Factors related to increased alcohol misuse by students compared to non-students during the first Covid-19 lockdown in France: the Confins study.

BACKGROUND: The closure of bars and lockdowns related to the Covid-19 pandemic changed alcohol use levels in France during the spring of 2020. We wondered whether this sudden cessation of social interactions impacted students more than non-students and what factors specific to students would explain the increase in alcohol misuse. The aims of this study were to compare self-reported changes in alcohol misuse (alcohol intake and binge-drinking frequency) during the first Covid-19 lockdown from March 17 to May 10, 2020, between French students and non-students and describe factors associated with this alcohol misuse in each subgroup. METHODS: Data collected in the Confins study from April 8 to May 10, 2020, were used in cross-sectional analyses stratified by student status. Multiple logistic regression was performed to estimate the association between self-reported increase in alcohol intake or binge-drinking frequency (at least six drinks of alcohol on one occasion) and demographic, socioeconomic, and clinical factors, as well as conditions associated with the Covid-19 pandemic. The population-attributable fraction was then used to estimate the contribution of identified risk factors to increased alcohol misuse in students and non-students. RESULTS: Among both students and non-students, a self-reported decrease or no change in alcohol intake or binge-drinking was more common than an increase. However, the risk factors explaining an increase in alcohol intake differed among students (≥ 25 years old, not working or studying in the health field, and having suicidal ideation during the last 7 days) and non-students (having a medical diagnosis of mental disorders). The risk factors explaining an increase in binge-drinking frequency were similar in the two subgroups (being a tobacco smoker before lockdown and not practicing any physical activity during the last 7 days), except suicidal thoughts, which was a risk factor for alcohol misuse specific to students. CONCLUSIONS: These results highlight the vulnerability of certain French students to alcohol misuse and the necessity of combining both mental health and substance use-related screening in the student population.

Attention deficit hyperactivity disorder symptoms and lifetime use of psychoactive substances among French university students: A cross-sectional study.

In a cross sectional study of 13,837 university students, we aimed to explore the association between attention deficit hyperactivity disorder (ADHD) symptoms and lifetime psychoactive substance use (LPSU) on a wide range of illicit substances. Logistic and Hurdel multivariable regressions were used. ADHD symptoms were significantly associated with the lifetime use of ketamine, magic mushrooms, poppers, and nine other psychoactive substances. There was an association between ADHD symptoms and both LPSU and truncated count of lifetime psychoactive substance use. High levels of ADHD symptoms are associated with the use of a large variety and multiple LPSU.

Major depressive disorder in post-secondary students attending foodbanks in France.

Introduction: Poor mental health among youth is a major public health issue that has risen to the forefront since the COVID-19 crisis, especially among post-secondary students and precarious populations. The objectives of this work were to evaluate the rate of major depressive disorder (MDD) among precarious post-secondary students in the greater Paris region, to describe its risk factors, and to identify determinants for not seeking care. Methods: We conducted a multi-site, cross-sectional survey of post-secondary students attending a selection of 13 student foodbanks in the greater Paris region (France) between 30 November 2021 and 27 January 2022. This study had two complementary epidemiological and sociological components: a quantitative description of MDD through completion of a questionnaire performed through face-to-face or telephone interviews, and a qualitative assessment of the factors underlying MDD through in-depth follow-up interviews conducted among a sub-selection of students who participated in the first phase. Results: Among 456 students who participated in our survey, 35.7% presented with MDD. The risk of suffering from MDD was higher among women, students housed by third-parties, students reporting moderately to severely hungry and/or poor physical health. Students receiving material and/or social support were less likely to present with MDD. Among students who reported needing health care in the last year or since their arrival in France, 51.4% did not seek care. Conclusion: To address poor mental health among precarious students, policy action must jointly consider financial precarity, administrative barriers, housing, food security, physical health, and access to health services, especially mental health.

