Mental disorders & self-injurious thoughts and behaviors predict high risk of role impairment among university students - results from the world mental health international college student initiative

Jordi Alonso; Maria V. Petukhova; Sue Lee; Nancy A. Sampson; Yasmin A. Altwaijri; Ahmad N. AlHadi; Nouf K. Al-Saud; Claes Andersson; Randy P. Auerbach; Laura Ballester; Jason Bantjes; Marcus Bendtsen; Corina Benjet; Anne H. Berman; Paula Carrasco; Silver C.N. Chan; Irina Cohut; Marcelo A. Crockett; Pim Cuijpers; Oana A. David; Dong Dong; Jorge Gaete; Mireia Felez-Nobrega; Carlos García Forero; Margalida Gili; Raúl A. Gutiérrez-García; Josep Maria Haro; Xanthe Hunt; Álvaro I. Langer; Irene Léniz; Yan Liu; Scarlett Mac-Ginty; Vania Martínez; Andre Mason; Andrea Miranda-Mendizabal; Daniel Núñez; Claudiu C. Papasteri; José A. Piqueras; Codruta A. Popescu; Charlene Rapsey; Tiscar Rodriguez-Jimenez; Wylene Saal; Oi ling Siu; Dan J. Stein; Sascha Y. Struijs; Cristina T.Tomoiaga; Samuel Y.S. Wong; Gemma Vilagut; Ronald C. Kessler

doi:10.1016/j.jad.2025.120847

Mental disorders & self-injurious thoughts and behaviors predict high risk of role impairment among university students - results from the world mental health international college student initiative

Jordi Alonso^*, Maria V. Petukhova, Sue Lee, Nancy A. Sampson, Yasmin A. Altwaijri, Ahmad N. AlHadi, Nouf K. Al-Saud, Claes Andersson, Randy P. Auerbach, Laura Ballester, Jason Bantjes, Marcus Bendtsen, Corina Benjet, Anne H. Berman, Paula Carrasco, Silver C.N. Chan, Irina Cohut, Marcelo A. Crockett, Pim Cuijpers, Oana A. DavidDong Dong, Jorge Gaete, Mireia Felez-Nobrega, Carlos García Forero, Margalida Gili, Raúl A. Gutiérrez-García, Josep Maria Haro, Xanthe Hunt, Álvaro I. Langer, Irene Léniz, Yan Liu, Scarlett Mac-Ginty, Vania Martínez, Andre Mason, Andrea Miranda-Mendizabal, Daniel Núñez, Claudiu C. Papasteri, José A. Piqueras, Codruta A. Popescu, Charlene Rapsey, Tiscar Rodriguez-Jimenez, Wylene Saal, Oi ling Siu, Dan J. Stein, Sascha Y. Struijs, Cristina T.Tomoiaga, Samuel Y.S. Wong, Gemma Vilagut, Ronald C. Kessler

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Objective We examined psychopathological conditions accounting for the highest risk of role impairment among university students. Method Cross-sectional online survey of first-year students (60 universities, 10 countries) assessing role impairment due to emotional problems in previous 30 days with the 3-item emotional subscale of the VR-36. Cross-tabulations and Poisson regression examined associations between 12 psychopathological conditions (8 probable mental disorders and 4 SITB) and socio-demographics with “significant role impairment” (“most”/”all of the time” in 2+ VR-36 items). We used machine learning methods to predict probabilities (risk) of significant role impairment based on the 12 psychopathological conditions. Observed prevalence of significant role impairment was examined within and across the 20 population ventiles to assess risk concentration using sensitivity (SN) and positive predictive value (PPV). Results 43,990 students responded to the survey (median age = 19, IQR = 18–23). 27.1 % had significant role impairment due to emotional problems and 65.8 % had at least one psychopathological condition. Students with one or more of these conditions were more likely to have significant impairment than those without (RR = 3.9; 95 %CI: 3.6–4.2). In multivariable analyses, probable Depression and Bipolar disorders were the strongest correlates of significant impairment. Most (69.6 %) of the observed significant role impairment occurred among the roughly 35 % of respondents with highest predicted risk (PPV = 53.2 %). Conclusion Significant role impairment due to emotional problems is highly prevalent among university students. High risk of significant role impairment concentrates in one third of the students, those with several psychopathological conditions. Assessing these conditions should help identifying highest role impairment risk university students.

