ABSTRACT Objectives To establish diagnostic prevalences for common mental disorders among students at higher education institutions (HEI's) in Sweden. Methods This was a cross‐sectional study assessing diagnostic prevalences for 17,948 students at 30‐day, 12‐month and lifetime timepoints, according to the Diagnostic and Statistical Manual, fifth edition (DSM‐5). Sample participants at 15 HEI's answered an online survey 2020‐2023 within the World Mental Health International College Student (WMH‐ICS) initiative. Diagnoses are reported for Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), Panic Disorder (PD), Bipolar Disorder (BD, any), Alcohol Use Disorder (AUD) and Substance Use Disorder (SUD). Multilevel logistic regression was used to estimate odds ratios in relation to diagnoses of any mental disorder. Results Respondents (69.4% women, 25.5 mean age, range 18 to ≥ 36) reported 25.2%, 39.3% and 44.5% prevalences for any mental disorder at 30‐day, 12‐month and lifetime periods. Odds for any mental disorder were markedly higher for non‐binary students and those with non‐heterosexual orientation; odds were also higher for students aged 20–29 years, women, heterosexual individuals with same‐sex attraction and post‐pandemic respondents. Conclusions The findings augment existing concern over student mental health. Student mental health services should expand menus for low‐threshold treatment interventions, to promote flourishing and resilience.

Abstract Introduction Problem drinking (PD), defined as hazardous or harmful drinking, constitutes a major health and economic burden worldwide. However, most individuals with PD typically remain untreated for many years as part of the “treatment gap” between prevalence and treatment access. The main objective of this study was to evaluate an unguided, app-based intervention for reducing alcohol consumption, compared to an information control app. Secondary analyses targeted motivation effects, subgroup differences in heavy drinking days, and the proportion of participants with excessive drinking. Methods In this two-armed randomized controlled trial (RCT), Swedish-speaking adults seeking help for PD on the Internet were recruited via online ads (n = 576). Eligible participants, defined as those who reported PD without significant comorbid conditions, were randomly assigned to one of two unguided interventions, either the “TeleCoach” app (n = 293) or the information control app (n = 283), and followed up via online questionnaires at six-, 12- and 26-weeks post-recruitment. Participants and researchers were blinded to group assignment at recruitment but not for outcome analyses. The primary outcome was the number of standard drinks consumed per week. Results Participants reported drinking a mean of 28 (SD = 18) standard drinks per week at the baseline recruitment measure, and 65% of the participants reported a history of PD for over three years; only 7% of the participants reported less than a year of PD history. Only 26% of the participants had sought help before. A significant within-group reduction in alcohol consumption occurred in both conditions at the six-week follow-up (B = −10.57, SE = 0.83, 95% CI [−12.20, −8.94], p < 0.01; Cohen’s d = 0.69), sustained until the 26-week follow-up (B = −11.44, SE = 0.91, 95% CI [−13.23, −9.65], p < 0.01, Cohen’s d = 0.67), with no significant differences between the two groups. No adverse events were reported. Conclusions The findings, although null, nonetheless supported app-based interventions’ feasibility and potential as a scalable digital approach for reaching individuals who have not previously sought help for PD. Trial registration ClinicalTrials.gov as NCT03696888, Oct 5, 2018; analysis plan at https://osf.io/wxfqg , on Dec. 18, 2023 prior to analysis.