Association between ADHD symptoms and illicit stimulants use following 1 year among French university students of the i-Share cohort.

PURPOSE: Although attention deficit hyperactivity disorder (ADHD) has been associated with illicit stimulants use, less is known about their prospective association in university students. We aimed to examine the association between ADHD symptoms at inclusion and illicit stimulants use following 1 year among university students. METHODS: The i-Share cohort recruited French students from February 2013 to July 2020. The study included 4270 participants. The Adult ADHD Self-Report Scale (ASRS) was used to evaluate ADHD symptoms at inclusion. Illicit stimulants use was assessed at inclusion and 1 year after inclusion. Multivariable logistic regressions were conducted to assess the association between ADHD symptoms at inclusion and illicit stimulants use following 1 year. RESULTS: High levels of ADHD symptoms at inclusion were associated with a greater probability of illicit stimulants use following 1 year (adjusted OR: 2.42 (1.51-3.8)). The adjusted odds ratio was 2.7 (1.08-7.84) among participants who had used illicit stimulant at least once (continuation) and 2.25 (1.04-4.37) among participants who had never used illicit stimulants at inclusion (initiation). CONCLUSION: High levels of ADHD symptoms are a feature that may promote both initiation and continuation of illicit stimulants use among university students. Our findings suggest that university students with high levels of ADHD symptoms may benefit from screening to help identify those at risk of illicit stimulants use.

Genomics of perivascular space burden unravels early mechanisms of cerebral small vessel disease.

Perivascular space (PVS) burden is an emerging, poorly understood, magnetic resonance imaging marker of cerebral small vessel disease, a leading cause of stroke and dementia. Genome-wide association studies in up to 40,095 participants (18 population-based cohorts, 66.3 ± 8.6 yr, 96.9% European ancestry) revealed 24 genome-wide significant PVS risk loci, mainly in the white matter. These were associated with white matter PVS already in young adults (N = 1,748; 22.1 ± 2.3 yr) and were enriched in early-onset leukodystrophy genes and genes expressed in fetal brain endothelial cells, suggesting early-life mechanisms. In total, 53% of white matter PVS risk loci showed nominally significant associations (27% after multiple-testing correction) in a Japanese population-based cohort (N = 2,862; 68.3 ± 5.3 yr). Mendelian randomization supported causal associations of high blood pressure with basal ganglia and hippocampal PVS, and of basal ganglia PVS and hippocampal PVS with stroke, accounting for blood pressure. Our findings provide insight into the biology of PVS and cerebral small vessel disease, pointing to pathways involving extracellular matrix, membrane transport and developmental processes, and the potential for genetically informed prioritization of drug targets.

Contribution of perceived loneliness to suicidal thoughts among French university students during the COVID-19 pandemic.

Restrictive measures during the COVID-19 epidemic have led to increased levels of loneliness, especially among university students, although the influence on suicidal thoughts remains unclear. In this cross-sectional study of 1913 French university students, those with the highest level of loneliness had a fourfold increased risk of suicidal thoughts. Perceived loneliness should be incorporated into suicide risk assessment, and assistance in coping with loneliness should be considered as a means of reducing suicidal risk in vulnerable groups, like university students.

Association of parental death and illness with offspring suicidal ideation: cross-sectional study in a large cohort of university students.

