Salud Mental

Machine learning approaches to identify profiles and predictors of psychosocial discomfort among Italian college students


Chiara Buizza
Jessica Dagani
Clarissa Ferrari
Herald Cela
Alberto Ghilardi


Introduction. College students live a crucial period of transition from late adolescence to adulthood when they have to deal with important stressful tasks. Thus, university often represents a stressful environment, pushing students to cope with a high academic pressure. As a result, this period constitutes a sensitive age for the onset of mental disorders. Typically, students are not aware of the early signs of their own compromised mental health until symptoms aggravate to an overt disorder. Therefore, it is important to timely detect subthreshold symptoms mostly related to generic mental distress.

Objective. First, to assess psychophysical well-being and mental distress among college students in northern Italy, and to detect predictors, among socio-demographic and academic characteristics, and risky drug use of these two outcomes.

Method. The study involved 13,886 students who received an email explaining the purpose of the e-research. The questionnaires used were the General Health Questionnaire (GHQ-12), the University Stress Scale (USS), and a modified version of World Health Organization-ASSIST v3.0.

Results. 3,754 students completed the web-survey. Students showed poor well-being and mental distress. The strongest predictor of mental distress and compromised well-being was physical health, followed by sex, study field, risky drug use, and academic performance concerns.

Discussion and conclusion. This study shows that it is very important to promote in college students healthy behaviors in order to increase their physical exercise and reduce substance use. Moreover, it would be desirable to improve academic counselling facilities as an important front-line service to intercept mental health issues among young adults.
Well-being, mental distress, college students, predictors, web-survey


Auerbach, R. P., Mortier, P., Bruffaerts, R., Alonso, J., Benjet, C., Cuijpers, P., … WHO WMH-ICS Collaborators. (2018). The WHO World Mental Health Surveys International College Student Project: Prevalence and Distribution of Mental Disorders. Journal of Abnormal Psychology, 127(7), 623-638. doi: 1037/abn0000362

Barreto, H. A., de Oliveira, A., & Boerngen-Lacerda, R. (2014). Development of a self-report format of ASSIST with university students. Addictive Behaviors, 39(7), 1152-1158. doi: 10.1016/j.addbeh.2014.03.014

Bayram, N., & Bilgel, N. (2008). The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Social Psychiatry and Psychiatric Epidemiology, 43(8), 667-672. doi: 10.1007/s00127-008-0345-x

Beiter, R., Nash, R., McCrady, M., Rhoades, D., Linscomb, M., Clarahan, M., & Sammut, S. (2015). The prevalence and correlates of depression, anxiety, and stress in a sample of college students. Journal of Affective Disorders, 173, 90-96. doi: 10.1016/j.jad.2014.10.054

Bhochhibhoya, A., Collado, M., Branscum, P., & Sharma, M. (2015). The role of global mental health and type-D personality in predicting alcohol use among a sample of college students. Alcoholism Treatment Quarterly, 33(3), 283-295. doi: 10.1080/07347324.2015.1050932

Blanco, C., Okuda, M., Wright, C., Hasin, D. S., Grant, B. F., Liu, S.-M., & Olfson, M. (2008). Mental health of college students and their non-college-attending peers: Results from the National Epidemiologic Study on Alcohol and Related Conditions. Archives of General Psychiatry, 65(12), 1429-1437. doi: 10.1001/archpsyc.65.12.1429

Blank, M.-L., Connor, J., Gray, A., & Tustin, K. (2016). Alcohol use, mental well-being, self-esteem and general self-efficacy among final-year university students. Social Psychiatry and Psychiatric Epidemiology, 51(3), 431-441. doi: 10.1007/s00127-016-1183-x

Breiman, L., Friedman, J. H., Olshen, R. A., & Stone, C. J. (1984). Classification and Regression Trees. Belmont, CA: Wadsworth International Group.

Brougham, R. R., Zail, C. M., Mendoza, C. M., & Miller, J. R. (2009). Stress, sex differences, and coping strategies among college students. Current Psychology, 28(2), 85-97. doi: 10.1007/s12144-009-9047-0

Bruffaerts, R., Mortier, P., Auerbach, R. P., Alonso, J., Hermosillo De la Torre, A. E., Cuijpers, P., WHOWMH-ICS Collaborators. (2019). Lifetime and 12-month treatment for mental disorders and suicidal thoughts and behaviors among first year college students. International Journal of Methods in Psychiatric Research, 28(2), e1764. doi: 10.1002/mpr.1764