BackgroundUniversity students show a high prevalence of diverse mental health problems, requiring adaptable interventions to assist them in improving their mental health. ObjectiveThis study aimed to evaluate the feasibility of transdiagnostic internet-delivered cognitive behavioral therapy (ICBT) for anxiety and depression in preparation for a randomized controlled trial. ICBT incorporated 2 innovative approaches to increase precision: user-steered content personalization and within-treatment adaptive modification based on early symptom trajectory. MethodsThis single-group, open-label study was conducted online in Sweden in the autumn of 2021, recruiting from students who had completed the World Health Organization (WHO) World Mental Health International College Student (WMH-ICS) mental health survey. Participants were eligible if they scored 5-19 on the Patient Health Questionnaire-9 (PHQ-9), or ≥5 on the Generalized Anxiety Disorder-7 (GAD-7), or both. Participants completed an 8-week ICBT program with therapist support. They initially personalized their program by selecting a primary problem orientation, anxiety or depression, and choosing additional elective modules, and could consult their therapist regarding these choices. At midtreatment, stepped care was piloted, in which participants without symptom improvement were randomized to adaptive enhancement of therapist support or to continue treatment as before. The main feasibility outcomes included data on reach and uptake, intervention acceptability, stepped care procedures, and assessment retention up to 6 months. The GAD-7 and PHQ-9 were the primary outcome measures, with changes in scores calculated using mixed effects models. ResultsOf 749 invited students, 55 (7%) completed the study screening, and 28 (4%) were included. The GAD-7 baseline score was 9.5 (SD 4.4), and the PHQ-9 baseline score was 11.2 (SD 5.2). Participants opened 6.2 (SD 2.2) out of the 8 treatment modules. The user-directed personalization yielded 27 unique treatment configurations across 28 participants. At week 4, 16/27 (59%) participants remaining in treatment were randomized in the stepped care procedure. Ratings on self-report measures showed acceptable to good therapeutic alliance and treatment satisfaction. Eleven participants reported increased stress associated with the treatment. Reductions in depression and anxiety symptoms were observed at postmeasurement and 6 months follow-up, with 43% attrition at those times. ConclusionsThis pioneering study of personalized ICBT with adaptive change among university students demonstrated the overall feasibility of the treatment. To enhance the design of a future definitive trial, modifications are necessary to mitigate assessment attrition and reduce treatment-related stress. Trial RegistrationClinicalTrials.gov NCT05509660; https://clinicaltrials.gov/study/NCT05509660

Abstract Objective Research in the mental health field has focused on exploration and implementation of digital interventions both in research and society. However, demographic and mental health factors that may influence engagement with research on such interventions have not been explored. This study aims to investigate the relationship between demographics, signs of mental disorders, and interest in participating in an intervention study. Using data collected in the Swedish arm of the World Health Organization’s World Mental Health International College Student (WHO-WMH-ICS) initiative (n = 9140), we conducted a multinomial logistic regression to assess relationships between these factors. Results Older age, as well as female and non-binary gender identities, were factors significantly associated with increased interest in the intervention study. Treatment flags, indicating fulfilment of criteria for possible mental disorder diagnosis, were significantly associated with clear interest (“yes” response) in intervention research for five of the 15 treatment flags: depression, general anxiety, social anxiety, panic disorder and self-harm. Possible interest (“maybe” response) was also indicated for four of these, excluding general anxiety. These findings may facilitate a better-informed approach to recruiting student participants for treatment research, enhancing unbiased recruitment practices, reducing treatment gaps, and increasing engagement in digital intervention studies for improved mental health.

Background: Mental disorders are highly prevalent among students worldwide. This study aims to examine comorbidity and temporal associations between mental disorders among students. Methods: The study included 72,288 students from 18 countries as part of the World Mental Health International College Student (WMH-ICS) Initiative, with cross-sectional data collected between 2017 and 2023. Screening for common DSM-5 disorders was conducted using validated screening measures. Latent variables were examined using exploratory principal axis factor analysis on a correlation matrix among the lifetime mental disorders. Based on age-of-onset information, multivariable poisson regression models were used to examine associations of prior disorders with the first onset of other disorders. Results: 27.0 % of students screened positive for only one lifetime disorder, 17.1 % for two, 10.9 % for three, and 10.6 % for 4+ disorders. In the factor analysis, three latent variables were found, comprising: internalizing disorders (generalized anxiety disorder, major depressive episode, post-traumatic stress disorder, and panic disorder), substance use disorders (drug use disorder and alcohol use disorder), and externalizing disorders (attention deficit/hyperactivity disorder and mania/hypomania). Prior internalizing and externalizing disorders were associated with the subsequent first onset of all other disorders with risk ratios ranging from 1.5-7.5. Substance use disorders were less consistently associated with the subsequent first onset of other disorders, but alcohol use disorder was associated with the first onset of drug use disorder and vice versa. Conclusions: Mental disorder comorbidity is common among students, and students with disorders across the internalizing and externalizing spectrum have an increased risk of future mental disorder comorbidities.

