Changes in mental health problems and suicidal behaviour in students and their associations with COVID-19-related restrictions in Norway: a national repeated cross-sectional analysis

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

The SHoT study is a national student survey for higher education in Norway.

“The SHoT study (Students’ Health and Well-being Study) is a national student survey for higher education in Norway.”

• Also stated in: § Study design, participants and setting · plain

  “The SHoT study (Students’ Health and Well-being Study) is a national student survey for higher education in Norway, initiated by the three largest student welfare organisations.”

• cites [14] sourceSupported

May combine two claims.

Being young was associated both with having a recovering and with a deteriorating mental health trajectory.

“being young was associated both with having a recovering and with a deteriorating trajectory.”

• cites [26] Saunders, 2021, Understanding different trajectories of mental health across the general population during the COVID-19 pandemic, Psychol Med sourceSupported

Classified as probably not a substantial claim.

Most previous studies concluded that a swift increase in mental health problems in the early stages of the pandemic was quickly followed by a similar decline in symptoms of anxiety and depression.

“Most of these studies reported on mental health trajectories during the first few weeks and months following the outbreak, concluding that a swift increase in mental health problems in the early stages of the pandemic was quickly followed by a similar decline in symptoms of anxiety and depression.6”

• cites [6] sourcePartly supported

  The Introduction (page unavailable) reports that earlier studies found increased psychological distress in the first weeks of lockdown. The Results and Discussion (pages unavailable) report a rapid subsequent decline in anxiety and depressive symptoms in this study's England sample. The paper does not establish that most previous studies found that full trajectory, or that the decline was similar in magnitude to the initial increase. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

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

Pierce et al found that the mental health of the general population steadily improved through to October 2020, but not to pre-pandemic levels.

“A slightly different picture was provided by Pierce et al who found that the mental health of the general population steadily improved through to October 2020, but not to pre-pandemic levels.26”

• cites [26] Saunders, 2021, Understanding different trajectories of mental health across the general population during the COVID-19 pandemic, Psychol Med sourcePartly supported

  The Discussion (page unavailable) reports average improvements in depression and anxiety symptoms during lockdown and the following weeks. It does not establish improvement through October 2020 or a comparison with pre-pandemic levels; the Limitations state that pre-pandemic severity scores were unavailable. The cited paper is by Saunders et al., not Pierce et al. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

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

The latter study identified vulnerable subgroups who did not experience overall improvements in mental health, but reported a steadily worsening to levels far worse than before the pandemic.

“the latter study also identified vulnerable subgroups who did not experience the overall improvements in mental health, but rather reported a steadily worsening to levels far worse than before the pandemic.”

• cites [26] Saunders, 2021, Understanding different trajectories of mental health across the general population during the COVID-19 pandemic, Psychol Med sourcePartly supported

  The Discussion reports vulnerable subgroups whose symptoms did not follow the overall improvement, including a group with severe symptoms that continued to increase. But the Limitations section says severity scores before the pandemic were unavailable, so the study cannot establish that symptoms reached levels far worse than before the pandemic. (LLM, conf=0.91)

  Experimental — accuracy not yet measured

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

People may be more prone to participate in a survey if the topic seems relevant to them personally.

“people may also be more prone to participate in a survey if the topic seems relevant to them personally.30”

• cites [30] Edwards, 2009, Methods to increase response to postal and electronic questionnaires, Cochrane Database Syst Rev sourceSupported

May combine two claims.

The prevalence of mental health problems above the HSCL-5 cut-off increased from 27% to 41% in men and from 45% to 62% in women between 2018 and 2021.

“especially from 2018 (men: 27%/women: 45%) to 2021 (men: 41%/women: 62%, p <0.001)”

• AssumptionRests on an assumption: The SHoT samples are representative of the Norwegian higher education student population.
• AssumptionRests on an assumption: The four SHoT waves are comparable for examining trends in mental health problems and suicidal thoughts.

May combine two claims.

Mean HSCL-5 scores increased from 1.75 in 2010 to 2.27 in 2021 in the total sample, with all time point differences significant at p<0.001.

“Total sample | 1.75 | 0.69 | 1.87 | 0.71 | 2.00 | 0.79 | 2.27 | 0.78 | T1<T2<T3<T4*”

• Also stated in: § Changes in mental health problems · plain

  “Note: *All differences significant at p<0.001.”

• AssumptionRests on an assumption: The SHoT samples are representative of the Norwegian higher education student population.
• AssumptionRests on an assumption: The four SHoT waves are comparable for examining trends in mental health problems and suicidal thoughts.

