RESUMEN
OBJECTIVE: The COVID-19 pandemic has affected the mental health of populations around the world, but few longitudinal studies of its impact on suicidal thoughts and behaviors have been published especially from low- and middle-income countries. METHODS: This is a prospective cohort study of 1,385 first-year students from 5 Universities in Mexico followed-up for 1 year. We report 1-year cumulative incidence of suicidal thoughts and behaviors before (September 19, 2019-March 29, 2020) and during the COVID-19 period (March 30, 2020-June 30, 2020), focusing on those in the COVID-19 period with risk conditions and positive coping strategies during the pandemic. RESULTS: There was an increase in the incidence of suicidal ideation during the COVID-19 period compared to the pre-COVID-19 period (RR 1.65, 95%CI 1.08-2.50). This increase was mostly found among students with heightened sense of vulnerability (RR 1.95), any poor coping behavior (RR 2.40) and a prior mental disorder (RR 2.41). While we found no evidence of an increased risk of suicidal planning or attempts, there was evidence that those without lifetime mental health disorders were at greater risk of suicidal plans than those with these disorders especially if they had poor coping strategies (RR 3.14). CONCLUSION: In the short term, how students deal with the pandemic, being at high risk and having poor coping behavior, increased the new occurrence of suicidal thoughts and behaviors. Studies with longer follow-up and interventions to reduce or enhance these behaviors are needed.HIGHLIGHTSSuicidal ideation increased during the COVID-19 periodThose with heightened sense of vulnerability and poor coping were more affectedStudies with longer follow-up are needed.
Asunto(s)
COVID-19 , Ideación Suicida , Humanos , Intento de Suicidio/psicología , Pandemias , Universidades , Estudios Prospectivos , México/epidemiología , COVID-19/epidemiología , Estudiantes/psicologíaRESUMEN
Importance: Guided internet-delivered cognitive behavioral therapy (i-CBT) is a low-cost way to address high unmet need for anxiety and depression treatment. Scalability could be increased if some patients were helped as much by self-guided i-CBT as guided i-CBT. Objective: To develop an individualized treatment rule using machine learning methods for guided i-CBT vs self-guided i-CBT based on a rich set of baseline predictors. Design, Setting, and Participants: This prespecified secondary analysis of an assessor-blinded, multisite randomized clinical trial of guided i-CBT, self-guided i-CBT, and treatment as usual included students in Colombia and Mexico who were seeking treatment for anxiety (defined as a 7-item Generalized Anxiety Disorder [GAD-7] score of ≥10) and/or depression (defined as a 9-item Patient Health Questionnaire [PHQ-9] score of ≥10). Study recruitment was from March 1 to October 26, 2021. Initial data analysis was conducted from May 23 to October 26, 2022. Interventions: Participants were randomized to a culturally adapted transdiagnostic i-CBT that was guided (n = 445), self-guided (n = 439), or treatment as usual (n = 435). Main Outcomes and Measures: Remission of anxiety (GAD-7 scores of ≤4) and depression (PHQ-9 scores of ≤4) 3 months after baseline. Results: The study included 1319 participants (mean [SD] age, 21.4 [3.2] years; 1038 women [78.7%]; 725 participants [55.0%] came from Mexico). A total of 1210 participants (91.7%) had significantly higher mean (SE) probabilities of joint remission of anxiety and depression with guided i-CBT (51.8% [3.0%]) than with self-guided i-CBT (37.8% [3.0%]; P = .003) or treatment as usual (40.0% [2.7%]; P = .001). The remaining 109 participants (8.3%) had low mean (SE) probabilities of joint remission of anxiety and depression across all groups (guided i-CBT: 24.5% [9.1%]; P = .007; self-guided i-CBT: 25.4% [8.8%]; P = .004; treatment as usual: 31.0% [9.4%]; P = .001). All participants with baseline anxiety had nonsignificantly higher mean (SE) probabilities of anxiety remission with guided i-CBT (62.7% [5.9%]) than the other 2 groups (self-guided i-CBT: 50.2% [6.2%]; P = .14; treatment as usual: 53.0% [6.0%]; P = .25). A total of 841 of 1177 participants (71.5%) with baseline depression had significantly higher mean (SE) probabilities of depression remission with guided i-CBT (61.5% [3.6%]) than the other 2 groups (self-guided i-CBT: 44.3% [3.7%]; P = .001; treatment as usual: 41.8% [3.2%]; P < .001). The other 336 participants (28.5%) with baseline depression had nonsignificantly higher mean (SE) probabilities of depression remission with self-guided i-CBT (54.4% [6.0%]) than guided i-CBT (39.8% [5.4%]; P = .07). Conclusions and Relevance: Guided i-CBT yielded the highest probabilities of remission of anxiety and depression for most participants; however, these differences were nonsignificant for anxiety. Some participants had the highest probabilities of remission of depression with self-guided i-CBT. Information about this variation could be used to optimize allocation of guided and self-guided i-CBT in resource-constrained settings. Trial Registration: ClinicalTrials.gov Identifier: NCT04780542.
