Stressful Life Events and Chronic Stressors as Predictors of Psychopathological Conditions in the WMH-ICS Initiative
##plugins.themes.bootstrap3.article.main##
Abstract
Introduction. Stressful life events (SLEs) and chronic stressors are established risk factors for psychopathology, yet their bidirectional associations with psychopathological conditions remain understudied among university students.
Objective. To examine whether prior lifetime psychopathological conditions predict subsequent exposure to 12-month SLEs and current chronic stressors, and whether these stressors predict 12-month onset and persistence of psychopathological conditions among incoming university students.
Method. Data were from the World Mental Health International College Student Initiative. Web-based surveys at 77 universities in 18 countries assessed prior lifetime psychopathological conditions, SLEs, chronic stressors, mental disorders, non-suicidal self-injury, and suicidal thoughts and behaviors among first-year students (n = 60,673). Poisson regression models estimated reciprocal associations of stressors with prior psychopathological conditions.
Results. Exposure to recent stressors was highly prevalent: 72.9% reported one or more 12-month SLEs, and 46.1% reported one or more current chronic stressors. Relationships of psychopathological conditions with stressors were largely positive and reciprocal. Population-attributable risk proportions (PARPs) for stressors predicting lifetime first onsets of psychopathological conditions occurring in the 12 months before the survey were 17.0%–35.8% across conditions for SLEs, 10.9%–34.9% for chronic stressors, and 29.9%–51.4% for either SLEs or chronic stressors. Comparable PARPs predicting 12-month persistence of psychopathological conditions were 3.8%–30.0% across conditions for SLEs, 5.8%–22.0% for chronic stressors, and 10.1%–44.6% for either SLEs or chronic stressors.
Discussion and conclusion. These findings highlight the prevalence of stressors among university students and suggest that prevention and early intervention efforts should focus on reducing exposure to these stressors and/or their psychological effects.
References
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). https://doi.org/10.1176/appi.books.9780890425787
Auerbach, R. P., Mortier, P., Bruffaerts, R., Alonso, J., Benjet, C., Cuijpers, P., Demyttenaere, K., Ebert, D. D., Green, J. G., Hasking, P., Murray, E., Nock, M. K., Pinder-Amaker, S., Sampson, N. A., Stein, D. J., Vilagut, G., Zaslavsky, A. M., Kessler, R. C., & WHO WMH-ICS Collaborators. (2018). WHO World Mental Health Surveys International College Student Project: Prevalence and distribution of mental disorders. Journal of Abnormal Psychology, 127(7), 623–638. https://doi.org/10.1037/abn0000362
Babor, T. F., de la Fuente, J. R., Saunders, J., & Grant, M. (1992). AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for use in primary health care (WHO/PSA/92.4). World Health Organization. https://auditscreen.org/cmsb/uploads/1992-audit-the-alcohol-use-disorders-identification-test-guidelines-for-use-in-primary-health-care-geneva-world-health-organization-1992.pdf
Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., Stokes, J., Handelsman, L., Medrano, M., Desmond, D., & Zule, W. (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect, 27(2), 169–190. https://doi.org/10.1016/s0145-2134(02)00541-0
Brugha, T., Bebbington, P., Tennant, C., & Hurry, J. (1985). The List of Threatening Experiences: A subset of 12 life event categories with considerable long-term contextual threat. Psychological Medicine, 15(1), 189–194. https://doi.org/10.1017/s003329170002105x
Brugha, T. S., & Cragg, D. (1990). The List of Threatening Experiences: The reliability and validity of a brief life events questionnaire. Acta Psychiatrica Scandinavica, 82(1), 77–81. https://doi.org/10.1111/j.1600-0447.1990.tb01360.x
Chen, W., Qian, L., Shi, J., & Franklin, M. (2018). Comparing performance between log-binomial and robust Poisson regression models for estimating risk ratios under model misspecification. BMC Medical Research Methodology, 18(1). https://doi.org/10.1186/s12874-018-0519-5
Dackehag, M., Ellegård, L. M., Gerdtham, U. G., & Nilsson, T. (2019). Debt and mental health: New insights about the relationship and the importance of the measure of mental health. European Journal of Public Health, 29(3), 488–493. https://doi.org/10.1093/eurpub/ckz002
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8
Greenland, S., & Drescher, K. (1993). Maximum Likelihood Estimation of the Attributable Fraction from Logistic Models. Biometrics, 49(3), 865–872. https://doi.org/10.2307/2532206
Hammen, C. (2006). Stress generation in depression: Reflections on origins, research, and future directions. Journal of Clinical Psychology, 62(9), 1065–1082. https://doi.org/10.1002/jclp.20293
Harkness, J., Pennell, B., Villar, A., Gebler, N., Aguilar-Gaxiola, S., & Bilgen, I. (2008).Translation procedures and translation assessment in the World Mental Health Survey Initiative. In R. C. Kessler & T. B. Ustun (Eds.), The WHO World Mental Health Surveys: Global perspectives on the epidemiology of mental disorders (pp. 91–113). Cambridge University Press.