Original language	English
Article number	120847
Pages (from-to)	1-11
Number of pages	11
Journal	Journal of Affective Disorders
Volume	397
Early online date	8 Dec 2025
DOIs	https://doi.org/10.1016/j.jad.2025.120847
Publication status	E-pub ahead of print - 8 Dec 2025

Bibliographical note

Publisher Copyright:
Copyright © 2025. Published by Elsevier B.V.

Funding

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). 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). 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. The Netherlands: ZonMw ( Netherlands Organization 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. 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 . AMM reports grant funding - Sara Borrell grant ( CD23/00010) ISC-III . Chile: MAC, VM, JG, and ÁIL, received funding from ANID/Millennium Science Initiative Program - NCS2021_081 and ANID/FONDECYT REGULAR - N°1,221,230 . New Zealand: The WMH-ICS NZ surveys were supported by a Rutherford Discovery Fellowship and a James Hume Bequest Grant . Romania: This work was supported by a grant of the Ministry of Research, Innovation and Digitization , CNCS - UEFISCDI , project number PN-IV-P1-PCE-2023-1854 , within PNCDI IV. SM-G received funding from ANID/Millennium Science Initiative Program - NCS2021_081 and ANID/PFCHA/DOCTORADO EN EL EXTRANJERO BECAS CHILE/2019 - 72,200,092 . 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.

Funders	Funder number
South African Medical Research Council
Eli Lilly and Company
Saudi Basic Industries Corporation
Protestants Fonds voor de Geestelijke Volksgezondheid
Departament de Recerca i Universitats
Ministerio de Ciencia e Innovación and Unión Europea
ISC-III
Agencia Nacional de Investigación y Desarrollo
King Saud University
ZonMw
Generalitat de Catalunya
King Abdulaziz City for Science and Technology , Ministry of Health
James Hume Bequest
Instituto de Salud Carlos III
Ministry of Research
Pan American Health Organization
John D. and Catherine T. MacArthur Foundation
PFCHA
GlaxoSmithKline
Saudi University Mental Health Survey
Pfizer Foundation
CNCS
CIBER
Ortho-McNeil Pharmaceutical
AGAUR	2021 SGR 00624
US Public Health Service	R01 DA016558, R13-MH066849, R01-MH069864
Netherlands Organization for Health Research and Development	636110005
European Union	PI20/00006
Fogarty International Center	FIRCA R03-TW006481
Swedish Research Council	2019-01127
National- Institute of Mental Health NIMH	R01MH070884
Doctorado	CHILE/2019 - 72,200,092
Millennium Science Initiative Program	NCS2021_081
Fondo Nacional de Desarrollo Científico y Tecnológico	1,221,230
Consorcio Centro de Investigación Biomédica en Red	CB06/02/0046
Sara Borrell	CD23/00010
Public Health Agency in Sweden	04252-2021-2.3.2
UEFISCDI	PN-IV-P1-PCE-2023-1854

Keywords

mental disorders
risk concentration
risk prediction
role impairment
self-injurious thoughts and behaviors
targeted interventions
university students

Access to Document

10.1016/j.jad.2025.120847

Persistent URL (handle)

Persistent link

Cite this

Alonso, J., Petukhova, M. V., Lee, S., Sampson, N. A., Altwaijri, Y. A., AlHadi, A. N., Al-Saud, N. K., Andersson, C., Auerbach, R. P., Ballester, L., Bantjes, J., Bendtsen, M., Benjet, C., Berman, A. H., Carrasco, P., Chan, S. C. N., Cohut, I., Crockett, M. A., Cuijpers, P., ... Kessler, R. C. (2026). Mental disorders & self-injurious thoughts and behaviors predict high risk of role impairment among university students - results from the world mental health international college student initiative. Journal of Affective Disorders, 397, 1-11. Article 120847. Advance online publication. https://doi.org/10.1016/j.jad.2025.120847

