The first year of college may carry especially high risk for onset of alcohol use disorders. We assessed the one-year incidence of alcohol use disorders (AUD) among incoming first-year students, predictors of AUD-incidence, prediction accuracy and population impact. A prospective cohort study of first-year college students (baseline: N = 5843; response rate = 51.8%; 1-year follow-up: n = 1959; conditional response rate = 41.6%) at a large university in Belgium was conducted. AUD were evaluated with the AUDIT and baseline predictors with the Composite International Diagnostic Interview Screening Scales (CIDI-SC). The one-year incidence of AUD was 3.9% (SE = 0.4). The most important individual-level baseline predictors of AUD incidence were being male (OR = 1.53; 95% CI = 1.12–2.10), a break-up with a romantic partner (OR = 1.67; 95% CI = 1.08–2.59), hazardous drinking (OR = 3.36; 95% CI = 1.31–8.63), and alcohol use characteristics at baseline (ORs between 1.29 and 1.38). Multivariate cross-validated prediction (cross-validated AUC = 0.887) shows that 55.5% of incident AUD cases occurred among the 10% of students at highest predicted risk (20.1% predicted incidence in this highest-risk subgroup). Four out of five students with incident AUD would hypothetically be preventable if baseline hazardous drinking was to be eliminated along with a reduction of one standard deviation in alcohol use characteristics scores, and another 15.0% would potentially be preventable if all 12-month stressful events were eliminated. Screening at college entrance is a promising strategy to identify students at risk of transitioning to more problematic drinking and AUD, thus improving the development and deployment of targeted preventive interventions.
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Arnett JJ (2006) Emerging adulthood: the winding road from the late teens through the twenties. Emerg Adulthood Wind Road from Late Teens through Twenties. https://doi.org/10.1093/acprof:oso/9780195309379.001.0001
Blanco C, Okuda M, Wright C et al (2008) Mental health of college students and their non-college-attending peers: Results from the national epidemiologic study on alcohol and related conditions. Arch Gen Psychiatry 65:1429–1437. https://doi.org/10.1001/archpsyc.65.12.1429
Eisenberg D, Hunt J, Speer N (2013) Mental health in american colleges and universities: Variation across student subgroups and across campuses. J Nerv Ment Dis 201:60–67. https://doi.org/10.1097/NMD.0b013e31827ab077
Auerbach RP, Mortier R, Bruffaerts J et al (2018) WHO World Mental Health Surveys International College Student Project: prevalence and distribution of mental disorders. J Abnorm Psychol 127:623. https://doi.org/10.1037/abn0000362
Bruffaerts R, Mortier P, Kiekens G et al (2018) Mental health problems in college freshmen: Prevalence and academic functioning. J Affect Disord 225:97–103. https://doi.org/10.1016/j.jad.2017.07.044
Auerbach RP, Alonso J, Axinn WG et al (2016) Mental disorders among college students in the World Health Organization World Mental Health Surveys. Psychol Med 46:2955–2970. https://doi.org/10.1017/S0033291716001665
GBD (2016) Alcohol and Drug Use Collaborators (2018) The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Psychiatry 5:987–1012. https://doi.org/10.1016/S2215-0366(18)30337-7
Pulay AJ, Dawson DA, Hasin DS et al (2008) Violent behavior and DSM-IV psychiatric disorders: Results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 69:12–22. https://doi.org/10.4088/jcp.v69n0103
Hingson RW, Zha W, Weitzman ER (2009) Magnitude of and trends in alcohol-related mortality and morbidity among U.S. college students ages 18–24, 1998–2005. J Stud Alcohol Drugs https://doi.org/10.15288/jsads.2009.s16.12.
