The British Journal of Psychiatry最新文献

Mental health problems among university students have been on the rise, with particularly high levels reported during the COVID-19 pandemic. While many studies have examined the immediate effects of the pandemic, long-term trends in anxiety, depression, non-suicidal self-harm (NSSH) and suicidality remain less explored.

To investigate trends in mental health problems among Norwegian higher education students before, during and after the COVID-19 pandemic, focusing on anxiety, depression, NSSH and suicidality.

The Students’ Health and Wellbeing Study (SHOT) is a national survey of Norwegian students, with data from six waves (2010–2023). Four primary waves (2010, 2014, 2018 and 2022) were supplemented by two additional waves during the COVID-19 pandemic (2021 and 2023), including nearly 200 000 students across all waves. Mental health outcomes were measured using the Hopkins Symptom Checklist(HSCL). Sex-specific cut-offs were applied to estimate the prevalence of major depressive episodes (MDE) and generalised anxiety disorder (GAD). Secondary outcomes included NSSH, suicidal thoughts and suicide attempts.

Mental health problems increased consistently over the 13 years, with a more pronounced rise among women. Mean HSCL scores significantly increased for both sexes from 2010 to 2023, peaking during the COVID-19 lockdown in 2021, followed by a slight decline in 2022, but remaining higher than pre-pandemic levels. The prevalence of MDE and GAD followed similar patterns, increasing from 12.5 to 33.7% in women and 9.4 to 26.8% in men. Reports of NSSH also surged post-lockdown, particularly among women, while suicidal thoughts and attempts increased, especially in women, between 2021 and 2022.

Student mental health has worsened over the past decade. Although there was some post-pandemic improvement, rates of anxiety, depression and suicidality remain high. These findings underscore the continued importance of tiered mental health support and structural interventions within higher education to address student mental health.

In low- and middle-income countries (LMICs), suicide is a major problem. Research on the effectiveness of large-scale suicide prevention interventions is limited.

To test the effectiveness of an integrated intervention (school-based prevention; reducing access to means of suicide; increased identification and management of suicide risk) in reducing deaths by suicide and suicide attempts; and to evaluate the implementation and effectiveness of sub-interventions.

In this pragmatic cluster randomised controlled trial, 124 villages from Mehsana, India, were randomly assigned to either intervention or control arm. The intervention comprised school-based awareness intervention, community pesticide storage and training of community health workers (CHWs) to recognise, support, refer and follow up people at risk. Intention-to-treat analysis using mixed-effects Poisson regression tested the primary outcome (suicide attempts plus deaths by suicide), and multilevel linear models assessed sub-interventions. The primary outcome was captured through a novel suicide surveillance system.

There was no statistically significant difference in the primary outcome between the intervention (54 of 62 consenting villages) and control (62 villages) arms. Separately, the intervention arm showed a 43% reduction in risk of death by suicide at 12 months (suicide rate 30.7 versus 43.6 per 100 000 person-years in intervention versus control arm; incidence rate ratio 0.57, 95% CI: 0.32–1.02, adjusting for baseline and clustering). Most students (≥90%, n = 2330/2560) from 47 schools received the intervention and had lower depression and suicidal ideation than controls at month 3. Nearly all villages (52/54, 96.2%) provided pesticide lockers (n = 8370 households, 88.83% uptake). Compared with controls, CHWs in the intervention arm had significantly higher knowledge, confidence and skills, and identified 108 at-risk individuals.

The intervention increased identification without significantly reducing suicide attempts, but reduced suicide deaths. This trial, involving 116 villages and a multicomponent intervention implemented at scale, advances suicide prevention and complex intervention research, especially in LMICs.