Husky, M. M., Lee, S., Sampson, N. A., Borowski, S., Albor, Y., Alhadi, A. N., Alonso, J., Al-Saud, N. K., Altwaijri, Y. A., Andersson, C., Atwoli, L., Muaka, C. A., Báez-Mansur, P. M., Ballester, L., Bantjes, J., Baumeister, H., Bendtsen, M., Benjet, C., … World Mental Health International College Student collaborators (2025). Childhood adversities and their associations with mental disorders in the World Mental Health International College Student surveys initiative. Psychiatry Research, 351, Article 116585. https://doi.org/10.1016/j.psychres.2025.116585
Karyotaki, E., Cuijpers, P., Albor, Y., Alonso, J., Auerbach, R. P., Bantjes, J., Bruffaerts, R., Ebert, D. D., Hasking, P., Kiekens, G., Lee, S., McLafferty, M., Mak, A., Mortier, P., Sampson, N. A., Stein, D. J., Vilagut, G., & Kessler, R. C. (2020). Sources of Stress and Their Associations With Mental Disorders Among College Students: Results of the World Health Organization World Mental Health Surveys International College Student Initiative. Frontiers in Psychology, 11, Article 1759. https://doi.org/10.3389/fpsyg.2020.01759
Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., Howes, M. J., Jin, R., Secnik, K., Spencer, T., Ustun, T. B., & Walters, E. E. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256. https://doi.org/10.1017/s0033291704002892
Kessler, R. C., Adler, L. A., Gruber, M. J., Sarawate, C. A., Spencer, T., & Van Brunt, D. L. (2007). Validity of the World Health Organization Adult ADHD Self‐Report Scale (ASRS) Screener in a representative sample of health plan members. International Journal of Methods in Psychiatric Research, 16(2), 52–65. https://doi.org/10.1002/mpr.208
Kessler, R. C., Santiago, P. N., Colpe, L. J., Dempsey, C. L., First, M. B., Heeringa, S. G., Stein, M. B., Fullerton, C. S., Gruber, M. J., Naifeh, J. A., Nock, M. K., Sampson, N. A., Schoenbaum, M., Zaslavsky, A. M., & Ursano, R. J. (2013). Clinical reappraisal of the Composite International Diagnostic Interview Screening Scales (CIDI‐SC) in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). International Journal of Methods in Psychiatric Research, 22(4), 303–321. https://doi.org/10.1002/mpr.1398
Khaled, S. M., Al‐Thani, S. M., Sampson, N. A., Kessler, R. C., Woodruff, P. W., & Alabdulla, M. (2024). Twelve‐month prevalence, persistence, severity, and treatment of mood and anxiety disorders in Qatar's national mental health study. International Journal of Methods in Psychiatric Research, 33(S1), e2012. https://doi.org/10.1002/mpr.2012
Lepore, S. J. (1995). Measurement of chronic stressors. In S. Cohen, R. C. Kessler, & L. U. Gordon (Eds.), Measuring stress: A guide for health and social scientists (pp. 102–120). Oxford University Press.
