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Severe role impairment associated with mental disorders: Results of the WHO World Mental Health Surveys International College Student Project

Open access
Alonso, Jordi, Mortier, Philippe, Auerbach, Randy P., Bruffaerts, Ronny, Vilagut, Gemma, Cuijpers, Pim, Demyttenaere, Koen, Ebert, David D. +11 more·2018·Depression and Anxiety
DOI 10.1002/da.22778PMC PMC6123270
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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 analyzed from 13,984 incoming first-year college students (Response = 45.5%), across 19 universities in eight 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 three or more mental disorders had almost fivefold 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.

AI snapshot

Written from the paper’s full text.

TL;DR

In a cross-national survey of 13,984 incoming first-year college students, 20.4% reported any severe role impairment, with much higher prevalence among those with 12-month mental disorders than without. Major depression, generalized anxiety, and panic disorder showed the strongest adjusted associations with severe impairment, and nearly half of severe impairment was attributable to the disorders studied.

Key findings

  • Any severe role impairment was reported by 20.4% of students: 10% of those with no 12-month mental disorder vs. 42.9% of those with at least one disorder (p < 0.01). Twelve-month prevalence of any mental disorder was 31.4%, ranging from 3% for drug use disorder to 18.5% for major depression.
  • In bivariate analyses, panic disorder and broad mania had the highest proportions with severe impairment (60.6% and 57.5%, respectively); impairment increased with number of disorders, reaching almost 69% among students with three or more mental disorders.
  • In multiple logistic regression, 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, with only minimal deviations across countries.
  • Population attributable risk proportions indicated that 45.2% of any severe role impairment could be avoided if the six 12-month mental disorders were eliminated, with PARPs over 50% for social life, close relationships, and work impairment.

Methods

  • Cross-sectional baseline web-based self-report surveys from the WHO WMH-ICS project, conducted in 19 universities across 8 countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, and the United States) between October 2014 and February 2017; the analytic sample was 13,984 full-time male or female first-year students, mean age 19.3 (SD = 0.59), 54.4% female, with a weighted mean response rate of 45.5%.
  • Role impairment was measured with an adapted Sheehan Disability Scale across four domains (home management/chores, college-related and other work, close personal relationships, and social life), with severe impairment defined as a rating of 7–10; 12-month mental disorders were assessed with CIDI-SC screening scales for major depression, broad mania, GAD, panic disorder, and drug use disorder, plus AUDIT for alcohol use disorder.
  • Analyses used weighted prevalence estimates, multiple imputation, and logistic regression models adjusted for sociodemographic and college-related variables and country; Akaike’s information criterion selected the best-fitting model, and population attributable risk proportions and country-interaction tests were also calculated.

Limitations

  • Stated by the authors: response rates were low in several sites; samples were convenience samples rather than nationally representative; the adapted SDS did not differentiate physical from mental health impairment; mental disorders were assessed by self-report screening scales rather than clinical diagnostic interviews; data were cross-sectional and adjusted for a limited range of variables; and monetary incentives may have affected participation and representativeness.
  • Evident from the design: the cross-sectional data preclude causal or directional interpretation of the association between mental disorders and role impairment, as the authors also note.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/da.22778

Cites

51 of 51 references verified0 citation errors · 0 not checkable

Statistics

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Claims the paper makes

0 of 52 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Students reporting 3 or more mental disorders had almost five-fold more frequently severe impairment relative to those without mental disorders.

    “Students reporting 3 or more mental disorders had almost five-fold more frequently severe impairment relative to those without mental disorders.”
    Quote in the paperSubstantial claim
  • Findingown data

    Panic disorder and mania were associated most frequently with severe impairment (60.6% and 57.5%, respectively).

    “panic disorder and mania were associated most frequently with severe impairment (60.6% and 57.5%, respectively)”
    • Also stated in: § Prevalence of mental disorders and severe role impairment · plain
      “Students with panic disorder and broad mania showed the highest proportion with severe impairment (60.6 and 57.5%, respectively)”
    Quote in the paperNot a substantial claim
  • Findingown data

    20.4% of the sample reported any severe role impairment.

