Comorbidity and temporal associations between mental disorders among college students in the World Mental Health International College Student Initiative

Annelieke M. Roest; Ymkje Anna de Vries; Julia R. Pozuelo; Maria V. Petukhova; Sue Lee; Nancy A Sampson; Yesica Albor; Ahmad N. Alhadi; Jordi Alonso; Nouf Al-Saud; Yasmin Altwaijri; Claes Andersson; Lukoye Atwoli; Randy P. Auerbach; Caroline Ayuya Muaka; Patricia M. Báez-Mansur; Laura Ballester; Jason Bantjes; Harald Baumeister; Marcus Bendtsen; Corina Benjet; Anne H. Berman; Ronny Bruffaerts; Paula Carrasco; Silver C.N. Chan; Irina Cohut; María Anabell Covarrubias Díaz Couder; Marcelo A. Crockett; Pim Cuijpers; Oana A. David; Dong Dong; David D. Ebert; Jorge Gaete; Carlos García Forero; Margalida Gili; Raúl Gutiérrez-García; Josep Maria Haro; Penelope Hasking; Xanthe Hunt; Mathilde M. Husky; Florence Jaguga; Álvaro I. Langer; Irene Léniz; Scarlett Mac-Ginty; Vania Martínez; Margaret McLafferty; Andrea Miranda; Iris Ruby Monroy-Velasco; Elaine K. Murray; Catherine M. Musyoka; Catalin Nedelcea; Daniel Núñez; Siobhan M. O’Neill; José A. Piqueras; Codruta A. Popescu; Ana Paula Prescivalli; Charlene Rapsey; Kealagh Robinson; Tiscar Rodriguez-Jimenez; Wylene Saal; Oi-Ling Siu; Dan J. Stein; Sascha Y. Struijs; Cristina T. Tomoiaga; Karla Patricia Valdés-García; Eunice Vargas-Contreras; Daniel V. Vigo; Angel Y. Wang; Samuel Y.S. Wong; Ronald C. Kessler

doi:10.1016/j.psychres.2025.116605

Comorbidity and temporal associations between mental disorders among college students in the World Mental Health International College Student Initiative

Annelieke M. Roest
, Ymkje Anna de Vries
, Julia R. Pozuelo
, Maria V. Petukhova
, Sue Lee
, Nancy A Sampson
, Yesica Albor
, Ahmad N. Alhadi
, Jordi Alonso
, Nouf Al-Saud
, Yasmin Altwaijri
, Claes Andersson
, Lukoye Atwoli
, Randy P. Auerbach
, Caroline Ayuya Muaka
, Patricia M. Báez-Mansur
, Laura Ballester
, Jason Bantjes
, Harald Baumeister
, Marcus Bendtsen

Corina Benjet, Anne H. Berman, Ronny Bruffaerts, Paula Carrasco, Silver C.N. Chan, Irina Cohut, María Anabell Covarrubias Díaz Couder, Marcelo A. Crockett, Pim Cuijpers, Oana A. David, Dong Dong, David D. Ebert, Jorge Gaete, Carlos García Forero, Margalida Gili, Raúl Gutiérrez-García, Josep Maria Haro, Penelope Hasking, Xanthe Hunt, Mathilde M. Husky, Florence Jaguga, Álvaro I. Langer, Irene Léniz, Scarlett Mac-Ginty, Vania Martínez, Margaret McLafferty, Andrea Miranda, Iris Ruby Monroy-Velasco, Elaine K. Murray, Catherine M. Musyoka, Catalin Nedelcea, Daniel Núñez, Siobhan M. O’Neill, José A. Piqueras, Codruta A. Popescu, Ana Paula Prescivalli, Charlene Rapsey, Kealagh Robinson, Tiscar Rodriguez-Jimenez, Wylene Saal, Oi-Ling Siu, Dan J. Stein, Sascha Y. Struijs, Cristina T. Tomoiaga, Karla Patricia Valdés-García, Eunice Vargas-Contreras, Daniel V. Vigo, Angel Y. Wang, Samuel Y.S. Wong, Ronald C. Kessler

