Severe role impairment associated with mental disorders: results of the WHO world mental health surveys international college student project

Abstract

Background—College entrance is a stressful period with a high prevalence of mental disorders. Aims—To assess the role impairment associated with 12-month mental disorders among incoming first-year college students within a large cross-national sample. Methods—Web-based self-report surveys assessing the prevalence of DSM-IV mental disorders and health-related role impairment (Sheehan Disability Scale) were obtained and analysed from 13,984 incoming first-year college students (Response= 45.5%), across 19 universities in 8 countries. Impairment was assessed in the following domains: home management, work (e.g., college-related problems), close personal relationships, and social life. Results—Mean age of the sample was 19.3 (SD=0.59) and 54.4% were female. Findings showed that 20.4% of students reported any severe role impairment (10% of those without a mental disorder vs. 42.9% of those with at least one disorder, p < 0.01). In bivariate analyses, panic disorder and mania were associated most frequently with severe impairment (60.6% and 57.5%, respectively). Students reporting 3 or more mental disorders had almost five-fold more frequently severe impairment relative to those without mental disorders. Multiple logistic regression showed that major depression (OR= 4.0; 95% CI 3.3, 4.8), generalized anxiety (OR=3.9; 95% CI 3.1, 4.8), and panic disorder (OR=2.9; 95% CI 2.4, 4.2) were associated with the highest odds of severe impairment. Only minimal deviations from these overall associations were found across countries. Conclusion—Mental disorders among first-year college students are associated with substantial role impairment. Providing preventative interventions targeting mental disorders and associated impairments is a critical need for institutions to address.