The relation between economic stressors and higher education students' mental health during the initial outbreak of the COVID-19 pandemic.

AIMS: The COVID-19 pandemic has had a large impact on the financial situation of higher education students, disproportionately affecting students with a low socioeconomic status (SES). This raises the question of whether economic stressors related to COVID-19 have aggravated existing socioeconomic inequalities in mental health. This study examined the relationship between economic stressors and students' depressive symptoms, and the role of students' SES and countries' socioeconomic conditions. METHODS: Data from the COVID-19 International Student Well-being Study was used for multilevel analyses, with depressive symptoms as dependent variable. Three indicators measured SES: educational level of the parents, ability to borrow money from their social network, and struggling with financial resources prior to COVID-19. RESULTS: Students with a low SES had more depressive symptoms, and those not able to borrow money and with parents without higher education were more exposed to a deterioration in their financial situation. Both economic stressors (reduction in working hours and a deterioration of their financial situation) were positively related to depressive symptoms. In addition, the positive relationship between a decrease in working hours and depressive symptoms was stronger in countries with a higher unemployment rate. CONCLUSIONS: We observed socioeconomic inequalities in students' mental health, which, in part, can be ascribed to a larger exposure to the economic stressors related to COVID-19 among students' with a low SES. The macroeconomic context also played a role, as the impact of a reduction in working hours on depressive symptoms was stronger in countries with poor economic conditions.

Efficacy of health literacy interventions aimed to improve health gains of higher education students-a systematic review.

BACKGROUND: Health literacy (HL) among higher education students is low, making them vulnerable about their health. To reverse this trend, higher education institutions promote HL interventions with various topics and methods. A comprehensive understanding of HL interventions is essential to determine whether these interventions meet the health information needs to improve health outcomes (health gains). The aim of this review was to identify and synthesise evidence on the efficacy of HL interventions implemented in academic settings to improve health outcomes. METHODS: A systematic review was performed followed the PRISMA guidelines, protocol was registered in PROSPERO (CRD42022369869). A search strategy was performed in the EBSCO Host Web platform, the time limit placed was: 01/01/2017 to 30/09/2022. Eligible studies were those published in peer-reviewed journals and involved higher education students over the age of 18 as the subject of the intervention. Eligible interventions included any interventions evaluated in a study with comparison group that included a pre-post measure of health outcomes, were conducted in an academic setting. To methodology quality of included studies, it was used the Joanna Briggs Institute critical appraisal tool. To synthesise results narrative and thematic synthesis was conducted. RESULTS: A total of 9 articles were included in this review, identified health literacy interventions with an impact on health outcomes. The total studies involved 2902 higher education students. All 9 studies were randomised controlled trials. The synthesised evidence supports the efficacy of interventions that contributed to positive changes in mental health, attitudes, norms, and self-efficacy of condom use, emotional, social, and psychological well being, subjective sleep quality, sleep latency, and habitual sleep efficiency, physical activity, and self-reported servings fried foods. HL interventions were educational or motivational and related to health promotion, disease prevention or healthcare. CONCLUSIONS: HL interventions in higher education students can significantly improve health outcomes protecting them from the negative effects of threats for their health. The interventions designed with different strategies are more effective. HL interventions are associated with health benefits on health promotion, disease prevention and healthcare. For the attendance of higher education to be a successful experience, continuity of HL interventions developed in academic settings is necessary.

The impact of distance education on the socialization of college students in the Covid-19 era: problems in communication and impact on mental health.

