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Borges G, Orozco R, Gunnell D, Gutiérrez-García RA, Albor Y, Quevedo Chávez GE, Hernández Uribe PC, Cruz Hernández S, Covarrubias Díaz Couder MA, Alonso J, Medina-Mora ME, Benjet C. Suicidal Ideation and Behavior Among Mexican University Students Before and During the COVID-19 Pandemic. Arch Suicide Res 2024; 28:342-357. [PMID: 36762658 DOI: 10.1080/13811118.2023.2176270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has affected the mental health of populations around the world, but few longitudinal studies of its impact on suicidal thoughts and behaviors have been published especially from low- and middle-income countries. METHODS This is a prospective cohort study of 1,385 first-year students from 5 Universities in Mexico followed-up for 1 year. We report 1-year cumulative incidence of suicidal thoughts and behaviors before (September 19, 2019-March 29, 2020) and during the COVID-19 period (March 30, 2020-June 30, 2020), focusing on those in the COVID-19 period with risk conditions and positive coping strategies during the pandemic. RESULTS There was an increase in the incidence of suicidal ideation during the COVID-19 period compared to the pre-COVID-19 period (RR 1.65, 95%CI 1.08-2.50). This increase was mostly found among students with heightened sense of vulnerability (RR 1.95), any poor coping behavior (RR 2.40) and a prior mental disorder (RR 2.41). While we found no evidence of an increased risk of suicidal planning or attempts, there was evidence that those without lifetime mental health disorders were at greater risk of suicidal plans than those with these disorders especially if they had poor coping strategies (RR 3.14). CONCLUSION In the short term, how students deal with the pandemic, being at high risk and having poor coping behavior, increased the new occurrence of suicidal thoughts and behaviors. Studies with longer follow-up and interventions to reduce or enhance these behaviors are needed.HIGHLIGHTSSuicidal ideation increased during the COVID-19 periodThose with heightened sense of vulnerability and poor coping were more affectedStudies with longer follow-up are needed.
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Benjet C, Albor Y, Alvis-Barranco L, Contreras-Ibáñez CC, Cuartas G, Cudris-Torres L, González N, Cortés-Morelos J, Gutierrez-Garcia RA, Medina-Mora ME, Patiño P, Vargas-Contreras E, Cuijpers P, Gildea SM, Kazdin AE, Kennedy CJ, Luedtke A, Sampson NA, Petukhova MV, Zainal NH, Kessler RC. Internet-delivered cognitive behavior therapy versus treatment as usual for anxiety and depression among Latin American university students: A randomized clinical trial. J Consult Clin Psychol 2023; 91:694-707. [PMID: 38032621 PMCID: PMC11078571 DOI: 10.1037/ccp0000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
OBJECTIVE Untreated mental disorders are important among low- and middle-income country (LMIC) university students in Latin America, where barriers to treatment are high. Scalable interventions are needed. This study compared transdiagnostic self-guided and guided internet-delivered cognitive behavioral therapy (i-CBT) with treatment as usual (TAU) for clinically significant anxiety and depression among undergraduates in Colombia and Mexico. METHOD 1,319 anxious, as determined by the Generalized Anxiety Disorder-7 (GAD-7) = 10+ and/or depressed, as determined by the Patient Health Questionnaire-9 (PHQ-9) = 10+, undergraduates (mean [SD] age = 21.4 [3.2]); 78.7% female; 55.9% first-generation university student) from seven universities in Colombia and Mexico were randomized to culturally adapted versions of self-guided i-CBT (n = 439), guided i-CBT (n = 445), or treatment as usual (TAU; n = 435). All randomized participants were reassessed 3 months after randomization. The primary outcome was remission of both anxiety (GAD-7 = 0-4) and depression (PHQ-9 = 0-4). We hypothesized that remission would be higher with guided i-CBT than with the other interventions. RESULTS Intent-to-treat analysis found significantly higher adjusted (for university and loss to follow-up) remission rates (ARD) among participants randomized to guided i-CBT than either self-guided i-CBT (ARD = 13.1%, χ12 = 10.4, p = .001) or TAU (ARD = 11.2%, χ12 = 8.4, p = .004), but no significant difference between self-guided i-CBT and TAU (ARD = -1.9%, χ12 = 0.2, p = .63). Per-protocol sensitivity analyses and analyses of dimensional outcomes yielded similar results. CONCLUSIONS Significant reductions in anxiety and depression among LMIC university students could be achieved with guided i-CBT, although further research is needed to determine which students would most likely benefit from this intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Corina Benjet
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Yesica Albor
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | | | - Gina Cuartas
- Facultad de Psicología, Universidad Cooperativa de Colombia, Medellin, Colombia
| | - Lorena Cudris-Torres
- Programa de Psicología, Fundación Universitaria del Area Andina, Valledupar, Colombia
| | - Noé González
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Jacqueline Cortés-Morelos
- Departamento de Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Maria Elena Medina-Mora
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Pamela Patiño
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Eunice Vargas-Contreras
- Facultad de Ciencias Administrativas y Sociales, Universidad Autónoma de Baja California, Ensenada, Mexico
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - Sarah M. Gildea
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Alan E. Kazdin
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Chris J. Kennedy
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Alex Luedtke
- Department of Statistics, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Maria V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Nur Hani Zainal
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Benjet C, Zainal NH, Albor Y, Alvis-Barranco L, Carrasco-Tapias N, Contreras-Ibáñez CC, Cudris-Torres L, de la Peña FR, González N, Guerrero-López JB, Gutierrez-Garcia RA, Jiménez-Peréz AL, Medina-Mora ME, Patiño P, Cuijpers P, Gildea SM, Kazdin AE, Kennedy CJ, Luedtke A, Sampson NA, Petukhova MV, Kessler RC. A Precision Treatment Model for Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression Among University Students: A Secondary Analysis of a Randomized Clinical Trial. JAMA Psychiatry 2023; 80:768-777. [PMID: 37285133 PMCID: PMC10248814 DOI: 10.1001/jamapsychiatry.2023.1675] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/10/2023] [Indexed: 06/08/2023]
