Perceived impact of contextual determinants on depression, anxiety and stress: a survey with university students

Young adults starting college or university education encounter multiple stressors related to transitional life-stage and novel environments. Current studies reveal high rates of symptoms related to common mental health problems like depression, anxiety and stress. However, limited knowledge exists on the determinants on these problems among Canadian students. The primary aim of the study was to investigate the impact of contextual determinants, as perceived by students, on self-reported mental health, and how these impacts varied by depression, anxiety and stress.

A cross-sectional survey was conducted with students attending a large university in Toronto, Canada. Participants completed a self-administered online questionnaire as part of a larger project. The questions asked about contextual determinants related to personal, interpersonal, family, social, socio-economic and political factors along with levels of depression, anxiety and stress as measured by Patient Health Questionnaire-9, Beck Anxiety Inventory and Perceived Stress Scale.

A total of 148 students completed the questionnaire (37 males and 111 females) with an age range of 19-54 years (median 22, IQR 21-24.8). English was reported as first language by 62.8% while 34.5% self-identified as white and 58.1% reported being born in Canada. Overall, 39.5% reported symptoms of moderate to severe depression, 23.8% reported moderate-severe anxiety and 80.3% reported moderate-severe levels of perceived stress, with no significant differences between males and females. In the final multivariate analysis, variables significantly associated with depression were grade-point-average (aOR 2.46, 95% CI 1.017-5.97), family factors (aOR 3.46, 95% CI 1.50-7.94), social factors (aOR 3.24, 1.30-8.1), self-rated health (aOR 0.34, 95% CI 0.14-0.82) and political factors (aOR 0.40, 95% CI 0.16-0.97). Anxiety was significantly associated with family factors (aOR 2.79, 1.09-7.18), socioeconomic factors (aOR 2.59, 95% CI 1.05-6.42) and age (aOR 0.33, 95% CI 0.11-0.98). The significant factors for stress were grade-point-average (aOR 2.41, 1.01-5.75) and social factors (aOR 3.87, 95% CI 1.59-9.43).

The study found strong to moderate impact of several determinants on depression, anxiety and stress. The results suggest a need to address a variety of factors affecting students' mental health.Trial registration Parent trial: http://www.isrctn.com/ISRCTN92827275.