Dynamics of depressive states among university students in Japan during the COVID-19 pandemic: an interrupted time series analysis

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Abstract

Background

The coronavirus disease 2019 (COVID-19) pandemic was reported to have increased depression among university students which was associated with impairments in their campus lives. This study examined changes in depressive states among Japanese university students during the COVID-19 pandemic.

Methods

A secondary data analysis from a factorial randomized controlled trial involving smartphone-based cognitive-behavioral therapy was performed. Six cohorts ( N = 1626) underwent an 8-week intervention during the spring or autumn of 2019–2021, with a 9-month follow-up. We evaluated participants’ depressive states weekly using the Patient Health Questionnaire-9 (PHQ-9) during the intervention, with monthly evaluations thereafter. The follow-up periods included Japan’s four states of emergency (SOEs) to control COVID-19. Hypothesizing that SOEs caused a sudden worsening of depressive states, Study 1 compared the cohorts’ PHQ-9 scores, and Study 2 employed time series analysis with a mixed-effects model to estimate identified changes in PHQ-9 scores.

Results

Although no changes in depressive states were observed in relation to the SOEs, Study 1 identified sudden increases in PHQ-9 scores at the 28-week evaluation point, which corresponded to the beginning of the new academic year for the three autumn cohorts. In contrast, the three spring cohorts did not exhibit similar changes. Study 2 showed that, for all three autumn cohorts ( n = 522), the 0.60-point change was significant (95% CI 0.42–0.78; p < .001) at 28 weeks; that is, when their timeline was interrupted.

Conclusions

While the results do not indicate any notable impact of the SOEs, they highlight the influence of the new academic year on university students’ mental health during COVID-19.

Trial registration UMIN, CTR-000031307. Registered on February 14, 2018.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12991-023-00468-9.

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Most cited references 39

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The PHQ-9: validity of a brief depression severity measure.

K Kroenke, R L Spitzer, J. Williams (2001)

While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.

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Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire.

R L Spitzer, K Kroenke, J. Williams (1999)

The Primary Care Evaluation of Mental Disorders (PRIME-MD) was developed as a screening instrument but its administration time has limited its clinical usefulness. To determine if the self-administered PRIME-MD Patient Health Questionnaire (PHQ) has validity and utility for diagnosing mental disorders in primary care comparable to the original clinician-administered PRIME-MD. Criterion standard study undertaken between May 1997 and November 1998. Eight primary care clinics in the United States. Of a total of 3000 adult patients (selected by site-specific methods to avoid sampling bias) assessed by 62 primary care physicians (21 general internal medicine, 41 family practice), 585 patients had an interview with a mental health professional within 48 hours of completing the PHQ. Patient Health Questionnaire diagnoses compared with independent diagnoses made by mental health professionals; functional status measures; disability days; health care use; and treatment/referral decisions. A total of 825 (28%) of the 3000 individuals and 170 (29%) of the 585 had a PHQ diagnosis. There was good agreement between PHQ diagnoses and those of independent mental health professionals (for the diagnosis of any 1 or more PHQ disorder, kappa = 0.65; overall accuracy, 85%; sensitivity, 75%; specificity, 90%), similar to the original PRIME-MD. Patients with PHQ diagnoses had more functional impairment, disability days, and health care use than did patients without PHQ diagnoses (for all group main effects, P<.001). The average time required of the physician to review the PHQ was far less than to administer the original PRIME-MD (<3 minutes for 85% vs 16% of the cases). Although 80% of the physicians reported that routine use of the PHQ would be useful, new management actions were initiated or planned for only 117 (32%) of the 363 patients with 1 or more PHQ diagnoses not previously recognized. Our study suggests that the PHQ has diagnostic validity comparable to the original clinician-administered PRIME-MD, and is more efficient to use.

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WHO world mental health surveys international college student project: Prevalence and distribution of mental disorders.

Nancy Sampson, Alan Zaslavsky, Dan J. Stein … (2018)

Increasingly, colleges across the world are contending with rising rates of mental disorders, and in many cases, the demand for services on campus far exceeds the available resources. The present study reports initial results from the first stage of the WHO World Mental Health International College Student project, in which a series of surveys in 19 colleges across 8 countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, United States) were carried out with the aim of estimating prevalence and basic sociodemographic correlates of common mental disorders among first-year college students. Web-based self-report questionnaires administered to incoming first-year students (45.5% pooled response rate) screened for six common lifetime and 12-month DSM-IV mental disorders: major depression, mania/hypomania, generalized anxiety disorder, panic disorder, alcohol use disorder, and substance use disorder. We focus on the 13,984 respondents who were full-time students: 35% of whom screened positive for at least one of the common lifetime disorders assessed and 31% screened positive for at least one 12-month disorder. Syndromes typically had onsets in early to middle adolescence and persisted into the year of the survey. Although relatively modest, the strongest correlates of screening positive were older age, female sex, unmarried-deceased parents, no religious affiliation, nonheterosexual identification and behavior, low secondary school ranking, and extrinsic motivation for college enrollment. The weakness of these associations means that the syndromes considered are widely distributed with respect to these variables in the student population. Although the extent to which cost-effective treatment would reduce these risks is unclear, the high level of need for mental health services implied by these results represents a major challenge to institutions of higher education and governments. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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Author and article information