Abstract
Importance Guided internet-delivered cognitive behavioral therapy (i-CBT) is a low-cost way to address high unmet need for anxiety and depression treatment. Scalability could be increased if some patients were helped as much by self-guided i-CBT as guided i-CBT. Objective To develop an individualized treatment rule using machine learning methods for guided i-CBT vs self-guided i-CBT based on a rich set of baseline predictors. Design, Setting, and Participants This prespecified secondary analysis of an assessor-blinded, multisite randomized clinical trial of guided i-CBT, self-guided i-CBT, and treatment as usual included students in Colombia and Mexico who were seeking treatment for anxiety (defined as a 7-item Generalized Anxiety Disorder [GAD-7] score of ≥10) and/or depression (defined as a 9-item Patient Health Questionnaire [PHQ-9] score of ≥10). Study recruitment was from March 1 to October 26, 2021. Initial data analysis was conducted from May 23 to October 26, 2022. Interventions Participants were randomized to a culturally adapted transdiagnostic i-CBT that was guided (n = 445), self-guided (n = 439), or treatment as usual (n = 435). Main Outcomes and Measures Remission of anxiety (GAD-7 scores of ≤4) and depression (PHQ-9 scores of ≤4) 3 months after baseline. Results The study included 1319 participants (mean [SD] age, 21.4 [3.2] years; 1038 women [78.7%]; 725 participants [55.0%] came from Mexico). A total of 1210 participants (91.7%) had significantly higher mean (SE) probabilities of joint remission of anxiety and depression with guided i-CBT (51.8% [3.0%]) than with self-guided i-CBT (37.8% [3.0%]; P = .003) or treatment as usual (40.0% [2.7%]; P = .001). The remaining 109 participants (8.3%) had low mean (SE) probabilities of joint remission of anxiety and depression across all groups (guided i-CBT: 24.5% [9.1%]; P = .007; self-guided i-CBT: 25.4% [8.8%]; P = .004; treatment as usual: 31.0% [9.4%]; P = .001). All participants with baseline anxiety had nonsignificantly higher mean (SE) probabilities of anxiety remission with guided i-CBT (62.7% [5.9%]) than the other 2 groups (self-guided i-CBT: 50.2% [6.2%]; P = .14; treatment as usual: 53.0% [6.0%]; P = .25). A total of 841 of 1177 participants (71.5%) with baseline depression had significantly higher mean (SE) probabilities of depression remission with guided i-CBT (61.5% [3.6%]) than the other 2 groups (self-guided i-CBT: 44.3% [3.7%]; P = .001; treatment as usual: 41.8% [3.2%]; P < .001). The other 336 participants (28.5%) with baseline depression had nonsignificantly higher mean (SE) probabilities of depression remission with self-guided i-CBT (54.4% [6.0%]) than guided i-CBT (39.8% [5.4%]; P = .07). Conclusions and Relevance Guided i-CBT yielded the highest probabilities of remission of anxiety and depression for most participants; however, these differences were nonsignificant for anxiety. Some participants had the highest probabilities of remission of depression with self-guided i-CBT. Information about this variation could be used to optimize allocation of guided and self-guided i-CBT in resource-constrained settings. Trial Registration ClinicalTrials.gov Identifier: NCT04780542.
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Affiliation(s)
- Corina Benjet
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Nur Hani Zainal
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Yesica Albor
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | | | | | - Lorena Cudris-Torres
- Programa de Psicología, Fundación Universitaria del Area Andina, Valledupar, Colombia
| | - Francisco R. de la Peña
- Unidad de Fomento a la Investigacion, Direccion de Servicios Clínicos, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Noé González
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | | | - Ana Lucía Jiménez-Peréz
- Facultad de Ciencias Administrativas y Sociales, Universidad Autónoma de Baja California, Ensenada, Mexico
| | - Maria Elena Medina-Mora
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Pamela Patiño
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Sarah M. Gildea
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Alan E. Kazdin
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Chris J. Kennedy
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Alex Luedtke
- Department of Statistics, University of Washington, Seattle
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Maria V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Borges G, Benjet C, Orozco R, Albor Y, Contreras EV, Monroy-Velasco IR, Hernández-Uribe PC, Báez-Mansur PM, Covarrubias Diaz Couder MA, Quevedo-Chávez GE, Gutierrez-García RA, Machado N. Internet Gaming Disorder Does Not Predict Mood, Anxiety or Substance Use Disorders in University Students: A One-Year Follow-Up Study. Int J Environ Res Public Health 2023; 20:2063. [PMID: 36767430 PMCID: PMC9915849 DOI: 10.3390/ijerph20032063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/11/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
We seek to evaluate whether Internet Gaming Disorder (IGD) among university students in Mexico during their first year at university predicts a long list of mental disorders a year later, controlling for baseline mental health disorders as well as demographics. This is a prospective cohort study with a one-year follow-up period conducted during the 2018-2019 academic year and followed up during the 2019-2020 academic year at six Mexican universities. Participants were first-year university students (n = 1741) who reported symptoms compatible with an IGD diagnosis at entry (baseline). Outcomes are seven mental disorders (mania, hypomania, and major depressive episodes; generalized anxiety disorder and panic disorder; alcohol use disorder and drug use disorder), and three groups of mental disorders (mood, anxiety, and substance use disorders) at the end of the one-year follow-up. Fully adjusted models, that included baseline controls for groups of mental disorders, rendered all associations null. The association between baseline IGD and all disorders and groups of disorders at follow-up was close to one, suggesting a lack of longitudinal impact of IGD on mental disorders. Conflicting results from available longitudinal studies on the role of IGD in the development of mental disorders warrant further research.