Jackson C, Geddes R, Haw S, Frank J (2012) Interventions to prevent substance use and risky sexual behaviour in young people: A systematic review. Addiction 107:733–747. https://doi.org/10.1111/j.1360-0443.2011.03751.x
Nichols LR, Samek DR, McConnell L (2019) Key personality traits and alcohol use disorder symptoms in first and second year college students: detangling antecedent from consequence. Addict Behav 89:178–187. https://doi.org/10.1016/j.addbeh.2018.10.004
van Zoonen K, Buntrock C, Ebert DD et al (2014) Preventing the onset of major depressive disorder: A meta-analytic review of psychological interventions. Int J Epidemiol 43:318–329. https://doi.org/10.1093/ije/dyt175
Grant BF, Goldstein RB, Chou SP et al (2009) Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, mood and anxiety disorders: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Mol Psychiatry 14:1051–1066. https://doi.org/10.1038/mp.2008.41
Harrer M, Adam SH, Baumeister H et al (2019) Internet interventions for mental health in university students: A systematic review and meta-analysis. Int J Methods Psychiatr Res. https://doi.org/10.1002/mpr.1759
Ebert DD, Mortier P, Kaehlke F et al (2019) Barriers of mental health treatment utilization among first-year college students: First cross-national results from the WHO World Mental Health International College Student Initiative. Int J Methods Psychiatr Res. https://doi.org/10.1002/mpr.1782
Ganz T, Braun M, Laging M, Schermelleh-Engel K, Michalak J, Heidenreich T (2018) Effects of a stand-alone web-based electronic screening and brief intervention targeting alcohol use in university students of legal drinking age: A randomized controlled trial. Addict Behav 77:81–88. https://doi.org/10.1016/j.addbeh.2017.09.017
Ebert DD, Franke M, Kählke F et al (2019) Increasing intentions to use mental health services among university students Results of a pilot randomized controlled trial within the World Health Organization’s World Mental Health International College Student Initiative. Int J Methods Psychiatr Res. https://doi.org/10.1002/mpr.1754
Hallfors D, Brodish PH, Khatapoush S, Sanchez V, Cho H, Steckler A (2006) Feasibility of screening adolescents for suicide risk in “real-world” high school settings. Am J Public Health 96:282–287. https://doi.org/10.2105/AJPH.2004.057281
Kiekens G, Hasking P, Claes L et al (2019) Predicting the incidence of non-suicidal self-injury in college students. Eur Psychiatry 59:44–51. https://doi.org/10.1016/j.eurpsy.2019.04.002
Ebert DD, Buntrock C, Mortier P et al (2018) Prediction of major depressive disorder onset in college students. Depress Anxiety 36:294–304. https://doi.org/10.1002/da.22867
Mortier P, Demyttenaere K, Auerbach RP et al (2017) First onset of suicidal thoughts and behaviours in college. J Affect Disord 207:291–299. https://doi.org/10.1016/j.jad.2016.09.033
Ebert DD, Cuijpers P, Muñoz RF, Baumeister H (2017) Prevention of mental health disorders using internet- and mobile-based interventions: A narrative review and recommendations for future research. Front Psychiatry. https://doi.org/10.3389/fpsyt.2017.00116
Ribeiro JD, Franklin JC, Fox KR et al (2016) Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies. Psychol Med 46:225–236. https://doi.org/10.1017/S0033291715001804
Saunders JB, Aasland OG, Babor TF, De La Fuente JR, Grant M (1983) Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II. Addiction 88:791–804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x
Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG (2001) The Alcohol Use Disorders Identification Test Guidelines for Use in Primary Health Care. World Health Organization. Geneva, Switz. http://apps.who.int/iris/handle/10665/67205
