Cuijpers Pim, Smit Filip, Aalten Pauline, Batelaan Neeltje, Klein Anke, Salemink Elske, Spinhoven Philip, Struijs Sascha, Vonk Peter, Wiers Reinout W, de Wit Leonore, Gentili Claudio, Ebert David Daniel, Bruffaerts Ronny, Kessler Ronald C, Karyotaki Eirini
Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, Netherlands.
Front Psychiatry. 2021 Sep 27;12:573637. doi: 10.3389/fpsyt.2021.573637. eCollection 2021.
Psychological problems like procrastination, perfectionism, low self-esteem, test anxiety and stress are common among college students. There are evidence-based interventions available for these problems that not only have direct effects on these problems, but also indirect effects on mental disorders such as depression and anxiety disorders. Targeting these psychological problems may offer new opportunities to prevent and treat mental disorders in a way that is less stigmatizing to students. In this study we examined the association of five psychological problems with five common mental disorders (panic, generalized anxiety, bipolar, major depressive, and substance use disorder) in a sample of 2,449 students from two Dutch universities. Psychological problems were measured with one item for each problem and mental disorders were measured with the Composite International Diagnostic Interview Screening Scales. Associations were examined with Poisson regression models as relative risks (RR) of the disorders as a function of the psychological problems. The population attributable fraction (PAF) indicates by what percentage the prevalence of the mental disorder would be reduced if the psychological problem was addressed successfully by an intervention. Especially generalized anxiety disorder was strongly associated with psychological problems (strong associations with stress and low self-esteem and moderately with test anxiety). The group with three or more psychological problems had a strongly increased risk for generalized anxiety (RR = 11.25; 95% CI: 7.51-16.85), and a moderately increase risk for major depression (RR = 3.22; 95% CI: 2.63-3.95), panic disorder (RR = 3.19; 95% CI: 1.96-5.20) and bipolar disorder (RR = 3.66; 95% CI: 2.40-5.58). The PAFs for having any of the psychological problems (one or more) were considerable, especially for generalized anxiety (60.8%), but also for panic disorder (35.1%), bipolar disorder (30.6%) and major depression (34.0%). We conclude that common psychological problems are associated with mental disorders and with each other. After adjustment, psychological problems are associated with different patterns of mental disorders. If the impact of the psychological problems could be taken away, the prevalence of several mental disorders would be reduced considerably. The psychological problems may provide a promising target to indirectly prevent and intervene in psychopathology in hard to reach college students with mental disorders.
拖延、完美主义、自卑、考试焦虑和压力等心理问题在大学生中很常见。针对这些问题有基于证据的干预措施，这些措施不仅对这些问题有直接影响，而且对抑郁症和焦虑症等精神障碍也有间接影响。针对这些心理问题可能会为预防和治疗精神障碍提供新的机会，且这种方式对学生的污名化程度较低。在本研究中，我们在来自两所荷兰大学的2449名学生样本中，研究了五种心理问题与五种常见精神障碍（惊恐障碍、广泛性焦虑症、双相情感障碍、重度抑郁症和物质使用障碍）之间的关联。心理问题通过每个问题的一个项目进行测量，精神障碍通过综合国际诊断访谈筛查量表进行测量。使用泊松回归模型将这些障碍的相对风险（RR）作为心理问题的函数来检验关联。人群归因分数（PAF）表明，如果通过干预成功解决心理问题，精神障碍的患病率将降低的百分比。特别是广泛性焦虑症与心理问题密切相关（与压力和自卑有强关联，与考试焦虑有中度关联）。有三种或更多心理问题的群体患广泛性焦虑症的风险大幅增加（RR = 11.25；95% CI：7.51 - 16.85），患重度抑郁症的风险中度增加（RR = 3.22；95% CI：2.63 - 3.95）、惊恐障碍（RR = 3.19；95% CI：1.96 - 5.20）和双相情感障碍（RR = 3.66；95% CI：2.40 - 5.58）。有任何一种（一种或多种）心理问题的PAF相当可观，特别是对于广泛性焦虑症（60.8%），但对于惊恐障碍（35.1%）、双相情感障碍（30.6%）和重度抑郁症（34.0%）也是如此。我们得出结论，常见的心理问题与精神障碍以及彼此之间都有关联。调整后，心理问题与不同模式的精神障碍有关联。如果能够消除心理问题的影响，几种精神障碍的患病率将大幅降低。心理问题可能为间接预防和干预患有精神障碍的难以接触到的大学生的精神病理学提供一个有前景的目标。