    “20.4% of students reported any severe role impairment”
    • Also stated in: § Prevalence of mental disorders and severe role impairment · plain
      “A 20.4% of the sample reported any severe role impairment”
    Quote in the paperSubstantial claim
  • Findingown data

    Only minimal deviations from these overall associations were found across countries.

    “Only minimal deviations from these overall associations were found across countries.”
    Quote in the paperNot a substantial claim
  • Findingown data

    GAD is closely behind MDE in association with impairment, with ORs ranging from 3.7 to 2.3.

    “closely followed by GAD (ORs ranging from 3.7 to 2.3).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 21
  • Classified as probably not a substantial claim. 29

  • May combine two claims.

    Findingown data

    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.

    “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.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    10% of those without a mental disorder vs 42.9% of those with at least one disorder reported severe role impairment.

    “(10% of those without a mental disorder vs. 42.9% of those with at least one disorder, p < 0.01)”
    • Also stated in: § Prevalence of mental disorders and severe role impairment · plain
      “10% for those with no mental disorder and 42.9% of those with any mental disorder (p<.0.001)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    All mental disorders are significantly associated with severe impairment in all four domains, with only two exceptions among 24 estimates.

    “All mental disorders are significantly associated with severe impairment in all four domains (with only two exceptions among 24 estimates).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Model 1 shows that all disorders were significantly associated with the reporting of severe role impairment, major depression and GAD being those disorders with the highest odds of severe impairment (OR=3.2 and OR=3.0, respectively).

    “Model 1 shows that all disorders were significantly associated with the reporting of severe role impairment, major depression and GAD being those disorders with the highest odds of severe impairment (OR=3.2 and OR=3.0, respectively).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Model 1 assumes that the joint effect of multiple disorders is the product of the odds-ratios.

  • May combine two claims.

    Findingcitation

    Differences across international sites were found for both the prevalence of mental disorders and for the frequency of severe role impairment.

    “Differences across international sites were found for both the prevalence of mental disorders (Auerbach et al., 2018) and for the frequency of severe role impairment.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Auerbach et al., 2018 source

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  • May combine two claims.

    Findingown data

    Results suggest a dose-dependent effect whereby the higher the number of disorders, the greater the impairment (almost 69% among students reporting three or more mental disorders).

    “Results suggest a dose-dependent effect whereby the higher the number of disorders, the greater the impairment (almost 69% among students reporting three or more mental disorders).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Model AUCs ranged from 0.781 (Model 2) to 0.785 (Models 1 and 5), suggesting similar model performance.

    “Model AUCs were similar, ranging from 0.781 (Model 2) to 0.785 (Models 1 and 5) suggesting similar model performance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Major Depressive episode is associated with the highest impairment, with ORs ranging from 4.4 for close relationships to 2.2 for home management.

    “Major Depressive episode is associated with the highest impairment (with ORs ranging from 4.4 for close relationships, to 2.2 for home management)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Twelve-month prevalence of any mental disorder was 31.4%, and ranged from 3% for drug use disorder to 18.5% for major depression.

    “As shown in Table 2 (first column), twelve-month prevalence of any mental disorder was 31.4%, and ranged from 3% for drug use disorder to 18.5% for major depression””
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Significant country differences were found for Belgium (MDE, GAD, broad mania, and for three or more disorders), Australia (GAD and for exactly 2 disorders), and Spain (panic disorder), with odds ratios of country differences ranging from 1.4 to 2.4.

    “significant differences were found for Belgium (MDE, GAD, broad mania, and for three or more disorders), Australia (GAD and for exactly 2 disorders), and Spain (panic disorder) (the odds ratios of country differences ranging from 1.4 to 2.4).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Spain and Australia students showed a lower likelihood, while Northern Ireland, South Africa, and Germany showed a higher likelihood of severe role impairment, adjusting for mental disorders and other sociodemographic variables.

