Over a Third of College Freshmen Screen Positive for Anxiety, Depression

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Self-perceived “connectedness” with university life was negatively impacted by depression, anxiety, lower self-esteem, higher stress, and poorer social support.

In a prospective cohort study of first year university students published in BJPsych Open, over a third screened positive for clinically significant depression or anxiety. Potential targets for intervention may include self-esteem, sleep quality, and stress levels.

Anne Duffy, MD, of the department of psychiatry, Queen’s University, Kingston, Ontario, Canada, led study efforts to estimate the incidence of clinically significant mental health symptoms in undergraduate students. All first year students at Queen’s University were sent a link to an electronic survey during the early weeks of the fall semester, around September 2018. The survey captured demographics, depression and anxiety symptoms, suicidal ideation, and lifetime suicide attempts. The survey also evaluated risk factors for psychiatric symptoms, including childhood adversity, early loss, and lifestyle risk factors, such as perceived stress burden and sleep quality.

A second survey administered at the end of the first year, in March 2019, reassessed psychological symptoms, self-harm, suicidal ideation and attempts, and overall wellbeing. The primary outcomes were the presence of clinically significant depression or anxiety, defined per the 9-item Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder assessment (GAD-7), respectively. The impact of mental health symptoms on cumulative grade point averages (GPAs) was also assessed. The researchers performed multivariable regression to identify correlates of depression and anxiety.

A total of 1530 first-year university students (73.5% women) completed both surveys. At entry to university, 28% and 33% of survey respondents screened positive for clinically significant depression and anxiety, respectively. At the second timepoint, these rates increased to 36% for depression and 39% for anxiety.

Among respondents to the follow-up survey, 14% reported suicidal thoughts, 1.6% reported suicide attempts, and 6% reported self-harm while at university. Significant overlap was observed between mental health outcomes, with 39% of students screening positive for both anxiety and depression at the second survey. In multivariable models, predictors of anxiety and depression included lower self-esteem (both P <.001), poorer sleep quality (both P <.001), and higher perceived stress (depression: P <.01; anxiety: P <.001).

Suicidal thoughts or attempts were significantly associated with lower self-esteem (P <.001), but not with other correlates of anxiety and depression. Cumulative GPA was significantly negatively affected by depression symptoms (P <.001), whereas greater anxiety predicted a slightly higher cumulative GPA (P <.01). Self-perceived “connectedness” with university life was negatively impacted by depression (P <.001), anxiety (P <.001), lower self-esteem (P <.001), higher stress (P =.03), and poorer social support (P <.001).

The findings underscore the significant burden of depression and anxiety among first year university students. However, as this cohort enrolled students at a single university, results may not be widely generalizable.

The researchers noted, “Transition to university comes at a time of disrupted social networks, although a stronger sense of university connectedness appears protective for well-being, life satisfaction and academic performance outcomes.” They called for universities to “develop a comprehensive student mental health strategy” involving “mental health literacy, prevention initiatives, timely assessment,” as well as “care of students presenting with mild-to moderate mental health conditions.”


Duffy A, Keown-Stoneman C, Goodday S, et al. Predictors of mental health and academic outcomes in first-year university students: identifying prevention and early-intervention targets. BJPsych Open. 2020;6(3):e46.