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Salud Pública de México

versão impressa ISSN 0036-3634

Salud pública Méx vol.61 no.1 Cuernavaca Jan./Fev. 2019  Epub 01-Jan-2019 

Original Article

Psychopathology and self-harm among incoming first-year students in six Mexican universities

Psicopatología y autolesiones en alumnos de nuevo ingreso en seis universidades mexicanas

Corina Benjet, PhD1  * 

Raúl A Gutiérrez-García, PhD2  3 

Adrián Abrego-Ramírez, PhD3 

Guilherme Borges, DSc1 

Anabell Covarrubias-Díaz, PhD4 

Ma del Socorro Durán, MPsych5 

Rogaciano González-González, PhD2 

Alicia E Hermosillo-de la Torre, PhD6 

Kalina I Martínez-Martínez, PhD6 

María Elena Medina-Mora, PhD1 

Humberto Mejía-Zarazúa, PhD7 

Gustavo Pérez-Tarango, MPsych5 

María Alicia Zavala-Berbena, PhD5 

Philippe Mortier, PhD8 

1Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz. Ciudad de México, México.

2Universidad De La Salle Bajío, campus Salamanca. Guanajuato, México.

3 Universidad Politécnica de Aguascalientes. Aguascalientes, México.

4 Universidad La Salle Noroeste. Ciudad Obregón, Sonora, México.

5 Universidad De La Salle Bajío, campus Campestre. León, Guanajuato, México.

6 Universidad Autónoma de Aguascalientes. Aguascalientes, México.

7 Universidad La Salle Pachuca. Hidalgo, México.

8 Research Group Psychiatry, Department of Neurosciences, KU Leuven University. Leuven, Belgium.



To estimate psychopathology and self-harm behavior of incoming first-year college students, socio-demographic correlates, service use and willingness to seek treatment.

Materials and methods:

4 189 male and female incoming first-year students of six universities in four different states of Mexico responded to an online survey with a 79.3% response rate.


Almost one in three incoming students has experienced some type of psychopathology; however, only one in five has received treatment. Female, students who are older, whose parents are not married or deceased, and who have a non-heterosexual orientation, no religion or a non-Catholic/Christian religion have greater odds (1.18 - 1.99), whereas those who attend a private university and have a parent with some college education have lower odds (0.68 - 0.75) of experiencing any probable disorder.


Substantial unmet need for mental health services combined with reported willingness to use university services suggests an opportunity for the detection, referral, and treatment of incoming students to promote a successful transition.

Keywords: mental disorders; suicide; substance-related disorders; students; Mexico



Estimar psicopatologías y autolesiones en universitarios de nuevo ingreso, así como los correlatos sociodemográficos, el uso de servicios y la disposición para recibir tratamiento.

Material y métodos:

4 189 estudiantes de nuevo ingreso de seis universidades en cuatro estados contestaron una encuesta en línea con una tasa de respuesta de 79.3%.


32.5% han padecido psicopatologías en su vida, pero únicamente 19.5% han recibido tratamiento. Mujeres, estudiantes con una orientación no heterosexual, estudiantes de mayor edad, quienes tienen padres fallecidos o no casados, sin religión o con una religión no católica/cristiana tienen mayor probabilidad de presentar psicopatologías (RM= 1.18-1.99), mientras que aquellos de universidades privadas y cuyos padres tienen estudios universitarios tienen menor probabilidad (RM= 0.68-0.75).


La alta tasa de psicopatologías no tratadas combinada con la disposición reportada de recibir servicios a través de su universidad sugiere una oportunidad para la detección, canalización y tratamiento de alumnos de nuevo ingreso para promover una transición exitosa.

