Résilience - COVID-19 - Résilience - Coronavirus disease 2019

Epidemic of Covid-19: Study of the Impact and the Profiles at Risk of Suicide among Students – ECLIPSE

ECLIPSE : Coronavirus Epidemic: Study of Impact and Suicidal Risk Profiles in Student Population.

Students ‘vulnerability to mental health problems is now certain, and the health crisis context of the COVID-19 epidemic may have further weakened this situation. While there is uncertainty about suicide risk in this period, it is likely that suicide risk will become a more pressing concern as the pandemic continues and has longer-term effects on fragile groups such as students.

The project’ objective is to assess the impact of the COVID-19 epidemic and lockdown on student suicidal risk in order to be able to propose leads for a preventive strategy.

Few data are available on the impact of the epidemic and lockdown on suicide risk among students, either internationally or in France. Moreover, few studies have focused more specifically on healthcare students who represent a subpopulation that is probably even more at risk since many of them are, have been or will be mobilized during the epidemic. In the course of this mobilization, they were directly or indirectly in contact with COVID-19 positive patients, where sanitary measures were difficult to implement. They were also able to witness challenging end-of-life situations, including in young patients. From previous epidemics, it is known that healthcare professionals have been particularly exposed to burnout risk and post-traumatic stress disorder. It is therefore important to document and measure this potential suicidal over-risk among all students and particularly among healthcare students who were largely mobilized during the epidemic.<br />The specific objectives are: (1) describing the impact of the epidemic and lockdown on students’ mental health and particularly on suicidal thoughts and their evolution; (2) identifying suicidal risk profiles in this context; (3) analyzing the psychological impact of the epidemic on the suicidal risk of healthcare students through a mixed-methods approach; 4) describing fluctuations in suicidal thoughts and their association with short-term risk factors, particularly emotional variability.<br />The ECLIPSE project will explore the impact of the epidemic and lockdowns in the short and long term on university students, a population vulnerable to suicidal risk, with a particular focus on healthcare students. Already collected data and new data collected during the project will allow us to identify the profiles of students at suicide risk, to define the risk factors for suicide, and ultimately to define the elements of a suicide prevention strategy. The capacity to take care of them cannot meet such massive need. Identifying the profiles of the most vulnerable and high-risk individuals will enable us to intervene upstream of suicide crisis and should be one of the keys for a real suicide prevention policy success. On the other hand, through the study of the short-term variability of suicidal thoughts and their triggering factors, we also hope to advance knowledge on these more fundamental issues, which could open new avenues of understanding and later prevention of suicidal risk.

Study population and data collection
• Existing data from the CONFINS cohort (www.confins.org): inclusion data collected since April 2020, monthly follow-up data since June 2020. The CONFINS cohort has the advantage of including both students and non-students which is a particularly relevant comparator, especially in terms of mental health indicators. Recruitment to the CONFINS cohort was voluntary through social networks and mailings. Suicidal thoughts are measured at inclusion and at each follow-up. Many parameters are measured in CONFINS and will allow us to identify student profiles at risk of suicidal thoughts.

• New data collected in the ECLIPSE project:
-Specific questionnaire for healthcare students (types of mission, contacts with COVID patients, training and supervision conditions, IES (Impact of Event Scale) to assess post-traumatic stress...).
-Qualitative survey of healthcare students. These interviews will be conducted and recorded by a sociologist with transcription and triangulation analysis of the text. These semi-structured interviews will allow the emergence of variables of interest that deserve to be taken into account in the models and that will complete the profiling of the students. About twenty interviews will be conducted to reach saturation.
-ESM data collected over a 14 days’ period. Volunteers who agree to participate specifically in the ESM study will be compensated with a gift card. Notifications inviting the participant to complete the questionnaire will be sent 5 times a day through the app for 14 days between 9am and 9pm in a semi-random design. The ESM questionnaires will collect the following information in real life: contextual variables (location, social interactions, activities), negative (sadness, anxiety, anger) and positive (happiness, calm, energy) emotions, self-esteem, stress, consumption (cannabis, alcohol), sleep.
Statistical analysis
The identification of risk profiles will be based on the modelling of the individual's initial characteristics and their evolution. Models for predicting suicidal thoughts will be developed, in particular machine learning methods such as random forests, which make it possible to include a large number of predictors and to take their interactions into account. For the data collected by ESM, the analyses will be based on the creation of mixed and multilevel models adapted to intensive longitudinal data that are highly auto-correlated. They will cover estimates of intra- and inter-individual changes, temporal changes, causality and mediation analyses.