PURPOSE: The aim of this study was to (1) investigate the association of parental death and illness with suicidal ideation using a large sample of university students and (2) test whether associations were moderated by perceived family support. METHODS: We used data from N = 15,008 French university students enrolled in the i-Share cohort (mean age, 20.5 years; 77% women). Students self-reported information on parental death, including the cause, parental illness (cardiovascular, stroke, cancer, depression/anxiety, alcohol abuse), and perceived family support during childhood/adolescence. Twelve-month suicidal ideation was self-reported and categorized into no, occasional, and frequent ideation. RESULTS: Occasional and frequent suicidal ideation were, respectively, reported by 2692 (17.5%) and 699 (4.6%) students. After adjustment for age, gender, and parental education, we found associations between parental death and risk of occasional and frequent suicidal ideation (respectively, RR = 1.98 [1.81-2.17] and RR = 2.73 [2.30-3.24]). Parental deaths from illness, accidents, and suicides had the strongest associations. We also found associations for parental depression/anxiety (occasional, RR = 1.98 [1.81-2.17]; frequent, RR = 2.73 [2.30-3.24]), alcohol use problems (occasional, RR = 1.71 [1.5-1.94]; frequent, RR = 2.33 [1.89-2.87]), and cardiovascular diseases (occasional, RR = 1.22 [1.06-1.40]; frequent, RR = 1.83 [1.47-2.27]). For participants who experienced parental death and stroke, associations with occasional and frequent suicidal ideation (respectively) increased as perceived family support increased (Psinteraction ≤ 0.005). CONCLUSIONS: Students who experienced parental death and common parental illnesses were at risk of reporting suicidal ideation, especially if their family were perceived as an important source of support. As information on parental death or illness can be routinely collected during health visits, attention should be paid to students reporting such experiences.

Genomic Studies Across the Lifespan Point to Early Mechanisms Determining Subcortical Volumes.

BACKGROUND: Subcortical brain structures play a key role in pathological processes of age-related neurodegenerative disorders. Mounting evidence also suggests that early-life factors may have an impact on the development of common late-life neurological diseases, including genetic factors that can influence both brain maturation and neurodegeneration. METHODS: Using large population-based brain imaging datasets across the lifespan (N ≤ 40,628), we aimed to 1) estimate the heritability of subcortical volumes in young (18-35 years), middle (35-65 years), and older (65+ years) age, and their genetic correlation across age groups; 2) identify whether genetic loci associated with subcortical volumes in older persons also show associations in early adulthood, and explore underlying genes using transcriptome-wide association studies; and 3) explore their association with neurological phenotypes. RESULTS: Heritability of subcortical volumes consistently decreased with increasing age. Genetic risk scores for smaller caudate nucleus, putamen, and hippocampus volume in older adults were associated with smaller volumes in young adults. Individually, 10 loci associated with subcortical volumes in older adults also showed associations in young adults. Within these loci, transcriptome-wide association studies showed that expression of several genes in brain tissues (especially MYLK2 and TUFM) was associated with subcortical volumes in both age groups. One risk variant for smaller caudate nucleus volume (TUFM locus) was associated with lower cognitive performance. Genetically predicted Alzheimer's disease was associated with smaller subcortical volumes in middle and older age. CONCLUSIONS: Our findings provide novel insights into the genetic determinants of subcortical volumes across the lifespan. More studies are needed to decipher the underlying biology and clinical impact.

A repeated cross-sectional analysis assessing mental health conditions of adults as per student status during key periods of the COVID-19 epidemic in France.

Previous studies have shown the negative impact of the COVID-19 epidemic on students' mental health. It is, however, uncertain whether students are really at higher risk of mental health disturbances than non-students and if they are differentially impacted by lockdown periods over time. The objective of our study was to compare the frequency of depressive symptoms, anxiety, and suicidal thoughts in students and non-students enrolled in the same study in France and during the same key periods of the COVID-19 epidemic. Using a repeated cross-sectional design, we collected data from a sample of 3783 participants in the CONFINS study during three recruitment waves between March 2020 and January 2021. Multivariate logistic regression models, adjusted for potential confounding factors, showed that students were more likely to have high scores of depressive symptoms and anxiety more frequently than non-students. These differences were particularly strong during the first (depressive symptoms: adjusted odds ratio aOR 1.59, 95% CI 1.22-2.08; anxiety: aOR 1.63, 95% CI 1.22-2.18) and second lockdowns (depressive symptoms: aOR 1.80, 95% CI 1.04-3.12; anxiety: aOR 2.25, 95% CI 1.24-4.10). These findings suggest that the restrictive measures-lockdown and curfew-have an alarmingly stronger negative impact on students than on non-students and underline the frailty of students' mental health and the need to pay greater attention to this population in this epidemic-related context.