Palabras clave: trastornos mentales; suicidio; trastornos relacionados con sustancias; estudiantes; México


University students may be considered a privileged group of youth in Mexico, given that only 23% of those between 25 and 34 years of age have any university education.1 Despite this, the evidence suggests that university graduates in Mexico have a similar rate of psychopathology as those with less educational attainment.2 Elsewhere, in the United States, university students have been found to have a similar rate of psychopathology as their non-student peers.3 While mental disorders are common among university students, the onset of psychopathology mostly occurs prior to college entry and is often greatly undertreated.4 Additionally, college is a time of extra demands and increasing exposure to substances. Mental health problems such as suicide ideation, severe substance use, depression and anxiety have been associated to academic performance5,6,7,8 and dropping out of higher education.9 However, a few studies have found no such associations.10,11 Thus, incoming first-year students with a prior untreated psychopathology, which may be exacerbated by new demands, may have a more difficult transition to university, affecting their academic achievement and ultimately their chances of graduation. The social investment in university students and the importance of mental health for academic outcomes mean that universities should be concerned about the mental health of their students.

Similarly, mental health, in general, and suicidal behavior or self-harm, in particular, in young people is of concern to the public health sector, due to the early ages of onset of psychiatric disorders,12 the evidence of high incidence during the transition from adolescence to early adulthood,13 the rising rates of suicide deaths among the young population in Mexico,14 and the overall impact of mental disorders on greater social conditions such as educational attainment,15 workforce entrance, participation and productivity,16 interpersonal relations,17 and human suffering overall.

General population studies in Mexico have evidenced low service utilization and significant unmet need for mental health problems.18,19 There is a dearth of information on service use for mental health problems by Mexican university students. While this age group is generally physically healthy and thus presumably has little contact with the health sector, the students may benefit from services offered in their universities; however, little is known about their willingness to seek help from these services versus other services outside of their universities.

Puertas (University Project for Healthy Students) was conducted at six Mexican universities as part of the WHO World Mental Health Surveys International College Student Initiative (WHO-WMH-ICS),* a multinational collaborative project to follow up college students’ mental health prospectively throughout the course of their college studies. This report provides the first Mexico-specific data; this initiative is novel in that it provides data from a large sample of students from a diversity of Mexican universities and includes only incoming students from a single cohort. This cohort can serve as an indicator of the problems that students bring with them to college that need to be addressed, a baseline by which to measure future cohorts and prospectively assess changes in students’ mental health over time, which is the ultimate aim of Puertas. The objectives of the present report are to describe the overall psychopathology (including substance use disorders) and suicidal thoughts and behaviors (STB) and non-suicidal self-injury of incoming first-year university students and their socio-demographic correlates, as well as the treatment they receive or have received, and their willingness to receive treatment for these mental health problems within or outside their universities. Because the prevalence of different mental health problems is known to vary by sex,20,21 we provide sex-specific estimates.

Materials and methods


The Puertas Project, conducted in six Mexican universities, included 4 189 male and female incoming first-year students with completed surveys. This was a census design in which all incoming students for the 2016-2017 academic year were invited to participate in a web-based self-report survey. Universities were chosen based on their interest in early detection of mental health problems. The following six universities of four different states in Mexico participated: Universidad Autónoma de Aguascalientes, Universidad Politécnica de Aguascalientes, Universidad De La Salle Bajío campus Campestre, Universidad De La Salle Bajío campus Salamanca, Universidad La Salle Noroeste, and Universidad La Salle Pachuca. The first two are public, and the latter four are private.


