Mental health and suicidal ideation from 2010 to 2023 among university students: national repeated cross-sectional analysis

BACKGROUND: Mental health problems among university students have been on the rise, with particularly high levels reported during the COVID-19 pandemic. While many studies have examined the immediate effects of the pandemic, long-term trends in anxiety, depression, non-suicidal self-harm (NSSH) and suicidality remain less explored. AIMS: To investigate trends in mental health problems among Norwegian higher education students before, during and after the COVID-19 pandemic, focusing on anxiety, depression, NSSH and suicidality. METHOD: The Students' Health and Wellbeing Study (SHOT) is a national survey of Norwegian students, with data from six waves (2010-2023). Four primary waves (2010, 2014, 2018 and 2022) were supplemented by two additional waves during the COVID-19 pandemic (2021 and 2023), including nearly 200 000 students across all waves. Mental health outcomes were measured using the Hopkins Symptom Checklist(HSCL). Sex-specific cut-offs were applied to estimate the prevalence of major depressive episodes (MDE) and generalised anxiety disorder (GAD). Secondary outcomes included NSSH, suicidal thoughts and suicide attempts. RESULTS: Mental health problems increased consistently over the 13 years, with a more pronounced rise among women. Mean HSCL scores significantly increased for both sexes from 2010 to 2023, peaking during the COVID-19 lockdown in 2021, followed by a slight decline in 2022, but remaining higher than pre-pandemic levels. The prevalence of MDE and GAD followed similar patterns, increasing from 12.5 to 33.7% in women and 9.4 to 26.8% in men. Reports of NSSH also surged post-lockdown, particularly among women, while suicidal thoughts and attempts increased, especially in women, between 2021 and 2022. CONCLUSION: Student mental health has worsened over the past decade. Although there was some post-pandemic improvement, rates of anxiety, depression and suicidality remain high. These findings underscore the continued importance of tiered mental health support and structural interventions within higher education to address student mental health.