BACKGROUND:Non-suicidal self-injury (NSSI) is associated with mental disorders, yet work regarding the direction of this association is inconsistent. We examined the prevalence, comorbidity, time-order associations with mental disorders, and sex differences in sporadic and repetitive NSSI among emerging adults. METHODS:We used survey data from n = 72,288 first-year college students as part of the World Mental Health-International College Student Survey Initiative (WMH-ICS) to explore time-order associations between onset of NSSI and mental disorders, based on retrospective age-of-onset reports using discrete-time survival models. We distinguished between sporadic (1-5 lifetime episodes) and repetitive (≥6 lifetime episodes) NSSI in relation to DSM-5 mood, anxiety, and externalizing disorders. RESULTS:We estimated a lifetime NSSI rate of 24.5%, with approximately half reporting sporadic NSSI and half repetitive NSSI. The time-order associations between onset of NSSI and mental disorders were bidirectional, but mental disorders were stronger predictors of the onset of NSSI (median RR = 1.94) than vice versa (median RR = 1.58). These associations were stronger among individuals engaging in repetitive rather than sporadic NSSI. While associations between NSSI and mental disorders generally did not differ by sex, repetitive NSSI was a stronger predictor for the onset of subsequent substance use disorders among females compared to males. Most mental disorders marginally increased the risk for persistent repetitive NSSI (median RR = 1.23). CONCLUSIONS:Our findings offer unique insights into the temporal order between NSSI and mental disorders. Further work exploring the mechanism underlying these associations will pave the way for early identification and intervention of both NSSI and mental disorders.

BACKGROUND:This study explored eating disorders (ED) prevalences, comorbidity of ED with other mental disorders, and risk factors for ED among university students. ED included binge eating disorder (BED), bulimia nervosa (BN), or other specified feeding and eating disorders (OSFED). METHODS:A total of 3425 first-year university students in Sweden completed an online survey covering a range of criteria for psychiatric diagnoses, within the World Mental Health International College Student (WMH-ICS) initiative. Pearson's χ2 -tests were used to compare algorithm-based diagnostic prevalences for eating disorders and other comorbid psychiatric disorders between three groups: students with ED with or without other comorbid psychiatric disorders (A), students with psychiatric disorders but no ED comorbidity (B), and students with no psychiatric disorders (C). Multinomial logistic regression was used to calculate between-group comparisons of odds ratios for independent risk factors, where group B served as the reference group for comparisons with groups A and C. RESULTS:Of the total sample, 75% had at least one psychiatric disorder and 28% had at least one lifetime ED diagnosis. Students with ED (group A) reported higher prevalences for comorbid anxiety disorders, depression, suicidal behavior, and non-suicidal self-injury compared to students with psychiatric disorders but no ED (group B). Group A participants exhibited a higher risk of hazardous drinking, were more likely to have received medical treatment, and to identify as bisexual. Compared to group B, students with no psychiatric disorders (group C) were more likely to report better mental and physical health, but less likely to engage in hazardous drinking, and to have sought mental health treatment. CONCLUSIONS:A large proportion of students with ED had additional psychiatric disorders, indicating that individuals with ED suffer from multiple mental health problems. It is crucial that student health services acquire competency to offer effective ED assessment and treatment.

OBJECTIVE:We examined psychopathological conditions accounting for the highest risk of role impairment among university students. METHOD:Cross-sectional online survey of first-year students (60 universities, 10 countries) assessing role impairment due to emotional problems in previous 30 days with the 3-item emotional subscale of the VR-36. Cross-tabulations and Poisson regression examined associations between 12 psychopathological conditions (8 probable mental disorders and 4 SITB) and socio-demographics with "significant role impairment" ("most"/"all of the time" in 2+ VR-36 items). We used machine learning methods to predict probabilities (risk) of significant role impairment based on the 12 psychopathological conditions. Observed prevalence of significant role impairment was examined within and across the 20 population ventiles to assess risk concentration using sensitivity (SN) and positive predictive value (PPV). RESULTS:43,990 students responded to the survey (median age = 19, IQR = 18-23). 27.1 % had significant role impairment due to emotional problems and 65.8 % had at least one psychopathological condition. Students with one or more of these conditions were more likely to have significant impairment than those without (RR = 3.9; 95 %CI: 3.6-4.2). In multivariable analyses, probable Depression and Bipolar disorders were the strongest correlates of significant impairment. Most (69.6 %) of the observed significant role impairment occurred among the roughly 35 % of respondents with highest predicted risk (PPV = 53.2 %). CONCLUSION:Significant role impairment due to emotional problems is highly prevalent among university students. High risk of significant role impairment concentrates in one third of the students, those with several psychopathological conditions. Assessing these conditions should help identifying highest role impairment risk university students.

