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Factors Associated With Mental Health Disorders Among University Students in France Confined During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What is the mental health state of university students in France who were confined during the coronavirus disease 2019 (COVID-19) pandemic, and what factors are associated with the development of mental health symptoms?

Findings  This survey study of 69 054 students who experienced quarantine found high prevalence rates of severe self-reported mental health symptoms. Among risk factors identified, female or nonbinary gender, problems with income or housing, history of psychiatric follow-up, symptoms compatible with COVID-19, social isolation, and low quality of information received were associated with altered mental health.

Meaning  The findings of this study suggest that students’ mental health is a public health issue that has become even more critical in the context of a pandemic, underlining the need to reinforce prevention, surveillance, and access to care.


Importance  The coronavirus disease 2019 (COVID-19) pandemic and quarantine measures have raised concerns regarding their psychological effects on populations. Among the general population, university students appear to be particularly susceptible to experiencing mental health problems.

Objectives  To measure the prevalence of self-reported mental health symptoms, to identify associated factors, and to assess care seeking among university students who experienced the COVID-19 quarantine in France.

Design, Setting, and Participants  This survey study collected data from April 17 to May 4, 2020, from 69 054 students living in France during the COVID-19 quarantine. All French universities were asked to send an email to their students asking them to complete an online questionnaire. The targeted population was approximately 1 600 000 students.

Exposure  Living in France during the COVID-19 quarantine.

Main Outcomes and Measures  The rates of self-reported suicidal thoughts, severe distress, stress, anxiety, and depression were assessed using the 22-item Impact of Events Scale–Revised, the 10-item Perceived Stress Scale, the 20-item State-Trait Anxiety Inventory (State subscale), and the 13-item Beck Depression Inventory, respectively. Covariates were sociodemographic characteristics, precariousness indicators (ie, loss of income or poor quality housing), health-related data, information on the social environment, and media consumption. Data pertaining to care seeking were also collected. Multivariable logistic regression analyses were performed to identify risk factors.

Results  A total of 69 054 students completed the survey (response rate, 4.3%). The median (interquartile range) age was 20 (18-22) years. The sample was mainly composed of women (50 251 [72.8%]) and first-year students (32 424 [47.0%]). The prevalence of suicidal thoughts, severe distress, high level of perceived stress, severe depression, and high level of anxiety were 11.4% (7891 students), 22.4% (15 463 students), 24.7% (17 093 students), 16.1% (11 133 students), and 27.5% (18 970 students), respectively, with 29 564 students (42.8%) reporting at least 1 outcome, among whom 3675 (12.4%) reported seeing a health professional. Among risk factors identified, reporting at least 1 mental health outcome was associated with female gender (odds ratio [OR], 2.10; 95% CI, 2.02-2.19; P < .001) or nonbinary gender (OR, 3.57; 95% CI, 2.99-4.27; P < .001), precariousness (loss of income: OR, 1.28; 95% CI, 1.22-1.33; P < .001; low-quality housing: OR, 2.30; 95% CI, 2.06-2.57; P < .001), history of psychiatric follow-up (OR, 3.28; 95% CI, 3.09-3.48; P < .001), symptoms compatible with COVID-19 (OR, 1.55; 95% CI, 1.49-1.61; P < .001), social isolation (weak sense of integration: OR, 3.63; 95% CI, 3.35-3.92; P < .001; low quality of social relations: OR, 2.62; 95% CI, 2.49-2.75; P < .001), and low quality of the information received (OR, 1.56; 95% CI, 1.49-1.64; P < .001).

Conclusions and Relevance  The results of this survey study suggest a high prevalence of mental health issues among students who experienced quarantine, underlining the need to reinforce prevention, surveillance, and access to care.

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Article Information

Accepted for Publication: September 17, 2020.

Published: October 23, 2020. doi:10.1001/jamanetworkopen.2020.25591

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Wathelet M et al. JAMA Network Open.

Corresponding Author: Fabien D’Hondt, PhD, Department of Psychiatry, Centre Hospitalier Universitaire de Lille, CS 70001, 59037 Lille Cedex, France (

Author Contributions: Drs D’Hondt and Wathelet had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Wathelet, Duhem, Vaiva, Baubet, Veerapa, Debien, Molenda, Grandgenèvre, Notredame, D’Hondt.