    “Spain and Australia students consistently showed a lower likelihood while Northern Ireland in particular, but also South Africa and Germany showed a higher likelihood of severe role impairment, adjusting by mental disorders and other sociodemographic variables.”
    • Also stated in: § DISCUSSION · hedged
      “Additional analyses adjusting by many variables (Online Supplement Table 2) do suggest that university students in Australia and Spain would show a somewhat lower risk of impairment than average, while Northern Ireland shows a higher risk.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    While comorbidity is linearly related to severe role impairment, after controlling for individual existing disorders, additional disorders show a sub-additive association with impairment.

    “while comorbidity is linearly related to severe role impairment, after controlling for individual existing disorders, additional disorders show a sub-additive association with impairment.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent metaanalysis reported that an average of 30.6% of students suffered from depression.

    “A recent metaanalysis reported that an average of 30.6% of the students suffered from depression (Ibrahim et al, 2013).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ibrahim et al, 2013 source

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  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Severity of health-related role impairment during the past 12 months was assessed using an adapted version of the Sheehan Disability Scale.

    “Severity of health-related role impairment during the past 12 months was assessed using an adapted version of the Sheehan Disability Scale (Leon, Olfson, Portera, Farber, & Sheehan, 1997; Ormel et al., 2008).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Leon et al., 1997 source

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    • cites Ormel et al., 2008 source

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    Study design and conductown data

    The weighted by achieved sample size mean response rate across all surveys was 45.5%.

    “Response= 45.5%”
    • Also stated in: § Participants · plain
      “The weighted by achieved sample size mean response rate across all surveys was 45.5%.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    Impairment in home management/chores, work, close personal relationships and social life remains poorly understood.

    “Nevertheless, impairment in other domains, including home management/chores, work, close personal relationships and social life remains poorly understood.”
    Quote in the paperSubstantial claim

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    Study design and conductcitation

    Data were weighted to adjust for differences between survey respondents and non-respondents on socio-demographic information.

    “Data were weighted to adjust for differences between survey respondents and non-respondents on whatever socio-demographic information was made available about the student body by University officials using post-stratification weights (Groves & Couper, 1998).”
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    • cites Groves & Couper, 1998

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    Premisecitation

    Pre-matriculation onset disorders are strong predictors of college attrition.

    “pre-matriculation onset disorders are strong predictors of college attrition (Auerbach et al., 2016).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Auerbach et al., 2016 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    College is a peak period for mental disorders, particularly mood, anxiety, and substance use disorders.

    “College is a peak period for mental disorders (Auerbach et al., 2016; Blanco et al., 2008; Cho et al., 2015; Eisenberg, Golberstein, & Gollust, 2007; Ibrahim, Kelly, Adams, & Glazebrook, 2013; Kendler, Myers, & Dick, 2015; Mojtabai et al., 2015; Vazquez, Torres, Otero, & Diaz, 2011), particularly mood, anxiety, and substance use disorders.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Auerbach et al., 2016 source

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    • cites Blanco et al., 2008 source

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    • cites Cho et al., 2015 source

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  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    College students are a key group in society in terms of human capital.

    “College students are a key group in society in terms of human capital (Abel & Deitz, 2012)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Abel & Deitz, 2012

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    Premisecitation

    College students are an increasingly higher proportion of the population younger than 25 in developed countries.

    “They are an increasingly higher proportion of the population younger than 25 in developed countries (OECD, 2016).”
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    • cites OECD, 2016

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    Premisecitation

    Mental disorders are a significant contributor to disability in the general population.

    “Mental disorders are a significant contributor to disability in the general population (Ormel et al., 2008; Verger, Guagliardo, Gilbert, Rouillon, & Kovess-Masfetty, 2010).”
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    • cites Ormel et al., 2008 source

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    • cites Verger et al., 2010 source

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    Premisecitation

    College entrance is a stressful period with a high prevalence of mental disorders.