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

69 Downloads (Pure)

Abstract

Mental disorders are highly prevalent among students worldwide. This study aims to examine comorbidity and temporal associations between mental disorders among students. The study included 72,288 students from 18 countries as part of the World Mental Health International College Student (WMH-ICS) Initiative, with cross-sectional data collected between 2017 and 2023. Screening for common DSM-5 disorders was conducted using validated screening measures. Latent variables were examined using exploratory principal axis factor analysis on a correlation matrix among the lifetime mental disorders. Based on age-of-onset information, multivariable poisson regression models were used to examine associations of prior disorders with the first onset of other disorders. 27.0 % of students screened positive for only one lifetime disorder, 17.1 % for two, 10.9 % for three, and 10.6 % for 4+ disorders. In the factor analysis, three latent variables were found, comprising: internalizing disorders (generalized anxiety disorder, major depressive episode, post-traumatic stress disorder, and panic disorder), substance use disorders (drug use disorder and alcohol use disorder), and externalizing disorders (attention deficit/hyperactivity disorder and mania/hypomania). Prior internalizing and externalizing disorders were associated with the subsequent first onset of all other disorders with risk ratios ranging from 1.5-7.5. Substance use disorders were less consistently associated with the subsequent first onset of other disorders, but alcohol use disorder was associated with the first onset of drug use disorder and vice versa. Mental disorder comorbidity is common among students, and students with disorders across the internalizing and externalizing spectrum have an increased risk of future mental disorder comorbidities. [Abstract copyright: Copyright © 2025. Published by Elsevier B.V.]

Original language	English
Article number	116605
Number of pages	13
Journal	Psychiatry research
Volume	351
Early online date	20 Jun 2025
DOIs	https://doi.org/10.1016/j.psychres.2025.116605
Publication status	Published (in print/issue) - 30 Sept 2025

Bibliographical note

Publisher Copyright:
© 2025

Data Availability Statement

The data analyzed in this study is subject to the following licenses/restrictions: The WMH-ICS data sharing agreement limits access of this data to members of the consortium. Requests to access these datasets should be directed to RCK.