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Affiliation(s)
- Guilherme Borges
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Corina Benjet
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Ricardo Orozco
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Yesica Albor
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Eunice V. Contreras
- Facultad de Ciencias Administrativas y Sociales, Universidad Autónoma de Baja California, Ensenada 22860, Mexico
| | | | | | | | | | | | - Raúl A. Gutierrez-García
- Facultad de Ciencias Sociales y Humanidades, Universidad De La Salle Bajío, Salamanca 36700, Mexico
| | - Nydia Machado
- Instituto Tecnológico de Sonora, Ciudad Obregón 85059, Mexico
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5
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Benjet C, Borges G, Miah S, Albor Y, Gutiérrez-García RA, Zavala Berbena A, Guzmán R, Vargas-Contreras E, Hermosillo de la Torre AE, Hernández Uribe PC, Quevedo G, Covarrubias Díaz A, Martínez Ruiz S, Valdés-García KP, Martínez Jerez AM, Mortier P. One-year incidence, predictors, and accuracy of prediction of suicidal thoughts and behaviors from the first to second year of university. Depress Anxiety 2022; 39:727-740. [PMID: 35980836 DOI: 10.1002/da.23278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 06/01/2022] [Accepted: 06/18/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Research is scarce on the prospective predictors of first onset suicidal thoughts and behaviors (STB) and the accuracy of these predictors in university students, particularly in low-and-middle income countries. Therefore, we assessed the 1-year incidence of STB among first-year students, a broad range of prospective predictors of STB incidence, and evaluated the prediction accuracy of a baseline multivariate risk prediction model to identify students at highest risk for STB onset over the subsequent 12 months. METHODS Students (n = 3238) from 13 universities in Mexico completed an online survey developed for the World Mental Health International College Student Surveys in their first year and again 12 months after. We ran generalized linear models and receiver operator curves. RESULTS The 1-year incidence of suicidal ideation, plan and attempt was 8.53%, 3.75%, and 1.16%, respectively. Predictors in final models were female sex (ideation only), minority sexual orientation (ideation only), depression, eating disorders, ADHD (ideation and plan), ongoing arguments or breakup with a romantic partner (ideation only), emotional abuse (ideation only), parental death (ideation, plan), not Catholic/Christian (ideation, plan), not having someone to rely on, psychotic experiences (plan only), and insufficient sleep (attempt only). Prediction accuracy for ideation, plan and attempt was area under the curve = 0.76, 0.81 and 0.78, respectively. Targeting the top 10% of students at highest risk could reduce STB in the subsequent year up to 36%. CONCLUSIONS By assessing these risk/protective factors in incoming students we identified students at greatest risk for developing STB to whom suicide prevention strategies could be targeted.
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Affiliation(s)
- Corina Benjet
- Epidemiological and Psychosocial Research, Center for Global Mental Health, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Guilherme Borges
- Epidemiological and Psychosocial Research, Center for Global Mental Health, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Sumaiya Miah
- Department of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Yesica Albor
- Escuela de Educación a Distancia, Universidad Cuauhtémoc, plantel Aguascalientes, Aguascalientes, Mexico
| | - Raúl A Gutiérrez-García
- Facultad de Ciencias Sociales y Humanidades, Universidad De La Salle Bajío, campus Salamanca, Salamanca, Mexico
| | - Alicia Zavala Berbena
- Dirección de Investigación, Universidad De La Salle Bajío, campus Campestre, León, Mexico
| | - Rebeca Guzmán
- Instituto de Ciencias de la Salud y Coordinación de Investigación, Universidad Autónoma del Estado de Hidalgo, Pachuca, Mexico
| | - Eunice Vargas-Contreras
- Facultad de Ciencias Administrativas y Sociales, Universidad Autónoma de Baja California, Ensenada, Mexico
| | | | | | - Guillermo Quevedo
- Coordinación de psicología, Universidad La Salle Cancún, Cancún, Mexico
| | | | | | | | - Ana María Martínez Jerez
- Unidad Académica de Ciencias Jurídicas y Sociales, Universidad Autónoma de Tamaulipas, Ciudad Victoria, Mexico
| | - Philippe Mortier
- Health Services Research Unit, IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain.,Epidemiología y Salud Pública, CIBER, Madrid, Spain
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6
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Benjet C, Mortier P, Kiekens G, Ebert DD, Auerbach RP, Kessler RC, Cuijpers P, Green JG, Nock MK, Demyttenaere K, Albor Y, Bruffaerts R. A risk algorithm that predicts alcohol use disorders among college students. Eur Child Adolesc Psychiatry 2022; 31:1-11. [PMID: 33723648 PMCID: PMC9336831 DOI: 10.1007/s00787-020-01712-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022]
Abstract
The first year of college may carry especially high risk for onset of alcohol use disorders. We assessed the one-year incidence of alcohol use disorders (AUD) among incoming first-year students, predictors of AUD-incidence, prediction accuracy and population impact. A prospective cohort study of first-year college students (baseline: N = 5843; response rate = 51.8%; 1-year follow-up: n = 1959; conditional response rate = 41.6%) at a large university in Belgium was conducted. AUD were evaluated with the AUDIT and baseline predictors with the Composite International Diagnostic Interview Screening Scales (CIDI-SC). The one-year incidence of AUD was 3.9% (SE = 0.4). The most important individual-level baseline predictors of AUD incidence were being male (OR = 1.53; 95% CI = 1.12-2.10), a break-up with a romantic partner (OR = 1.67; 95% CI = 1.08-2.59), hazardous drinking (OR = 3.36; 95% CI = 1.31-8.63), and alcohol use characteristics at baseline (ORs between 1.29 and 1.38). Multivariate cross-validated prediction (cross-validated AUC = 0.887) shows that 55.5% of incident AUD cases occurred among the 10% of students at highest predicted risk (20.1% predicted incidence in this highest-risk subgroup). Four out of five students with incident AUD would hypothetically be preventable if baseline hazardous drinking was to be eliminated along with a reduction of one standard deviation in alcohol use characteristics scores, and another 15.0% would potentially be preventable if all 12-month stressful events were eliminated. Screening at college entrance is a promising strategy to identify students at risk of transitioning to more problematic drinking and AUD, thus improving the development and deployment of targeted preventive interventions.