    “College entrance is a stressful period with a high prevalence of mental disorders.”
    • Also stated in: § INTRODUCTION · plain
      “College is a peak period for mental disorders (Auerbach et al., 2016; Blanco et al., 2008; Cho et al., 2015; Eisenberg, Golberstein, & Gollust, 2007; Ibrahim, Kelly, Adams, & Glazebrook, 2013; Kendler, Myers, & Dick, 2015; Mojtabai et al., 2015; Vazquez, Torres, Otero, & Diaz, 2011), particularly mood, anxiety, and substance use disorders.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Auerbach et al., 2016 source

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    • cites Blanco et al., 2008 source

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    • cites Cho et al., 2015 source

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    Premisecitation

    Mental disorders are associated with lower employment in adulthood.

    “More broadly, mental disorders are associated with lower employment in adulthood (Mojtabai et al., 2015).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Mojtabai et al., 2015 source

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    Premisecitation

    A French study reported that the presence of any 12-month mental disorder was associated with a 10-fold likelihood of "marked" or "extreme" impairment in the Sheehan Disability Scale.

    “A French study reported that the presence of any 12-month mental disorder was associated with a 10-fold likelihood of “marked” or “extreme” impairment in the Sheehan Disability Scale (Verger et al., 2010).”
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    Study design and conductown data

    Females were overrepresented in the survey.

    “Females were overrepresented in the survey.”
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    Interpretationcitation

    This similarity is consistent with reports about role impairment in the adult general population and suggests the generalizability of the impact of mental disorders.

    “This is consistent with reports about role impairment in the adult general population (Alonso et al., 2011), and suggests the generalizability of the impact of mental disorders.”
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    • cites Alonso et al., 2011 source

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    Premisecitation

    On-line screening and intervention programs have been shown to be feasible and effective for reducing symptoms and preventing onset of full mental disorders.

    “On-line screening and intervention programs have been evaluated and shown to be feasible and effective for reducing symptoms (Andersson & Cuijpers, 2009; Spek et al., 2008) and prevent onset of full mental disorders (Buntrock et al., 2016).”
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    • cites Andersson & Cuijpers, 2009 source

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    • cites Spek et al., 2008 source

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    Premisecitation

    Recognition of the high prevalence of comorbidity among mental disorders has led to the development of trans-diagnostic treatment approaches.

    “Recognition of this fact and of the high prevalence of comorbidity among mental disorders has led to the development of trans-diagnostic treatment approaches (Norton & Roberge, 2017).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Norton & Roberge, 2017

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    Interpretationown data

    Severe role impairment is common among students with mental disorders and encompasses broad domains of life, including social life, close personal relationships, and work domains.

    “Results indicate that severe role impairment is common among students with mental disorders and it encompasses broad domains of life, including social life, close personal relationships and work domains.”
    • Also stated in: § DISCUSSION · boosted
      “In summary, this large on-line survey of first-year university students in eight countries has revealed that role impairment associated with mental disorders is very high, affecting social life, close personal relationships, and work domains.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Similar high prevalence of major depressive episode and GAD have been previously reported.

    “Similar high prevalence of these two disorders have been previously reported (Auerbach et al., 2016; Farrer, Gulliver, Bennett, Fassnacht, & Griffiths, 2016; Ibrahim et al., 2013; Storrie, Ahern, & Tuckett, 2010; Vazquez et al., 2011).”
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    • cites Auerbach et al., 2016 source

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    • cites Farrer et al., 2016

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    • cites Ibrahim et al., 2013 source

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    Study design and conductnone given

    All models and ORs for country-specific effects are adjusted for sociodemographic and college-related variables, country membership, and variables-by-country interaction dummies.

    “All the models (and all the ORs shown) are also adjusted for sociodemographic and college-related variables, country membership, and variables-by-country interaction dummies.”
    Quote in the paperSubstantial claim

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    Premisecitation

    Major depression has been associated with a higher degree of attrition of university failure.

    “Major depression has been associated with a higher degree of attrition of university failure (Auerbach et al., 2016).”
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    • cites Auerbach et al., 2016 source

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    Interpretationcitation

    Our results are in line with studies of adults in the general population, where individuals with mental disorders reported severe role impairment more frequently than those with physical conditions, due to a higher association with social and personal relationships.