PURPOSE:This study investigates associations of childhood adversities (CAs) with lifetime prevalence, 12-month prevalence, and 12-month persistence of mental disorders in a large cross-national sample of university students. METHODS:Data came from epidemiologic surveys carried out by the World Mental Health International College Student (WMH-ICS)Initiative across 18 countries (n=60,719). The web-based surveys screened for lifetime and 12-month prevalence and age-of-onset of common DSM-5 disorders (Major Depressive Disorder, Bipolar I/II Disorder, Generalized Anxiety Disorder, Panic Disorder, Posttraumatic Stress Disorder, Alcohol and Drug Use disorders, Attention-Deficit/Hyperactivity Disorder) and five types of CAs (family dysfunction, emotional abuse, physical abuse, sexual abuse, neglect). Multivariable Poisson regression models estimated associations of CA type, number, and frequency with disorders. RESULTS:The majority of incoming students reported exposure to at least one CA (64.9%), including 50.0 % family dysfunction, 42.2 % emotional abuse, 21.2 % physical abuse, 18.8 % neglect, and 5.0 % sexual abuse. Lifetime and 12-month disorders were significantly associated with CAs in multivariable models, although associations with disorder persistence were weaker. Population attributable risk proportions of 12-month disorders associated with CAs were in the range of 40.7-61.0 % for anxiety and mood disorders and 13.5-55.2 % for substance use disorders. CONCLUSION:Six out of ten university students arrive at university having been exposed to CAs. These students have substantially higher risk of mental disorders than other students, primarily due to associations with lifetime risk rather than persistence. Given the considerable distress and impairment caused by mental disorders, these results underscore the need for primary and secondary prevention efforts.

Background: The college years are a developmentally sensitive period for mental disorder onset. Reliable epidemiological data are critical for informing public health responses. This study aimed to estimate prevalence and socio-demographic distributions of common DSM-5 mental disorders among first-year university students from 77 universities across 18 countries. Methods: Data were collected 2017-2023 in the World Mental Health International College Student Initiative with n = 72,288 university students. Online surveys assessed alcohol use, attention-deficit/hyperactivity, bipolar, drug use, generalized anxiety, major depression, panic, and post-traumatic stress disorders with validated screening scales. Socio-demographics included student age, sex at birth, gender modality, sexual orientation, and parent education. Results: The weighted mean response rate was 20.8%. Data were calibrated for differential response rates by sex at birth and age. 65.2% of respondents screened positive for lifetime mental disorders and 57.4% for 12-month mental disorders. Females had higher prevalence of internalizing disorders and males of substance and attentiondeficit/hyperactivity disorders. Older age was associated with lower prevalence of most 12-month but not lifetime mental disorders. Non-heterosexual sexual orientation and identifying as transgender were associated with highest prevalence of most mental disorders. Parent education was for the most part uncorrelated with prevalence. Conclusions: Although prevalence might have been overestimated due to the low response rate and possible screening scale miscalibration, results nonetheless suggest that mental disorders are highly prevalent among first-year university students worldwide and are widely distributed with respect to socio-demographic characteristics. These findings highlight the need to implement effective interventions to better support first-year university student mental health.

Mental health disparities have been reported among sexual minority individuals; minority stress theory posits that such disparities are a result of stigma and discrimination. We estimated the prevalence of mental disorders across sexual orientation groups among first-year college students and whether differences across sexual orientation groups varied by gender and country-level LGBTQ+ (lesbian, gay, bisexual, transgender, queer) social acceptance. Using data (N = 53,175; 13 countries) from the World Mental Health Surveys International College Surveys, we performed multilevel logistic regressions to estimate the associations between sexual orientation (i.e., heterosexual, heterosexual with same-gender attraction [SGA], gay/lesbian, bisexual, asexual, questioning, and other) and five twelve-month DSM-5 disorders (major depressive disorder, generalized anxiety disorder, panic disorder, alcohol use disorder, drug use disorder). Heterosexual students with SGA (AORs 1.30-2.15), gay/lesbian (AORs 1.49-2.70), bisexual (AORs 2.26-3.49), questioning (AORs 1.38-2.04), and "other" (AORs 1.76-2.94) students had higher odds of all disorders compared to heterosexual students with no SGA; asexual students did not. Significant interactions with gender show that the gender difference in prevalence was greater among bisexual individuals for most disorders and among all sexual minorities (except "other") for drug use disorder. Significant interactions with country level LGBT+ social acceptance showed some sexual minority groups had lower odds (AORs 0.83-0.95) of disorder as country-level acceptance increased. These findings provide further evidence of mental disorder disparities across a wide range of sexual orientations and how these disparities vary by gender and societal LGBTQ+ acceptance in students from diverse countries.