Funding

Funding to support this initiative was received from the National Institute of Mental Health (NIMH) R56MH109566 (RPA), and the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or NIMH. Local funding for surveys in each country is listed below: Australia: PH has received funding for this work from Suicide Prevention Australia, the Feilman Foundation, and the National Health and Medical Research Council (ID 2032058). Belgium: The Belgian Fund for Scientific Research (11N0514N/11N0516N/ 1114717N), the King Baudouin Foundation (2014-J2140150-102905) (RB), the Ministry of Education, Flanders - Grant# EDC-E3738, institutional payment, awarded to RB. Canada: Health Canada - Substance Use and Addictions Program. Grant for the Mental Health Systems and Services Laboratory at the University of British Columbia. Chile: VM, JG, ÁIL, and DN received funding from ANID/Millennium Science Initiative ProgramNCS2021_081 and ANID/FONDECYT 1221230. SM-G received funding from ANID/Millennium Science Initiative Program-NCS2021_081 and ANID/PFCHA/DOCTORADO EN EL EXTRANJERO BECAS CHILE/2019-72200092. France: Institut Universitaire de France. Germany: BARMER, a health care insurance company, for project StudiCare. Hong Kong: Shandong Taishan Scholar Young Expert Project (tsqn201909145), awarded to Yan Liu. Mexico: Consejo Nacional de Ciencia y Tecnología (Mexican National Council of Science and Technology). Grant CONACYT 285548 awarded to institution (National Institute of Psychiatry Ramon de la Fuente Muñiz) with CB as PI. The Netherlands: ZonMw (Netherlands Organisation for Health Research and Development; grant number 636110005) and the PFGV (PFGV; Protestants Fonds voor de Geestelijke Volksgezondheid) in support of the student survey project. New Zealand: The WMH-ICS NZ surveys were supported by a Rutherford Discovery Fellowship and a James Hume Bequest Grant. Northern Ireland: The Student Psychological Intervention Trial (SPIT) was supported by Clinical Healthcare Intervention Trials in Ireland Network (CHITIN). CHITIN has received €10.6 million funding from the European Union’s INTERREG VA programme managed by the Special EU Programmes Body (SEUPB) with match funding from the Departments of Health in NI and ROI (CHI/5433/18) Romania: This work was supported by the Romanian National Authority for Scientific Research, CNCS—UEFISCDI, Grant number PN-IV-P1-PCE-2023-1854, awarded to OD. Saudi Arabia: The Saudi University Mental Health Survey is conducted by the King Salman Center for Disability Research; funded by Saudi Basic Industries Corporation, King Abdulaziz City for Science and Technology, Ministry of Health (Saudi Arabia) and King Saud University. Funding in-kind was provided by King Faisal Specialist Hospital & Research Center, and Ministry of Economy & Planning, General Authority for Statistics, Riyadh. South Africa: The work reported herein was made possible through funding by the South African Medical Research Council (SAMRC) through its Division of Research Capacity Development under the MCSP (awarded to JB and XH). Spain: The PROMES-U study is supported by Instituto de Salud Carlos III (ISCIII) and cofunded by the European Union, grant number PI20/00006; the Departament de Recerca i Universitats of the Generalitat de Catalunya (AGAUR 2021 SGR 00624); and CIBER -Consorcio Centro de Investigación Biomédica en Red- (CB06/02/0046), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea. For surveys directed by Parc Sanitari Sant Joan de Déu, funding was provided by Fundació Sant Joan de Déu. Sweden: CA, MB and AHB received funding for this work from the Swedish Research Council (ID 2019-01127) as well as from a Public Health Agency in Sweden (ID 04252-2021-2.3.2). Both grants were awarded to AHB. JRP receives funding support from the National Institute of Mental Health (5R01MH121632-02). The World Mental Health International College Student (WMH-ICS) initiative is carried out as part of the World Mental Health (WMH) Survey Initiative. The WMH survey is supported by the National Institute of Mental Health NIMH R01MH070884, the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline, and Bristol-Myers Squibb (RCK).

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being
SDG 4 Quality Education
SDG 5 Gender Equality

Keywords

Internalizing
Externalizing
Comorbidity
college students
substance use disorders
Substance use disorders
College students

Access to Document

10.1016/j.psychres.2025.116605

1-s2.0-S0165178125002537-mainFinal published version, 1.4 MBLicence: CC BY

Cite this

Roest, A. M., de Vries, Y. A., Pozuelo, J. R., Petukhova, M. V., Lee, S., Sampson, N. A., Albor, Y., Alhadi, A. N., Alonso, J., Al-Saud, N., Altwaijri, Y., Andersson, C., Atwoli, L., Auerbach, R. P., Muaka, C. A., Báez-Mansur, P. M., Ballester, L., Bantjes, J., Baumeister, H., ... Kessler, R. C. (2025). Comorbidity and temporal associations between mental disorders among college students in the World Mental Health International College Student Initiative. Psychiatry research, 351, Article 116605. https://doi.org/10.1016/j.psychres.2025.116605

@article{562ba0dfee234c7080fe9b40a0fe3e8c,

title = "Comorbidity and temporal associations between mental disorders among college students in the World Mental Health International College Student Initiative",

abstract = "Mental disorders are highly prevalent among students worldwide. This study aims to examine comorbidity and temporal associations between mental disorders among students. The study included 72,288 students from 18 countries as part of the World Mental Health International College Student (WMH-ICS) Initiative, with cross-sectional data collected between 2017 and 2023. Screening for common DSM-5 disorders was conducted using validated screening measures. Latent variables were examined using exploratory principal axis factor analysis on a correlation matrix among the lifetime mental disorders. Based on age-of-onset information, multivariable poisson regression models were used to examine associations of prior disorders with the first onset of other disorders. 27.0 \% of students screened positive for only one lifetime disorder, 17.1 \% for two, 10.9 \% for three, and 10.6 \% for 4+ disorders. In the factor analysis, three latent variables were found, comprising: internalizing disorders (generalized anxiety disorder, major depressive episode, post-traumatic stress disorder, and panic disorder), substance use disorders (drug use disorder and alcohol use disorder), and externalizing disorders (attention deficit/hyperactivity disorder and mania/hypomania). Prior internalizing and externalizing disorders were associated with the subsequent first onset of all other disorders with risk ratios ranging from 1.5-7.5. Substance use disorders were less consistently associated with the subsequent first onset of other disorders, but alcohol use disorder was associated with the first onset of drug use disorder and vice versa. Mental disorder comorbidity is common among students, and students with disorders across the internalizing and externalizing spectrum have an increased risk of future mental disorder comorbidities. [Abstract copyright: Copyright {\textcopyright} 2025. Published by Elsevier B.V.]",