    “Our results are also in line with studies of adults in the general population, where individuals with mental disorders reported severe role impairment more frequently than those with physical conditions, due to a higher association with social and personal relationships (Ormel et al., 2008).”
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    • cites Ormel et al., 2008 source

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    Study design and conductnone given

    All models were adjusted for sociodemographic and college-related variables, and country membership.

    “All models were adjusted for sociodemographic and college-related variables, and country membership.”
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    Premisecitation

    Recent findings warn of potential overestimation of mental disorders when response rates are low.

    “recent findings warn of potential overestimation of mental disorders when response rates are low (Mortier, Cuijpers, et al., 2018).”
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    • cites Mortier, Cuijpers, et al., 2018

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    Study design and conductnone given

    Convenience samples rather than nationally representative samples of incoming first-year students were included in our study, which may limit the representativeness of the data.

    “In addition, convenience samples rather than nationally representative samples of incoming first-year students were included in our study, which may limit the representativeness of the data.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In our study Cronbach's alpha for the overall SDS scale was 0.876.

    “In our study Cronbach’s alpha for the overall SDS scale was 0.876.”
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    Study design and conductcitation

    Multiple imputation by chained equations was used to adjust for within-survey item non-response, random internal subsampling of survey sections, and missing data due to skip logic errors.

    “In addition, multiple imputation (MI) by chained equations(Van Buuren, 2012) was used to adjust for within-survey item non-response, random internal subsampling of survey sections, and missing data due to skip logic errors that occurred in a few surveys.”
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    • cites Van Buuren, 2012 source

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    Premisecitation

    The empirical relationship between response rate and nonresponse bias is weak.

    “While it has been shown that the empirical relationship between response rate and nonresponse bias is weak (Groves, 2006)”
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    • cites Groves, 2006 source

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    Study design and conductcitation

    The survey uses well-validated screening scales, with good concordance with blinded clinical diagnoses (AUC = 0.70-0.78 for mental disorders and 0.78-0.91 for alcohol use disorder).

    “While the survey uses well-validated screening scales, with good concordance with blinded clinical diagnoses (in the range AUC = 0.70-0.78 for mental disorders(Kessler et al., 2013) and 0.78-0.91 for alcohol use disorder (Reinert & Allen, 2002)”
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    • cites Kessler et al., 2013 source

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    • cites Reinert & Allen, 2002 source

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    Study design and conductnone given

    Monetary incentives were offered in our study.

    “Finally, monetary incentives were offered in our study.”
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The possibility of an associated bias from monetary incentives cannot be ruled out.

    “But, because the research on the use of incentives in web surveys is limited, the possibility of an associated bias cannot be ruled out.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The assessment of mental disorders is based on self-report surveys as opposed to in-depth clinical interviews.

    “Third, the assessment of mental disorders is based on self-report surveys as opposed to in-depth clinical interviews.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Self-report surveys are not a substitute for diagnostic interviews.

    “this is not a substitute for diagnostic interviews”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    We were limited to the use of cross-sectional data, and analyses only adjusted for a limited range of variables.

    “Fourth, we were limited to the use of cross-sectional data, and analyses only adjusted for a limited range of variables.”
    Quote in the paperNot a substantial claim

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    Study design and conductreasoning

    Monetary incentives might have augmented participation and therefore the representativity of the study samples.

    “This might have augmented participation and therefore the representativity of the study samples.”
    Quote in the paperNot a substantial claim
47 of 47

  • The authors state this as an assumption.

    Model 1 assumes that the joint effect of multiple disorders is the product of the odds-ratios.

    “Model 1 implicitly assumed that the joint effect of the multiple disorders is the product of the odds-ratios (ORs).”

  • The authors state this as an assumption.

    Models 2 and 3 assume that the disorder is unimportant once number of disorders is known, and the main effect coefficients for the various component disorders are the same.

    “The assumptions in Models 2 and 3 were that the disorder is unimportant once number of disorders is known, and the main effect coefficients for the various component disorders are assumed to be the same.”

  • The paper relies on this without support.

    This is the first study to report on the association between mental disorders and severe role impairment in first-year university students in a large, cross-national sample.