Liu, R. T., Hamilton, J. L., Boyd, S. I., Dreier, M. J., Walsh, R. F. L., Sheehan, A. E., Turnamian, M. R., Workman, A. R. C., & Jorgensen, S. L. (2024). A systematic review and Bayesian meta-analysis of 30 years of stress generation research: Clinical, psychological, and sociodemographic risk and protective factors for prospective negative life events. Psychological Bulletin, 150(9), 1021–1069. https://doi.org/10.1037/bul0000431
Liu, Y., Zhang, N., Bao, G., Huang, Y., Ji, B., Wu, Y., Liu, C., & Li, G. (2019). Predictors of depressive symptoms in college students: A systematic review and meta-analysis of cohort studies. Journal of Affective Disorders, 244, 196–208. https://doi.org/10.1016/j.jad.2018.10.084
March-Llanes, J., Marqués-Feixa, L., Mezquita, L., Fañanás, L., & Moya-Higueras, J. (2017). Stressful life events during adolescence and risk for externalizing and internalizing psychopathology: a meta-analysis. European Child & Adolescent Psychiatry, 26(12), 1409–1422. https://doi.org/10.1007/s00787-017-0996-9
Mason, A., Rapsey, C., Sampson, N., Lee, S., Albor, Y., Al-Hadi, A. N., Alonso, J., Al-Saud, N., Altwaijri, Y., Andersson, C., Atwoli, L., Auerbach, R. P., Ayuya, C., Báez-Mansur, P. M., Ballester, L., Bantjes, J., Baumeister, H., Bendtsen, M., Benjet, C., … WMH-ICS collaborators (2025). Prevalence, age-of-onset, and course of mental disorders among 72,288 first-year university students from 18 countries in the World Mental Health International College Student (WMH-ICS) initiative. Journal of Psychiatric Research, 183, 225–236. https://doi.org/10.1016/j.jpsychires.2025.02.016
McEwen, B. S. (1998). Protective and Damaging Effects of Stress Mediators. New England Journal of Medicine, 338(3), 171–179. https://doi.org/10.1056/nejm199801153380307
Miranda-Mendizabal, A., Castellví, P., Vilagut, G., Alayo, I., Almenara, J., Ballester, L., Echeburúa, E., Gabilondo, A., Gili, M., Mortier, P., Piqueras, J. A., Roca, M., Auerbach, R. P., Bruffaerts, R., Kessler, R. C., & Alonso Caballero, J. (2024). Suicidal ideation risk among LGB Spanish university students: The role of childhood and adolescence adversities and mental disorders. Journal of Affective Disorders, 353, 52–59. https://doi.org/10.1016/j.jad.2024.02.084
Monroe, S. M., & Harkness, K. L. (2005). Life Stress, the "Kindling" Hypothesis, and the Recurrence of Depression: Considerations From a Life Stress Perspective. Psychological Review, 112(2), 417–445. https://doi.org/10.1037/0033-295x.112.2.417
Monroe, S. M., & Harkness, K. L. (2022). Major Depression and Its Recurrences: Life Course Matters. Annual Review of Clinical Psychology, 18(1), 329–357. https://doi.org/10.1146/annurev-clinpsy-072220-021440
Monroe, S. M., & Reid, M. W. (2009). Life Stress and Major Depression. Current Directions in Psychological Science, 18(2), 68–72. https://doi.org/10.1111/j.1467-8721.2009.01611.x
Mortier, P., Yang, X., Altwaijri, Y. A., Holdcraft, J. A., Lee, S., Sampson, N. A., Albor, Y., Alhadi, A. N., Alonso, J., Al-Saud, N. K., Andersson, C., Atwoli, L., Auerbach, R. P., Muaka, C. A., Báez-Mansur, P. M., Ballester, L., Bantjes, J., Baumeister, H., Bendtsen, M., … World Mental Health International College Student collaborators (2025). The associations of childhood adversities and mental disorders with suicidal thoughts and behaviors: Results from the World Mental Health International College Student Initiative. Psychiatry Research, 350, Article 116555, 1–13. https://doi.org/10.1016/j.psychres.2025.116555
Niedhammer, I., Bertrais, S., & Witt, K. (2021). Psychosocial work exposures and health outcomes: a meta-review of 72 literature reviews with meta-analysis. Scandinavian Journal of Work, Environment & Health, 47(7), 489–508. https://doi.org/10.5271/sjweh.3968
Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-Injurious Thoughts and Behaviors Interview: Development, reliability, and validity in an adolescent sample. Psychological Assessment, 19(3), 309–317. https://doi.org/10.1037/1040-3590.19.3.309
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., & Mann, J. J. (2011). The Columbia–Suicide Severity Rating Scale: Initial Validity and Internal Consistency Findings From Three Multisite Studies With Adolescents and Adults. American Journal of Psychiatry, 168(12), 1266–1277. https://doi.org/10.1176/appi.ajp.2011.10111704