Acquisition, analysis, or interpretation of data: Wathelet, Duhem, Vaiva, Habran, Horn, Grandgenèvre, D’Hondt.

Drafting of the manuscript: Wathelet, Debien, Grandgenèvre, D’Hondt.

Critical revision of the manuscript for important intellectual content: Wathelet, Duhem, Vaiva, Baubet, Habran, Veerapa, Molenda, Horn, Grandgenèvre, Notredame, D’Hondt.

Statistical analysis: Wathelet, Habran, D’Hondt.

Obtained funding: Vaiva, D’Hondt.

Administrative, technical, or material support: Duhem, Vaiva, Baubet, Habran, Veerapa, Molenda, Grandgenèvre, Notredame, D’Hondt.

Supervision: Duhem, Vaiva, Debien, D’Hondt.

Conflict of Interest Disclosures: Dr Debien reported receiving grants from Sanofi outside the submitted work. Dr Horn reported receiving expenses for travel and accommodations from Janssen-Cilag, Lundbeck, and Otsuka Pharmaceutical France outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank the French Ministry of Higher Education, Research, and Innovation and the French National Center for School and University Affairs for disseminating the survey. We are also grateful to university students for their participation.

US Centers for Disease Control and Prevention. About quarantine and isolation. Published January 2020. Accessed September 24, 2020.
Barbera  J , Macintyre  A , Gostin  L ,  et al.  Large-scale quarantine following biological terrorism in the United States: scientific examination, logistic and legal limits, and possible consequences.   JAMA. 2001;286(21):2711-2717. doi:10.1001/jama.286.21.2711PubMedGoogle Scholar
Brooks  SK , Webster  RK , Smith  LE ,  et al.  The psychological impact of quarantine and how to reduce it: rapid review of the evidence.   Lancet. 2020;395(10227):912-920. doi:10.1016/S0140-6736(20)30460-8PubMedGoogle Scholar
Observatoire National du Suicide. Suicide: enjeux éthiques de la prévention, singularités du suicide à l’adolescence. Published February 5, 2018. Accessed September 24, 2020.
Observatoire National de la Vie Etudiante. Repères sur la santé des étudiants. Published 2018. Accessed September 24, 2020.
Kannarkat  JT , Smith  NN , McLeod-Bryant  SA .  Mobilization of telepsychiatry in response to COVID-19—moving toward 21st century access to care.   Adm Policy Ment Health. 2020;47(4):489-491. doi:10.1007/s10488-020-01044-zPubMedGoogle Scholar
Farand  L , Renaud  J , Chagnon  F .  Adolescent suicide in Quebec and prior utilization of medical services.   Can J Public Health. 2004;95(5):357-360. doi:10.1007/BF03405146PubMedGoogle Scholar
Wu  P , Katic  BJ , Liu  X , Fan  B , Fuller  CJ .  Mental health service use among suicidal adolescents: findings from a U.S. national community survey.   Psychiatr Serv. 2010;61(1):17-24. doi:10.1176/ps.2010.61.1.17PubMedGoogle Scholar
Taylor  MR , Agho  KE , Stevens  GJ , Raphael  B .  Factors influencing psychological distress during a disease epidemic: data from Australia’s first outbreak of equine influenza.   BMC Public Health. 2008;8:347. doi:10.1186/1471-2458-8-347PubMedGoogle Scholar
Wang  C , Pan  R , Wan  X ,  et al.  Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China.   Int J Environ Res Public Health. 2020;17(5):1729. doi:10.3390/ijerph17051729PubMedGoogle Scholar
Brunet  A , St-Hilaire  A , Jehel  L , King  S .  Validation of a French version of the Impact of Event Scale–Revised.   Can J Psychiatry. 2003;48(1):56-61. doi:10.1177/070674370304800111PubMedGoogle Scholar
Lesage  F-X , Berjot  S , Deschamps  F .  Psychometric properties of the French versions of the Perceived Stress Scale.   Int J Occup Med Environ Health. 2012;25(2):178-184. doi:10.2478/s13382-012-0024-8PubMedGoogle Scholar