@article{0603d2d1dfdb4a09bb7872c2657f196a,

title = "Mental disorders \& self-injurious thoughts and behaviors predict high risk of role impairment among university students - results from the world mental health international college student initiative",

abstract = "Objective We examined psychopathological conditions accounting for the highest risk of role impairment among university students. Method Cross-sectional online survey of first-year students (60 universities, 10 countries) assessing role impairment due to emotional problems in previous 30 days with the 3-item emotional subscale of the VR-36. Cross-tabulations and Poisson regression examined associations between 12 psychopathological conditions (8 probable mental disorders and 4 SITB) and socio-demographics with “significant role impairment” (“most”/”all of the time” in 2+ VR-36 items). We used machine learning methods to predict probabilities (risk) of significant role impairment based on the 12 psychopathological conditions. Observed prevalence of significant role impairment was examined within and across the 20 population ventiles to assess risk concentration using sensitivity (SN) and positive predictive value (PPV). Results 43,990 students responded to the survey (median age = 19, IQR = 18–23). 27.1 \% had significant role impairment due to emotional problems and 65.8 \% had at least one psychopathological condition. Students with one or more of these conditions were more likely to have significant impairment than those without (RR = 3.9; 95 \%CI: 3.6–4.2). In multivariable analyses, probable Depression and Bipolar disorders were the strongest correlates of significant impairment. Most (69.6 \%) of the observed significant role impairment occurred among the roughly 35 \% of respondents with highest predicted risk (PPV = 53.2 \%). Conclusion Significant role impairment due to emotional problems is highly prevalent among university students. High risk of significant role impairment concentrates in one third of the students, those with several psychopathological conditions. Assessing these conditions should help identifying highest role impairment risk university students.",

keywords = "mental disorders, risk concentration, risk prediction, role impairment, self-injurious thoughts and behaviors, targeted interventions, university students",

author = "Jordi Alonso and Petukhova, \{Maria V.\} and Sue Lee and Sampson, \{Nancy A.\} and Altwaijri, \{Yasmin A.\} and AlHadi, \{Ahmad N.\} and Al-Saud, \{Nouf K.\} and Claes Andersson and Auerbach, \{Randy P.\} and Laura Ballester and Jason Bantjes and Marcus Bendtsen and Corina Benjet and Berman, \{Anne H.\} and Paula Carrasco and Chan, \{Silver C.N.\} and Irina Cohut and Crockett, \{Marcelo A.\} and Pim Cuijpers and David, \{Oana A.\} and Dong Dong and Jorge Gaete and Mireia Felez-Nobrega and \{Garc{\'i}a Forero\}, Carlos and Margalida Gili and Guti{\'e}rrez-Garc{\'i}a, \{Ra{\'u}l A.\} and Haro, \{Josep Maria\} and Xanthe Hunt and Langer, \{{\'A}lvaro I.\} and Irene L{\'e}niz and Yan Liu and Scarlett Mac-Ginty and Vania Mart{\'i}nez and Andre Mason and Andrea Miranda-Mendizabal and Daniel N{\'u}{\~n}ez and Papasteri, \{Claudiu C.\} and Piqueras, \{Jos{\'e} A.\} and Popescu, \{Codruta A.\} and Charlene Rapsey and Tiscar Rodriguez-Jimenez and Wylene Saal and Siu, \{Oi ling\} and Stein, \{Dan J.\} and Struijs, \{Sascha Y.\} and Cristina T.Tomoiaga and Wong, \{Samuel Y.S.\} and Gemma Vilagut and Kessler, \{Ronald C.\}",