Contributors

N. Shiraishi:

ORCID: http://orcid.org/0000-0003-4089-1816

nao-shiraishi@umin.ac.jp

M. Sakata:

ORCID: http://orcid.org/0000-0002-5358-5263

sakata.masatsugu.3t@kyoto-u.ac.jp

R. Toyomoto:

ORCID: http://orcid.org/0000-0003-1125-3145

rie.toyomoto@gmail.com

K. Yoshida:

ORCID: http://orcid.org/0000-0003-4475-8043

amantes_amentes_1104@yahoo.ne.jp

Y. Luo:

ORCID: http://orcid.org/0000-0002-5271-5126

lilacluo@gmail.com

Y. Nakagami:

ORCID: http://orcid.org/0000-0001-7495-8957

nakagamiyukako@gmail.com

A. Tajika:

ORCID: http://orcid.org/0000-0003-3926-8867

aran.tajika28@gmail.com

T. Watanabe:

ORCID: http://orcid.org/0000-0001-5477-187X

tw28@h5.dion.ne.jp

E. Sahker:

ORCID: http://orcid.org/0000-0002-4269-4800

sahker.ethan.2e@kyoto-u.ac.jp

T. Uwatoko:

ORCID: http://orcid.org/0000-0002-7917-9060

uwatoko@kuhp.kyoto-u.ac.jp

T. Shimamoto:

ORCID: http://orcid.org/0000-0001-7661-6299

shimamoto.tomonari.5w@kyoto-u.ac.jp

T. Iwami:

ORCID: http://orcid.org/0000-0002-4150-7065

iwami.taku.8w@kyoto-u.ac.jp

T. A. Furukawa:

ORCID: http://orcid.org/0000-0003-2159-3776

furukawa@kuhp.kyoto-u.ac.jp

Journal

Journal ID (nlm-ta): Ann Gen Psychiatry

Journal ID (iso-abbrev): Ann Gen Psychiatry

Title: Annals of General Psychiatry

Publisher: BioMed Central (London )

ISSN (Electronic): 1744-859X

Publication date (Electronic): 10 October 2023

Publication date PMC-release: 10 October 2023

Publication date Collection: 2023

Volume: 22

Electronic Location Identifier: 38

Affiliations

[1 ]Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Science, ( https://ror.org/04wn7wc95) 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601 Japan

[2 ]Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, ( https://ror.org/02kpeqv85) Kyoto, Japan

[3 ]Kyoto University Health Service, ( https://ror.org/02kpeqv85) Kyoto, Japan

[4 ]Medical Education Center, Kyoto University Graduate School of Medicine, ( https://ror.org/02kpeqv85) Kyoto, Japan

[5 ]Department of Neuropsychiatry, Kyoto University Hospital, ( https://ror.org/04k6gr834) Kyoto, Japan

Author information

N. Shiraishi http://orcid.org/0000-0003-4089-1816

M. Sakata http://orcid.org/0000-0002-5358-5263

R. Toyomoto http://orcid.org/0000-0003-1125-3145

K. Yoshida http://orcid.org/0000-0003-4475-8043

Y. Luo http://orcid.org/0000-0002-5271-5126

Y. Nakagami http://orcid.org/0000-0001-7495-8957

A. Tajika http://orcid.org/0000-0003-3926-8867

T. Watanabe http://orcid.org/0000-0001-5477-187X

E. Sahker http://orcid.org/0000-0002-4269-4800

T. Uwatoko http://orcid.org/0000-0002-7917-9060

T. Shimamoto http://orcid.org/0000-0001-7661-6299

T. Iwami http://orcid.org/0000-0002-4150-7065

T. A. Furukawa http://orcid.org/0000-0003-2159-3776

Article

Publisher ID: 468

DOI: 10.1186/s12991-023-00468-9

PMC ID: 10563354

PubMed ID: 37814328

SO-VID: 4aa342cf-931a-42b8-a845-3f760161155e

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 14 April 2023

Date accepted : 22 September 2023

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001691, Japan Society for the Promotion of Science;

Award ID: 21K03049

Award ID: 18K18643

Award Recipient : M. Sakata T. Iwami

Funded by: FundRef http://dx.doi.org/10.13039/100007434, Suzuken Memorial Foundation;

Funded by: FundRef http://dx.doi.org/10.13039/501100011923, KDDI Foundation;

Funded by: FundRef http://dx.doi.org/10.13039/100014475, Pfizer Health Research Foundation;

Funded by: FundRef http://dx.doi.org/10.13039/100019833, World Health Organization Centre for Health Development;

Award ID: WHO Kobe Centre – WKC: K22001

Award Recipient : T. A. Furukawa

Funded by: FundRef http://dx.doi.org/10.13039/100009619, Japan Agency for Medical Research and Development;

Award ID: dk0307085

Award Recipient : T. A. Furukawa

Funded by: FundRef http://dx.doi.org/10.13039/501100020959, JST-Mirai Program;

Award ID: JPMJMI20D6

Award Recipient : T. A. Furukawa

Funded by: World Health Organization Mental Health Research

Award ID: 2021/HQ/WKC/0013

Award Recipient : T. A. Furukawa

Custom metadata

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: depression,gogatsubyou,higher education,novel coronavirus,student apathy

Data availability:

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: depression, gogatsubyou, higher education, novel coronavirus, student apathy

Dynamics of depressive states among university students in Japan during the COVID-19 pandemic: an interrupted time series analysis

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Abstract

Background

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Supplementary Information

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Novel Coronavirus Disease COVID-19

Most cited references 39

The PHQ-9: validity of a brief depression severity measure.

Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire.

WHO world mental health surveys international college student project: Prevalence and distribution of mental disorders.

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