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Affiliation(s)
- C Benjet
- Department of Epidemiology and Psychosocial Research, National Institute of Psychiatry Instituto Nacional de Psiquiatría Ramón de La Fuente Muñiz, Calzada México-Xochimilco 101, San Lornenzo Huipulco, CDMX, 14370, Mexico City, Mexico.
| | - P Mortier
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium
| | - G Kiekens
- Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium
- School of Psychology, Curtin University, Perth, Australia
| | - D D Ebert
- Clinical Psychology and Psychotherapy, Department of Psychology, Friedrich-Alexander-UniversityErlangen-Nürnberg, Erlangen, Germany
| | - R P Auerbach
- Department of Psychiatry, Columbia University, New York, USA
| | - R C Kessler
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, MA, USA
| | - P Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J G Green
- Wheelock College of Education and Human Development, Boston University, Boston, MA, USA
| | - M K Nock
- Department of Psychology, Harvard University, Cambridge, MA, 0000-0001-6508-1145, USA
| | - K Demyttenaere
- Universitair Psychiatrisch Centrum, Public Health Psychiatry, KU Leuven, Leuven, Belgium
| | - Y Albor
- National Institute of Psychiatry Ramón de La Fuente Muñiz, Mexico City and Universidad Cuauhtémoc Plantel Aguascalientes, Aguascalientes, Mexico
| | - R Bruffaerts
- Universitair Psychiatrisch Centrum, Public Health Psychiatry, KU Leuven, Leuven, Belgium
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7
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Benjet C, Kessler RC, Kazdin AE, Cuijpers P, Albor Y, Carrasco Tapias N, Contreras-Ibáñez CC, Durán González MS, Gildea SM, González N, Guerrero López JB, Luedtke A, Medina-Mora ME, Palacios J, Richards D, Salamanca-Sanabria A, Sampson NA. Study protocol for pragmatic trials of Internet-delivered guided and unguided cognitive behavior therapy for treating depression and anxiety in university students of two Latin American countries: the Yo Puedo Sentirme Bien study. Trials 2022; 23:450. [PMID: 35658942 PMCID: PMC9164185 DOI: 10.1186/s13063-022-06255-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 03/29/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are highly prevalent among university students and predict impaired college performance and later life role functioning. Yet most students do not receive treatment, especially in low-middle-income countries (LMICs). We aim to evaluate the effects of expanding treatment using scalable and inexpensive Internet-delivered transdiagnostic cognitive behavioral therapy (iCBT) among college students with symptoms of MDD and/or GAD in two LMICs in Latin America (Colombia and Mexico) and to investigate the feasibility of creating a precision treatment rule (PTR) to predict for whom iCBT is most effective. METHODS We will first carry out a multi-site randomized pragmatic clinical trial (N = 1500) of students seeking treatment at student mental health clinics in participating universities or responding to an email offering services. Students on wait lists for clinic services will be randomized to unguided iCBT (33%), guided iCBT (33%), and treatment as usual (TAU) (33%). iCBT will be provided immediately whereas TAU will be whenever a clinic appointment is available. Short-term aggregate effects will be assessed at 90 days and longer-term effects 12 months after randomization. We will use ensemble machine learning to predict heterogeneity of treatment effects of unguided versus guided iCBT versus TAU and develop a precision treatment rule (PTR) to optimize individual student outcome. We will then conduct a second and third trial with separate samples (n = 500 per arm), but with unequal allocation across two arms: 25% will be assigned to the treatment determined to yield optimal outcomes based on the PTR developed in the first trial (PTR for optimal short-term outcomes for Trial 2 and 12-month outcomes for Trial 3), whereas the remaining 75% will be assigned with equal allocation across all three treatment arms. DISCUSSION By collecting comprehensive baseline characteristics to evaluate heterogeneity of treatment effects, we will provide valuable and innovative information to optimize treatment effects and guide university mental health treatment planning. Such an effort could have enormous public-health implications for the region by increasing the reach of treatment, decreasing unmet need and clinic wait times, and serving as a model of evidence-based intervention planning and implementation. TRIAL STATUS IRB Approval of Protocol Version 1.0; June 3, 2020. Recruitment began on March 1, 2021. Recruitment is tentatively scheduled to be completed on May 30, 2024. TRIAL REGISTRATION ClinicalTrials.gov NCT04780542 . First submission date: February 28, 2021.
