depression and anxiety among the University community during the Covid-19 pandemic: a study in Southern Brazil

This study aimed to assess the mental health of a University community in South Brazil during the COVID-19 pandemic. A cross-sectional web-based survey was conducted between July-August 2020 through a self-administered questionnaire. All University staff and students were eligible. Depression was measured using the Patient Health Questionnaire-9 and anxiety by the Generalized Anxiety Disorder-7. To evaluate the effect of social distancing and mental health factors on outcomes, Poisson regression models with robust variance were performed, estimating Prevalence Ratios (PR) and 95% Confidence Intervals (95%CI). 2,785 individuals participated in the study. Prevalence of depression and anxiety were 39.2% (95%CI 37.3-41.1) and 52.5% (95% CI 50.6-54.4), respectively. Undergraduate students showed a higher prevalence of the outcomes. Not leaving the house routinely, mental health care, and previous diagnosis of mental illness were associated with both outcomes. Those with a previous medical diagnosis of depression had a 58% (PR 1.58; 95%CI 1.44; 1.74) and anxiety a 72% (PR 1.72; 95%CI 1.56; 1.91) greater prevalence of depression than their peers. An alarming prevalence of psychopathologies was observed. Despite the well-known benefits of social distancing to public health, it requires a surveillance on the population's mental health, especially students and those with previous mental illness diagnosis.

Key characteristics including sex, sexual orientation and internet use associated with worse mental health among university students in Brazil and implications

BACKGROUND

The symptoms of anxiety and depression disorders are multifactorial and can trigger a series of problems especially among university students. The aim of this study was to assess the prevalence and associated factors with anxiety and depression symptoms among first-semester university students at a Federal University in Brazil given the paucity of such data and the first semester is the most stressfultime.

METHODS

Cross-sectional study with first-semester university students. The questionnaire included socio-demographic variables, lifestyles, health conditions and the Depression Anxiety Stress Scales. Descriptive analysis was performed, followed by bivariate analysis and Poisson regression analysis.

RESULTS

Three hundred and fifty-six students (65.2%) across a range of courses in their first semester participated. The prevalence of anxiety was 42.5% and depression 33.2%. Regarding symptoms of anxiety and depression disorders, a positive association was observed among females, non-heterosexual, non-white skin color, excessive internet use, lack of physical activity, not attending university parties, having psychological counseling, history of anxiety in first- or second-degree relatives, poor self-rated health and use of psychotropic medicines.

CONCLUSIONS

Due to the high prevalence of anxiety and depression symptoms, the importance of developing programs to promote mental and physical health of university students is highlighted.

Validity and reliability of the Patient Health Questionnaire scale (PHQ-9) among university students of Bangladesh

This study investigated the reliability and factorial validity of Patient Health Questionnaire-9 (PHQ-9) in the context of university students in Bangladesh. The research aimed to assess whether the original one-dimensional model or a model containing both somatic and cognitive-emotional factors is appropriate in the case of a sample of university students. A repeated cross-sectional survey design based on convenience sampling was used to collect data from 677 university students from both public and private universities. The factor structure of the PHQ-9 was assessed using confirmatory factor analysis (CFA). Measurement invariances were assessed across gender, type of university, level of education and victim of domestic violence. Its convergent validity was determined by investigating its correlations with Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS). Results showed excellent reliability of PHQ-9 as measured by both Cronbach's α and McDonald's ω. CFA suggested that a modified one-factor model where the error variances between item-3 ('sleeping difficulties') and item-6 ('feeling as a failure'), item-6 and item-9 ('suicidal thoughts'), item-4 ('feeling tired') and item-9, item-3 and item-9 were allowed to covary is appropriate for the sample. This model provided high values of comparative fit index (CFI), goodness of fit index (GFI), and Tucker Lewis Index (TLI), low value of standardized root mean square residual (SRMR) and a non-significant root mean square error of approximation (RMSEA) as well as a high Factor Determinacy Score Coefficient. Correlation between PHQ-9 and GAD-7 was 0.751 and 0.934 between PHQ-9 and PHQ-ADS. Finally, the model is strictly invariant across gender and university type. Overall, the study provided support for modified unidimensional structure for PHQ-9 and showed high internal consistency along with good convergent validity.