keywords = "Internalizing, Externalizing, Comorbidity, college students, substance use disorders, Substance use disorders, College students",

author = "Roest, \{Annelieke M.\} and \{de Vries\}, \{Ymkje Anna\} and Pozuelo, \{Julia R.\} and Petukhova, \{Maria V.\} and Sue Lee and Sampson, \{Nancy A\} and Yesica Albor and Alhadi, \{Ahmad N.\} and Jordi Alonso and Nouf Al-Saud and Yasmin Altwaijri and Claes Andersson and Lukoye Atwoli and Auerbach, \{Randy P.\} and Muaka, \{Caroline Ayuya\} and B{\'a}ez-Mansur, \{Patricia M.\} and Laura Ballester and Jason Bantjes and Harald Baumeister and Marcus Bendtsen and Corina Benjet and Berman, \{Anne H.\} and Ronny Bruffaerts and Paula Carrasco and Chan, \{Silver C.N.\} and Irina Cohut and Couder, \{Mar{\'i}a Anabell Covarrubias D{\'i}az\} and Crockett, \{Marcelo A.\} and Pim Cuijpers and David, \{Oana A.\} and Dong Dong and Ebert, \{David D.\} and Jorge Gaete and Forero, \{Carlos Garc{\'i}a\} and Margalida Gili and Ra{\'u}l Guti{\'e}rrez-Garc{\'i}a and Haro, \{Josep Maria\} and Penelope Hasking and Xanthe Hunt and Husky, \{Mathilde M.\} and Florence Jaguga and Langer, \{{\'A}lvaro I.\} and Irene L{\'e}niz and Scarlett Mac-Ginty and Vania Mart{\'i}nez and Margaret McLafferty and Andrea Miranda and Monroy-Velasco, \{Iris Ruby\} and Murray, \{Elaine K.\} and Musyoka, \{Catherine M.\} and Catalin Nedelcea and Daniel N{\'u}{\~n}ez and O{\textquoteright}Neill, \{Siobhan M.\} and Piqueras, \{Jos{\'e} A.\} and Popescu, \{Codruta A.\} and Prescivalli, \{Ana Paula\} and Charlene Rapsey and Kealagh Robinson and Tiscar Rodriguez-Jimenez and Wylene Saal and Oi-Ling Siu and Stein, \{Dan J.\} and Struijs, \{Sascha Y.\} and Tomoiaga, \{Cristina T.\} and Vald{\'e}s-Garc{\'i}a, \{Karla Patricia\} and Eunice Vargas-Contreras and Vigo, \{Daniel V.\} and Wang, \{Angel Y.\} and Wong, \{Samuel Y.S.\} and Kessler, \{Ronald C.\}",