Association between student status and mental health indicators
Here we present the results of analyses that aimed to measure the association between student status and mental health indicators during key periods of the COVID-19 epidemic (published article).
Of the 3783 participants include, we showed that students were more likely than non-students to have moderate to severe symptoms of depression ([aOR: 1.59; 95% CI: 1.22-2.08] during the first lockdown; and [aOR: 1.80; 95% CI: 1.04-3.12] during the second lockdown) and anxiety ([aOR: 1.63; 95% CI: 1.22-2.18] during the first lockdown and [aOR: 2.25; 95% CI: 1.24-4.10] during the second lockdown). In contrast, we did not observe any statistically significant differences for the unconfined period. There were also no differences between the two groups regarding suicidal thoughts, regardless of the period.
Perceived loneliness and suicidal thoughts among students
An article is being prepared to measure the contribution of perceived loneliness to suicidal ideation in students during the COVID-19 pandemic and to investigate the role of depressive symptoms in this relationship.
Of the 1913 students included, 27% reported feelings of loneliness. Students who reported feelings of loneliness reported higher frequencies of suicidal thoughts (27.2% vs. 19.8%) and depressive symptoms (61.1% vs. 46.5%) than non-students who also reported feelings of loneliness. In all models, we found a strong association between perceived loneliness and suicidal thoughts among students. Thus, perceived loneliness was associated with a four fold increased risk of suicidal thoughts among students (aOR=4.28; 95% CI: 3.14-5.85) after adjusting for age, gender, inclusion period, telephone interactions, social network interactions, family status and history of psychiatric illness. In analyses stratified on depressive symptoms, the estimates remained high in all models, and in the same proportions whether participants reported depressive symptoms or not.
Initial description of the mental health of healthcare students
Of the 2201 students enrolled in CONFINS, 44% (n=976) are healthcare students. Healthcare students have better mental health indicators than non-healthcare students. Almost half of the healthcare students in the cohort completed the complementary questionnaire (n=432). Among them, 4.4% had moderate symptoms of PTSD, and 2.1% had severe symptoms (IES scale).

Data analysis
- To develop a risk algorithm to identify the main predictors of suicidal thoughts using random forest methods (ongoing).
- To finalize the analyses of quantitative data from specific healthcare student questionnaires (ongoing).
Qualitative survey of healthcare students
- Recruitment of a sociologist to conduct semi-structured interviews (in progress).
ESM study
- Launch of the study at the end of January 2022
- The CONFINS smartphone application that will allow data collection will be published on the stores at the beginning of January 2022.
- The solicitation lists, study documents, questionnaires and protocol have been updated.
-Gift card compensation arrangements are available.

-An article was published in the journal Scientific Reports and was the subject of an Inserm press release (https://presse.inserm.fr/covid-19-le-lourd-impact-de-lepidemie-sur-la-sante-mentale-des-etudiants-notamment-pendant-les-periodes-de-confinements/44052/).
Citation : Macalli, M., Texier, N., Schück, S. et al. A repeated cross-sectional analysis assessing mental health conditions of adults as per student status during key periods of the COVID-19 epidemic in France. Sci Rep 11, 21455 (2021). doi:10.1038/s41598-021-00471-8.
- The article “Contribution of perceived loneliness to suicidal thoughts during the COVID-19 pandemic: the role of depression symptoms” is in preparation.

University students, already at risk of suicide, are considerably affected by the COVID-19 epidemic because of their isolation and concerns about their studies and financial resources. The objective of the ECLIPSE project is to assess the impact of the COVID-19 epidemic on suicide risk among students. Specifically, we will: (1) describe the consequences of the epidemic and lockdown on students’ mental health and particularly on suicidal thoughts and their evolution; (2) identify suicidal risk profiles in this context; (3) analyze the psychological impact of the epidemic on healthcare students using mixed-methods; 4) describe fluctuations in suicidal thoughts and their association with short-term risk factors, particularly emotional variability. Our multidisciplinary project will deploy complementary methods: longitudinal analysis of existing questionnaires, semi-structured interviews, experience sampling method. Our final goal is to identify the profiles of students at risk, which will allow us to intervene before the suicidal crisis and promote an effective suicide prevention policy program.

Project coordination

Christophe TZOURIO (Bordeaux Population Health Research Center)

The author of this summary is the project coordinator, who is responsible for the content of this summary. The ANR declines any responsibility as for its contents.


BPH Bordeaux Population Health Research Center

Help of the ANR 79,744 euros
Beginning and duration of the scientific project: April 2021 - 12 Months

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