OBJECTIVE:To investigate the associations of demographic variables, childhood adversities (CAs), and mental disorders (MDx) with onset, transition, and persistence of suicidal thoughts and behaviors (STB) among first-year university students. METHOD:Poisson regression models within a discrete-time survival framework were constructed using web-based self-report survey data from 72,288 incoming university students across 18 countries (response rate=20.9%; median age=19 years, 57.9% female, 1.4% transgender, 21.0% non-heterosexual). These models examined the associations of four demographic variables, five CAs, and eight MDx with STB outcomes. RESULTS:Lifetime prevalence of suicidal ideation, plans, and attempts was 47.0%, 26.0%, and 9.6%, respectively; 12-month estimates were 30.6%, 14.0%, and 2.3%. In unadjusted analyses, associations were strongest between lifetime onset of suicidal ideation and CAs (RR range 4.4-7.0), particularly parental psychopathology (relative risk [RR]=7.0 [95% CI 6.5-7.7]), followed by MDx (RR range 1.3-3.0). Of the demographic subgroups, transgender students had highest risk of STB (lifetime ideation onset RR=2.4 [2.3-2.6]; ideation-to-attempt transition RR=1.5 [1.3-1.8]). In fully adjusted models, strongest predictors of lifetime ideation onset were emotional abuse (RR=2.1 [1.9-2.2]), major depressive disorder (RR=2.0 [1.9-2.1]), and bipolar disorder (RR=1.8 [1.6-2.0]). Ideation-to-attempt transition remained most strongly associated with panic disorder (RR=1.5 [1.3-1.7]), bipolar disorder (RR=1.4 [1.2-1.7]), and sexual abuse (RR=1.4 [1.2-1.7]). Most predictors were significantly but weakly associated with persistence of ideation and plan, while only physical abuse remained associated with repeated suicide attempts (RR=1.3 [1.0-1.8]). CONCLUSION:CAs and MDx are strong predictors of both onset of and transition within the STB spectrum, underscoring the importance of implementing early-life prevention interventions.

Objective This study used causal inference to estimate the longitudinal effects of contagion in cohabitants and family members on university students’ mental health and academic self-efficacy during the COVID-19 pandemic.Design A prospective longitudinal study including a baseline online measurement in May 2020, and online follow-ups after 5 months and 10 months. Participants were recruited through open-access online advertising.Setting Public universities and university colleges in Sweden.Participants The analytical sample included 2796 students.Outcome measures Contagion in cohabitants and in family members was assessed at baseline and at the 5-month follow-up. Mental health and academic self-efficacy were assessed at the 5-month and 10-month follow-ups.Results Mild symptoms reported in cohabitants at baseline resulted in negative mental health effects at follow-up 5 months later, and mild baseline symptoms in family members resulted in negative effects on academic self-efficacy at follow-ups both 5 and 10 months later.Conclusions Notwithstanding the lack of precision in estimated effects, the findings emphasise the importance of social relationships and the challenges of providing students with sufficient support in times of crisis.

Addressing the effects of non-compliance with health-related recommendations in pandemics is needed for informed decision-making. This longitudinal study investigated the effects of non-compliance on mental health and academic self-efficacy among university students in Sweden. Baseline assessments were conducted in May 2020, with follow-ups after 5 and 10 months. Students (n = 3123) from 19 universities completed online questionnaires covering compliance, mental health, and academic self-efficacy. Effects of non-compliance were estimated using causal inference and multilevel multinomial regression. Non-compliant students constituted a minority, but their proportion increased over time. Regarding mental health and academic self-efficacy, few differences were observed between compliant and non-compliant students. When differences were identified, non-compliant students experienced fewer negative effects on mental health and academic self-efficacy than compliant students. The findings may suggest that non-compliance may have involved a trade-off between increased individual freedom and mitigating negative outcomes. Addressing the research gap on non-compliance effects is crucial for informed decision-making and promoting the common good. This may guide strategies balancing individual autonomy and collective well-being during future pandemics. Center for Open Science (OSF), https://accounts.osf.io/login?service=https://osf.io/37dhm/ .