BACKGROUND: The problems of students' social interaction and psychological well-being associated with online learning dependent on self-directed learning have become an important topic of research in recent years worldwide due to the COVID-19 pandemic, affecting their Social Emotional Learning. This paper aimed to compare the students' loneliness, social anxiety, social interaction, and general psychological well-being at different stages of online learning (at the beginning and the height of the pandemic), considering their criteria (presence/absence of a job and own family). METHODS: For this, the researchers conducted an electronic survey of students (n = 320) twice, in February and May 2020, using four questionnaires: UCLA loneliness scale-3, Social Anxiety Scale for E-Learning Environments, Social Interaction Scale, and Brief Adjustment Scale. The responses at different stages of online learning were compared using Student's t-test. Differences between employed and unemployed students with or without their own families were determined using the analysis of variance (ANOVA). RESULTS: The findings showed that unemployed students without their families suffered the most from loneliness. Social interaction online was rated higher by students with their own families; psychological well-being at the beginning of the distance period and social anxiety at the height of the distance period were higher among unemployed students. CONCLUSIONS: This research can become a theoretical basis for a phase-by-phase study of social predictors for the psychological well-being of higher education students and is of practical value for teachers and administrators of online learning aimed at students' socialization. In addition, it provides education officials with information about how students perceive psychological well-being, anxiety, social interaction, and loneliness during distance learning, which can help officials direct their decisions and reforms to improve interaction in the online environment.

Optimism and fear of COVID-19 in higher education students: the mediating role of general anxiety.

Higher education students have faced several changes in their lives due to the COVID-19 pandemic. This study aims to explore the effect of dispositional optimism in students' fear of COVID-19 and to test the mediating role of general anxiety in the relationship between optimism and fear. Using an online survey, data were collected during the second wave of the pandemic in Portugal. The sample included 312 higher education students (76% females) aged 18-25 years old, who completed measures of dispositional optimism, general anxiety and fear of COVID-19. The results showed that higher optimism and lower general anxiety reduce fear of COVID-19. Moreover, the link between optimism and fear is fully mediated by general anxiety, showing that optimism reduces fear of COVID-19 indirectly through the reduction of students' anxiety. The role of optimism, anxiety and fear in higher education students is discussed and topics for further research are presented.

Political stringency, infection rates, and higher education students' adherence to government measures in the Nordic countries and the UK during the first wave of the COVID-19 outbreak.

Understanding predictors of adherence to governmental measures to prevent the spread of the COVID-19 is fundamental to guide health communication. This study examined whether political stringency and infection rates during the first wave of the pandemic were associated with higher education students' adherence to COVID-19 government measures in the Nordic countries (Denmark, Finland, Norway, Iceland, and Sweden) and the United Kingdom. Both individual- and country-level data were used in present study. An international cross-sectional subsample (n = 10,345) of higher-education students was conducted in May-June 2020 to collect individual-level information on socio-demographics, study information, living arrangements, health behaviors, stress, and COVID-19-related concerns, including adherence to government measures. Country-level data on political stringency from the Oxford COVID-19 Government Response Tracker and national infection rates were added to individual-level data. Multiple linear regression analyses stratified by country were conducted. Around 66% of students reported adhering to government measures, with the highest adherence in the UK (73%) followed by Iceland (72%), Denmark (69%), Norway (67%), Finland (64%) and Sweden (49%). Main predictors for higher adherence were older age, being female and being worried about getting infected with COVID-19 (individual-level), an increase in number of days since lockdown, political stringency, and information about COVID-19 mortality rates (country-level). However, incidence rate was an inconsistent predictor, which may be explained by imperfect data quality during the onset of the pandemic. We conclude that shorter lockdown periods and political stringency are associated with adherence to government measures among higher education students at the outset of the COVID-19 pandemic.

Digital Interventions for Psychological Well-being in University Students: Systematic Review and Meta-analysis.

