One-year incidence, predictors, and accuracy of prediction of suicidal thoughts and behaviors from the first to second year of university.

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.

Suicidal Ideation and Behavior Among Mexican University Students Before and During the COVID-19 Pandemic.

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.

Internet Gaming Disorder and the Incidence of Suicide-Related Ideation and Behaviors in College Students.

OBJECTIVES: The longitudinal associations between DSM-5 Internet Gaming Disorder (IGD) and suicide-related ideation and behaviors have not been explored. In this study, we therefore seek to examine the association between baseline IGD and incident suicide ideation, plans, and attempts. METHODS: This is a prospective cohort study of 2586 Mexican college students followed up from September 2018 to June 2022. We estimated hazards ratios modeling incidence of suicide ideation, plans, and attempts by fitting proportional hazards Cox models with person-time scaled in years. RESULTS: Among 2140 students without suicide ideation at baseline, there were 467 incident cases in 3987.6 person-years; ideation incidence rates were 179 cases per 1000 person-years among students with IGD and 114 cases per 1000 person-years among those without IGD. Incidence rates for suicide plans were 67 and 39 per 1000 among IGD and non-IGD students, and 15 and 10 per 1000, respectively for attempts. After controlling for age, sex, and mood, anxiety, and substance use disorders, IGD was associated with an 83% increased risk of suicide ideation. Although incidence rate estimates for plans and attempts were higher among students with IGD, results were not statistically significant. CONCLUSIONS: This study helps to raise awareness of the increased risk of at least suicidal ideation in people experiencing IGD. Clinicians treating patients with IGD may encounter complaints of suicide ideation over time, and even reports of suicidal behavior that should not be disregarded. Identifying these patients and treating/referring them for underlying suicidality should form part of IGD treatment.

Treatment Delivery Preferences Associated With Type of Mental Disorder and Perceived Treatment Barriers Among Mexican University Students.

PURPOSE: Although Internet-based electronic health (eHealth) interventions could potentially reduce mental health disparities, especially in college students in under-resourced countries, little is known about the relative acceptability of eHealth versus in-person treatment modalities and the treatment barriers associated with a preference for one type over the other. METHODS: Participants were from the 2018-2019 cohort of the University Project for Healthy Students (PUERTAS), a Web-based survey of incoming first-year students in Mexico and part of the World Mental Health International College Student Survey initiative. A total of 7,849 first-year students, 54.73% female, from five Mexican universities participated. We estimated correlates of preference for eHealth delivery over in-person modalities with a multivariate logistic regression. RESULTS: Thirty-eight percent of students prefer in-person services, 36% showed no preference for in-person over eHealth, 19% prefer not to use services of any kind, and 7% preferred eHealth over in-person treatment delivery. Being embarrassed, worried about harm to one's academic career, wanting to handle problems on one's own, beliefs about treatment efficacy, having depression, and having attention-deficient hyperactivity disorder were associated with a clear preference for eHealth delivery methods with odds ratios ranging from 1.47 to 2.59. CONCLUSIONS: Although more students preferred in-person services over eHealth, those reporting attitudinal barriers (i.e., embarrassment, stigma, wanting to handle problems on one's own, and beliefs about treatment efficacy) and with depression or attention-deficit hyperactivity disorder had a greater preference for eHealth interventions suggesting these are students to whom eHealth interventions could be targeted to alleviate symptoms and/or as a bridge to future in-person treatment.

DSM-5 Internet gaming disorder among a sample of Mexican first-year college students.

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.