The instrument was developed for the WHO-WMH-ICS and contains questions based on previously utilized and validated scales with skip logic so that affirmative answers are further probed. The section on self-harm measures broad suicidal ideation, plans, attempts and non-suicidal self-injury with the items of the Self-injurious Thoughts and Behaviors Interview (SITBI)22 and the Columbia-Suicide Severity Rating Scale (C-SSRS),23 which consist of 22 and 5 items, respectively, and are well-documented in the international literature. Broad suicidal ideation refers to both thoughts of killing oneself and the wish to be dead or to go to sleep and never wake up. A suicide plan refers to having thoughts about the method of how to kill oneself and an attempt refers to purposefully hurting oneself with at least some intent to die. Non-suicidal self-injury refers to deliberately hurting oneself without the intent to die. The mental disorders section is a screening for probable cases and evaluates symptoms of major depressive episodes, broadly defined mania, generalized anxiety disorder, attention deficit hyperactivity disorder (ADHD), and substance use disorders. These disorders were chosen because they have been shown to be among the most frequent among the general population of Mexican adolescents and young adults.13,20 These symptoms are evaluated for lifetime presence as well as in the prior 12-months, with the exception of ADHD, for which symptoms in the prior six months are evaluated. These screening questions are derived from a self-report version of the Composite International Diagnostic Interview (WMH-CIDI).24 The WMH-CIDI has shown adequate concordance with clinician-administered interviews with the SCID25 and it has been widely used in Mexico,20,26 following a rigorous process of translation and adaptation.27 The socio-demographic variables reported in this article include: gender (self-identification as male, female or other), age, public versus private university, parental education (classified by the highest level of education obtained by the parent with more education), parents’ marital status (classified as both married and alive versus not married or deceased), current living situation (classified as living with parents or family, with roommates, or on one’s own), religion (Catholic/Christian, other or none), sexual orientation (non-heterosexual [gay, lesbian, bisexual, asexual, not sure] versus heterosexual) and working in addition to studying for any number of hours per week. Service use was measured by a series of questions which asked about current, 12-month and lifetime treatment for an emotional or substance problem, whether the treatment was psychological counseling or medication, and willingness to seek services within and outside their university should they, during the coming school year, develop an emotional problem that would cause them a lot of distress or interference with school work (dichotomized into definitely/probably would go versus might or might not/probably not/ or definitely would not go).


While overall procedures were similar across universities, recruitment varied by university. At Universidad Autónoma de Aguascalientes, the survey was administered during the “health week” for new students, in which students were administered other general health questionnaires. They were given the survey link, a tablet, and the space and time to respond to the survey. At Universidad Politécnica de Aguascalientes, all first-year students take a class on personal and professional development, and they were invited to participate and given the link by their tutors as well as time to answer during class. Their tutors later gave reminders to their tutees. At Universidad De La Salle Bajío, Salamanca and Campestre campuses, all first-year students were invited and given the link as well as time and space to participate during teacher evaluations at the end of the semester. At Universidad La Salle Pachuca, all first-year students were invited and given the link during a personal development class. The faculty of that course later gave reminders to their students. Finally, at Universidad La Salle Noroeste, all first-year students were invited and given the link and time and space to participate during a technology tools class. The overall response rate (the number of students with completed surveys/ the number of total incoming first-year students as reported by each university) was 79.3%, varying from 44.2 to 90.8% in individual universities.

Ethical considerations

The Research Ethics Committee of the National Institute of Psychiatry approved the research protocol. Participation was confidential and voluntary. Informed consent was obtained from participants through the web platform. Only students aged 18 or above were eligible to participate. For all the participants who answered affirmatively to depressive symptomatology, alcohol or drug problems, STB or non-suicidal self-injury and those experiencing an extremely stressful event in the prior year, an automatic message was displayed providing them information of where they could obtain professional help. University-based, community-based and online options were provided.

Statistical analyses

Based on the age and sex distributions of the incoming students provided by each university, sample weights were calculated to ensure that the sample was representative of the total incoming student class. Thus, estimated proportions were weighted to adjust for differential responses by age and sex within each university. Prevalence estimates are reported as unweighted numbers (n), weighted proportions (%), and standard errors (SE). Chi square analysis was performed to evaluate differences in the prevalence between men and women. Associations between socio-demographic correlates and psychopathology were estimated with multivariate logistic regression equations. Analyses were conducted with Stata software.


Table I shows the unweighted and weighted socio-demographic distribution of the sample. Roughly half were female (48.8%), almost 80% were 18 or 19 years old, a quarter were from private universities, more than 80% lived with their parents or family, more than three quarters had parents who are currently married and alive, and more than half (55.1%) have parents with some college or postgraduate education. Roughly a fifth of the students are or will be working as well as studying. More than 80% self-identify as Catholic/Christian, and 9.1% as having a non-heterosexual orientation.