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Affiliation(s)
- Corina Benjet
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Ronald C. Kessler
- Department of Health care Policy, Harvard Medical School, Boston, MA USA
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Yesica Albor
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | | | | | - Sarah M. Gildea
- Department of Health care Policy, Harvard Medical School, Boston, MA USA
| | - Noé González
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz and School of Psychology, UNAM, Mexico City, Mexico
| | | | - Alex Luedtke
- Department of Statistics, University of Washington, Seattle, WA USA
| | - Maria Elena Medina-Mora
- Center for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz and School of Psychology, UNAM, Mexico City, Mexico
| | - Jorge Palacios
- SilverCloud Health, Dublin, Ireland
- E-mental Health Group, School of Psychology, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Derek Richards
- SilverCloud Health, Dublin, Ireland
- E-mental Health Group, School of Psychology, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Alicia Salamanca-Sanabria
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
| | - Nancy A. Sampson
- Department of Health care Policy, Harvard Medical School, Boston, MA USA
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8
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Mak AD, Lee S, Sampson NA, Albor Y, Alonso J, Auerbach RP, Baumeister H, Benjet C, Bruffaerts R, Cuijpers P, Ebert DD, Gutierrez-Garcia RA, Hasking P, Lapsley C, Lochner C, Kessler RC. ADHD Comorbidity Structure and Impairment: Results of the WHO World Mental Health Surveys International College Student Project (WMH-ICS). J Atten Disord 2022; 26:1078-1096. [PMID: 34753324 PMCID: PMC9064996 DOI: 10.1177/10870547211057275] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine the prevalence of ADHD and the association of comorbid disorders, and multivariate disorder classes with role impairment in college students. METHOD About 15,991 freshmen (24 colleges, 9 countries, WMH-ICS) (response rate = 45.6%) completed online WMH-CIDI-SC surveys for 6-month ADHD and six 12-month DSM-IV disorders. We examined multivariate disorder classes using latent class analysis (LCA) and simulated a population attributable risk proportions (PARPs) of ADHD-related impairment. RESULTS About 15.9% had ADHD, of which 58.4% had comorbidities. LCA classified ADHD respondents to pure (42.9%), internalizing (36.0%), bipolar comorbidities (11.3%), and externalizing disorder classes (9.8%). ADHD, comorbidities, and multivariate disorder classes independently predicted severe impairment. PARPs: eliminating ADHD hypothetically reduced severe impairment by 19.2%, 10.1% adjusted for comorbidities, 9.5% for multivariate disorder classes. CONCLUSIONS ADHD and comorbid disorders are common and impairing in college students. Personalized transdiagnostic interventions guided by multivariate disorder classes should be explored.
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Affiliation(s)
- Arthur D.P. Mak
- Department of Psychiatry, The Chinese University of Hong Kong, G/F Multicentre, Tai Po Hospital, Tai Po, Hong Kong SAR
| | - Sue Lee
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Yesica Albor
- Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain,CIBER en Epidemiología y Salud Pública (CIBERESP), Spain,Pompeu Fabra University (UPF), Barcelona, Spain
| | | | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Corina Benjet
- Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - David D. Ebert
- Department for Sport and Health Sciences, Technical University Munich; Munich, Germany
| | - Raúl A. Gutierrez-Garcia
- Department of Social Sciences and Humanities, De La Salle Bajio University, Salamanca, Guanajuato, Mexico
| | - Penelope Hasking
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Coral Lapsley
- Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute, Ulster University, Derry, United Kingdom
| | - Christine Lochner
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, South Africa
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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9
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Borges G, Orozco R, Benjet C, Mart´ınez KIM, Contreras EV, P´erez ALJ, Cedr´es AJP, Uribe PCH, Couder MACD, Gutierrez-Garcia RUA, Ch´avez GEQ, Albor Y, Mendez E, Medina-Mora ME, Mortier P, Ayuso-Mateos JL. (Internet) Gaming Disorder in DSM-5 and ICD-11: A Case of the Glass Half Empty or Half Full: (Internet) Le trouble du jeu dans le DSM-5 et la CIM-11: Un cas de verre à moitié vide et à moitié plein. Can J Psychiatry 2021; 66:477-484. [PMID: 32806957 PMCID: PMC8107956 DOI: 10.1177/0706743720948431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included in 2013 Internet gaming disorder (IGD) as a condition for further study, and in 2018, the World Health Organization included gaming disorder (GD) as a mental disorder in the International Classification of Disease (ICD-11). We aim to compare disorders of gaming in both diagnostic systems using a sample of young adults in Mexico. METHODS Self-administered survey to estimate the prevalence of DSM-5 IGD and ICD-11 GD in 5 Mexican universities; 7,022 first-year students who participated in the University Project for Healthy Students, part of the World Health Organization World Mental Health International College Student Initiative. Cross-tabulation, logistic regression, and item response theory were used to inform on 12- month prevalence of DSM-5 IGD and ICD-11 GD, without and with impairment. RESULTS The 12-month prevalence of DSM-5 IGD was 5.2% (95% CI, 4.7 to 5.8), almost twice as high as the prevalence using the ICD-11 GD criteria (2.7%; 95% CI, 2.4 to 3.1), and while adding an impairment requirement diminishes both estimates, prevalence remains larger in DSM-5. We found that DSM-5 cases detected and undetected by ICD-11 criteria were similar in demographics, comorbid mental disorders, service use, and impairment variables with the exception that cases detected by ICD-11 had a larger number of symptoms and were more likely to have probable drug dependence than undetected DSM-5 cases. CONCLUSION DSM-5 cases detected by ICD-11 are mostly similar to cases undetected by ICD-11. By using ICD-11 instead of DSM-5, we may be leaving (similarly) affected people underserved. It is unlikely that purely epidemiological studies can solve this discrepancy and clinical validity studies maybe needed.
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Affiliation(s)
- Guilherme Borges
- Instituto Nacional de Psiquiatría Ramón de la Fuente
Muñiz, Ciudad de México, México
- Guilherme Borges, Instituto Nacional de
Psiquiatría Ramon de la Fuente Muñiz, Calzada México Xochimilco No. 101, Col.