Mental health condition of college students compared to non-students during COVID-19 lockdown: the CONFINS study.

OBJECTIVES: To estimate the effect of student status on mental health condition during COVID-19 general lockdown in France. DESIGN: Cross-sectional analysis comparing students and non-students recruited in the same study. SETTING: Participants of the web-based CONFINS study implemented during the general lockdown in France in spring 2020. PARTICIPANTS: 2260 participants (78% women) including 1335 students (59%). PRIMARY AND SECONDARY OUTCOME MEASURES: Through an online questionnaire, participants declared if they have experienced suicidal thoughts, coded their perceived stress on a 10-points scale and completed validated mental health scales (Patient Health Questionnaire-9 for depressive symptoms, Generalised Anxiety Disorder-7 for anxiety symptoms) during the last 7 days. The effect of college student status on each mental health condition was estimated using multivariate logistic regression analyses. Stratified models for students and non-students were performed to identify population-specific factors. RESULTS: Student status was associated with a higher frequency of depressive symptoms (adjusted OR (aOR)=1.58; 95% CI 1.17 to 2.14), anxiety symptoms (aOR=1.51; 95% CI 1.10 to 2.07), perceived stress (n=1919, aOR=1.70, 95% CI 1.26 to 2.29) and suicidal thoughts (n=1919, aOR=1.57, 95% CI 0.97 to 2.53). Lockdown conditions that could be potentially aggravating on mental health like isolation had a higher impact on students than on non-students. CONCLUSIONS: College students were at higher risk of mental health disturbances during lockdown than non-students, even after taking into account several potential confounding factors. A close follow-up and monitoring of students' mental health status is warranted during lockdown periods in this vulnerable population.

Contributions of childhood peer victimization and/or maltreatment to young adult anxiety, depression, and suicidality: a cross-sectional study.

BACKGROUND: Childhood maltreatment and peer victimization are major risk factors for depression and suicidal behavior. Furthermore, childhood maltreatment increases the risk of peer victimization. Our objective was to distinguish between the contributions of parental maltreatment and peer victimization to the development of mental health problems in young adulthood. Specifically, we tested whether peer victimization alone or in combination with parental maltreatment before 18 years old was associated with anxiety, depression, and suicidal thoughts and behaviors at age 21 years. METHODS: We analyzed data collected from questionnaires administered in the i-Share (Internet-based Students' Health ResearchEnterprise) study in France from February 2013 to September 2019 (N = 2271 participants). We performed multinomial and binary logistic regression analyses to assess the single and combined contributions of childhood peer victimization and parental maltreatment to anxiety, depression, and suicidality in adulthood. RESULTS: Nearly one third of students (28.8%) reported at least one mental health problem; 29.8% reported peer victimization alone; 7.5% reported parental maltreatment alone; and 10.3% reported both parental maltreatment and victimization. In multivariate models, compared to participants that did not experience maltreatment or peer victimization, those that experienced peer victimization alone were more likely to report anxiety (adjusted odds ratio [aOR]: 1.90; 95% CI: 1.50-2.40), depression (aOR: 1.95; 95% CI: 1.46-2.60), or suicidal ideation, without (aOR: 1.62; 95% CI: 1.26-2.09) or with a suicide attempt (aOR: 2.70; 95% CI: 1.51-4.85). Similar associations were observed for participants that experienced maltreatment alone. Participants that experienced both maltreatment and peer victimization were at increased risk of depression (aOR: 2.63; 95% CI: 1.79-3.86) and suicidal ideation, with (aOR: 9.19; 95% CI: 4.98-16.92) and without a suicide attempt (aOR: 2.64; 95% CI: 1.86-3.76). CONCLUSIONS: Separate and combined exposures to parental maltreatment and peer victimization in childhood or adolescence were associated with increased risks of anxiety, depression, and suicidal behaviors. Peer victimization appeared to play a specific role in mental health disorders that were not otherwise explained by polyvictimization. Currently, peer victimization is a frequent, but avoidable type of child abuse; therefore, these findings have implications for policies for preventing and dealing with peer victimization.