Table I Weighted and unweighted sample characteristics, Puertas Baseline 2016, N=4 189. México 

Unweighted Weighted
n* % %
Male 2 135 50.9 51.1
Female 2 055 49.0 48.8
Other 8 0.2 0.2
18 2 548 60.7 57.3
19 884 21.1 21.6
20 335 8.0 10.7
21 168 4.0 4.1
22 112 2.7 2.7
23+ 152 3.6 3.6
U. Autonoma de Aguascalientes 152 3.6 3.6
U. Politecnica de Aguascalientes 621 14.8 14.8
U. De La Salle Bajio, Campus Campestre 758 18.1 18.1
U. De La Salle Bajio, Campus Salamanca 113 2.7 2.7
U. La Salle Noroeste 194 4.6 4.6
U. La Salle Pachuca 94 2.2 2.2
University type
Private 1 022 24.3 24.3
Public 3 177 75.7 75.7
Highest parental education
Less than high school 792 19.1 19.2
High School 1 072 25.8 25.7
College or postgraduate 2 292 55.2 55.1
Current living situation
With parents/family 3 359 81.1 81.2
With roommates 546 13.2 13.0
Other 238 5.7 5.8
Marital status of parents
Married and alive 3 100 76.2 76.2
Not married or deceased 968 23.8 23.8
Catholic/Christian 3 410 82.2 82.3
None 613 14.8 14.7
Other 128 14.8 14.7
Non-heterosexual orientation 374 9.1 9.1
Works in addition to studying 886 21.4 21.1

*There are missing data for some variables, so that the ns for all variables do not always add up to 4 189

The 12-month and lifetime prevalence of probable psychiatric disorders by gender are presented in table II. Almost 30% of students screened positive for any probable disorder in the 12 months prior to the survey and 32.5% during their lifetime. The most common were attention deficit/hyperactivity disorder, followed by depression and generalized anxiety. Gender differences were found for all disorders except mania and ADHD. Women had a higher proportion of positive screens for any probable mental disorder and a larger number of disorders, depression and generalized anxiety, whereas men had a higher proportion of positive screens for probable alcohol dependence and drug abuse/dependence.

Table II 12-month and lifetime psychopathology by gender, PUERTAS Baseline 2016. México 

All Men Women X2 p
n % SE n % SE n % SE
12-month prevalence
Depression 446 10.7 0.5 156 7.2 0.6 290 14.3 0.9 46.0 0.000
Broad mania 149 3.5 0.3 67 3.1 0.4 82 4.0 0.5 2.3 0.126
Generalized anxiety 431 10.4 0.5 140 6.6 0.6 291 14.4 0.9 56.6 0.000
ADH/D* 572 13.6 0.6 292 13.6 0.8 280 13.6 0.8 0.0 0.946
Alcohol dependence 276 6.8 0.4 182 8.7 0.7 94 4.8 0.5 21.5 0.000
Drug abuse/dependence 62 1.5 0.2 40 1.9 0.3 22 1.0 0.2 5.7 0.017
Any disorder 1 230 29.6 0.8 592 28.0 1.0 638 31.4 1.1 5.0 0.025
One disorder 755 18.1 0.6 398 18.9 0.9 357 17.4 0.9 1.4 0.242
Two disorders 302 7.5 0.5 126 6.0 0.5 176 9.0 0.8 10.4 0.001
Three or more disorders 173 4.0 0.3 68 3.1 0.4 105 5.0 0.5 9.4 0.002
Lifetime prevalence
Depression 525 12.6 0.6 189 8.8 0.6 336 16.5 0.9 48.3 0.000
Boad mania 166 3.9 0.3 75 3.5 0.4 91 4.4 0.5 2.2 0.136
Generalized anxiety 481 11.7 0.5 156 7.6 0.6 325 15.9 0.9 58.6 0.000
ADH/D* 572 13.6 0.6 292 13.6 0.8 280 13.6 0.8 0.0 0.946
Alcohol dependence 325 8.0 0.5 218 10.5 0.7 107 5.4 0.5 32.3 0.000
Drug abuse/dependence 116 2.8 0.3 79 3.8 0.4 37 1.7 0.3 15.6 0.000
Any disorder 1 347 32.5 0.8 657 31.1 1 690 33.9 1.1 3.3 0.067
One disorder 789 18.9 0.6 423 19.8 0.9 366 18.0 0.9 2.1 0.146
Two disorders 348 8.7 0.5 147 7.2 0.6 201 10.2 0.8 8.7 0.003
Three or more disorders 210 4.9 0.3 87 4.0 0.4 123 5.8 0.5 6.7 0.010