    “To the best of our knowledge, this is the first study to report on the association between mental disorders and severe role impairment in first-year university students in a large, cross-national sample.”

  • The authors state this as an assumption.

    The observed association between mental disorders and severe role impairment is causal.

    “assuming that the observed association is causal”
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Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The prevalence of moderate to severe anxiety symptoms in this sample is consistent with studies in the same age group.

    “which is consistent with studies in the same age group.4,33”

    From Mental Health, Suicidality, Health, and Social Indicators Among College Students Across Nine States in India (2025) · cites this paper as [4]

    The Results and Discussion (pages not provided) address mental disorders, including generalized anxiety, in first-year university students of mean age 19.3. They do not report the prevalence of moderate-to-severe anxiety symptoms or establish that the citing sample’s prevalence is consistent with theirs; severe role impairment is a different measure. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Model 5 is assigned to two different tables

    Minor

    The text points readers to Table 3 for Model 5 when discussing the final regression, but earlier places the logistic regression models in Table 4.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Inc., 2010, SAS/STATR software
  2. Nock, 2012, Suicide: Global perspective from the WHO World Mental Health surveys

Cited by

Sorted by citations

Related

Authors
Alonso, J., Mortier, P., Auerbach, R. P., Bruffaerts, R., Vilagut, G., Cuijpers, P., Demyttenaere, K., Ebert, D. D., Ennis, E., Gutiérrez-García, R. A., Green, J. G., Hasking, P., Lochner, C., Nock, M. K., Pinder-Amaker, S., Sampson, N. A., Zaslavsky, A. M., Kessler, R. C., & Collaborators, W. W.-I.
Affiliations
  • Universitat Pompeu Fabra (ES)
  • KU Leuven (BE)
  • Harvard University (US)
  • Municipal Institute for Medical Research (ES)
  • Amsterdam Public Health (NL)
  • Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
  • University of Ulster (GB)
  • Campus Salamanca; De La Salle Bajio University; León Mexico
  • Boston University (US)
  • Curtin University (AU)
  • SAMRC/UCT/SU Unit on Risk & Resilience in Mental Disorders; Department of Psychiatry; Stellenbosch University; Stellenbosch South Africa
Corresponding author
Alonso, Jordi
ORCID
Venue
Depression and Anxiety
Publisher
Wiley
Published
2018-05-30
Volume
35
Issue
9
Pages
802-814
ISSN
1091-4269 (ISSN-L)
DOI
10.1002/da.22778
PMC
PMC6123270
OpenAlex
W2807406377
Semantic Scholar
e7649d4d86a1b23b4035a1b7c2d728431f72fbe3
Cited by
205
References
51
Citations by year
2026: 20 · 2025: 25 · 2024: 30 · 2023: 24 · 2022: 27 · 2021: 37 · 2020: 23 · 2019: 14 · 2018: 5
FWCI
26.74
Type
journal article
Language
en
Open access
Licence
Locations
  • Depression and Anxiety (publishedVersion)
  • PubMed (publishedVersion)
  • Ulster University Research Portal (Ulster University) (publishedVersion, other-oa)
  • VU Research Portal (publishedVersion, other-oa)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • RECERCAT (Consorci de Serveis Universitaris de Catalunya) (acceptedVersion)
  • eSpace (Curtin University) (submittedVersion)
  • Lirias (submittedVersion)
  • Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders
  • National Institute of Mental Health (R56MH109566)
  • Belgian Fund for Scientific Research (11N0514N/11N0516N/1114717N)
  • King Baudouin Foundation (2014-J2140150-102905)
  • Eli Lilly and Company (IIT-H6U-BX-I002)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Developmental and Educational Psychology › Student Stress and Coping
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
Keywords
role impairment, mental illness, first-year college students, major depressive disorder, generalized anxiety disorder, panic disorder, mania, comorbidities, disability, cross-national comparison, student mental health
MeSH terms
Adolescent, Adult, Mental Disorders, Female, Health Surveys, Humans, Male, Mental Health, Students, Universities, Global Health, World Health Organization, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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