note = "Publisher Copyright: Copyright {\textcopyright} 2025. Published by Elsevier B.V.",

year = "2025",

month = dec,

day = "8",

doi = "10.1016/j.jad.2025.120847",

language = "English",

volume = "397",

pages = "1--11",

journal = "Journal of Affective Disorders",

issn = "0165-0327",

publisher = "Elsevier B.V.",

}

Alonso, J, Petukhova, MV, Lee, S, Sampson, NA, Altwaijri, YA, AlHadi, AN, Al-Saud, NK, Andersson, C, Auerbach, RP, Ballester, L, Bantjes, J, Bendtsen, M, Benjet, C, Berman, AH, Carrasco, P, Chan, SCN, Cohut, I, Crockett, MA, Cuijpers, P, David, OA, Dong, D, Gaete, J, Felez-Nobrega, M, García Forero, C, Gili, M, Gutiérrez-García, RA, Haro, JM, Hunt, X, Langer, ÁI, Léniz, I, Liu, Y, Mac-Ginty, S, Martínez, V, Mason, A, Miranda-Mendizabal, A, Núñez, D, Papasteri, CC, Piqueras, JA, Popescu, CA, Rapsey, C, Rodriguez-Jimenez, T, Saal, W, Siu, OL, Stein, DJ, Struijs, SY, T.Tomoiaga, C, Wong, SYS, Vilagut, G & Kessler, RC 2026, 'Mental disorders & self-injurious thoughts and behaviors predict high risk of role impairment among university students - results from the world mental health international college student initiative', Journal of Affective Disorders, vol. 397, 120847, pp. 1-11. https://doi.org/10.1016/j.jad.2025.120847

Mental disorders & self-injurious thoughts and behaviors predict high risk of role impairment among university students - results from the world mental health international college student initiative. / Alonso, Jordi; Petukhova, Maria V.; Lee, Sue et al.
In: Journal of Affective Disorders, Vol. 397, 120847, 15.03.2026, p. 1-11.

Research output: Contribution to Journal › Article › Academic › peer-review

TY - JOUR

T1 - Mental disorders & self-injurious thoughts and behaviors predict high risk of role impairment among university students - results from the world mental health international college student initiative

AU - Alonso, Jordi

AU - Petukhova, Maria V.

AU - Lee, Sue

AU - Sampson, Nancy A.

AU - Altwaijri, Yasmin A.

AU - AlHadi, Ahmad N.

AU - Al-Saud, Nouf K.

AU - Andersson, Claes

AU - Auerbach, Randy P.

AU - Ballester, Laura

AU - Bantjes, Jason

AU - Bendtsen, Marcus

AU - Benjet, Corina

AU - Berman, Anne H.

AU - Carrasco, Paula

AU - Chan, Silver C.N.

AU - Cohut, Irina

AU - Crockett, Marcelo A.

AU - Cuijpers, Pim

AU - David, Oana A.

AU - Dong, Dong

AU - Gaete, Jorge

AU - Felez-Nobrega, Mireia

AU - García Forero, Carlos

AU - Gili, Margalida

AU - Gutiérrez-García, Raúl A.

AU - Haro, Josep Maria

AU - Hunt, Xanthe

AU - Langer, Álvaro I.

AU - Léniz, Irene

AU - Liu, Yan

AU - Mac-Ginty, Scarlett

AU - Martínez, Vania

AU - Mason, Andre

AU - Miranda-Mendizabal, Andrea

AU - Núñez, Daniel

AU - Papasteri, Claudiu C.

AU - Piqueras, José A.

AU - Popescu, Codruta A.

AU - Rapsey, Charlene

AU - Rodriguez-Jimenez, Tiscar

AU - Saal, Wylene

AU - Siu, Oi ling

AU - Stein, Dan J.

AU - Struijs, Sascha Y.

AU - T.Tomoiaga, Cristina

AU - Wong, Samuel Y.S.

AU - Vilagut, Gemma

AU - Kessler, Ronald C.

