Predictors of Mental Health and School-Related Outcomes in First Year University Students: Identifying Prevention Targets

Background: Student demand for mental health support is straining university resources, yet there is limited information about the scope of need and determinants. Therefore, our objective was to longitudinally examine the importance of potentially modifiable psychosocial and lifestyle factors for mental health and school-related outcomes. Methods: Canadian undergraduates were invited to complete electronic surveys at entry and completion of first year. The baseline survey measured important distal and proximal risk factors and the follow-up survey assessed mental health and well-being. Surveys were linked to academic grades. Multivariable models of proximal risk factors and mental health and school-related outcomes were fit and adjusted for confounders. Outcomes: In a representative sample of 1,530 students, over one-third screened positive for clinically significant depressive and anxiety symptoms at entry, increasing to 36% and 39% respectively at completion of first year. Over the school year, 14% of students reported suicidal thoughts and 1.5% suicide attempts. There was evidence of persistence and overlap in mental health outcomes. Modifiable psychosocial and lifestyle risk factors at entry were associated with positive screens for all mental health outcomes at completion of first year, while anxiety and depressive symptoms were associated with lower grades and school well-being. Interpretation: A substantial proportion of first year university students experience clinically significant mental health symptoms that are negatively associated with academic performance and school well-being. A research-informed comprehensive mental health strategy that includes a whole university approach and development of effective prevention initiatives seems justified. Funding Statement: The U-Flourish Student Well-Being and Academic Success study is funded by an operating grant from the Canadian Institutes of Health Research. Declaration of Interests: All authors confirm that they have no financial or personal conflict of interest to disclose in relationship to this manuscript. Ethics Approval Statement: Ethics approval for this study was received from the Queen’s University and Affiliated Teaching Hospitals Research Ethics Board (HSREB PSIY-609-18).