Prevalence of Mental Health Problems Among Undergraduate Students at the Universidad de Los Andes

Study Overview
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Brief Summary
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This project seeks to know the prevalence of mental health problems among undergraduate students, through internationally and nationally validated screening instruments. The project also aims to understand better the associated factors contributing to the mental health problems of this population. Through the critical analysis of the results, our proposal aims to establish the prevalence of anxiety, depression, suicidality and substance use, and the association with socioeconomic features, academic stress, sense of belonging to the university, interpersonal relationships, and sleep habits among other factors. Once finalized the study, the results obtained will be disseminated to the university community and published in peer-reviewed journals. The results will help the university authorities to design and implement measures to prevent mental health problems in this community.

Detailed Description
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Background Mental health in the university population has become in recent years a common and serious problem worldwide. There are various studies, systematic reviews and meta-analyses that have been carried out over the past 5 years, which show very worrying figures. In the USA, it has been described in medical students that between 6.0% and 66.5% have depression, between 7.7% and 65.5% anxiety disorders, and between 12.2% and 96.7% refer having stress. In China, on the other hand, a study was reported in 2016 that revealed a prevalence of depression of 23.8%. In Latin America we find a study carried out in Brazil among medical students, which shows a prevalence of depression of 30.6%, anxiety disorders of 32.9, and stress of 49.9%, among other indicators described. In Chile, during 2019 appears the results of the First National Survey of Mental Health among university students, surveying over 600 students from three universities in Chile. This study showed that 46% of the students presented depressive symptoms, 46% had anxiety symptoms, 53.5% stress symptoms and 29.7% presented all three symptoms simultaneously. In addition, 5.1% of the students reported having suicidal thoughts at the time of the study. There are multiple determinants that influence mental health, both social, biological, and psychological factors. Within these, the socioeconomic levels of the families of origin and the education attained by their parents stand out, but also the contexts of violence -in its multiple forms- to which university students may be exposed, levels of stress for academic reasons, discrimination for various reasons, in addition to poor health in general. University students are a group that has certain characteristics in common that makes it particularly vulnerable in terms of their mental health. Among these factors, we can mention: the process of adaptation from the school environment to the university environment, the vocational uncertainty, being subjected to a constant academic workload, responding with demands of both their own and their environment (such as parents and society), and facing worries about entering into the world of work. In short, passing through the university is a period of constant changes, which demands self-management and support, but it also means an adaptation process that can help to eventually develop mental health problems. At Universidad de los Andes there are no official published figures on the prevalence of mental health problems among university students, nor on possible associated factors among its students. It is important to have a clear and precise current status, as this would allow the implementation of prevention policies, interventions, and the creation of support networks that can help students' mental health. General Aim: The general aim of this project is to describe the mental health of the students of the Universidad de los Andes and its association with individual factors, especially academic stress, sense of university belonging, peer violence, substance abuse, and sleep habits. Methodology Participants. All regular undergraduate students from first to last year of career and older than 18 years old from the Universidad de los Andes will be invited to participate. The various academic units and faculties have offered support and will join the study. Participation is voluntary. Sample size. Random sampling will be considered for each stratum defined by the career and its year, the sample size is determined from the number of enrolled. For this sample calculation, it has been used as p = 0.1, considering that different studies have estimated the prevalence of suicidal ideation in the last year of 10% (10). A non-response of 20% is anticipated, therfore the sample size is increased by that percentage. A total of 4836 students are expected to participate. Instruments. A detailed description of the instruments can be found in the Outcomes section of this protocol.

Official Title
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Prevalence of Mental Health Problems Among Undergraduate Students at the Universidad de Los Andes

Conditions
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Student, Mental Health, Depression, Anxiety, Depression, Anxiety, College Drinking, Stress