*6-month prevalence

Note: n’s are unweighted; %’s are weighted

Table III shows the 12-month and lifetime prevalence of STB and non-suicidal self-injury by gender. 27.8% of students reported self-injurious thoughts and/or behaviors sometime in their life, and 12.2% in the previous 12 months. Broad suicidal ideation was reported most frequently, followed by non-suicidal self-injury, suicide plan, and, lastly, a suicide attempt. 3.5% had a suicide attempt during their lifetime, and 0.7% in the previous 12-months. Women had a higher proportion of lifetime and 12-month self-injurious thoughts and behaviors than men, except for a suicide attempt in the previous 12 months.

Table III 12-month and lifetime suicidal and non-suicidal self-harm by gender, PUERTAS Baseline 2016. México 

All Men Women X2 p
n % SE n % SE n % SE
12-month prevalence
Suicidal ideation (broad) 415 9.7 0.5 170 7.9 0.6 245 11.7 0.7 16.5 0.000
Suicide plan 168 3.9 0.3 73 3.3 0.4 95 4.6 0.5 4.2 0.041
Suicide attempt 32 0.7 0.1 13 0.6 0.2 19 0.9 0.2 1.4 0.230
Non-suicidal self-injury 225 5.3 0.4 92 4.2 0.4 133 6.4 0.6 9.3 0.002
Any self-harm thoughts or behaviors 522 12.2 0.5 220 10.2 0.7 302 14.3 0.8 15.9 0.000
Lifetime prevalence
Suicidal ideation (broad) 975 23.0 0.7 391 18.0 0.8 584 28.2 1.0 56.8 0.000
Suicide plan 389 9.3 0.5 152 7.0 0.6 237 11.8 0.8 24.1 0.000
Suicide attempt 149 3.5 0.3 41 1.9 0.3 108 5.3 0.5 34.5 0.000
Non-suicidal self-injury 572 13.3 0.5 222 10.2 0.7 350 16.6 0.8 35.9 0.000
Any self-harm thoughts or behaviors 1 184 27.8 0.7 448 22.5 0.9 696 33.4 1.1 57.1 0.000

Note: n’s are unweighted; %’s are weighted

In table IV, we present treatment use among the total sample and among those with any probable mental disorder. One in every five students has received treatment for a mental health or substance use condition at some point in their life, primarily psychological therapy (18.8%) rather than pharmacological treatment (3.5%). Only 6.7% have received treatment in the previous 12 months, and 2.0% are currently in treatment. Treatment is substantially greater among those with a probable mental disorder, with 32.7% of those with a lifetime disorder receiving treatment at any point during their lifetime. 64.7% of students would definitely or probably use services offered at their university; a lower proportion (55.9%) would definitely or probably go to treatment outside of the university if they had a problem that they felt required attention.

Table IV Treatment in the total sample and among those with a probable mental health condition by gender, PUERTAS Baseline 2016. México 

All Men Women X2 p
n % SE n % SE n % SE
Total sample
Currently in treatment 82 2.0 0.2 37 1.8 0.3 45 2.2 0.3 0.9 0.338
12-month treatment 266 6.7 0.4 111 5.5 0.5 155 7.8 0.7 6.9 0.009
Lifetime treatment 794 19.5 0.7 363 17.6 0.9 431 21.5 1.0 8.3 0.004
Lifetime psychological treatment 765 18.8 0.7 347 16.8 0.9 418 20.8 1.0 9.1 0.003
Lifetime pharmacological treatment 150 3.5 0.3 78 3.6 0.4 72 3.4 0.4 0.1 0.712
Would probably go to a university-based treatment if had a problem 2 697 64.7 0.80 1 330 63.2 1.1 1 367 66.3 1.1 3.9 0.047
Would probably go to treatment outside of the university if had a problem 1 982 55.9 0.9 972 51.5 1.3 1 110 59.9 1.3 22.6 0.000
Among those with any LT mental disorder
Lifetime treatment 434 32.7 1.4 182 28.4 1.9 252 36.7 2 9.0 0.003
Lifetime psycological treatment 417 31.3 1.4 173 26.9 1.8 244 35.6 2 10.1 0.002
Lifetime pharmacological treatment 110 8.0 0.8 57 8.7 1.1 53 7.4 1.0 0.7 0.389
Would probably go to university-based treatment if had a problem 802 59.6 1.5 377 58.5 2 425 60.7 2.1 0.6 0.456
Would probably go to treatment outside of the university if had a problem 616 53.3 1.60 265 49.2 2.3 351 56.9 2.2 6.0 0.014