Reinert DF, Allen JP (2002) The alcohol use disorders identification test (AUDIT): A review of recent research. Alcohol Clin Exp Res 26:272–279. https://doi.org/10.1111/j.1530-0277.2002.tb02534.x
Lange S, Shield K, Monteiro M, Rehm J (2019) Facilitating Screening and Brief Interventions in Primary Care: A Systematic Review and Meta-Analysis of the AUDIT as an Indicator of Alcohol Use Disorders. Alcohol Clin Exp Res 43:2028–2037. https://doi.org/10.1111/acer.14171
Australian Government Department of Veteran Affairs. http://nceta.flinders.edu.au/files/3314/2257/4957/Right_Mix_3.pdf. Accessed 23 July 2020
Kessler RC, Üstün BB (2004) The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 13:93–117. https://doi.org/10.1002/mpr.168
Felitti VJ, Anda RF, Nordenberg D et al (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) Study. Am J Prev Med 14:245–258. https://doi.org/10.1016/s0749-3797(98)00017-8
Swearer SM, Cary PT (2003) Perceptions and Attitudes Toward Bullying in Middle School Youth. J Appl Sch Psychol 19:63–79. https://doi.org/10.1300/j008v19n02_05
Nansel TR, Overpeck M, Pilla RS, Ruan WJ, Simons-Morton B, Scheidt P (2001) Bullying behaviors among US youth: Prevalence and association with psychosocial adjustment. J Am Med Assoc 285:2094–2100. https://doi.org/10.1001/jama.285.16.2094
Brugha TS, Cragg D (1990) The List of Threatening Experiences: the reliability and validity of a brief life events questionnaire. Acta Psychiatr Scand 82:77–81. https://doi.org/10.1111/j.1600-0447.1990.tb01360.x
Bray RM, Hourani LL (2007) Substance use trends among active duty military personnel: Findings from the United States Department of Defense Health Related Behavior Surveys, 1980–2005. Addiction 102:1092–1101. https://doi.org/10.1111/j.1360-0443.2007.01841.x
Vogt DS, Proctor SP, King DW, King LA, Vasterling JJ (2008) Validation of scales from the deployment risk and resilience inventory in a sample of operation Iraqi freedom veterans. Assessment 15:391–403. https://doi.org/10.1177/1073191108316030
Stoeckel M, Weissbrod C (2015) Growing up with an ill parent: An examination of family characteristics and parental illness features. Fam Syst Heal 33:356–362. https://doi.org/10.1037/fsh0000140
Rostila M, Berg L, Arat A, Vinnerljung B, Hjern A (2016) Parental death in childhood and self-inflicted injuries in young adults-a national cohort study from Sweden. Eur Child Adolesc Psychiatry 25:1103–1111. https://doi.org/10.1007/s00787-016-0833-6
Buitron V, Hill RM, Pettit JW, Green KL, Hatkevich C, Sharp C (2016) Interpersonal stress and suicidal ideation in adolescence: An indirect association through perceived burdensomeness toward others. J Affect Disord 190:143–149. https://doi.org/10.1016/j.jad.2015.09.077
Trotman GE, Young-Anderson C, Deye KP (2016) Acute sexual assault in the pediatric and adolescent population. J Pediatr Adolesc Gynecol 29:518–526. https://doi.org/10.1016/j.jpag.2015.05.001
Viswanathan S, Datta S, Sheridan P, Lax-Pericall T (2014) “Too young to be worried!” Psychiatric assessment and follow-up of young people after severe physical assault in an Inner City Hospital of South London. Ann Med Health Sci Res 4:85–89. https://doi.org/10.4103/2141-9248.126607
Salekin RT (2008) Psychopathy and recidivism from mid-adolescence to young adulthood: cumulating legal problems and limiting life opportunities. J Abnorm Psychol 117:386–395. https://doi.org/10.1037/0021-843X.117.2.386
Kessler RC, Santiago PN, Colpe LJ et al (2013) Clinical reappraisal of the composite international diagnostic interview screening scales (cidi-sc) in the army study to assess risk and resilience in servicemembers (Army STARRS). Int J Methods Psychiatr Res 22:303–321. https://doi.org/10.1002/mpr.1398