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 years old or older Regular undergraduate students Exclusion Criteria: Nonconsent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Depression, Anxiety and Stress Scale (DASS-21) | Self-reported symptoms with the Depression, Anxiety and Stress Scale (DASS-21), which have 21 items, each scoring between 0 and 3, the minimum score is 0 and the maximum score of 63. The cut-off score for the depression subscale is 6, Anxiety is 5, Stress is 6. | Up to 4 weeks | 
| Columbia-Suicide Severity Rating Scale (C-SSRS) | The Columbia-Suicide Severity Rating Scale (C-SSRS) is a questionnaire used for suicide assessment. This scale has 6 items and each item has to be answered Yes or No. The total score is 6. A score of 0 is no ideation is present. | Up to 4 weeks | 
| CAGE | Self-report of harmful alcohol drinking. 4 items. CAGE stands for: C: Have you felt the need to Cut down drinking? A: Have you ever felt Annoyed by criticism of drinking? G: Have you had Guilty feelings about drinking? E: Do you ever take a morning Eye opener (a drink first thing in the morning to steady your nerves or get rid of a hangover)? The range score goes from 0 to 4. The point cut off is >= 2. | Up to 4 weeks | 
| Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) | Adaptation of The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) interview model, including prescription and nonprescription drugs and vaping. It has 8 items exploring the frequency of substance use in the last 3 months (daily, weekly, yearly) and the problems associated with the use. It explores the use of 10 kinds of drugs. | Up to 4 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sociodemographic characteristics | Ad hoc self-report survey: Current age University enrollment year Current years of study Sex Gender Civil status Parenting and number of child(s) Nationality Etnicity Ocupational situation: only study, part-time worker, fulltime worker and study Carrer Maximum parents studies degree: analphabet, school, undergraduate, postgraduate; complete or incomplete studies. Payment of studies: credit, schollarship, self-pay Travel time from home to campus: minutes, hours. | Up to 4 weeks | 
| General Health perception | Self-perception on a subjective analogous scale of physical health | Up to 4 weeks | 
| General Menta Health perception | Self-perception on a subjective analogous scale of mental health | Up to 4 weeks | 
| History of chronic diseases | Ad hoc self-report survey of any previous chronic physical disease | Up to 4 weeks | 
| Physical activity | Ad hoc self-report survey of minutes of physical activity during the past week | Up to 4 weeks | 
| Social activities | Ad hoc self-report survey of time spent with friends or social gatherings | Up to 4 weeks | 
| Family functionality (APGAR) | Family functionality APGAR score: a 5-item measure of perceived family support in the domains of adaptation, partnership, growth, affection, and resolve. E.g. I find that my family accepts my wishes to take on new activities or make changes in my lifestyle. Scores range from 0 to 10, being 10 a total satisfaction with family functionality. | Up to 4 weeks | 
| History of personal and family mental health problems | Ad hoc self-report questionnaire of personal and family mental health history: Previous diagnosis of depression, bipolar disorder, panic attacks, anxiety disorders, eating disorders, ADHD. Current psychotherapy of psychiatric medication Family history of psychiatric disorders | Up to 4 weeks | 
| Insomnia Severity Index (ISI) | Self-report of insomnia perception. it has 7 items, and responses can range from 0 to 4, where higher scores indicate more acute symptoms of insomnia. Scores ranges from 0 to 28. A clinical Insomnia threshold score of 15. | Up to 4 weeks | 
| University violence and bullying | Ad hoc self-report survey of violence suffered from teachers, administrative, auxiliaries, and other students; discrimination and bullying. | Up to 4 weeks | 
| Sexuality and sexual health | Ad hoc self-report survey of sexual health, including sexual orientation, the current status of an emotional relationship, number of sex partners in the last year, history of Sexually Transmitted Disease (STD). | Up to 4 weeks | 
| Sense of Social and Academic Fit (SSAF) | Sense of Social and Academic Fit (SSAF) is a self-report questionnaire of 17 items, with responses on a Likert format from 1-7. It measures academic and social sense of belonging. The score is produced as the average of the scores reported in each item. The minimum score is 1 and the maximum score is 17. A higher score means higher sense of belonging. | Up to 4 weeks | 
| COVID-19 questions | Ad-hoc self-report survey of current perception and possible diagnosis of COVID-19: Fear or preoccupation about getting COVID-19 Sense of severity if diagnosed with COVID-19 Fear or preoccupation about a family member or friend to get COVID-19 Current diagnosis of COVID-19 A family member diagnosed with COVID19 Sense of compliance with social isolation and quarantine Persons living with (family, friends, alone) Frequency of: going out of home, gather with others, virtual socialization, keeping a routine, exercise realized, recreative activities, meditation or prayer, seek information about the situation of COVID19 Frequency of the following symptoms: nervousness, hopelessness, depression, amount of effort required to realize activities, self-value, anhedonia. | Up to 4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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college students, undergraduate