BACKGROUND: Life at university provides important opportunities for personal growth; however, this developmental phase also coincides with the peak period of risk for the onset of mental health disorders. In addition, specific university lifestyle factors, including impaired sleep and academic and financial stress, are known to exacerbate psychological distress in students. As a result, university students have been identified as a vulnerable population who often experience significant barriers to accessing psychological treatment. Digital psychological interventions are emerging as a promising solution for this population, but their effectiveness remains unclear. OBJECTIVE: This systematic review and meta-analysis aimed to assess digital interventions targeting psychological well-being among university students. METHODS: Database searches were conducted on December 2, 2021, via Embase, MEDLINE, PsycINFO, and Web of Science. RESULTS: A total of 13 eligible studies were identified, 10 (77%) of which were included in the meta-analysis. Mean pre-post effect sizes indicated that such interventions led to small and significant improvement in psychological well-being (Hedges g=0.32, 95% CI 0.23-0.4; P<.001). These effects remained, albeit smaller, when studies that included a wait-list control group were excluded (Hedges g=0.22, 95% CI 0.08-0.35; P=.002). An analysis of acceptance and commitment therapy approaches revealed small and significant effects (k=6; Hedges g=0.35, 95% CI 0.25-0.45; P<.001). CONCLUSIONS: Digital psychological interventions hold considerable promise for university students, although features that optimize service delivery and outcomes require further assessment. TRIAL REGISTRATION: PROSPERO CRD42020196654; https:/www.crd.york.ac.uk/prospero/display_record.php?RecordID=196654.

Higher education students' achievement emotions and their antecedents in e-learning amid COVID-19 pandemic: A multi-country survey.

The outbreak of the COVID-19 pandemic has had a wide range of negative consequences for higher education students. We explored the generalizability of the control-value theory of achievement emotions for e-learning, focusing on their antecedents. We involved 17019 higher education students from 13 countries, who completed an online survey during the first wave of the pandemic. A structural equation model revealed that proximal antecedents (e-learning self-efficacy, computer self-efficacy) mediated the relation between environmental antecedents (cognitive and motivational quality of the task) and positive and negative achievement emotions, with some exceptions. The model was invariant across country, area of study, and gender. The rates of achievement emotions varied according to these same factors. Beyond their theoretical relevance, these findings could be the basis for policy recommendations to support stakeholders in coping with the challenges of e-learning and the current and future sequelae of the pandemic.

Reducing drug-use harms among higher education students: MyUSE contextual-behaviour change digital intervention development using the Behaviour Change Wheel.

BACKGROUND: Digital harm-reduction interventions typically focus on people with severe drug-use problems, yet these interventions have moderate effectiveness on drug-users with lower levels of risk of harm. The difference in effectiveness may be explained by differences in behavioural patterns between the two groupings. Harnessing behavioural theories to understand what is at the core of drug-use behaviours and mapping the content of new interventions, may improve upon the effectiveness of interventions for lower-risk drug-users. To the best of our knowledge, this is the first study to systematically apply the Behaviour Change Wheel (BCW) approach to understand the components, influencing capabilities, opportunities, and motivations (COM-B) of higher education students to change their drug-use behaviors. It is also the first study which identifies specific patterns of behaviours that are more responsive to harm reduction practices through the use of the Theoretical Domain Framework (TDF). METHODS: We employed an explanatory sequential mix-method design. We first conducted an on-line survey and a Delphi exercise to understand the factors influencing COM-B components of higher education students to change their drug-use. Subsequently, we mapped all evidence onto the COM-B components and the TDF domains to identify clusters of behaviours to target for change, using a pattern-based discourse analysis. Finally, a series of multidisciplinary group meetings identified the intervention functions-the means by which the intervention change targeted behaviours and the Behavioural Change Techniques (BCTs) involved using the behaviour change technique taxonomy (v.1). RESULTS: Twenty-nine BCTs relevant to harm-reduction practices were identified and mapped across five intervention functions (education, modelling, persuasion, incentivization, and training) and five policy categories (communication/marketing, guidelines, regulation, service provision, and environmental/social planning). These BCTs were distributed across eight identified saturated clusters of behaviours MyUSE intervention attempts to change. CONCLUSIONS: The BCTs, identified, will inform the development of a digitally delivered behaviour change intervention that focuses on increasing mindful decision-making with respect to drug-use and promotes alternatives to drug-use activities. The findings can also inform implementation scientists in applying context-specific harm-reduction practices in higher education. We present examples of how the eight identified clusters of target behaviours are mapped across the COM-B components and the TDF, along with suggestions of implementation practices for harm reduction at student population level.

Managing student mental health: The challenges faced by academics on professional healthcare courses.