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Terapia Cognitivo-Conductual , Depresión , Humanos , Femenino , Adulto Joven , Adulto , Depresión/terapia , Universidades , Ansiedad/terapia , Trastornos de Ansiedad/terapia , Trastornos de Ansiedad/psicología , Terapia Cognitivo-Conductual/métodos , Resultado del Tratamiento , InternetRESUMEN
We seek to evaluate whether Internet Gaming Disorder (IGD) among university students in Mexico during their first year at university predicts a long list of mental disorders a year later, controlling for baseline mental health disorders as well as demographics. This is a prospective cohort study with a one-year follow-up period conducted during the 2018-2019 academic year and followed up during the 2019-2020 academic year at six Mexican universities. Participants were first-year university students (n = 1741) who reported symptoms compatible with an IGD diagnosis at entry (baseline). Outcomes are seven mental disorders (mania, hypomania, and major depressive episodes; generalized anxiety disorder and panic disorder; alcohol use disorder and drug use disorder), and three groups of mental disorders (mood, anxiety, and substance use disorders) at the end of the one-year follow-up. Fully adjusted models, that included baseline controls for groups of mental disorders, rendered all associations null. The association between baseline IGD and all disorders and groups of disorders at follow-up was close to one, suggesting a lack of longitudinal impact of IGD on mental disorders. Conflicting results from available longitudinal studies on the role of IGD in the development of mental disorders warrant further research.
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Conducta Adictiva , Trastorno Depresivo Mayor , Trastornos Relacionados con Sustancias , Juegos de Video , Humanos , Estudios de Seguimiento , Universidades , Estudios Prospectivos , Trastorno de Adicción a Internet , Conducta Adictiva/psicología , Ansiedad , Trastornos de Ansiedad , Trastornos Relacionados con Sustancias/epidemiología , Manía , Juegos de Video/psicología , Estudiantes , InternetRESUMEN
BACKGROUND AND OBJECTIVES: Internet gaming disorder (IGD) is associated with health, social, and academic problems but whether these are consequences of the disorder rather than precursors or correlates is unclear. We aimed to evaluate whether IGD in the 1st year of university predicts health, academic and social problems 1 year later, controlling for baseline health, academic and social problems, demographics, and mental health symptoms. METHODS: In a prospective cohort study, 1741 university students completed both a baseline online survey in their 1st year and a follow-up survey 1 year later. Log-binomial models examined the strength of prospective associations between baseline predictor variables (IGD, baseline health, academic and social problems, sex, age, and mental health symptoms) and occurrence of health, academic and social problems at follow-up. RESULTS: When extensively adjusted by the corresponding outcome at baseline, any mental disorder symptoms, sex, and age, baseline IGD was associated only with severe school impairment and poor social life (risk ratio [RR] = 1.77; 95% confidence interval [CI] = 1.14-2.75, p = .011; RR = 1.22; 95% CI = 1.07-1.38, p = .002, respectively). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: University authorities and counselors should consider that incoming 1st-year students that meet criteria for IGD are likely to have increased academic and social impairments during their 1st year for which they may want to intervene. This study adds to the existing literature by longitudinally examining a greater array of negative outcomes of IGD than previously documented.