Budzynski-Seymour, E., Conway, R., Wade, M., Lucas, A., Jones, M., Mann, S., & Steele, J. (2020). Physical activity, mental and personal well-being, social isolation, and perceptions of academic attainment and employability in university students: the Scottish and British Active Students Surveys. Journal of Physical Activity and Health, 17(6), 610-620. doi: 10.1123/jpah.2019-0431

Chao, R. C.-L. (2012). Managing perceived stress among college students: The roles of social support and dysfunctional coping. Journal of College Counseling, 15(1), 5-21. doi: 10.1002/j.2161-1882.2012.00002.x

Click, K. A., Huang, L. V., & Kline, L. (2017). Harnessing inner strengths of at-risk university students: relationships between well-being, academic achievement and academic attainment. Perspectives: Policy and Practice in Higher Education, 21(2-3), 88-100. doi: 10.1080/13603108.2016.1273260

Cordero-Oropeza, R., García-Méndez, M., Cordero-Oropeza, M., & Corona-Maldonado, J. J. (2021). Characterization of alcohol consumption and related problems in university students from Mexico City. Salud Mental, 44(3), 107-115. doi: 10.17711/SM.0185-3325.2021.015

Edwards, P. J., Roberts, I., Clarke, M. J., DiGuiseppi, C., Wentz, R., Kwan, I., … Pratap, S. (2009). Methods to increase response to postal and electronic questionnaires. Cochrane Database of Systematic Reviews, 8(3), MR000008. doi: 10.1002/14651858.MR000008.pub4

Eisenberg, D., Hunt, J., & Speer, N. (2012). Help-seeking for mental health on college campuses: review of evidence and next steps for research and practice. Harvard Review of Psychiatry, 20(4), 222-232. doi: 10.3109/10673229.2012.712839

Ferrari, C, Macis, A., Rossi, R., & Cameletti M. (2018). Multivariate Statistical Techniques to Manage Multiple data in Psychology. Open Access Journal of Behavioural Science & Psychology, 1(2).

Forouhari, S., Teshnizi, S. H., Ehrampoush, M. H., Mahmoodabad, S. S. M., Fallahzadeh, H., Tabei, S. Z., ... Dehkordi, J. G. (2019). Relationship between religious orientation, anxiety, and depression among college students: A systematic review and meta-analysis. Iranian Journal of Public Health, 48(1), 43-52.

Goldberg, D. P., & Blackwell, B. (1970). Psychiatric illness in general practice: A detailed study using a new method of case identification. British Medical Journal, 2, 439-443. doi: 10.1136/bmj.2.5707.439

Greenacre, M. J. (1993). Biplot in correspondence analysis. Journal of Applied Statistics, 20(2), 251-269. doi: 10.1080/02664769300000021

Gunnel, D., Caul, S., Appleby, L., John, A., & Hawton, K. (2020). The incidence of suicide in University students in England and Wales 2000/2001-2016/2017: Recors linkage study. Journal of Affective Disorders, 261, 113-120. doi: 10.1016/j.jad.2019.09.079

Hefner, J., & Eisenberg, D. (2009). Social support and mental health among college students. American Journal of Orthopsychiatry, 79(4), 491-499. doi: 10.1037/a0016918

Humeniuk, R., Ali, R., Babor, T. F., Farrell, M., Formigoni, M. L., Jittiwutikarn, J., … Simon, S. (2008). Validation of the alcohol, smoking and substance involvement screening test (ASSIST). Addiction, 103(6), 1039-1047. doi: 10.1111/j.1360-0443.2007.02114.x

Humeniuk, R., Ali, R., Babor, T., Souza-Formigoni, M. L. O., Boerngen de Lacerda, R., Ling, W., … Vendetti, J. (2012). A randomized controlled trial of a brief intervention for illicit drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in clients recruited from primary health-care settings in four countries. Addiction, 107(5), 957-966. doi: 10.1111/j.1360-0443.2011.03740.x

James, G., Witten, D., Hastie, T., & Tibshirani, R. (2013). An Introduction to Statistical Learning with Applications to R. New York: Springer.