AIMS: To explore how academics on nursing and healthcare programmes are managing their roles and responsibility in relation to student mental health. BACKGROUND: There is growing concern about the mental health of university students in general and healthcare students in particular. Shifts in Higher Education policy, encouraging a "whole university approach," may place greater responsibility for student mental health on academics. However, little is known about the challenges that poor student mental health creates for academics on healthcare programmes. DESIGN: A qualitative approach, using semi-structured interviews and focus groups, provided the opportunity for in-depth analysis. METHODS: Fourteen academics on healthcare programmes, including seven lecturers from nursing programmes, were interviewed between May-June 2017. Constant comparison analysis was followed to support grounded theory. RESULTS: Four key themes emerged. Academics had difficulty identifying and maintaining boundaries due to competing academic and professional identities. Student disclosures are accompanied by challenges arising due to professional responsibilities. Supporting student mental health on placement is difficult. Academics are aware and concerned about the potential negative impact of course content and practice on student mental health. CONCLUSION: This is the first study to explore in-depth the challenges faced by academics on healthcare programmes by the rising prevalence of and concern for, student mental health. The findings indicate that leaders of nursing education programmes and their managers, need to be aware that academics face complex challenges in managing and responding student mental health and may struggle to maintain boundaries due, in part, to competing professional identities.

Psychometric Properties of the Psychological Vulnerability Scale in Higher Education Students.

BACKGROUND: Psychological vulnerability is related to cognitive beliefs that reflect dependence on one's sense of self-worth and to maladaptive functioning. It is a disadvantage that renders people less protected to face negative life experiences. OBJECTIVE: The purpose of this study was to adapt and test the psychometric properties of the Psychological Vulnerability Scale in a sample of 267 Portuguese higher education students. DESIGN: A psychometric study of the Psychological Vulnerability Scale, after translation into Portuguese, was performed with a convenience sample of higher education students. Participants were asked to fill in the sociodemographic questionnaire, the Psychological Vulnerability Scale, the Brief Symptom Inventory, and a one-item question about the Perception of Vulnerability. RESULTS: The mean age of the participants was 20.5 years ( SD = 3.3). A factor analysis confirmed the original one-factor structure, explaining 42.9% of the total variance. The Psychological Vulnerability Scale showed adequate internal consistency and excellent test-retest stability. Convergent validity was confirmed by positive correlations with the Brief Symptom Inventory and Perception of Vulnerability. CONCLUSIONS: Overall, the Psychological Vulnerability Scale showed good validity, reliability, and stability over time. The Psychological Vulnerability Scale is now ready to be used by practitioners and researchers to measure the psychological vulnerability among Portuguese higher education students. These data add to the body of knowledge of psychiatric and mental health nursing and provides support for the use of the Psychological Vulnerability Scale in higher education students.

Eating behaviour among undergraduate students. Comparing nutrition students with other courses.

Our main aim was to compare eating behaviour between Portuguese undergraduate nutrition students and students attending other courses. Several eating behaviour dimensions were compared between 154 nutrition students and 263 students from other areas. Emotional and external eating were assessed by the Dutch Eating Behavior Questionnaire, dietary restraint was measured using the flexible and rigid control of eating behaviour subscales, binge eating was measured using the Binge Eating Scale, and eating self-efficacy using the General Eating Self-Efficacy Scale. Higher levels of flexible and rigid control were found in nutrition students from both sexes when compared to students from other courses. Female nutrition students also presented higher binge eating levels than their colleagues from other courses. To our knowledge no other work has previously assessed all eating behaviour dimensions considered in the current study among nutrition students. Besides the results by themselves, the data obtained from this study provide several clues to further studies to be developed regarding the still rarely approached issue of eating behaviour among nutrition students.

Psychological distress and lifestyle of students: implications for health promotion.

