University students develop significant levels of anxiety or depression by the end of first year

About a third of first-year college students have or develop moderate to severe anxiety and/or depression, notes the first-of-its-kind study, published in the journal Open Access BMJ is open.

The results show that increased use of prescription (but nonprescription) and illicit drug use among those without mental health issues at the start of their school course is associated with greater odds of developing significant levels of anxiety and depression by the end of their first year.

But socialization and participation in student clubs, societies and sports teams are associated with a lower odds of developing important symptoms as well as enhanced recovery for those already experiencing symptoms of depression and anxiety when they start their studies.

The researchers pointed out that the transition to university life coincides with the peak period for the emergence of mental illnesses, most of which (75%) begin in adulthood.

The most common of these disorders are anxiety and depression, known as “internal disorders” because they are directed or experienced internally and often include sadness and loneliness.

The researchers wanted to know which factors might predict recovery in students who started college with moderate to severe anxiety and/or depressive symptoms, and which factors might predict the onset of these symptoms in first-year students without pre-existing anxiety and depression.

The researchers relied on survey answers for a representative sample of first-year students enrolled at a large public research-based university in Kingston, Ontario, Canada in 2018.

The survey explored factors previously associated with students’ academic performance and mental health, and was submitted two weeks after the first semester in September 2018 and again two weeks before the start of the testing period in March 2019.

Respondents also provided additional information about potential influencing factors: parental education; early life adversities, such as divorce and sexual/physical/emotional abuse; And the emergence of mood disorders and anxiety throughout the life.

The Undergraduate Wellbeing Scale was used to assess students’ sense of belonging on campus and with their peers, while the Adolescent Resilience Subscale Social Support Scale was used to measure levels of social support.

amount and frequency of alcohol; sleeping pills and stimulants that were not prescribed; hemp; sedatives; opium; anesthetic. Other recreational drugs used by the students were formally evaluated at both time points.

About 58% of eligible students completed the first round of questionnaires and assessments (3,029 out of 5,245) and 37% (1952) completed both sets.

The prevalence of clinically significant anxiety and depressive symptoms among respondents was 32% and 27%, respectively, at the beginning of the school year in 2018. These figures had increased to 37% and 33%, respectively, by March 2019.

Analysis of factors associated with recovery showed that students with a history of internalizing disorders at the start of the course were approximately 4 times as likely to not recover from significant levels of anxiety/depressive symptoms as those without this history.

But students who felt connected to college life and their peers had greater odds of recovering from depression and anxiety, with each point on this scale increasing, corresponding to 18% and 14% higher odds, respectively.

For factors associated with the onset of anxiety/depression during the first year, each 1 point increase in the correlation scale was associated with 10% and 6% lower odds of developing depression and anxiety, respectively.

But increased drug use was strongly associated with increased risk: Every one-point increase in the score, which ranges from 0-24, was associated with 16% higher odds of developing clinically significant levels of depressive symptoms.

This is an observational study, and as such, cannot prove cause. The researchers noted that the results may not be applicable more widely to other universities in other countries.

They add that many interrelated factors influence the emergence and maintenance of mental health problems, including biological, psychological and social factors.

Nevertheless, the findings have important implications for university mental health policies, programs, and practices, with the availability of clubs, societies, and sporting activities potentially essential in promoting students’ mental health and well-being, they suggest.

They conclude: “Moderate to severe levels of anxiety and depression are common among students upon entering college and persist through the first year. University bonding may reduce the risk of persistent or emerging symptoms, while drug use appears to increase these risks.


Journal reference:

Adams, Kuala Lumpur, et al. (2021) Mental health trajectories of undergraduate students during the first year of university: a longitudinal cohort study. BMJ is open.


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