Kang, H. K., Rhodes, C., Rivers, E., Thornton, C. P., & Rodney, T. (2021). Prevalence of Mental Health Disorders Among Undergraduate University Students in the United States: A Review. Journal of Psychosocial Nursing and Mental Health Services, 59(2), 17-24. doi: 10.3928/02793695-20201104-03

Kenney, S. R., DiGuiseppi, G. T., Meisel, M. K., Balestrieri, S. G., & Barnett, N. P. (2018). Poor mental health, peer drinking norms, and alcohol risk in a social network of first-year college students. Addictive Behaviors, 84, 151-159. doi: 10.1016/j.addbeh.2018.04.012

Kessler, R. C., Amminger, G. P., Aguilar-Gaxiola, S., Alonso, J., Lee, S., & Ustün, T. B. (2007). Age of onset of mental disorders: A review of recent literature. Current Opinion in Psychiatry, 20(4), 359-364. doi: 10.1097/YCO.0b013e32816ebc8c

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602. doi: 10.1001/archpsyc.62.6.593

Kim, S., Sinn, D., & Syn, S. Y. (2018). Analysis of College Students’ Personal Health Information Activities: Online Survey. Journal of Medical Internet Research, 20(4), e132. doi: 10.2196/jmir.9391

Klainin Yobas, P., Keawkerd, O., Pumpuang, W., Thunyadee, C., Thanoi, W., & He, H.-G. (2014). The mediating effects of coping on the stress and health relationships among nursing students: A structural equation modelling approach. Journal of Advanced Nursing, 70(6), 1287-1298. doi: 10.1111/jan.12283

Lin, X.-J., Zhang, C.-Y., Yang, S., Hsu, M.-L., Cheng, H., Chen, J., & Yu, H. (2020). Stress and its association with academic performance among dental undergraduate students in Fujian, China: a cross-sectional online questionnaire survey. BMC Medical Education, 20(1), 181. doi: 10.1186/s12909-020-02095-4

Liu, C. H., Stevens, C., Wong, S. H. M, Yasui, M., & Chen, J. A. (2018). The prevalence and predictors of mental health diagnoses and suicide among U.S. college students: Implications for addressing disparities in service use. Depression and Anxiety, 36(1), 8-17. doi: 10.1002/da.22830

Loh, W.-Y., He, X., & Man, M. (2015). A regression tree approach to identifying subgroups with differential treatment effects. Statistics in Medicine, 34(11), 1818-1833. doi: 10.1002/sim.6454

Loh, W.-Y., He, X., & Man, M. (2015). A regression tree approach to identifying subgroups with differential treatment effects. Statistics in Medicine, 34(11), 1818-1833. doi: 10.1002/sim.6454

Lovell, G. P., Nash, K., Sharman, R., & Lane, B. R. (2015). A cross-sectional investigation of depressive, anxiety, and stress symptoms and health-behavior participation in Australian university students. Nursing & Health Sciences, 17(1), 134-142. doi: 10.1111/nhs.12147

Mahmoud, J. S. R., Staten, R. T., Hall, L. A., & Lennie, T. A. (2021). The relationship among young adult college students’ depression, anxiety, stress, demographics, life satisfaction, and coping styles. Issues in Mental Health Nursing, 33(3), 149-156. doi: 10.3109/01612840.2011.632708

McLafferty, M., Lapsley, C. R., Ennis, E., Armour, C., Murphy, S., Bunting, B. P., … O’Neill, S. M. (2017). Mental health, behavioural problems and treatment seeking among students commencing university in Northern Ireland. PLoS One, 13, 12(12), e0188785. doi: 10.1371/journal.pone.0188785

Mortier, P., Cuijpers, P., Kiekens, G., Auerbach, R. P., Demyttenaere, K., Green, J. G., … Bruffaerts, R. (2018). The prevalence of suicidal thoughts and behaviours among college students: a meta-analysis. Psychological Medicine, 48(4), 554-565. doi: 10.1017/S0033291717002215

Mukherjee, M., McKinney, L., Hagedorn, L. S., Purnamasari, A., & Martinez, F. S. (2017). Stretching every dollar: The impact of personal financial stress on the enrollment behaviors of working and nonworking community college students. Community College Journal of Research and Practice, 41(9), 551-565. doi: 10.1080/10668926.2016.1179602

Oh, H. Y., Marinovich, C., Jay, S., Zhou, S., & Kim, J. H. J. (2021). Abuse and suicide risk among college students in the United States: Findings from the 2019 Healthy Minds Study. Journal of Affective Disorders, 282, 554-560. doi: 10.1016/j.jad.2020.12.140

Patel, V., Flisher, A. J., Hetrick, S., & McGorry, P. (2007). Mental health of young people: a global public-health challenge. Lancet, 369(9569), 1302-1313. doi: 10.1016/S0140-6736(07)60368-7

Pealer, L., & Weiler, R. M. (2003). Guidelines for designing a Web-delivered college health risk behavior survey: lessons learned from the University of Florida Health Behavior Survey. Health Promotion Practice, 4(2), 171-179. doi: 10.1177/1524839902250772