Poor diet, physical inactivity, tobacco smoking and alcohol consumption are major risk factors for chronic disease and premature mortality. These behaviours are of concern among higher education students and may be linked to psychological distress which is problematic particularly for students on programmes with practicum components such as nursing and teaching. Understanding how risk behaviours aggregate and relate to psychological distress and coping among this population is important for health promotion. This research examined, via a comprehensive survey undergraduate nursing/midwifery and teacher education students' (n = 1557) lifestyle behaviour (Lifestyle Behaviour Questionnaire), self-reported psychological distress (General Health Questionnaire) and coping processes (Ways of Coping Questionnaire). The results showed that health- risk behaviours were common, including alcohol consumption (93.2%), unhealthy diet (26.3%), physical inactivity (26%), tobacco smoking (17%), cannabis use (11.6%) and high levels of stress (41.9%). Students tended to cluster into two groups: those with risk behaviours (n = 733) and those with positive health behaviours (n = 379). The group with risk behaviours had high psychological distress and used mostly passive coping strategies such as escape avoidance. The potential impact on student health and academic achievement is of concern and suggests the need for comprehensive health promotion programmes to tackle multiple behaviours. As these students are the nurses and teachers of the future, their risk behaviours, elevated psychological distress and poor coping also raise concerns regarding their roles as future health educators/promoters. Attention to promotion of health and well-being among this population is essential.

Suicide ideation in higher education students: influence of social support.

OBJECTIVES: To determine the prevalence of students' suicidal ideation and to assess its connection with social support. METHODS: Quantitative, descriptive and exploratory study on a sample of 1074 students from a higher education institution in Portugal. The data was collected through an online platform that included a questionnaire regarding the sociodemographic and academic profile of the students, the Social/Familiar Support Satisfaction Scale1 and the Suicidal Ideation Questionnaire2. RESULTS: Students' ages varies between 17 and 49 (X¯=23,9 years old ± 6,107 sd), with the great majority (64.7%) being females. Results show that the presence/severity of suicidal thoughts is low (X¯=13.84; ± 20.29 SD) on a scale from 0 to 180 and cut-off point > 41 for values that suggest potential suicide risk, identifying 84 students at risk (7.8%). We verified significant connections between suicidal ideation and some dimensions of social support: social activities (r=-0.305; P=.000), intimacy (r=-0.272; P=.000) and overall social support (r=-0.168; P=.002). CONCLUSIONS: Suicidal ideation severity is higher on students who are far from home and living alone; students with weak social/familiar support networks (less involvement on social activities and intimate relationships). These results allow us to conclude that a frail social support network positively associates with ideation and suicidal risk.

Psychosocial determinants of academic achievement in Ethiopian higher education students, 2024. Systematic review and meta-analysis.

Introduction: Ethiopian students' academic achievement goes beyond just cognitive ability. It is interwoven with psychological and social factors. This analysis examines how these interconnected dimensions, including behaviour, emotions, and mental well-being, influence academic attainment. By revealing the multifaceted factors that shape student well-being and success, this review highlights their critical role in the higher education landscape. Methods: This systematic review and meta-analysis study aimed to contribute to the academic literature by exploring the psychosocial factors affecting the academic achievement of Ethiopian higher education students. It leveraged a diverse array of scholarly databases, and adherence to recommended reporting guidelines ensured methodological rigor and transparency throughout the investigation. Result: This systematic review synthesizes findings from 14 high-quality Ethiopian cross-sectional studies assessed using the Newcastle-Ottawa Scale. The overall pooled mean grade point average of respondents was 3.04, [(95 % CI: 2.75, 3.32), I2 = 0.00 %, P < 0.001)]. The pooled odds ratio psychosocial predictors of academic achievement was 0.47, [(95 % CI: 0.46, 0.48), I2 = 0.00 %, P = 0.001)]. The study explored factors affecting academic achievement, including psychological (sleep, stress, self-esteem) and sociological factors (social media, financial hardship, social support). The review found that these factors emerged as significant influences, highlighting the multifaceted nature of academic success. Conclusion: This synthesized study champions a holistic approach to education, urging the integration of academic progress and student well-being. It emphasizes interventions in mental health, social support, and resource access, and acknowledge their multifaceted impact on learning. In addition, it would be better to build inclusive environments with the involvement of educators and policymakers to optimize the academic success of higher education students.