May combine two claims.

Among students, the prevalence of last-year non-suicidal self-harm increased significantly for male students from 2.1% in 2018 to 2.4% in 2021, but not for female students.

“the prevalence of NSSH last year increased significantly for male students (from 2.1% to 2.4%, p<0.05), but not for female students”

May combine two claims.

Among students, the prevalence of last-year non-suicidal self-harm thoughts increased significantly for male students from 4.5% in 2018 to 5.0% in 2021, but not for female students.

“while there was an increase in male students (from 4.5% to 5.0%, p<0.05), no change was observed for female students”

May combine two claims.

The increase in suicidal thoughts was particularly strong from 2018 to 2021, especially among female students.

“It is notable that the increase was also particularly strong from 2018 to 2021, especially among female students.”

• AssumptionRests on an assumption: The SHoT samples are representative of the Norwegian higher education student population.
• AssumptionRests on an assumption: The four SHoT waves are comparable for examining trends in mental health problems and suicidal thoughts.

May combine two claims.

The increase in mental health problems was evident both when examining HSCL-5 categorically and continuously.

“This pattern was evident both when examining the HSCL-5 categorically using predefined cut-offs (figure 2), as well as when using the measure as a continuous mean score (table 3).”

• AssumptionRests on an assumption: The SHoT samples are representative of the Norwegian higher education student population.
• AssumptionRests on an assumption: The four SHoT waves are comparable for examining trends in mental health problems and suicidal thoughts.

May combine two claims.

There was a significant overall increase in students reporting suicidal thoughts in the last 14 days from 2010 to 2021 in both male (8.1% to 15.7%) and female (7.3% to 14.7%) students.

“There was a significant overall increase in students reporting suicidal thoughts the last 14 days (‘a little’, ‘quite a bit’ or ‘extremely’) from 2010 to 2021 in both male students (from 8.1% to 15.7%) and female students (from 7.3% to 14.7%).”

• AssumptionRests on an assumption: The SHoT samples are representative of the Norwegian higher education student population.
• AssumptionRests on an assumption: The four SHoT waves are comparable for examining trends in mental health problems and suicidal thoughts.

May combine two claims.

There were substantial increases in both mental health problems and suicidal thoughts from 2010 to 2021, and especially from 2018 to 2021.

“there were substantial increases in both mental health problems and suicidal thoughts from 2010 to 2021, and especially from 2018 to 2021.”

• Also stated in: § Discussion · hedged

  “it does show a disturbingly sharp deterioration of students’ mental health over time, especially from 2018 to 2021.”

May combine two claims.

In sensitivity analyses using last-week self-harm/suicide-related items, the same inverse dose-response pattern emerged, except for actual suicide attempt last week due to low statistical power/few events (n=31).

“The same pattern emerged for these analyses; clear inverse dose–response association (with the exception of actual suicide attempt last week, due to lack of statistical power/few overall events; n=31).”

May combine two claims.

The current study provides evidence of a sharp increase and disturbingly high levels of mental health problems and suicide-related factors among students pursuing higher education during the COVID-19 pandemic.

“the current study provides evidence of a sharp increase and disturbingly high levels of mental health problems and suicide-related factors among students pursuing higher education during the COVID-19 pandemic.”

May combine two claims.

Mental health problems and suicide risk among students increased sharply during the COVID-19 pandemic.

“This study demonstrates a sharp increase and disturbing levels of mental health problems and suicide risk among students during the COVID-19 pandemic.”

• AssumptionRests on an assumption: The SHoT samples are representative of the Norwegian higher education student population.
• AssumptionRests on an assumption: The four SHoT waves are comparable for examining trends in mental health problems and suicidal thoughts.

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

There was generally very little missing data (n<140 of 62,498) on the included variables.

“There was generally very little missing data (n<140 of 62 498) on the included variables, and the missing values were handled using listwise deletion.”

Classified as probably not a substantial claim. May combine two claims.

An average score on the HSCL-5 >2.0 is commonly used as a cut-off for identifying a high level of mental health problems, and corresponds well with the original cut-off of 1.75 on the HSCL-25.

“An average score on the HSCL-5 >2.0 is commonly used as a cut-off for identifying a high level of mental health problems, and corresponds well with the original cut-off of 1.75 on the longer version HSCL-25.18”

• cites [18] sourceNot checked — no full text of the source

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

The response rates in SHoT studies ranged from 23% to 34%.

“Limitations of the study include the relatively low response rates in SHoT studies (23%–34%).”

