Mental disorder comorbidity and suicidal thoughts and behaviors in the World Health Organization World Mental Health Surveys International College Student initiative

WHO WMH-ICS Collaborators, Randy P. AUERBACH*, Philippe MORTIER, Ronny BRUFFAERTS, Jordi ALONSO, Corina BENJET, Pim CUIJPERS, Koen Demyttenaere, David D. EBERT, Jennifer Greif GREEN, Penelope HASKING, Sue LEE, Christine LOCHNER, Margaret MCLAFFERTY, Maria V. PETUKHOVA, Stephanie PINDER-AMAKER, Anthony J. ROSELLINI, Nancy A. SAMPSON, Gemma VILAGUT, Alan M. ZASLAVSKYRonald C. KESSLER, Oi Ling SIU (Collaborator)

*Corresponding author for this work

Research output: Journal PublicationsJournal Article (refereed)peer-review

77 Citations (Scopus)


Objectives: Comorbidity is a common feature of mental disorders. However, needs assessment surveys focus largely on individual disorders rather than on comorbidity even though the latter is more important for predicting suicidal thoughts and behaviors. In the current report, we take a step beyond this conventional approach by presenting data on the prevalence and correlates (sociodemographic factors, college-related factors, and suicidal thoughts and behaviors) of the main multivariate profiles of common comorbid Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV disorders among students participating in the first phase of the World Health Organization World Mental Health International College Student initiative. 

Method: A web-based mental health survey was administered to first year students in 19 colleges across eight countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, United States; 45.5% pooled response rate) to screen for seven common DSM-IV mental disorders: major depression, mania/hypomania, generalized anxiety disorder, panic disorder, attention-deficit/hyperactivity disorder, alcohol use disorder, and drug use disorder. We focus on the 14,348 respondents who provided complete data; 38.4% screened positive for at least one 12-month disorder. 

Results: Multivariate disorder profiles were detected using latent class analysis (LCA). The least common class (C1; 1.9% of students) was made up of students with high comorbidity (four or more disorders, the majority including mania/hypomania). The remaining 12-month cases had profiles of internalizing–externalizing comorbidity (C2; 5.8%), internalizing comorbidity (C3; 14.6%), and pure disorders (C4; 16.1%). The 1.9% of students in C1 had much higher prevalence of suicidal thoughts and behaviors than other students. Specifically, 15.4% of students in C1 made a suicide attempt in the 12 months before the survey compared with 1.3–2.6% of students with disorders in C2–4, 0.2% of students with lifetime disorders but no 12-month disorders (C5), and 0.1% of students with no lifetime disorders (C6). 

Conclusions: In line with prior research, comorbid mental disorders were common; however, sociodemographic correlates of LCA profiles were modest. The high level of comorbidity underscores the need to develop and test transdiagnostic approaches for treatment in college students.

Original languageEnglish
Article numbere1752
Pages (from-to)e1752
JournalInternational Journal of Methods in Psychiatric Research
Issue number2
Early online date20 Jan 2019
Publication statusPublished - 1 Jun 2019

Bibliographical note

Prof. SIU Oi-ling is one of the WHO WMH-ICS Collaborators


  • college student mental health
  • comorbidity
  • mental disorders
  • suicide thoughts and behaviors


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