Pedrelli, P., Borsari, B., Lipson, S. K., Heinze, J. E., & Eisenberg, D. (2016). Gender differences in the relationships among major depressive disorder, heavy alcohol use, and mental health treatment engagement among college students. Journal of Studies on Alcohol and Drugs, 77(4), 620-628. doi: 10.15288/jsad.2016.77.620

Politi, P. L., Piccinelli, M., & Wilkinson, G. (1994). Reliability, validity and factor structure of the 12-item General Health Questionnaire among young males in Italy. Acta Psychiatrica Scandinavica, 90(6), 432-437. doi: 10.1111/j.1600-0447.1994.tb01620.x

Poznyak, V. (2008). Management of substance abuse: The WHO ASSIST (The Alcohol, Smoking and Substance Involvement Screening Test) Project. Geneva: World Health Organization.

Rencher, A. C. (2003). Methods of Multivariate Analysis (2nd. Edition), Wiley Series in Probability and Statistics. USA: John Wiley & Sons, Inc.

Rencher, A. C. (2003). Methods of Multivariate Analysis, (2nd. Ed). USA: Wiley Series in Probability and Statistics, John Wiley & Sons, Inc.

Rith-Najarian, L. R., Boustani, M. M., & Chorpita, B. F. (2019). A systematic review of prevention programs targeting depression, anxiety, and stress in university students. Journal of Affective Disorders, 257, 568-584. doi: 10.1016/j.jad.2019.06.035

Saeys, Y., Inza, I., & Larrañaga, P. (2007). A review of feature selection techniques in bioinformatics. Bioinformatics, 23(19), 2507-2517. doi: 10.1093/bioinformatics/btm344

Saeys, Y., Inza, I., & Larrañaga, P. (2007). A review of feature selection techniques in bioinformatics. Bioinformatics, 23(19), 2507-2517. doi: 10.1093/bioinformatics/btm344

Sajid, A., Ahmad, T., & Khalid, T. (2015). Stress in medical undergraduates; its association with academic performance. Bangladesh Journal of Medical Science, 14(2), 135-141. doi: 10.3329/bjms.v14i2.21815

Sebena, R., El Ansari, W., Stock, C., Orosova, O., & Mikolajczyk, R. T. (2012). Are perceived stress, depressive symptoms and religiosity associated with alcohol consumption? A survey of freshmen university students across five European countries. Substance Abuse Treatment, Prevention, and Policy, 7(1), 21. doi: 10.1186/1747-597X-7-21

Skidmore, C. R., Kaufman, E. A., & Crowell, S. E. (2016). Substance use among college students. Child and Adolescent Psychiatric Clinics of North America, 25(4), 735-753. doi: 10.1016/j.chc.2016.06.004

Speiser, J. L. (2021). A random forest method with feature selection for developing medical prediction models with clustered and longitudinal data. Journal of Biomedical Informatics, 117, 103763. doi: 10.1016/j.jbi.2021.103763

Speiser, J. L. (2021). A random forest method with feature selection for developing medical prediction models with clustered and longitudinal data. Journal of Biomedical Informatics, 117, 103763. doi: 10.1016/j.jbi.2021.103763

Stallman, H. M. (2008). University Stress Scale. Queensland University of Technology.

Stallman, H. M. (2010). Psychological distress in university students: A comparison with general population data. Australian Psychologist, 45(4), 249-257. doi: 10.1080/00050067.2010.482109

Stallman, H. M., & Hurst, C. P. (2016). The University Stress Scale: Measuring Domains and Extent of Stress in University Students. Australian Psychologist, 51(2), 128-134. doi: 10.1111/AP.12127

Stowell, D., Lewis, R. K., & Brooks, K. (2019). Perceived stress, substance use, and mental health issues among college students in the Midwest. Journal of Prevention & Intervention in the Community, 49(3), 221-234. doi: 10.1080/10852352.2019.1654263

Tembo, C., Burns, S., & Kalembo, F. (2017). The association between levels of alcohol consumption and mental health problems and academic performance among young university students. PLoS One, 12(6), e0178142. doi: 10.1371/journal.pone.0178142

Therneau, T. M., Atkinson, E., & Mayo Foundation. (2018). An introduction to Recursive Partitioning Using the RPART Routines. Available at

Wilkinson, L. (1992). Tree Structured Data Analysis: AID, CHAID and CART. Sun Valley: Sawtooth/SYSTAT Joint Software Conference, ID.

World Health Organization. (2016). Suicide data.