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

The SHoT2021 study had a response rate of 34.4% (62,498 of 181,828 invited students).

“In all, 181 828 students were invited to participate, of which 62 498 students completed the survey, yielding a response rate of 34.4%.”

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

The sample was large and heterogeneous.

“The strengths of the study include the large and heterogeneous sample”

Classified as probably not a substantial claim.

The HSCL-5 is a screening tool designed to detect symptoms of anxiety and depression.

“Mental health problems were assessed using The Hopkins Symptoms Checklist (HSCL-5),17 derived from the 90-item Symptom Checklist, a screening tool designed to detect symptoms of anxiety and depression.”

• cites [17] sourceNot checked — no full text of the source

May combine two claims.

The study did not include multiple assessment points prior to or during the pandemic, and thus was unable to explore detailed trajectories of students' mental health.

“the study did not include multiple assessments points neither prior to or during the pandemic, and as such we were unable to explore detailed trajectories of the students’ mental health from pre-pandemic to during, and during the first weeks and months of the pandemic.”

May combine two claims.

The attendance rate was relatively modest (34.4%), with no information about non-participants other than age and gender distribution.

“the attendance rate was relatively modest (34.4%), with no information about non-participants other than the age and gender distribution.”

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

Strengths of the current study include the large and heterogeneous sample, and use of official data documenting COVID-19 cases and COVID-19-related restrictions that pertain to the same timeframe as the SHoT data collection.

“Strengths of the current study include the large and heterogeneous sample, and use of official data documenting the COVID-19 cases and COVID-19-related restrictions which pertain to the same timeframe as the SHoT data collection.”

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

It is not known to what extent non-participation patterns were similar across study waves.

“We neither know to what extent non-participation patterns were similar across study waves.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Updated optimal cut-offs for HSCL-5 in general, and for student populations in particular, are lacking.

“updated optimal cut-offs for HSCL-5 in general, and for student populations in particular, are lacking.”

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

Students may have been vulnerable due to the many restrictions specifically targeting students in Norway.

“Students may also have been vulnerable due to the many restrictions specifically targeting students in Norway.”

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

Mental health outcomes in countries with a more severe COVID-19 situation and stricter lockdown measures may be even worse.

“mental health outcomes in countries with a more severe COVID-19 situation and stricter lockdown measures may be even worse.”

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

Studies from the general population have found lower levels of mental health problems during the COVID-19 outbreak in Norway compared with other countries.

“studies from the general population have found lower levels of mental health problems during the COVID-19 outbreak in Norway compared with other countries.27”

• cites [27] Geirdal, 2021, Mental health, quality of life, wellbeing, loneliness and use of social media in a time of social distancing during the COVID-19 outbreak. A cross-country comparative study, J Ment Health sourceNot checked — no full text of the source

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

Non-participants of health surveys generally have worse health than participants.

“non-participants of health surveys generally have worse health than participants,29”

• cites [29] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Common spaces including campuses, recreational facilities and cafes and pubs may be more important venues for social contact for students than for younger and older people, and thus restrictions may have a larger impact on students' lives.

“Common spaces including campuses, recreational facilities and cafes and pubs may be more important venues for social contact for students than both younger and older people, and thus the restrictions may have a larger impact on their lives.”

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

The study did not standardise data collection procedures across sites, with some but not all universities allowing students to fill out the questionnaire during lectures.

“we did not standardise the data collection procedures across sites, with some (but not all), universities allowing their students to fill out the questionnaire during lectures.”

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

The vulnerability of students could be due to being in a developmental period with many changes, including establishing new social networks and social roles.

“The vulnerability could both be in terms of being in a developmental period with many changes, and including establishing new social networks and social roles.”

May combine two claims.

There were large geographical differences in the prevalence of mental health problems in 2021, which corresponded closely to both levels of COVID-19 cases and regionally dependent COVID-19 restrictions in Norway.

“There were also large geographical differences in the prevalence of mental health problems in 2021, which corresponded closely to both levels of COVID-19 cases in these areas of Norway and the regionally dependent COVID-19 restrictions.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

It is possible that students with existing mental health problems spend fewer days on campus compared with students without such problems.

“we cannot disregard the possibility of the students with existing mental health problems will spend fewer days on campus, compared with students without such problems.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The self-report limitation is unlikely to explain any of the main findings of this study.

“this latter limitation is unlikely to explain any of the main findings of this study.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The increase in the number of students attending college and university over time may have influenced the results.

“we cannot disregard the possibility that the increase in the number of students attending college and university from over time may have influenced the results.”