Nock MK, Holmberg EB, Photos VI, Michel BD (2007) Self-injurious thoughts and behaviors interview: development, reliability, and validity in an adolescent sample. Psychol Assess 19:309–317. https://doi.org/10.1037/1040-35126.96.36.1999
Sheehan DV, Lecrubier Y, Sheehan KH et al (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59:22–23
Rosenbaum PR, Rubin DB (1983) The central role of the propensity score in observational studies for causal effects. Biometrica 70:41–55. https://doi.org/10.1093/biomet/70.1.41
van Buuren S (2007) Multiple imputation of discrete and continuous data by fully conditional specification. Stat Methods Med Res 16:219–242. https://doi.org/10.1177/0962280206074463
Efron B, Gond G (1983) A Leisurely Look at the Bootstrap, the Jackknife, and Cross-Validation. Am Stat 37:36–48. https://doi.org/10.2307/2685844
Barendregt JJ, Veerman JL (2010) Categorical versus continuous risk factors and the calculation of potential impact fractions. J Epidemiol Community Health 64:209–212. https://doi.org/10.1136/jech.2009.090274
Prince MA, Read JP, Colder CR (2019) Trajectories of college alcohol involvement and their associations with later alcohol use disorder symptoms. Prev Sci 20:741–752. https://doi.org/10.1007/s11121-018-0974-6
Read JP, Colder CR, Merrill JE, Ouimette P, White J, Swartout A (2012) Trauma and posttraumatic stress symptoms predict alcohol and other drug consequence trajectories in the first year of college. J Consult Clin Psychol 80:426–439. https://doi.org/10.1037/a0028210
Meisel MK, Barnett NP (2017) Protective and risky social network factors for drinking during the transition from high school to college. J Stud Alcohol Drugs 78:922–9. https://doi.org/10.15288/jsad.2017.78.922.
Fleming CB, White HR, Oesterle S, Haggerty KP, Catalano RF (2010) Romantic relationship status changes and substance use among 18- to 20-year-olds. J Stud Alcohol Drugs 71:847–56. https://doi.org/10.15288/jsad.2010.71.847
Paul E, Tsypes A, Eidlitz L, Ernhout C, Whitlock J (2015) Frequency and functions of non-suicidal self-injury: Associations with suicidal thoughts and behaviors. Psychiatry Res 225:276–282. https://doi.org/10.1016/j.psychres.2014.12.026
Kessler R, Farley P, Gruber M et al (2010) Concordance of computerized self-report measures of DSM-IV-Tr mood and anxiety disorders compared to gold standard clinical assessments in primary care. Atlanta, Georgia: International Society for Pharmacoeconomics and Outcomes Research 15th Annual International Meeting
Meque I, Salom C, Betts KS, Alati R (2019) Predictors of alcohol use disorders among young adults: a systematic review of longitudinal studies. Alcohol Alcohol 54:310–324. https://doi.org/10.1093/alcalc/agz020
Berking M, Margraf M, Ebert D, Wuppermann P, Hofmann S, Junghanns K (2011) Deficits in emotion-regulation skills predict alcohol use during and after cognitive-behavioral therapy for alcohol dependence. J Consult Clin Psychol 79:307–318
Scott-Sheldon LAJ, Carey KB, Elliott JC, Garey L, Carey MP (2014) Efficacy of alcohol interventions for first-year college students: A meta-analytic review of randomized controlled trials. J Consult Clin Psychol 82:177–188. https://doi.org/10.1037/a0035192
Hennessy EA, Tanner-Smith EE, Mavridis D, Grant SP (2019) Comparative effectiveness of brief alcohol interventions for college students: results from a network meta-analysis. Prev Sci 20:715–740. https://doi.org/10.1007/s11121-018-0960-z
Turrisi R, Larimer M, Mallett K, et al (2009) A randomized clinical trial evaluating a combined alcohol intervention for high-risk college students. J Stud Alcohol Drugs 70:555–67. https://doi.org/10.15288/jsad.2009.70.555.