PY - 2025/12/8

Y1 - 2025/12/8

N2 - Objective We examined psychopathological conditions accounting for the highest risk of role impairment among university students. Method Cross-sectional online survey of first-year students (60 universities, 10 countries) assessing role impairment due to emotional problems in previous 30 days with the 3-item emotional subscale of the VR-36. Cross-tabulations and Poisson regression examined associations between 12 psychopathological conditions (8 probable mental disorders and 4 SITB) and socio-demographics with “significant role impairment” (“most”/”all of the time” in 2+ VR-36 items). We used machine learning methods to predict probabilities (risk) of significant role impairment based on the 12 psychopathological conditions. Observed prevalence of significant role impairment was examined within and across the 20 population ventiles to assess risk concentration using sensitivity (SN) and positive predictive value (PPV). Results 43,990 students responded to the survey (median age = 19, IQR = 18–23). 27.1 % had significant role impairment due to emotional problems and 65.8 % had at least one psychopathological condition. Students with one or more of these conditions were more likely to have significant impairment than those without (RR = 3.9; 95 %CI: 3.6–4.2). In multivariable analyses, probable Depression and Bipolar disorders were the strongest correlates of significant impairment. Most (69.6 %) of the observed significant role impairment occurred among the roughly 35 % of respondents with highest predicted risk (PPV = 53.2 %). Conclusion Significant role impairment due to emotional problems is highly prevalent among university students. High risk of significant role impairment concentrates in one third of the students, those with several psychopathological conditions. Assessing these conditions should help identifying highest role impairment risk university students.

AB - Objective We examined psychopathological conditions accounting for the highest risk of role impairment among university students. Method Cross-sectional online survey of first-year students (60 universities, 10 countries) assessing role impairment due to emotional problems in previous 30 days with the 3-item emotional subscale of the VR-36. Cross-tabulations and Poisson regression examined associations between 12 psychopathological conditions (8 probable mental disorders and 4 SITB) and socio-demographics with “significant role impairment” (“most”/”all of the time” in 2+ VR-36 items). We used machine learning methods to predict probabilities (risk) of significant role impairment based on the 12 psychopathological conditions. Observed prevalence of significant role impairment was examined within and across the 20 population ventiles to assess risk concentration using sensitivity (SN) and positive predictive value (PPV). Results 43,990 students responded to the survey (median age = 19, IQR = 18–23). 27.1 % had significant role impairment due to emotional problems and 65.8 % had at least one psychopathological condition. Students with one or more of these conditions were more likely to have significant impairment than those without (RR = 3.9; 95 %CI: 3.6–4.2). In multivariable analyses, probable Depression and Bipolar disorders were the strongest correlates of significant impairment. Most (69.6 %) of the observed significant role impairment occurred among the roughly 35 % of respondents with highest predicted risk (PPV = 53.2 %). Conclusion Significant role impairment due to emotional problems is highly prevalent among university students. High risk of significant role impairment concentrates in one third of the students, those with several psychopathological conditions. Assessing these conditions should help identifying highest role impairment risk university students.

KW - mental disorders

KW - risk concentration

KW - risk prediction

KW - role impairment

KW - self-injurious thoughts and behaviors

KW - targeted interventions

KW - university students

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DO - 10.1016/j.jad.2025.120847

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AN - SCOPUS:105024885795

SN - 0165-0327

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JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

M1 - 120847

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Alonso J, Petukhova MV, Lee S, Sampson NA, Altwaijri YA, AlHadi AN et al. Mental disorders & self-injurious thoughts and behaviors predict high risk of role impairment among university students - results from the world mental health international college student initiative. Journal of Affective Disorders. 2026 Mar 15;397:1-11. 120847. Epub 2025 Dec 8. doi: 10.1016/j.jad.2025.120847

Mental disorders & self-injurious thoughts and behaviors predict high risk of role impairment among university students - results from the world mental health international college student initiative

Abstract

Bibliographical note

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Keywords

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