Background Emerging adulthood is often associated with mental health problems. About one in three university students report symptoms of depression and anxiety that can negatively affect their developmental trajectory concerning work, intimate relationships, and health. This can interfere with academic performance, as mood and anxiety disorders are key predictors of dropout from higher education. A treatment gap exists, where a considerable proportion of students do not seek help for mood and anxiety symptoms. Offering internet interventions to students with mental health problems could reduce the treatment gap, increase mental health, and improve academic performance. A meta-analysis on internet interventions for university students showed small effects for depression and none for anxiety. Larger trials are recommended to further explore effects of guidance, transdiagnostic approaches, and individual treatment components. Methods This study will offer 1200 university students in Sweden participation in a three-armed randomized controlled trial (RCT) evaluating a guided or unguided transdiagnostic internet intervention for mild to moderate depression and anxiety, where the waitlist control group accesses the intervention at 6-month follow-up. Students reporting suicidal ideation/behaviors will be excluded and referred to treatment within the existing healthcare system. An embedded study within the trial (SWAT) will assess at week 3 of 8 whether participants in the guided and unguided groups are at higher risk of failing to benefit from treatment. Those at risk will be randomized to an adaptive treatment strategy, or to continue the treatment as originally randomized. Primary outcomes are symptoms of depression and anxiety. Follow-ups will occur at post-treatment and at 6-, 12-, and 24-month post-randomization. Between-group outcome analyses will be reported, and qualitative interviews about treatment experiences are planned. Discussion This study investigates the effects of a transdiagnostic internet intervention among university students in Sweden, with an adaptive treatment strategy employed during the course of treatment to minimize the risk of treatment failure. The study will contribute knowledge about longitudinal trajectories of mental health and well-being following treatment, taking into account possible gender differences in responsiveness to treatment. With time, effective internet interventions could make treatment for mental health issues more widely accessible to the student group.

Commensurate measures of alcohol-related consequences across countries and cultures are critical for addressing the global burden of hazardous alcohol use. The Rutgers Alcohol Problem Index (RAPI), developed and validated in the United States, is a popular measure of alcohol problems. This study examined measurement invariance of the RAPI across samples of U.S. and Swedish high school seniors. Latent mean differences in alcohol problems across countries and differences in associations between alcohol problems with alcohol use and protective behavioral strategies (PBS) were also examined. The RAPI was scalar invariant. Swedish students reported fewer problems than U.S. students (latent mean difference = -0.19, p = .047). In both samples, the RAPI was positively correlated with alcohol use frequency and quantity (ps < .001), and negatively correlated with PBS use (ps < .05). Overall, the RAPI demonstrated measurement invariance, and we found evidence for its validity across samples of U.S. and Swedish high school seniors.

In higher education, students' trust in the university management may affect both mental health and academic self-efficacy. This longitudinal study, conducted during the most challenging course of the COVID-19 pandemic, uses multinomial regression and causal inference to estimate the effects of students' trust in their universities' strategies for managing the pandemic, on students' self-reported changes in mental health and academic self-efficacy. The analyzed sample (N = 2796) was recruited through online advertising and responded to a baseline online survey in the late spring of 2020, with two follow-up surveys five and ten months later. Results show that positive trust in university management of the pandemic protected against experiencing one's mental health and academic self-efficacy as worse rather than unchanged, both five and ten months after the baseline assessment. The findings emphasize the importance of developing and maintaining trust-building measures between academia and students to support students' mental health and academic self-efficacy in times of uncertainty.

Objective: To investigate perceived changes in academic self-efficacy associated with self-reported symptoms of COVID-19, changes in mental health, and trust in universities' management of the pandemic and transition to remote education during lockdown of Swedish universities in the spring of 2020. Methods: 4495 participated and 3638 responded to self-efficacy questions. Associations were investigated using multinomial regression. Results: Most students reported self-experienced effects on self-efficacy. Lowered self-efficacy was associated with symptoms of contagion, perceived worsening of mental health and low trust in universities' capacity to successfully manage the lockdown and transition to emergency remote education. Increased self-efficacy was associated with better perceived mental health and high trust in universities. Conclusion: The initial phase of the pandemic was associated with a larger proportion of students reporting self-experienced negative effects on academic self-efficacy. Since self-efficacy is a predictor of academic performance, it is likely that students' academic performance will be adversely affected.