Kazdin AE (2018) Innovations in psychosocial interventions and their delivery: Leveraging cutting-edge science to improve the world’s mental health. Innov Psychosoc Interv Their Deliv Leveraging Cutting-Edge Sci to Improv World’s Ment Heal. https://doi.org/10.1093/med-psych/9780190463281.001.0001.
Riper H, Hoogendoorn A, Cuijpers P et al (2018) Effectiveness and treatment moderators of internet interventions for adult problem drinking: An individual patient data meta-analysis of 19 randomised controlled trials. PLoS Med. https://doi.org/10.1371/journal.pmed.1002714
Sundström C, Blankers M, Khadjesari Z (2017) Computer-based interventions for problematic alcohol use: a review of systematic reviews. Int J Behav Med 24:646–658. https://doi.org/10.1007/s12529-016-9601-8
Bhochhibhoya A, Hayes L, Branscum P, Taylor L (2015) The use of the internet for prevention of binge drinking among the college population: A systematic review of evidence. Alcohol Alcohol 50:526–535. https://doi.org/10.1093/alcalc/agv047
Carey KB, Scott-Sheldon LA, Elliott JC, Garey L, Carey MP (2012) Face-to-face versus computer-delivered alcohol interventions for college drinkers: a meta-analytic review, 1998 to 2010. Clin Psychol Rev 32:690–703. https://doi.org/10.1016/j.cpr.2012.08.001
Kypri K, Vater T, Bowe SJ et al (2014) Web-based alcohol screening and brief intervention for university students: A randomized trial. JAMA - J Am Med Assoc 311:1218–1224. https://doi.org/10.1001/jama.2014.2138
The Leuven College Survey was carried out in conjunction with the World Health Organization World Mental Health (WMH) survey initiative and is a part of the World Mental Health International College Student project. A complete list of all within‐country and cross‐national WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/.
Conflict of interest
In the past 3 years, Dr. Kessler received support for his epidemiological studies from Sanofi Aventis, he was a consultant for Johnson & Johnson Wellness and Prevention, Shire and Takeda, and served on an advisory board for the Johnson & Johnson Services Inc. Lake Nona Life Project. Dr. Kessler is a co-owner of DataStat, Inc., a market research firm that carries out healthcare research. Dr. Demyttenaere has served on advisory boards for Boehringer Ingelheim Eli Lilly, Lundbeck, Johnson&Johnson, Livanova, Servier, and has research grants from Eli Lilly, foundation ‘ga voor geluk’, Fonds voor Wetenschappelijk Onderzoek Vlaanderen. Dr. Ebert reports to have received consultancy fees/served in the scientific advisory board from several companies, such as Sanofi, Novartis, Minddistrict, Lantern, Schoen Kliniken, and German health insurance companies (BARMER, Techniker Krankenkasse). He is also a stakeholder of the Institute for health training online (GET.ON), which aims to implement scientific findings related to digital health interventions into routine care. The other authors have no interests to declare.
The study’s protocol was approved by the University Hospital Leuven Biomedical Ethical Board and complies with the ethical standards of the Helsinki Declaration of 1975, as revised in 2008.
The Belgium survey was supported by the Belgian Fund for Scientific Research (11N0514N/11N0516N/1114717 N/1114719 N), the King Baudouin Foundation (2014‐J2140150‐102905), Eli Lilly (IIT‐H6U‐BX‐I002), and Fonds GaVoorGeluk/ Diepensteyn Foundation (2018-LUF-0070).
Informed consent was obtained from all students.
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Benjet, C., Mortier, P., Kiekens, G. et al. A risk algorithm that predicts alcohol use disorders among college students. Eur Child Adolesc Psychiatry (2021). https://doi.org/10.1007/s00787-020-01712-3
- Alcohol use disorder
- Hazardous drinking
- University students
- Risk algorithm