Assessment of Intuitive Eating and Mindful Eating among Higher Education Students: A Systematic Review.

BACKGROUND: The role of mindful eating (ME) and intuitive eating (IE) in improving eating behavior, diet quality, and health is an area of increasing interest. OBJECTIVE: The objective of this review was to identify the instruments used to assess ME and IE among higher education students and outcomes related to these dimensions. METHODS: This review was carried out according to the PRISMA statement, through systematic searches in PubMed, Web of Science, PsycInfo, and Scopus. The inclusion criteria selected for higher education students, levels of ME and/or IE reported, and observational and clinical studies. The exclusion criteria selected against reviews, qualitative studies, and case studies. Quality was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. RESULTS: A total of 516 initial records were identified, from which 75 were included. Cross-sectional studies were the most common research design (86.7%). Most studies were conducted with samples that were predominantly female (90.7%), White (76.0%), aged 18 to 22 years (88.4%), with BMI < 25 kg/m2 (83.0%), and in the United States (61.3%). The Intuitive Eating Scale (IES), the Mindful Eating Questionnaire (MEQ), and their different versions were the most used instruments. The outcomes most studies included were eating behavior and disorders (77.3%), anthropometric assessments (47.8%), mental health (42.0%), and body image (40.6%). Regarding the quality of studies, 34.7% of studies were assigned a positive, 1.3% a negative, and 64.0% a neutral rate. CONCLUSIONS: IES and MEQ were the most used instruments. RCT and cohort studies are scarce, and future research with a higher level of quality is needed, especially on the topics of food consumption, diet quality, and biochemical markers.

Depressive Symptoms Among Higher Education Students in Germany-A Systematic Review and Meta-Analysis.

Objectives: Higher education students in Germany are vulnerable to depressive symptoms. Despite ample evidence, no comprehensive review has recently been conducted. Thus, our systematic review and meta-analysis aims at describing the extent to which students are affected by depressive symptoms. Methods: We searched three databases for articles reporting the prevalence rates of depressiveness among students in Germany published between 2002 and 2023. Pooled prevalence rates were calculated using random effects models, both for the overall sample and for subgroups categorized by gender, study setting, assessment instrument, and whether the study was conducted before or during the COVID-19 pandemic. Results: The search yielded 992 records. After screening, 60 articles remained for data extraction. About one out of five students (21.1%) exhibits depressive symptoms. Pooled prevalence rates differ between subgroups, with higher rates during the COVID-19 pandemic than before (30.6% versus 18.0%) and with females being more affected than their male counterparts (29.0% versus 23.1%). Conclusion: This review underlines the urgency with which the mental health of students should be addressed at the (higher educational) policy level.Clinical Trial Registration: PROPSPERO, Identifier CRD42022384066.

Containment Measures and Alcohol Consumption Among Drinking Higher Education Students Before and During the COVID-19 Pandemic: A Multilevel Analysis in 25 Countries.

Hazardous alcohol use tends to be more prominent among higher education students. The COVID-19 pandemic severely altered student life, raising questions on its impact on students' alcohol use patterns. The current study examined cross-country variations in drinking behaviors (weekly drinking and binge drinking), and the extent to which these variations were associated with containment measures implemented during the first wave of the COVID-19 pandemic. Data were obtained from the COVID-19 International Student Well-being Study, covering students in 25 middle- and upper-high income countries. Data on government responses were retrieved from the Oxford COVID-19 Government Response Tracker. Multilevel multinomial logistic regression analyses were performed on weekly drinking (n = 44,212) and binge drinking (n = 32,785). Considerable cross-country variation existed for weekly drinking and binge drinking. In the majority of countries, a self-reported decrease in weekly drinking and a substantial self-reported decrease in binge drinking were observed. Closings of schools were associated with decreases in weekly drinking, while limitations on social gatherings were associated with increases in weekly drinking. The stringency index was associated with reporting decreased binge drinking. The study findings demonstrate a number of small yet significant associations between containment measures and changes in student drinking behaviors. Future studies are required to uncover why some students increased their alcohol consumption, particularly in countries with stricter limitations on social gatherings.