note = "Publisher Copyright: {\textcopyright} 2025",

year = "2025",

month = sep,

day = "30",

doi = "10.1016/j.psychres.2025.116605",

language = "English",

volume = "351",

journal = "Psychiatry research",

issn = "0165-1781",

publisher = "Elsevier Ireland Ltd",

}

Roest, AM, de Vries, YA, Pozuelo, JR, Petukhova, MV, Lee, S, Sampson, NA, Albor, Y, Alhadi, AN, Alonso, J, Al-Saud, N, Altwaijri, Y, Andersson, C, Atwoli, L, Auerbach, RP, Muaka, CA, Báez-Mansur, PM, Ballester, L, Bantjes, J, Baumeister, H, Bendtsen, M, Benjet, C, Berman, AH, Bruffaerts, R, Carrasco, P, Chan, SCN, Cohut, I, Couder, MACD, Crockett, MA, Cuijpers, P, David, OA, Dong, D, Ebert, DD, Gaete, J, Forero, CG, Gili, M, Gutiérrez-García, R, Haro, JM, Hasking, P, Hunt, X, Husky, MM, Jaguga, F, Langer, ÁI, Léniz, I, Mac-Ginty, S, Martínez, V, McLafferty, M, Miranda, A, Monroy-Velasco, IR, Murray, EK, Musyoka, CM, Nedelcea, C, Núñez, D, O’Neill, SM, Piqueras, JA, Popescu, CA, Prescivalli, AP, Rapsey, C, Robinson, K, Rodriguez-Jimenez, T, Saal, W, Siu, O-L, Stein, DJ, Struijs, SY, Tomoiaga, CT, Valdés-García, KP, Vargas-Contreras, E, Vigo, DV, Wang, AY, Wong, SYS & Kessler, RC 2025, 'Comorbidity and temporal associations between mental disorders among college students in the World Mental Health International College Student Initiative', Psychiatry research, vol. 351, 116605. https://doi.org/10.1016/j.psychres.2025.116605

TY - JOUR

T1 - Comorbidity and temporal associations between mental disorders among college students in the World Mental Health International College Student Initiative

AU - Roest, Annelieke M.

AU - de Vries, Ymkje Anna

AU - Pozuelo, Julia R.

AU - Petukhova, Maria V.

AU - Lee, Sue

AU - Sampson, Nancy A

AU - Albor, Yesica

AU - Alhadi, Ahmad N.

AU - Alonso, Jordi

AU - Al-Saud, Nouf

AU - Altwaijri, Yasmin

AU - Andersson, Claes

AU - Atwoli, Lukoye

AU - Auerbach, Randy P.

AU - Muaka, Caroline Ayuya

AU - Báez-Mansur, Patricia M.

AU - Ballester, Laura

AU - Bantjes, Jason

AU - Baumeister, Harald

AU - Bendtsen, Marcus

AU - Benjet, Corina

AU - Berman, Anne H.

AU - Bruffaerts, Ronny

AU - Carrasco, Paula

AU - Chan, Silver C.N.

AU - Cohut, Irina

AU - Couder, María Anabell Covarrubias Díaz

AU - Crockett, Marcelo A.

AU - Cuijpers, Pim

AU - David, Oana A.

AU - Dong, Dong

AU - Ebert, David D.

AU - Gaete, Jorge

AU - Forero, Carlos García

AU - Gili, Margalida

AU - Gutiérrez-García, Raúl

AU - Haro, Josep Maria

AU - Hasking, Penelope

AU - Hunt, Xanthe

AU - Husky, Mathilde M.

AU - Jaguga, Florence

AU - Langer, Álvaro I.

AU - Léniz, Irene

AU - Mac-Ginty, Scarlett

AU - Martínez, Vania

AU - McLafferty, Margaret

AU - Miranda, Andrea

AU - Monroy-Velasco, Iris Ruby

AU - Murray, Elaine K.

AU - Musyoka, Catherine M.

AU - Nedelcea, Catalin

AU - Núñez, Daniel

AU - O’Neill, Siobhan M.

AU - Piqueras, José A.

AU - Popescu, Codruta A.

AU - Prescivalli, Ana Paula

AU - Rapsey, Charlene

AU - Robinson, Kealagh

AU - Rodriguez-Jimenez, Tiscar

AU - Saal, Wylene

AU - Siu, Oi-Ling

AU - Stein, Dan J.

AU - Struijs, Sascha Y.

AU - Tomoiaga, Cristina T.

AU - Valdés-García, Karla Patricia

AU - Vargas-Contreras, Eunice

AU - Vigo, Daniel V.

AU - Wang, Angel Y.

AU - Wong, Samuel Y.S.

AU - Kessler, Ronald C.