A machine learning approach for predicting suicidal thoughts and behaviours among college students.

Suicidal thoughts and behaviours are prevalent among college students. Yet little is known about screening tools to identify students at higher risk. We aimed to develop a risk algorithm to identify the main predictors of suicidal thoughts and behaviours among college students within one-year of baseline assessment. We used data collected in 2013-2019 from the French i-Share cohort, a longitudinal population-based study including 5066 volunteer students. To predict suicidal thoughts and behaviours at follow-up, we used random forests models with 70 potential predictors measured at baseline, including sociodemographic and familial characteristics, mental health and substance use. Model performance was measured using the area under the receiver operating curve (AUC), sensitivity, and positive predictive value. At follow-up, 17.4% of girls and 16.8% of boys reported suicidal thoughts and behaviours. The models achieved good predictive performance: AUC, 0.8; sensitivity, 79% for girls, 81% for boys; and positive predictive value, 40% for girls and 36% for boys. Among the 70 potential predictors, four showed the highest predictive power: 12-month suicidal thoughts, trait anxiety, depression symptoms, and self-esteem. We identified a parsimonious set of mental health indicators that accurately predicted one-year suicidal thoughts and behaviours in a community sample of college students.

Perceived stress partially accounts for the association between Attention Deficit Hyperactivity Disorder (ADHD) symptoms and suicidal ideation among students.

The association between Attention Deficit Hyperactivity Disorder (ADHD) and suicidal ideation has been the focus of recent research interest among youths and young adults. However, the role perceived stress plays in this association is unclear. We investigated whether perceived stress accounts for the association between ADHD and subsequent suicidal ideation among French students enrolled in the i-Share cohort. The associations between ADHD symptoms, perceived stress at baseline, and suicidal ideation during follow-up were investigated using logistic regression models, and Structural Equation Modeling was used to estimate the indirect effect via perceived stress. In total 4333 participants (median age: 20.3 years; [interquartile range: 18.7-21.8]) were included in the main analyses. ADHD was associated with suicidal ideation (adjusted Odds Ratio = 1.15 [95% Confidence Interval: 1.04-1.26]). Perceived stress partially accounts for the association between ADHD and suicidal ideation (proportion explained 49%). Our study suggests that ADHD and perceived stress represent mental health targets for suicide prevention programs.

Health Risk Behaviors and Self-Esteem Among College Students: Systematic Review of Quantitative Studies.

BACKGROUND: Due to their impact on premature mortality and long-term disabilities, a better understanding of health risk behavior (HRB) determinants among college students is crucial in order to build the most appropriate prevention tools. Although self-esteem appears to be a relevant candidate, a clear picture summarizing its multiple links with HRB is lacking to guide clinicians and researchers. This study aims to provide a systematic review of the associations between health risk behavior and self-esteem among college students. METHODS: This search was performed in several databases on 02/02/17. Study eligibility criteria were original articles in peer-reviewed journals, in English; observational quantitative studies; among college students; and investigated the association between self-esteem and HRB. The PRISMA statements were complied with. RESULTS: One hundred fifteen articles were included: 46 on substance use, 35 on sexual behavior, 11 on nutritional habits, 27 on physical activity, and 5 on other HRB. Most studies reported an association between higher self-esteem and healthier behavior. For alcohol consumption and number of sexual partners, both negative and positive associations have been reported. Directionality was investigated in a few studies suggesting potential bidirectional effects. CONCLUSIONS: This review points out the need for consensus for the definition of self-esteem and HRB. There was high heterogeneity in (1) the measurement of self-esteem either in the concept measured (global vs. domain) or in the way to implement validated tools; and (2) the definition of HRB. Self-esteem seems to be a relevant target to intervene on HRB, especially alcohol abuse and physical activity. TRIAL REGISTRATION: Registration number: PROSPERO (ID = CRD42017056599).