*Note: %’s are unweighted; %’s are weighted

The results of four multiple logistic regression equations to estimate the association of socio-demographic characteristics with any lifetime and 12-month probable mental health disorder and any lifetime and 12-month suicidal thoughts or self-harm behaviors are shown in table V. Being female, a student aged more than 19 years, having parents not married or deceased, a non-heterosexual orientation and no religion or a religion other than Catholic/Christian was positively associated with any lifetime and 12-month probable disorder, with odds ratios between 1.18 and 1.99. On the other hand, attending a private university and having a parent with some college or post-graduate education was associated with lower odds of having any lifetime or 12-month probable disorder, with odds ratios between 0.68 and 0.75. With regard to any lifetime or 12-month suicidal thought or harm behavior, being female, having parents not married or deceased, a non-heterosexual orientation and no religion or a religion other than Catholic/Christian had higher odds, whereas having some “other” current living situation was associated with lower odds of any lifetime suicidal thoughts or self-harm behaviors.

Table V Socio-demographic correlates of mental health problems, PUERTAS Baseline 2016. México 

Any lifetime disorder Any lifetime suicidal thought or self-harm behavior Any 12-month disorder Any 12-month suicidal thought or self-harm behavior
aOR 95%CI p aOR 95%CI p aOR 95%CI p aOR 95%CI p
Female 1.21 1.04-1.40 0.012 1.82 1.57-2.12 0.000 1.42 1.21-1.67 0.000 1.54 1.26-1.88 0.000
Aged 20+ (vs. 18-19) 1.32 1.09-1.61 0.005 0.98 0.80-1.21 0.875 1.32 1.06-1.63 0.012 0.90 0.69-1.17 0.427
Private university (vs Public) 0.68 0.57-0.81 0.000 0.96 0.81-1.16 0.696 0.72 0.60-0.87 0.001 1.04 0.81-1.32 0.777
Parental education
Less than high school 1.00 REF 1.00 REF 1.00 REF 1.00 REF
High school 0.98 0.83-1.17 0.832 0.85 0.71-1.02 0.076 0.96 0.80-1.16 0.698 0.99 0.78-1.25 0.913
College or post-graduate 0.75 0.62-0.92 0.005 0.89 0.73-1.08 0.235 0.68 0.55-0.85 0.001 0.9 0.68-1.18 0.446
Parents not married/deceased 1.18 1.00-1.40 0.047 1.33 1.13-1.58 0.001 1.13 0.94-1.4 0.185 1.29 1.04-1.62 0.024
Current living situation
With parents/family 1.00 REF 1.00 REF 1.00 REF 1.00 REF
With roommates 0.98 0.79-1.21 0.825 0.94 0.75-1.18 0.593 0.97 0.77-1.23 0.807 1.03 0.76-1-39 0.847
Other 0.86 0.62-1.19 0.350 0.84 0.59-1.18 0.304 0.69 0.47-1.00 0.054 0.45 0.25-0.81 0.007
Non-heterosexual orientation 1.67 1.32-2.10 0.000 1.92 1.51-2.43 0.000 1.79 1.40-2.30 0.000 1.79 1.34-2.39 0.000
Catholic/Christian 1.00 REF 1.00 REF 1.00 REF 1.00 REF
Other 1.94 1.61-2.34 0.000 1.97 1.62-2.39 0.000 1.8 1.46-2.21 0.000 2.22 1.74-2.82 0.000
None 1.99 1.31-3.01 0.001 1.67 1.11-2.50 0.014 1.6 1.04-2.46 0.031 2.16 1.33-3.49 0.002
Works in addition to studying 1.09 0.92-1.29 0.333 0.97 0.86-1.16 0.73 1.04 0.86-1.26 0.699 1.08 0.85-1.40 0.506
X2 124.6 155 108.6 98.86
p <0.001 <0.001 <0.001 <0.001