San Lorenzo Huipulco, CP, 14370 CDMX, México. Emails:
;
| | - Ricardo Orozco
- Instituto Nacional de Psiquiatría Ramón de la Fuente
Muñiz, Ciudad de México, México
| | - Corina Benjet
- Instituto Nacional de Psiquiatría Ramón de la Fuente
Muñiz, Ciudad de México, México
| | | | | | | | | | | | | | | | | | - Yesica Albor
- Universidad Cuauhtémoc plantel
Aguascalientes, México
| | - Enrique Mendez
- Instituto Nacional de Psiquiatría Ramón de la Fuente
Muñiz, Ciudad de México, México
| | - Maria Elena Medina-Mora
- Center of Global Mental Health Research, Instituto Nacional de Psiquiatría Ramón de la Fuente
Muñiz, Ciudad de México, México
| | - Philippe Mortier
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), CIBER en
Epidemiología y Salud Pública (CIBERESP), Center for Public Health Psychiatry, KU
Leuven, Belgium
| | - Jos´e Luis Ayuso-Mateos
- Departamento de Psiquiatría, Universidad Autónoma de
Madrid, CIBER en Salud Mental (CIBERSAM), Spain
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10
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Rentería R, Benjet C, Gutierrez-Garcia RA, Ábrego Ramírez A, Albor Y, Borges G, Covarrubias Díaz Couder MA, Durán MDS, González González R, Guzmán Saldaña R, Hermosillo De la Torre AE, Martínez-Jerez AM, Martinez Martinez KI, Medina-Mora ME, Martínez Ruiz S, Paz Pérez MA, Pérez Tarango G, Zavala Berbena MA, Méndez E, Auerbach RP, Mortier P. Suicide thought and behaviors, non-suicidal self-injury, and perceived life stress among sexual minority Mexican college students. J Affect Disord 2021; 281:891-898. [PMID: 33243555 PMCID: PMC7856251 DOI: 10.1016/j.jad.2020.11.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/13/2020] [Accepted: 11/07/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sexual minority college students are at a higher risk for suicidal thoughts and self-injurious behaviors compared to heterosexual students. Minority stress theory proposes sexual minority individuals experience higher stress due to stigma. Using a sample of Mexican college students, this study tested perceived life stress as a mediator of suicide and self-injury outcomes across various sexual orientation groups. METHODS The sample of college students (N=7882) was recruited from nine Mexican universities as part of the WHO World Mental Health International College Student (WMH-ICS) initiative. Participants completed an online survey including demographic questions, measure of perceived life stress, suicide outcomes, and non-suicidal self-injury (NSSI) in the past 12 months. RESULTS Logistic regression analyses revealed identifying as a sexual minority significantly predicted a higher likelihood of suicide ideation (ORs 2.05-3.00), suicide attempts (ORs 2.48-8.73), and NSSI (ORs 2.92-4.18) compared to heterosexual students reporting no same-gender attraction. Significant indirect effects from mediation path analyses showed perceived life stress mediated the relationship between a sexual minority identity and suicide ideation (range of proportion mediated 10.48-31.48%), attempts (10.48-31.48%), and NSSI (7.69-20.09%) across each group except among asexual students. LIMITATIONS The cross-sectional nature of the survey design precludes drawing causal inferences. CONCLUSION Findings from this study contribute to minority stress theory by elucidating the role of perceived life stress as a mediator of suicide ideation and attempts and NSSI among sexual minority college students. Clinical interventions may benefit in focusing on experiences of stress across various life areas when supporting sexual minority college students.
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Affiliation(s)
- Roberto Rentería
- Counseling & Counseling Psychology, Arizona State University, Tempe, Arizona, United States of America
| | - Corina Benjet
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México.
| | - Raúl A Gutierrez-Garcia
- Facultad de Ciencias Sociales y Humanidades, Universidad De La Salle Bajío, Campus Salamanca, Salamanca, Guanajuato, México
| | - Adrián Ábrego Ramírez
- Dirección de Investigación, Universidad Politécnica de Aguascalientes, Aguascalientes, Aguascalientes, México; Dirección de Educación a Distancia, Universidad Cuauhtémoc, Plantel Aguascalientes, Aguascalientes, Aguascalientes, México
| | - Yesica Albor
- Departamento de Salud Púbica, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Guilherme Borges
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | | | - María Del Socorro Durán
- Dirección de Orientación y Desarrollo Educativo, Universidad De La Salle Bajío, Campus Campestre, León, Guanajuato, México
| | - Rogaciano González González
- Facultad de Ciencias Sociales y Humanidades, Universidad De La Salle Bajío, Campus Salamanca, Salamanca, Guanajuato, México
| | - Rebeca Guzmán Saldaña
- Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Hidalgo, México
| | | | - Ana María Martínez-Jerez
- Facultad de Derecho y Ciencias Sociales, Universidad Autónoma de Tamaulipas. Tampico, Tamaulipas, México
| | - Kalina I Martinez Martinez
- Departamento de Psicología, Universidad Autónoma de Aguascalientes, Aguascalientes, Aguascalientes, México
| | - María Elena Medina-Mora
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | | | - María Abigail Paz Pérez
- Facultad de Ciencias Sociales y Humanidades, Universidad De La Salle Bajío, Campus Salamanca, Salamanca, Guanajuato, México
| | - Gustavo Pérez Tarango
- Dirección de Orientación y Desarrollo Educativo, Universidad De La Salle Bajío, Campus Campestre, León, Guanajuato, México
| | - María Alicia Zavala Berbena
- Dirección de Orientación y Desarrollo Educativo, Universidad De La Salle Bajío, Campus Campestre, León, Guanajuato, México
| | - Enrique Méndez
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York City, New York, USA
| | - Philippe Mortier
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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11
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Rentería R, Benjet C, Gutiérrez-García RA, Abrego-Ramírez A, Albor Y, Borges G, Covarrubias Díaz-Couder MA, Durán MDS, González-González R, Guzmán Saldaña R, E Hermosillo De la Torre A, Martínez-Jerez AM, Martinez Martinez KI, Medina-Mora ME, Martínez Ruiz S, Paz Pérez MA, Pérez Tarango G, Zavala Berbena MA, Méndez E, Auerbach RP, Mortier P. Prevalence of 12-month mental and substance use disorders in sexual minority college students in Mexico. Soc Psychiatry Psychiatr Epidemiol 2021; 56:247-257. [PMID: 32886133 DOI: 10.1007/s00127-020-01943-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/07/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Mental health disparities have been documented among sexual minority college students, but there is a dearth of evidence from developing countries. The aim is to estimate the prevalence of 12-month mental and substance use disorders across a range of sexual identities among first-year college students in Mexican universities, and test whether there is an association between sexual identity and disorders and whether the association is moderated by gender. METHOD The University Project for Healthy Students, a web-based survey conducted as part of the World Health Organization's World Mental Health International College Student initiative, recruited 7874 students from nine Mexican universities in 2016 and 2017. Logistic regressions estimated the association of sexual identity with 12-month major depressive episode, generalized anxiety disorder, panic disorder, alcohol abuse/dependence, and drug abuse/dependence, with interaction terms for gender. RESULTS Compared to heterosexual students reporting no same-sex attraction (SSA), heterosexual students with SSA (AORs range 1.77-3.67) and lesbian/gay and bisexual students (AORs range 2.22-5.32) were at a higher risk for several disorders. Asexual students were at higher risk for drug abuse/dependence (AOR = 3.64). Students unsure of their sexual identity were at a higher risk for major depressive episode, panic disorder, and drug abuse/dependence (AORs range 2.25-3.82). Gender differences varied across sexual identity and disorder. CONCLUSION These findings are the first empirical report of sexual minority psychiatric disparities among a college student population from a developing nation and underscore the importance of clinical interventions that address mental health needs among sexual minority college students.