Dietary practices of university students according to the Dietary Guidelines for the Brazilian Population: PADu study

ABSTRACT Objective To evaluate factors associated with dietary practices in students of a institution of higher education, included in the PADu study: “Anxiety and depression symptoms among university students in Minas Gerais: a longitudinal study”. Methods Cross-sectional study of PADu project baseline with undergraduate first period students, who responded in person to a printed and self-administered questionnaire. Dietary practices were evaluated through a 24 items scale based on recommendations of Dietary Guidelines for the Brazilian Population. Answer choices are four-point Likert scale: “strongly agree”, “agree”, “disagree” and “strongly disagree”. The sum of the items corresponded a score ranging (0-72 points), a high score indicating greater adequacy. The explanatory variables were: sociodemographics (gender, age, knowledge area, skin color, marital status, monthly household income), behaviors (excess alcohol consumption, physical exercise, screen exposure, internet use), health conditions (self-rated health, nutritional status, symptoms of depression, anxiety, stress). Adjusted multiple linear regression model was used to estimate the coefficients and their 95% CI. Results 356 students participated in the study. The average of dietary practices was 34.9±9.3 (0-63) points. Physical exercise practice (β: 3.75; CI: 1.83; 5.67) was associated with higher scores in the eating students score. We observed factors associated with the lowest score greater exposure to screens (β: -0.44; CI: -0.67; -0.13), excessive internet use (β: -3.05; CI: -5.22; -0.88), poor health self-assessment (β: -3.63; CI: -4.97; -1.21), excessive alcohol consumption (β: -2.09; CI: -3.92;-0.26) and stress symptoms (β: -2.81; CI: -4.72; -0.77). Conclusion Most students have inadequate dietary practices associated with internet use, alcohol consumption and stress.

Factors Related to Depressive Symptoms in University Students

Objective: To identify and discuss the frequency of depressive symptoms and their associated factors in university students. Materials and method: This is a cross-sectional and descriptive study with a quantitative approach, conducted in a Higher Education Institution. The study was developed with a convenience sample consisting of 571 undergraduate students from different areas. A questionnaire was used to collect sociodemographic/academic data, as well as depressive symptoms and their associations, life habits, emotional aspects, and possible eating disorders. For data analysis, descriptive statistics and Pearson’s chi-square test were used for associations, with a significance level of 5 % (p-value ≤ 0.05). Results: The university students presented depressive symptoms such as sleep disorders (61.1 %) and reduced self-confidence (50.9 %). There was an association of depressive symptoms with the course, satisfaction with academic performance, obesity, consumption of sugars and sweets, and practice and frequency of physical activity. Conclusions: It is expected that the results of this research contribute to the population’s critical and reflective thinking to expand visibility and scientific studies referring to the theme, as well as to increase resources for the management of mental health and reduce the stigmas generated.

Major depressive episode externalizing symptoms among university students

INTRODUCTION

Depression affects 32% of university students and Major Depressive Episode (MDE) externalizing symptoms indicate the severity of the case. This study assessed MDE externalizing symptom prevalence and associated factors among university students, with emphasis on aspects related to the academic environment, including interpersonal relationships and study area chosen by students.

METHODS

A census was performed on new students in the first semester of 2017 at a university in Southern Brazil. Depressive symptom prevalence was assessed by the Patient Health Questionnaire-9. The multivariate analysis of the associated factors followed a hierarchical model, using Poisson regression with backward selection.

RESULTS

MDE externalizing symptoms were present in 20% of the university students and were more frequent among females, those with brown, black or other skin color in comparison to those with white skin color. Individuals with a family history of depression, minority sexual orientation, negative self-reported academic performance, students taking courses in the area of Linguistics, Modern Languages and Arts and students who reported strong conflicts with university teachers or colleagues also had higher prevalence of externalizing symptoms.

CONCLUSION

It is important for education institutions to train teachers to identify and deal adequately with students who have externalizing symptoms of MDE. In addition, education institutions need to pay attention to conflicts, both between students and also between students and teachers in order to take preventive measures in these circumstances.