REF= Reference category


Problems faced by incoming university students

The results of this study show that almost one in three incoming first year students arrives at university having experienced some type of emotional, substance-related or behavioral problem in the past. While most of these students have experienced only one probable mental disorder, a small group has experienced two (8.7%) or even three or more (4.9%) probable disorders. Furthermore, many have experienced self-harm, thus putting their lives at risk. While a greater proportion has had suicidal ideation (23.0%), a smaller proportion has attempted suicide (3.5%). These estimates are remarkably similar to the 22.3% and 3.2% reported for suicidal ideation and attempt in a recent meta-analysis of university students from North America, Asia, Europe and Africa, though no study from Latin America was included.28 In regard to previous studies of university students in Mexico, González-Macip and colleagues29 reported an estimated 18.9% with suicidal ideation (an estimate slightly lower than ours, though perhaps using a less broad definition of ideation), while Unikel and colleagues cited 10% of a small non representative sample of female university and high school students.30 These estimates are all much lower than the 47% with suicidal ideation and 9% with an attempt cited in a representative study of high school students in Mexico, indicating perhaps that many high school students with suicidality may not go on to college.31 Few studies have reported the prevalence of psychopathology in Mexican university students; according to one of these, 36% of medical students reported depressive symptomatology.32 Strunin and colleagues33 found changes in alcohol use (both increases and decreases) among incoming first-year university students in Mexico City. Decreases among previously excessive or heavy drinkers were related to new obligations and lack of time as well as friendship changes. Increased drinking behaviors among previously occasional and regular drinkers were related to increased autonomy and changes in friendships.

Who are the distressed students?

Females screened positive for more disorders, suicidal thoughts and self-harm behaviors, and most types of disorders, with the exception of ADHD and mania, for which there were no sex differences, and substance disorders, which were more prevalent among male students. This is consistent with prior studies on sex differences for specific disorders.20,21

Older students were found to have greater odds of psychopathology (though not suicidal thoughts or self-harm behaviors). The fact that psychopathology is more frequent among older students might be explained by mental disorders influencing their delay in obtaining university admission or entrance, though this is speculative and cannot be determined from this study due to its cross-sectional nature. Regardless of the cause, these results suggest that older students might be a target for intervention, or at the very least for screening, during the transition to college.

Family characteristics were important correlates of psychopathology and suicidal thoughts and self-harm behaviors, particularly the educational level and marital status of parents; thus, students of college-educated parents had lower odds, while students of not married or deceased parents had higher odds. Prior research has found that first-generation university students may have greater difficulty adjusting to college, resulting in increased depressive symptoms and reduced well-being.34 This might be due to both family achievement guilt and socio-economic factors. Similarly, the impact of parental separation and death are likely to involve both socio-emotional and socioeconomic aspects.35,36

Consistent with our findings in Mexican university students, a systematic review of mental disorders, suicide and deliberate self-harm in sexual minorities, reported a two-fold risk of suicide ideation and attempts, and a 1.5 risk for depression and anxiety disorders and substance dependence in non-heterosexual individuals in comparison with heterosexuals.37 This greater risk is likely due to the impact of discrimination, victimization, social stress and internalized homophobia on emotional wellbeing.38

Religion has been found to protect against suicidal behavior, though the evidence is inconsistent and often depends upon different dimensions of religion, such as affiliation, practice, and spirituality. A recent systematic review has found that religious affiliation (which is what we included in this study) does not necessarily protect against ideation; however, it does protect against attempt, and this protection against attempt is dependent upon culturally specific implications of affiliating with a particular religion.39 In this study we found that having no religious affiliation or a non-Catholic/Christian affiliation was associated to increased risk of both suicidal behavior and overall psychopathology, which could be due to the social support provided by having a religious affiliation and/or to the Catholic religion´s teachings on suicide.