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Affiliation(s)
- Roberto Rentería
- Counseling & Counseling Psychology, Arizona State University, Tempe, Arizona, USA
| | - Corina Benjet
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad De México, Mexico.
| | - Raúl A Gutiérrez-García
- Facultad de Ciencias Sociales y Humanidades, Universidad De La Salle Bajío, Campus Salamanca, Salamanca, Guanajuato, Mexico
| | - Adrián Abrego-Ramírez
- Dirección de Investigación, Universidad Politécnica de Aguascalientes, Aguascalientes, Aguascalientes, Mexico.,Dirección de Educación a Distancia, Universidad Cuauhtémoc, Plantel Aguascalientes, Aguascalientes, Mexico
| | - Yesica Albor
- Departamento de Salud Púbica, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad De México, Mexico
| | - Guilherme Borges
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad De México, Mexico
| | | | - María Del Socorro Durán
- Dirección de Orientación y Desarrollo Educativo, Universidad De La Salle Bajío, Campus Campestre, León, Guanajuato, Mexico
| | - Rogaciano González-González
- Facultad de Ciencias Sociales y Humanidades, Universidad De La Salle Bajío, Campus Salamanca, Salamanca, Guanajuato, Mexico
| | - Rebeca Guzmán Saldaña
- Instituto de Ciencias de la Salud y Coordinación de Investigación, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico
| | | | - Ana María Martínez-Jerez
- Unidad Académica de Ciencias Jurídicas y Sociales, Universidad Autónoma de Tamaulipas, Ciudad Victoria, Tamaulipas, Mexico
| | - Kalina I Martinez Martinez
- Departamento de Psicología, Universidad Autónoma de Aguascalientes, Aguascalientes, Aguascalientes, Mexico
| | - María Elena Medina-Mora
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad De México, Mexico
| | | | - María Abigail Paz Pérez
- Facultad de Ciencias Sociales y Humanidades, Universidad De La Salle Bajío, Campus Salamanca, Salamanca, Guanajuato, Mexico
| | - Gustavo Pérez Tarango
- Dirección de Orientación y Desarrollo Educativo, Universidad De La Salle Bajío, Campus Campestre, León, Guanajuato, Mexico
| | | | - Enrique Méndez
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad De México, Mexico
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York City, NY, USA
| | - Philippe Mortier
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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12
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Karyotaki E, Cuijpers P, Albor Y, Alonso J, Auerbach RP, Bantjes J, Bruffaerts R, Ebert DD, Hasking P, Kiekens G, Lee S, McLafferty M, Mak A, Mortier P, Sampson NA, Stein DJ, Vilagut G, Kessler RC. Sources of Stress and Their Associations With Mental Disorders Among College Students: Results of the World Health Organization World Mental Health Surveys International College Student Initiative. Front Psychol 2020; 11:1759. [PMID: 32849042 PMCID: PMC7406671 DOI: 10.3389/fpsyg.2020.01759] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/25/2020] [Indexed: 11/30/2022] Open
Abstract
The college years are stressful for many students. Identifying the sources of stress and their relative importance in leading to clinically significant emotional problems may assist in the development of targeted stress management interventions. The current report examines the distribution and associations of perceived stress across major life areas with 12-month prevalence of common mental disorders in a cross-national sample of first-year college students. The 20,842 respondents were from 24 universities in 9 countries that participated in the World Health Organization World Mental Health International College Student Initiative. Logistic regression analysis examined associations of current perceived stress in six life areas (financial situation, health, love life, relationships with family, relationships at work/school, problems experienced by loved ones) with six types of 12-month mental disorders (major depressive disorder, bipolar disorder, generalized anxiety disorder, panic disorder, alcohol use disorder, drug use disorder). Population attributable risk proportions (PARPs) were calculated to estimate the upper-bound potential effects of interventions focused on perceived stress in reducing prevalence of mental disorders. The majority of students (93.7%) reported at least some stress in at least one of the six areas. A significant dose-response association was found between extent of stress in each life area and increased odds of at least one of the six disorders. The multivariable models that included all stress measures were significant for all disorders (F = 20.6–70.6, p < 0.001). Interpretation of PARPs as representing causal effects of stresses on disorders suggests that up to 46.9–80.0% of 12-month disorder prevalence might be eliminated if stress prevention interventions were developed to block the associations of stress with these disorders.