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Rendimiento Académico , Conducta Adictiva , Juegos de Video , Humanos , Estudios Longitudinales , Estudios Prospectivos , Trastorno de Adicción a Internet , Juegos de Video/psicología , Conducta Adictiva/psicología , Estudiantes , Estado de Salud , InternetRESUMEN
BACKGROUND: Research is scarce on the prospective predictors of first onset suicidal thoughts and behaviors (STB) and the accuracy of these predictors in university students, particularly in low-and-middle income countries. Therefore, we assessed the 1-year incidence of STB among first-year students, a broad range of prospective predictors of STB incidence, and evaluated the prediction accuracy of a baseline multivariate risk prediction model to identify students at highest risk for STB onset over the subsequent 12 months. METHODS: Students (n = 3238) from 13 universities in Mexico completed an online survey developed for the World Mental Health International College Student Surveys in their first year and again 12 months after. We ran generalized linear models and receiver operator curves. RESULTS: The 1-year incidence of suicidal ideation, plan and attempt was 8.53%, 3.75%, and 1.16%, respectively. Predictors in final models were female sex (ideation only), minority sexual orientation (ideation only), depression, eating disorders, ADHD (ideation and plan), ongoing arguments or breakup with a romantic partner (ideation only), emotional abuse (ideation only), parental death (ideation, plan), not Catholic/Christian (ideation, plan), not having someone to rely on, psychotic experiences (plan only), and insufficient sleep (attempt only). Prediction accuracy for ideation, plan and attempt was area under the curve = 0.76, 0.81 and 0.78, respectively. Targeting the top 10% of students at highest risk could reduce STB in the subsequent year up to 36%. CONCLUSIONS: By assessing these risk/protective factors in incoming students we identified students at greatest risk for developing STB to whom suicide prevention strategies could be targeted.
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Ideación Suicida , Intento de Suicidio , Femenino , Humanos , Masculino , Universidades , Incidencia , Estudiantes/psicología , Factores de RiesgoRESUMEN
PURPOSE: Mental health disparities have been documented among sexual minority college students, but there is a dearth of evidence from developing countries. The aim is to estimate the prevalence of 12-month mental and substance use disorders across a range of sexual identities among first-year college students in Mexican universities, and test whether there is an association between sexual identity and disorders and whether the association is moderated by gender. METHOD: The University Project for Healthy Students, a web-based survey conducted as part of the World Health Organization's World Mental Health International College Student initiative, recruited 7874 students from nine Mexican universities in 2016 and 2017. Logistic regressions estimated the association of sexual identity with 12-month major depressive episode, generalized anxiety disorder, panic disorder, alcohol abuse/dependence, and drug abuse/dependence, with interaction terms for gender. RESULTS: Compared to heterosexual students reporting no same-sex attraction (SSA), heterosexual students with SSA (AORs range 1.77-3.67) and lesbian/gay and bisexual students (AORs range 2.22-5.32) were at a higher risk for several disorders. Asexual students were at higher risk for drug abuse/dependence (AOR = 3.64). Students unsure of their sexual identity were at a higher risk for major depressive episode, panic disorder, and drug abuse/dependence (AORs range 2.25-3.82). Gender differences varied across sexual identity and disorder. CONCLUSION: These findings are the first empirical report of sexual minority psychiatric disparities among a college student population from a developing nation and underscore the importance of clinical interventions that address mental health needs among sexual minority college students.