While both public and private universities must contend with similar rates of suicidal behavior, these findings suggest that the students of the public universities that participated in this study had greater risk for probable mental disorders than those from the participating private universities. It is not possible to determine whether this is due to the characteristics of the specific universities in this study or is generalizable to all public and private universities, as the participating universities were not randomly selected. Important differences between the public and private universities which participated in this study include size, whether the universities were religious or not, and their geographic location, all of which could account for these differences.

Treatment possibilities for university students

Because psychopathology, substance abuse and suicidal thoughts and self-harm behaviors are likely to influence students´ transition to university and academic success, and because university students are accessible and contained, detection, referral and treatment of students upon entry to university is important and feasible. While almost 70% of students with a probable lifetime disorder have not received any lifetime treatment, a majority of students state that they would be willing to seek treatment on campus for university-based services and, to a lesser extent, off campus. Not all universities provide such services for their students. Some of our universities that don´t have mental health services have tutoring programs that can serve as a gateway for detecting and referring students. A study of university undergraduates in a Canadian university found three groups of student preferences for services: a group (45.5%) that preferred university-based psychological or psychiatric professional services, a group that preferred alternative services (39.3%) such as peer counseling or e-mental health options, and a small hesitant group (15.2%) that would prefer not to seek help even though clearly distressed.40 Interestingly, in our study, the proportion of students with probable 12-month disorders who have received services is lower than the proportion of students who say they would seek services if they had a mental health problem. This may be due to students not recognizing that they have a problem, not knowing where to find services, the lack of services or barriers to service use.


Certain limitations should be considered. Prevalence estimates are based on a self-report web-based survey rather than a comprehensive clinical diagnostic interview and therefore should be considered a screening of possible cases rather than a confirmed diagnosis. Furthermore, while we utilized internationally used and validated scales, we do not have data on the validity for Mexican youth specifically. While the overall participant response rate was quite good (compared to the 44% response rate of an online survey of college students in 26 universities of the United States),41 and the universities included were both public and private, located in four different states, they were not randomly selected and therefore the study participants are not representative of all university students in Mexico. Finally, because this is a cross-sectional survey, disorder correlates are associations for which no causality or directionality can be attributed.


This report provides the first Mexico-specific data of the Puertas Project, aimed to understand the mental health status and service needs of incoming first-year university students, and serves as a baseline for future prospective analyses. The current results show that there is substantial unmet need for mental health services among Mexican university students and that these students are similarly if not more willing to use mental health services provided in their university than off campus when these services are available. This suggests an opportunity for the detection, referral and treatment of incoming university students through student services that may reduce the barriers to service use. Further research should examine the potential for both standard professional mental health services on campus and other alternatives, like e-mental health services, to meet this need in a way that is cost effective for universities and desirable to students. The Puertas Project will provide such information in the future.


The survey was carried out in conjunction with the WHO World Mental Health International College Surveys Initiative (WHO WMH-ICS). The authors thank the WHO WMH-ICS collaborators and staff for assistance with instrumentation and fieldwork. Dr. Benjet received support from the National Council on Science and Technology (Conacyt; CB 285548) and Fundación Miguel Alemán A.C. Dr. Mortier’s work was funded by the Belgian Fund for Scientific Research (11N0514N/11N0516N).


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* The WHO World Mental Health Surveys International College Student Initiative (WMH-ICS).

Stata/SE 13 for Windows [Software]. Texas, EU: StataCorp LP.

Received: October 31, 2017; Accepted: February 16, 2018

Corresponding author: Dra. Corina Benjet. Dirección de investigaciones epidemiológicas y psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz. Calzada México-Xochimilco 101 col. San Lorenzo Huipulco. 14370 Ciudad de Mexico, Mexico. E-mail:

Declaration of conflict of interests. The authors declare that they have no conflict of interests.

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