Uncovering the prevalence of psychiatric symptoms amongst individuals perusing university level study

In a recently published dataset in Scientific Data conducted by a team of researchers from the University of Lincoln, Oxford, Sheffield, Edinburgh, and Northumbria University, we uncover the prevalence and correlates of psychiatric difficulties in university students studying in the UK. Typically studies focus on specific symptoms,  single-item scales, or bespoke measures - with few providing comprehensive examination of risk factors. Therefore, using well-validated scales with robust psychometric properties, our recent work examined the prevalence of anxiety, depression, mania, stress, psychotic experiences, suicidal ideation, and loneliness in students from various university institutions in the United Kingdom. Here, the prevelance rates emerged provide cause for concern:

• Stress: The most prominent factor, with 85% of students reporting moderate to severe levels of perceived stress. 
• Loneliness: 67% of students indicated a significant degree of loneliness.
• Depression: Almost half of the sample (47%) reported moderate to severe symptoms.
• Anxiety & Insomnia:  44% reported moderate to severe levels of anxiety and insomnia respectively.
• Mania: 39% of the sampled students were deemed at-risk for symptoms of mania.
• Suicidal Ideation: A startling number of students (37%) were deemed at risk of experiencing suicidal thoughts and behaviours.
• Psychotic Experiences:  30% of students were deemed at risk of experiencing psychotic-like experiences.

Precipitating factors related to the university experience 

 Whilst  existing student wellbeing services should be improved,  a greater emphasis on prevention may attenuate the onset and/or exacerbation of symptom presentation occurring in response to stress. Indeed, students experiencing an acute period of distress  may better respond when interventions target modifiable psychological risk-factors.  

1. Reducing Loneliness: The experience of loneliness is known to predict stress,  anxiety and depression. The current data evidenced over two thirds of students reported feeling lonely, highlighting a focal point for intervention. In this context, institutions and collegial societies may organise events to facilitate meeting new people, showcase volunteering opportunities, and group exercises to help those struggling form a stable social group. 
2. Targeting Sleep: If we consider the liniar emergence of psychiatric distress, anxiety and stress are significant predictors of insomnia - one of the greatest risk factors for depression. When stress, anxiety and symptoms of insomnia emerge, several cognitive processes (e.g., cognitive biases, misperception of symptoms, catastrophizing)  facilitate what was an initially acute disturbance to a chronic problem. In the context of the symptoms examined in our study, we must think about the most appropriate targets to facilitate early intervention. Sleep may be one such target. Indeed, those with insomnia become consumed with getting more sleep, altering their normal pattern of behaviour to favour more time in bed with the hope of achieving sleep (known as behavioural sleep effort). This may involve skipping class, work, and  social activities to catch up with sleep, going to bed  earlier than normal. However, this leads to a  circadian rhythm shift and may occur at a time when the homeostatic drive for sleep has not reached full potential. A possible pre-existing  problem amongst individuals experiencing loneliness in the face of greater isolation and excessive time at home, resulting in naps and attempting to sleep out of boredom. Therefore students should be provided with sleep education as a means of curbing insomnia. Indeed, recent work found that individuals experiencing acute insomnia fully remised after a single session of Cognitive Behavioural Therapy for insomnia and a self-help pamphlet. 
3. Self Esteem & Perception : One of the most concerning outcomes pertains to the number of students at-risk of experiencing suicidal thoughts and behaviours. Clinical levels of anxiety, stress, insomnia, depression, loneliness, and psychotic like experiences all serve to predict the onset of suicidal ideation. However, each of these disorders requires complex treatment, adherence, and can be psychologically demanding to complete alongside full time higher education study. Here, research highlights several possible modifiable risk factors which may be readily targeted by institutional services. More specifically, by improving self-perception across a number of domains: self esteem, self-disgust, and physical appearance. 

The interaction between insomnia, self-perception and loneliness

Self-disgust is a self-conscious emotion of disgust and revulsion directed towards the self in a way which manifests as physical ('I find myself repulsive') and/or behavioural ('I often do things I find revolting') in nature. Like insomnia and loneliness, expressing self-disgust also predicts suicidal thoughts and experience. Theoretically, emotional regulation difficulties and comorbid anxiety and depression may serve to diminish one's self-perception leading to the emergence of self-disgust. Indeed, insomnia is already related to deficits in physical perception due to the manifestation of physiological changes to in facial appearance (skin blood coloration, muscle tone) due to sleep loss and fatigue. Here, cognitive biases accentuate these perpetual deficits  dues to excessive monitoring of physical cures related to poor sleep which are subsequently interpreted in a way that confirms the nature of insomnia, known as an interpretive bias. Together, these factors may increase social withdrawal and avoidance of social events due to poor self esteem and the need to catch up with sleep (e.g., I look / feel too tired to go out). Over time, these mechanisms cycle to worsen psychiatric distress and symptoms of self-disgust whilst also increasing the experience of loneliness. As mentioned, self-disgust predicts suicidal ideation. However, one of the strongest predictors of completed suicides appears to be the experience of outward disgust with the world. In the current context, increased social isolation may shift the focus of disgust externally to others/the world (as a source of blame) eventually contributing to total withdrawal from life and suicidal ideation. If correct, then self-disgust would also be a worthwhile target for assessment and intervention in preventing the transition from insomnia symptoms to increased suicidal ideation.

 Concluding remarks