Symptoms of Depression, Anxiety, and Stress and Prevalence of Major Depression and Its Predictors in Female University Students

Depression, anxiety and stress are increasingly concerning phenomena in our society, with serious consequences on physical and mental health. The repercussions may be particularly devastating in particular population subgroups, such as female university students. The purpose of this study was to determine the levels of depression, anxiety, and stress and the prevalence of depression and associated factors, in Spanish university women. A cross-sectional study was conducted with a random sample of 871 students from the Santiago de Compostela University (mean age 20.7 years, SD = 2.8). Information was collected on sociodemographic and academic characteristics; symptoms of depression, anxiety, and stress; diagnosis of major depression; optimism, resilience, social support, life engagement, and five personality domains, using validated instruments. Of the participants, 18.1%, 22.8% and 13.5% presented with severe/very severe levels of depression, anxiety and stress, respectively. A total of 12.9% had major depression. Higher life engagement was associated with lower risk of depression (OR = 0.92, 95% CI 0.87–0.98), while higher levels of neuroticism (OR = 1.20, 95% CI, 1.12–1.28) and openness to experience (OR = 1.08, 95% CI, 1.02–1.14) were associated with greater risk. These findings reveal an alarming percentage of female university students who experience major depression and severe/very severe stress.

Prevalence of depression and its relationship with quality of life among university students in Macau, Hong Kong and mainland China

There is compelling evidence that depressive symptoms (depression hereafter) are common in university students and are considerably influenced by the given socioeconomic context. Being former European colonies, Macau and Hong Kong are China’s special administrative regions, with different sociocultural and economic background compared to mainland China. This study compared the prevalence of depression in university students between Macau, Hong Kong and mainland China and examined the association between depression and quality of life (QOL). The Beck Depression Inventory-II and the World Health Organization Quality of Life—Brief Version (WHOQOL-BREF) were used to measure depression and QOL, respectively. Altogether, 2,312 university students participated in this study. The overall prevalence of depression was 28.9%; 35.2% in Macau, 41.0% in Hong Kong, and 16.8% in mainland China. Compared to the “No depression” group, students with depression had significantly lower QOL scores in the physical, psychological, social and environmental domains. Factors associated with depression were different between the three study sites. Sleep disturbances and high academic pressure were positively associated with depression in all the three samples. In mainland China, male students (OR = 1.68; 95% CI: 1.10–2.56) were more likely to have depression while those who were interested in their major (OR = 0.45; 95% CI: 0.29–0.69) were less likely to have depression. In Macau, students in Grade 3 (OR = 0.56; 95% CI: 0.36–0.89) and those who were interested in their major (OR = 0.58; 95% CI: 0.42–0.81) or had optimistic perspective about their future (OR = 0.51; 95% CI: 0.36–0.73) were less likely to have depression. Nursing students (OR = 1.86; 95% CI: 1.21–2.87) and students with the average score on major subject less than 65 (OR = 3.13; 95% CI: 1.70–5.78) were more likely to have depression. In Hong Kong, students with optimistic perspective about their future (OR = 0.44; 95% CI: 0.22–0.91) were less prone to have depression. Depression is common among Chinese university students, particularly in Macau and Hong Kong. Considering the negative impact of depression on QOL, regular screening and effective treatments should be offered to this population.

Prevalence and Socio-Demographic, Academic, Health and Lifestyle Predictors of Illicit Drug/s Use among University Undergraduate Students in Finland

Illicit drug/s use (IDU) among university students is a public health concern. We assessed the associations between socio-demographic, academic, and health and lifestyle characteristics (independent variables) and regular, occasional or never IDU (dependent variables). Data were collected across seven faculties (1177 students) at the University of Turku (Finland) via an online questionnaire. About 1.5% of the sample had regular IDU, 19% occasional IDU, and 79% never IDU. Independent predictors of ever (lifetime) IDU included males [adjusted odds ratio (AOR) 1.82, P = 0.001], not living with parents (AOR 2.59, P < 0.001), singles (AOR 0.51, P < 0.001), lower religiosity (AOR 1.49, P = 0.022), better self-rated general health (AOR 0.41, P = 0.003), higher health awareness (AOR 1.93, P = 0.014), more depressive symptoms (AOR 1.82, P = 0.004), daily smokers (AOR 3.69, P < 0.001), heavy episodic drinking (AOR 2.38, P < 0.001) and possible alcohol dependency (AOR 2.55, P < 0.001). We observed no independent associations between ever IDU with age, study discipline, perceived stress or academic performance. The 20.5% ever IDU is concerning. The compelling independent predictors of ever IDU included not living with parents, lower religiosity, daily smokers, heavy episodic drinking and possible alcohol dependency (AOR range 2.38-3.69). Education and prevention need to emphasize the negative consequences to reinforce abstinence from IDU. Health promotion could focus on beliefs and expectations about IDU and target students at risk for successful efforts.