Risk of Eating Disorders and Social Desirability among Higher Education Students: Comparison of Nutrition Students with Other Courses.

The transition to college is a period of higher risk of the development of eating disorders, with nutrition/dietetics students representing a group of particular vulnerability. Hence, it is interesting to assess eating disorders, taking into consideration potential sources of bias, including social desirability. Our aims were to compare the risk of eating disorders between students of nutrition/dietetics and those attending other courses and to study potential social desirability biases. A total of 799 higher education students (81.7% females) aged 18 to 27 years old completed a questionnaire assessing the risk of eating disorders (EAT-26) and social desirability (composite version of the Marlowe-Crowne Social Desirability Scale). The proportion of students with a high risk of eating disorders was higher among females (14.5% vs. 8.2%, p = 0.044). Nutrition/dietetics students did not differ from those attending other courses regarding the risk of eating disorders. The social desirability bias when assessing the risk of eating disorders was overall low (EAT-26 total score: r = -0.080, p = 0.024). Social desirability correlated negatively with the Diet (r = -0.129, p < 0.001) and Bulimia and food preoccupation subscales (r = -0.180, p < 0.001) and positively with Oral self-control (r = 0.139, p < 0.001).

The relation between lifestyles and positive mental health in Portuguese higher education students.

Healthy lifestyles are commonly associated with improved physical and mental health. Sleep patterns, nutrition, physical exercise, consumption of psychoactive substances, among others, can strongly influence positive mental health. The aims are: characterize lifestyles based on positive mental health clusters, considering the cross-sectional cohort sample of higher education students, and analyse the lifestyles associated with positive mental health. A cross-sectional, descriptive, correlational and multicentric study of quantitative approach was conducted. The Positive Mental Health Questionnaire was applied. Through the k-means method, four clusters were obtained based on positive mental health levels. The sample of 3647 higher education students was mostly female (78.8%), single (89.5%), with an average age of 23 years (SD = 6.68). Differences were found between clusters based on the sociodemographic characteristics and lifestyles. Findings in Cluster 1 were highlighted because they included students with a higher level of positive mental health, which was associated with greater satisfaction in affective relationships, higher recreational and sports activities, better sleep quality, a healthy diet, and lower medication and illicit drugs consumption. These key findings emphasize the promotion of healthy lifestyles and highlight the importance of positive mental health in promoting the health of higher education students.

The Impact of COVID-19 Confinement on Substance Use and Mental Health in Portuguese Higher Education Students.

The mental health of higher education students is a constant concern, and the pandemic situation caused by COVID-19 has intensified this concern. The social measures imposed to control and minimize the disease have led, among other things, to the reconfiguration of higher education students' academic life habits, which has naturally altered their emotional balance, mental health, and substance abuse. This cross-sectional, descriptive, and correlational study assesses the influence of higher education students' personal characteristics on their (self-reported) use of addictive substances (alcohol, tobacco, drugs, and pharmaceutical drugs) before and during their first compulsory confinement in Portugal, as well as its relationship with mental health. An online questionnaire was applied between 15 April and 20 May 2020, to students from various study cycles of higher education institutions in one region of Portugal (northern area of Alentejo), which included the Mental Health Inventory in its reduced version (MHI-5) and questions (constructed by the authors) on personal characterization and on the use of addictive substances before and during confinement. The convenience sample included 329 mostly female health care students between the ages of 18 and 24. In our results, we found a statistically significant decrease in tobacco, alcohol, and drug use; however, there was an increase in tobacco use among older students and an increase in anxiolytic use among students with higher academic achievement and among students who exhibited more active social behavior in the period prior to confinement. Students who took anxiolytics during confinement had higher MHI-5 scores and students who used the most addictive substances during confinement had lower MHI-5 scores than the other students.