PY - 2025/9/30

Y1 - 2025/9/30

N2 - Mental disorders are highly prevalent among students worldwide. This study aims to examine comorbidity and temporal associations between mental disorders among students. The study included 72,288 students from 18 countries as part of the World Mental Health International College Student (WMH-ICS) Initiative, with cross-sectional data collected between 2017 and 2023. Screening for common DSM-5 disorders was conducted using validated screening measures. Latent variables were examined using exploratory principal axis factor analysis on a correlation matrix among the lifetime mental disorders. Based on age-of-onset information, multivariable poisson regression models were used to examine associations of prior disorders with the first onset of other disorders. 27.0 % of students screened positive for only one lifetime disorder, 17.1 % for two, 10.9 % for three, and 10.6 % for 4+ disorders. In the factor analysis, three latent variables were found, comprising: internalizing disorders (generalized anxiety disorder, major depressive episode, post-traumatic stress disorder, and panic disorder), substance use disorders (drug use disorder and alcohol use disorder), and externalizing disorders (attention deficit/hyperactivity disorder and mania/hypomania). Prior internalizing and externalizing disorders were associated with the subsequent first onset of all other disorders with risk ratios ranging from 1.5-7.5. Substance use disorders were less consistently associated with the subsequent first onset of other disorders, but alcohol use disorder was associated with the first onset of drug use disorder and vice versa. Mental disorder comorbidity is common among students, and students with disorders across the internalizing and externalizing spectrum have an increased risk of future mental disorder comorbidities. [Abstract copyright: Copyright © 2025. Published by Elsevier B.V.]

AB - Mental disorders are highly prevalent among students worldwide. This study aims to examine comorbidity and temporal associations between mental disorders among students. The study included 72,288 students from 18 countries as part of the World Mental Health International College Student (WMH-ICS) Initiative, with cross-sectional data collected between 2017 and 2023. Screening for common DSM-5 disorders was conducted using validated screening measures. Latent variables were examined using exploratory principal axis factor analysis on a correlation matrix among the lifetime mental disorders. Based on age-of-onset information, multivariable poisson regression models were used to examine associations of prior disorders with the first onset of other disorders. 27.0 % of students screened positive for only one lifetime disorder, 17.1 % for two, 10.9 % for three, and 10.6 % for 4+ disorders. In the factor analysis, three latent variables were found, comprising: internalizing disorders (generalized anxiety disorder, major depressive episode, post-traumatic stress disorder, and panic disorder), substance use disorders (drug use disorder and alcohol use disorder), and externalizing disorders (attention deficit/hyperactivity disorder and mania/hypomania). Prior internalizing and externalizing disorders were associated with the subsequent first onset of all other disorders with risk ratios ranging from 1.5-7.5. Substance use disorders were less consistently associated with the subsequent first onset of other disorders, but alcohol use disorder was associated with the first onset of drug use disorder and vice versa. Mental disorder comorbidity is common among students, and students with disorders across the internalizing and externalizing spectrum have an increased risk of future mental disorder comorbidities. [Abstract copyright: Copyright © 2025. Published by Elsevier B.V.]

KW - Internalizing

KW - Externalizing

KW - Comorbidity

KW - college students

KW - substance use disorders

KW - Substance use disorders

KW - College students

UR - https://linkinghub.elsevier.com/retrieve/pii/S0165178125002537

UR - https://pure.ulster.ac.uk/en/publications/562ba0df-ee23-4c70-80fe-9b40a0fe3e8c

UR - https://www.scopus.com/pages/publications/105009377639

U2 - 10.1016/j.psychres.2025.116605

DO - 10.1016/j.psychres.2025.116605

M3 - Article

C2 - 40582274

SN - 0165-1781

VL - 351

JO - Psychiatry research

JF - Psychiatry research

M1 - 116605

ER -

Comorbidity and temporal associations between mental disorders among college students in the World Mental Health International College Student Initiative

Abstract

Bibliographical note

Data Availability Statement

Funding

UN SDGs

Keywords

Access to Document

Other files and links

Fingerprint

Cite this