Perceived parental support in childhood and adolescence as a tool for mental health screening in students: A longitudinal study in the i-Share cohort.

BACKGROUND: Negative events in childhood are associated with increased risk of mental health problems, and evaluation could help identify students at high risk of mental health disorder. However, childhood adversity measures are difficult to implement in routine care. Perceived parental support in childhood and adolescence may be more easily assessed, as it is a rather neutral and non-intrusive question. METHODS: We retrieved students' health data collected from the French i-Share cohort, in a longitudinal population-based study including 4463 students of 18-24 years of age. Students in this cohort completed a self-reported questionnaire about major psychiatric problems at one-year follow-up. RESULTS: Among 4463 participants, 26% reported a major mental health problem-including suicidal behavior (17%), major depression (7%), and severe generalized anxiety disorder (15%). Adjusted logistic regression revealed that a lower level of perceived parental support was significantly associated with higher risk of any mental health problem. Compared to students who reported extremely strong perceived parental support, students who perceived no support had a nearly 4-fold higher risk of mental health problems (aOR 3.80, CI 2.81-5.13). Lower levels of perceived parental support were dose-dependently associated with higher incidences of suicidal behavior, major depression, and severe generalized anxiety disorder. LIMITATIONS: Study limitations included a moderate follow-up response rate, and retrospective self-report questionnaires. CONCLUSION: Perceived parental support was strongly associated with the incidence of mental health problems among college students. If validated, these results suggest that health professionals should consider using this simple marker to improve mental health risk assessment and screening.

Perceived parental support in childhood and adolescence and suicidal ideation in young adults: a cross-sectional analysis of the i-Share study.

BACKGROUND: Suicidal ideation and suicidal risk assessment are major concerns for health professionals. The perception of a low level of parental support is a risk factor for suicidal tendencies among adolescents, but little is known about its long-term impact on the vulnerability to suicidal behavior in young adults. We investigated whether the perceived level of parental support during childhood and adolescence was associated with current suicidal ideation in young adults. METHODS: We retrieved data collected in the i-Share study from February 1st, 2013 through January 30, 2017. This cross-sectional study included 10,015 French students, aged 18-24 years that completed an on-line self-reported questionnaire about suicidal ideation in the last 12 months and their perceived parental support in childhood and adolescence. We performed multinomial logistic regressions and sensitivity analyses to assess associations between the degree of perceived parental support and the frequency suicidal thoughts, after adjusting for the main known risk factors of suicidal ideation. We employed multiple imputations to account for missing data. RESULTS: The study sample included 7539 female (75.7%) and 2436 male (24.3%) students (mean [SD] age 20.0 [1.8] years). About one in five students reported occasional suicidal thoughts (n = 1775, 17.7%) and 368 students (3.7%) reported frequent suicidal thoughts. The adjusted multinomial logistic regression revealed a significant negative association between perceived parental support and suicidal thoughts. A lack of perceived parental support in childhood and adolescence was associated with > 4-fold elevated risk of occasional (adjusted OR, 4.55; 95% CI: 2.97-6.99) and nearly 9-fold elevated risk of frequent (adjusted OR, 8.58; 95% CI: 4.62-15.96) suicidal thoughts, compared to individuals that perceived extremely strong parental support. This association was strongest among students with no personal history of depression or suicide attempts. CONCLUSIONS: Students that perceived low levels of past parental support had a higher risk of suicidal ideation. Past perceived parental support appeared to be a potent marker of suicidal risk in young adults. This marker should be routinely collected in studies on suicidal risk in young adults, and it could be considered an additional screening tool.