Alharbi  H , Alshehry  A .  Perceived stress and coping strategies among ICU nurses in government tertiary hospitals in Saudi Arabia: a cross-sectional study.   Ann Saudi Med. 2019;39(1):48-55. doi:10.5144/0256-4947.2019.48PubMedGoogle Scholar
Kim  D-S , Sung  H-H , Lee  J-W , Cho  E-K .  The relationship between Perceived Stress Scale and carotid intima-media thickness using ultrasonography in university students.   Korean J Clin Lab Sci. 2017;49:308-315. doi:10.15324/kjcls.2017.49.3.308Google Scholar
Bourque  P , Beaudette  D .  Étude psychometrique du questionnaire de dépression de Beck auprès d’un échantillon d’étudiants universitaires francophones.   Can J Behav Sci Rev Can Sci Comport. 1982;14(3):211-218. doi:10.1037/h0081254Google Scholar
Beck  AT , Beamesderfer  A .  Assessment of depression: the depression inventory.   Mod Probl Pharmacopsychiatry. 1974;7(0):151-169. doi:10.1159/000395074PubMedGoogle Scholar
Schweitzer  MB , Paulhan  I . Manuel pour l’inventaire d’anxiété Trait-Etat (Forme Y). Laboratoire de Psychologie Santé Universitaire Bordeaux; 1990.
Bauer  C , Rimmelé  T , Duclos  A ,  et al.  Anxiety and stress among anaesthesiology and critical care residents during high-fidelity simulation sessions.   Anaesth Crit Care Pain Med. 2016;35(6):407-416. doi:10.1016/j.accpm.2016.01.004PubMedGoogle Scholar
The American Association for Public Opinion Research. Standard definitions: final dispositions of case codes and outcome rates for RDD telephone surveys and in-person household surveys. Published 2011. Accessed September 24, 2020.
Alonso  J , Angermeyer  MC , Bernert  S ,  et al; ESEMeD/MHEDEA 2000 Investigators, European Study of the Epidemiology of Mental Disorders (ESEMeD) Project.  Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.   Acta Psychiatr Scand Suppl. 2004;109(420):21-27.PubMedGoogle Scholar
Lehtinen  V , Joukamaa  M , Lahtela  K ,  et al.  Prevalence of mental disorders among adults in Finland: basic results from the Mini Finland Health Survey.   Acta Psychiatr Scand. 1990;81(5):418-425. doi:10.1111/j.1600-0447.1990.tb05474.xPubMedGoogle Scholar
Gulliver  A , Griffiths  KM , Christensen  H .  Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review.   BMC Psychiatry. 2010;10(1):113. doi:10.1186/1471-244X-10-113PubMedGoogle Scholar
Campo  JV .  Youth suicide prevention: does access to care matter?   Curr Opin Pediatr. 2009;21(5):628-634. doi:10.1097/MOP.0b013e32833069bdPubMedGoogle Scholar
World Health Organization. Preventing suicide: a global imperative. Published 2014. Accessed September 24, 2020.
Galea  S , Tracy  M .  Participation rates in epidemiologic studies.   Ann Epidemiol. 2007;17(9):643-653. doi:10.1016/j.annepidem.2007.03.013PubMedGoogle Scholar
Søgaard  AJ , Selmer  R , Bjertness  E , Thelle  D .  The Oslo Health Study: the impact of self-selection in a large, population-based survey.   Int J Equity Health. 2004;3(1):3. doi:10.1186/1475-9276-3-3PubMedGoogle Scholar
Yehuda  R , Hoge  CW , McFarlane  AC ,  et al.  Post-traumatic stress disorder.   Nat Rev Dis Primers. 2015;1:15057. doi:10.1038/nrdp.2015.57PubMedGoogle Scholar
Dutheil  F , Mondillon  L , Navel  V .  PTSD as the second tsunami of the SARS-CoV-2 pandemic.   Psychol Med. 2020;1-2:1-2. doi:10.1017/S0033291720001336PubMedGoogle Scholar
American Psychiatric Association.  Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.
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