Raghunathan, T. E., & Grizzle, J. E. (1995). A Split Questionnaire Survey Design. Journal of the American Statistical Association, 90(429), 54–63. https://doi.org/10.1080/01621459.1995.10476488
Ribeiro, J. D., Huang, X., Fox, K. R., & Franklin, J. C. (2018). Depression and hopelessness as risk factors for suicide ideation, attempts and death: Meta-analysis of longitudinal studies. British Journal of Psychiatry, 212(5), 279–286. https://doi.org/10.1192/bjp.2018.27
Rnic, K., Santee, A. C., Hoffmeister, J., Liu, H., Chang, K. K., Chen, R. X., Neufeld, R. W. J., Machado, D. A., Starr, L. R., Dozois, D. J. A., & LeMoult, J. (2023). The vicious cycle of psychopathology and stressful life events: A meta-analytic review testing the stress generation model. Psychological Bulletin, 149(5-6), 330–369. https://doi.org/10.1037/bul0000390
Robles, T. F., Slatcher, R. B., Trombello, J. M., & McGinn, M. M. (2014). Marital quality and health: A meta-analytic review. Psychological Bulletin, 140(1), 140–187. https://doi.org/10.1037/a0031859
Santee, A. C., Rnic, K., Chang, K. K., Chen, R. X., Hoffmeister, J., Liu, H., LeMoult, J., Dozois, D. J., & Starr, L. R. (2023). Risk and protective factors for stress generation: A meta-analytic review. Clinical Psychology Review, 103, 102299. https://doi.org/10.1016/j.cpr.2023.102299
Scott, A. J., Correa, A. B., Bisby, M. A., & Dear, B. F. (2023). Depression and Anxiety Trajectories in Chronic Disease: A Systematic Review and Meta-Analysis. Psychotherapy and Psychosomatics, 92(4), 227–242. https://doi.org/10.1159/000533263
Sheldon, E., Simmonds-Buckley, M., Bone, C., Mascarenhas, T., Chan, N., Wincott, M., Gleeson, H., Sow, K., Hind, D., & Barkham, M. (2021). Prevalence and risk factors for mental health problems in university undergraduate students: A systematic review with meta-analysis. Journal of Affective Disorders, 287, 282–292. https://doi.org/10.1016/j.jad.2021.03.054
Streiner, D. L. (2003). Being Inconsistent About Consistency: When Coefficient Alpha Does and Doesn't Matter. Journal of Personality Assessment, 80(3), 217–222. https://doi.org/10.1207/s15327752jpa8003_01
Stroud, C. B., Davila, J., Hammen, C., & Vrshek-Schallhorn, S. (2011). Severe and nonsevere events in first onsets versus recurrences of depression: Evidence for stress sensitization. Journal of Abnormal Psychology, 120(1), 142–154. https://doi.org/10.1037/a0021659
Toner, P., Böhnke, J. R., Andersen, P., & McCambridge, J. (2019). Alcohol screening and assessment measures for young people: A systematic review and meta-analysis of validation studies. Drug and Alcohol Dependence, 202, 39–49. https://doi.org/10.1016/j.drugalcdep.2019.01.030
Van Buuren, S. (2012). Flexible imputation of missing data (1st ed.). Chapman & Hall/CRC. https://doi.org/10.1201/b11826
Villarosa-Hurlocker, M. C., Schutts, J. W., Madson, M. B., Jordan, H. R., Whitley, R. B., & Mohn, R. C. (2020). Screening for alcohol use disorders in college student drinkers with the AUDIT and the USAUDIT: a receiver operating characteristic curve analysis. The American Journal of Drug and Alcohol Abuse, 46(5), 531–545. https://doi.org/10.1080/00952990.2020.1712410
Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD Checklist for DSM-5 (PCL-5). National Center for PTSD. https://www.ptsd.va.gov/
Zhang, A., Borowski, S., Holdcraft, J. A., Zainal, N. H., & Roest, A. M. (in press). Stressful life events and chronic stressors as predictors of mental disorders, NSSI, and suicidality in the WMH-ICS surveys. In C. Benjet, R. Bruffaerts, P. Cuijpers, & R. C. Kessler (Eds.), The mental health of university students: Global perspectives on prevalence and innovations in treatment from the World Mental Health International College Student Initiative. Cambridge University Press.
Zou, G. (2004). A Modified Poisson Regression Approach to Prospective Studies with Binary Data. American Journal of Epidemiology, 159(7), 702–706. https://doi.org/10.1093/aje/kwh090
Zuromski, K. L., Ustun, B., Hwang, I., Keane, T. M., Marx, B. P., Stein, M. B., Ursano, R. J., & Kessler, R. C. (2019). Developing an optimal short‐form of the PTSD Checklist for DSM‐5 (PCL‐5). Depression and Anxiety, 36(9), 790–800. https://doi.org/10.1002/da.22942