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Affiliation(s)
- Eirini Karyotaki
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States.,Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Yesica Albor
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Jordi Alonso
- Health Services Research Unit, IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain.,CIBER en Epidemiología y Salud Pública, Madrid, Spain.,Pompeu Fabra University, Barcelona, Spain
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, United States
| | - Jason Bantjes
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven, Leuven, Belgium
| | - David D Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Glenn Kiekens
- Center for Public Health Psychiatry, Katholieke Universiteit, Leuven, Belgium
| | - Sue Lee
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Margaret McLafferty
- School of Biomedical Sciences, Ulster University, Londonderry, United Kingdom
| | - Arthur Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Philippe Mortier
- Health Services Research Unit, IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain.,CIBER en Epidemiología y Salud Pública, Madrid, Spain
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Dan J Stein
- Department of Psychiatry and Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Gemma Vilagut
- Health Services Research Unit, IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain.,CIBER en Epidemiología y Salud Pública, Madrid, Spain
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
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13
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Borges G, Orozco R, Benjet C, Martínez Martínez KI, Contreras EV, Jiménez Pérez AL, Peláez Cedrés AJ, Hernández Uribe PC, Díaz Couder MAC, Gutierrez-Garcia RA, Quevedo Chavez GE, Albor Y, Mendez E, Medina-Mora ME, Mortier P, Rumpf HJ. DSM-5 Internet gaming disorder among a sample of Mexican first-year college students. J Behav Addict 2019; 8:714-724. [PMID: 31830812 PMCID: PMC7044582 DOI: 10.1556/2006.8.2019.62] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND AIMS DSM-5 includes Internet gaming disorder (IGD) as a condition for further study. While online and offline gaming may produce undesired negative effects on players, we know little about the nosology of IGD and its prevalence, especially in countries with emerging economies. METHODS A self-administered survey has been employed to estimate prevalence of DSM-5 IGD and study the structure and performance of an instrument in Spanish to measure DSM-5 IGD among 7,022 first-year students in 5 Mexican universities that participated in the University Project for Healthy Students (PUERTAS), part of the World Health Organization's World Mental Health International College Student Initiative. RESULTS The scale for IGD showed unidimensionality with factor loadings between 0.694 and 0.838 and a Cronbach's α = .816. Items derived from gaming and from substance disorders symptoms mixed together. We found a 12-month prevalence of IGD of 5.2% in the total sample; prevalence was different for males (10.2%) and females (1.2%), but similar for ages 18-19 years (5.0%) and age 20+ (5.8%) years. Among gamers, the prevalence was 8.6%. Students with IGD were more likely to report lifetime psychological or medical treatment [OR = 1.8 (1.4-2.4)] and any severe role impairment [OR = 2.4 (1.7-3.3)]. Adding any severe role impairment to the diagnostic criteria decreased the 12-month prevalence of IGD to 0.7%. DISCUSSION AND CONCLUSIONS Prevalence of DSM-5 IGD and the performance of diagnostic criteria in this Mexican sample were within the bounds of what is reported elsewhere. Importantly, about one in every seven students with IGD showed levels of impairment that would qualify them for treatment under DSM-5.
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Affiliation(s)
- Guilherme Borges
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico,Corresponding author: Guilherme Borges; Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Calzada México Xochimilco No. 101, Col. San Lorenzo Huipulco, CP: 14370, CDMX, México; E-mail: ;
| | - Ricardo Orozco
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Corina Benjet
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | | | | | | | | | | | | | | | | | - Yesica Albor
- Universidad Cuauhtémoc Plantel Aguascalientes, Aguascalientes, Mexico
| | - Enrique Mendez
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Maria Elena Medina-Mora
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico,Center of Global Mental Health Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Philippe Mortier
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Hans-Juergen Rumpf
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lubeck, Germany
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14
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Benjet C, Menendez D, Albor Y, Borges G, Orozco R, Medina-Mora ME. Adolescent Predictors of Incidence and Persistence of Suicide-Related Outcomes in Young Adulthood: A Longitudinal Study of Mexican Youth. Suicide Life Threat Behav 2018; 48:755-766. [PMID: 28972296 PMCID: PMC5882600 DOI: 10.1111/sltb.12397] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/26/2017] [Indexed: 11/28/2022]
Abstract
In recent years, Mexico has seen one of the largest increases in suicide rates worldwide, especially among adolescents and young adults. This study uses data from the 1,071 respondents who participated in a two-wave longitudinal study when they were between 12 and 17 years of age, and again when they were between 19 and 26 years of age. The World Mental Health Composite International Diagnostic Interview assessed suicidal behavior and DSM-IV mental disorders. We used Cox regressions to evaluate which sociodemographic and psychiatric factors and life events predicted the incidence and remission of suicide ideation, plan, and attempt throughout the 8-year span. The 8-year incidence of suicide ideation, plan, and attempt was 13.3%, 4.8%, and 5.9%, respectively. We found that the number of traumatic life events during childhood, no longer being in school, and tobacco use predicted which adolescents developed suicide behaviors as they transitioned into young adulthood. Psychiatric disorders, particularly anxiety disorders, played a larger role in the persistence of those who already had suicidal behaviors, while behavioral disorders played a role in the transition from ideation to attempt. This distinction may be useful for clinicians to assess the risk of suicide.
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Affiliation(s)
- Corina Benjet
- National Institute of Psychiatry Ramon de la Fuente Muñiz
| | | | - Yesica Albor
- National Institute of Psychiatry Ramon de la Fuente Muñiz
| | | | - Ricardo Orozco
- National Institute of Psychiatry Ramon de la Fuente Muñiz
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