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Trastorno Depresivo Mayor , Trastornos Mentales , Minorías Sexuales y de Género , Trastornos Relacionados con Sustancias , Trastorno Depresivo Mayor/epidemiología , Femenino , Humanos , Trastornos Mentales/epidemiología , México/epidemiología , Prevalencia , Estudiantes , Trastornos Relacionados con Sustancias/epidemiología , UniversidadesRESUMEN
BACKGROUND: Sexual minority college students are at a higher risk for suicidal thoughts and self-injurious behaviors compared to heterosexual students. Minority stress theory proposes sexual minority individuals experience higher stress due to stigma. Using a sample of Mexican college students, this study tested perceived life stress as a mediator of suicide and self-injury outcomes across various sexual orientation groups. METHODS: The sample of college students (N=7882) was recruited from nine Mexican universities as part of the WHO World Mental Health International College Student (WMH-ICS) initiative. Participants completed an online survey including demographic questions, measure of perceived life stress, suicide outcomes, and non-suicidal self-injury (NSSI) in the past 12 months. RESULTS: Logistic regression analyses revealed identifying as a sexual minority significantly predicted a higher likelihood of suicide ideation (ORs 2.05-3.00), suicide attempts (ORs 2.48-8.73), and NSSI (ORs 2.92-4.18) compared to heterosexual students reporting no same-gender attraction. Significant indirect effects from mediation path analyses showed perceived life stress mediated the relationship between a sexual minority identity and suicide ideation (range of proportion mediated 10.48-31.48%), attempts (10.48-31.48%), and NSSI (7.69-20.09%) across each group except among asexual students. LIMITATIONS: The cross-sectional nature of the survey design precludes drawing causal inferences. CONCLUSION: Findings from this study contribute to minority stress theory by elucidating the role of perceived life stress as a mediator of suicide ideation and attempts and NSSI among sexual minority college students. Clinical interventions may benefit in focusing on experiences of stress across various life areas when supporting sexual minority college students.
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Conducta Autodestructiva , Minorías Sexuales y de Género , Estudios Transversales , Femenino , Humanos , Masculino , México/epidemiología , Conducta Autodestructiva/epidemiología , Estrés Psicológico/epidemiología , Estudiantes , Ideación Suicida , UniversidadesRESUMEN
PURPOSE: Although Internet-based electronic health (eHealth) interventions could potentially reduce mental health disparities, especially in college students in under-resourced countries, little is known about the relative acceptability of eHealth versus in-person treatment modalities and the treatment barriers associated with a preference for one type over the other. METHODS: Participants were from the 2018-2019 cohort of the University Project for Healthy Students (PUERTAS), a Web-based survey of incoming first-year students in Mexico and part of the World Mental Health International College Student Survey initiative. A total of 7,849 first-year students, 54.73% female, from five Mexican universities participated. We estimated correlates of preference for eHealth delivery over in-person modalities with a multivariate logistic regression. RESULTS: Thirty-eight percent of students prefer in-person services, 36% showed no preference for in-person over eHealth, 19% prefer not to use services of any kind, and 7% preferred eHealth over in-person treatment delivery. Being embarrassed, worried about harm to one's academic career, wanting to handle problems on one's own, beliefs about treatment efficacy, having depression, and having attention-deficient hyperactivity disorder were associated with a clear preference for eHealth delivery methods with odds ratios ranging from 1.47 to 2.59. CONCLUSIONS: Although more students preferred in-person services over eHealth, those reporting attitudinal barriers (i.e., embarrassment, stigma, wanting to handle problems on one's own, and beliefs about treatment efficacy) and with depression or attention-deficit hyperactivity disorder had a greater preference for eHealth interventions suggesting these are students to whom eHealth interventions could be targeted to alleviate symptoms and/or as a bridge to future in-person treatment.
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Trastornos Psicóticos , Universidades , Femenino , Humanos , Masculino , México , Estudiantes , Encuestas y CuestionariosRESUMEN
BACKGROUND AND AIMS: DSM-5 includes Internet gaming disorder (IGD) as a condition for further study. While online and offline gaming may produce undesired negative effects on players, we know little about the nosology of IGD and its prevalence, especially in countries with emerging economies. METHODS: A self-administered survey has been employed to estimate prevalence of DSM-5 IGD and study the structure and performance of an instrument in Spanish to measure DSM-5 IGD among 7,022 first-year students in 5 Mexican universities that participated in the University Project for Healthy Students (PUERTAS), part of the World Health Organization's World Mental Health International College Student Initiative. RESULTS: The scale for IGD showed unidimensionality with factor loadings between 0.694 and 0.838 and a Cronbach's α = .816. Items derived from gaming and from substance disorders symptoms mixed together. We found a 12-month prevalence of IGD of 5.2% in the total sample; prevalence was different for males (10.2%) and females (1.2%), but similar for ages 18-19 years (5.0%) and age 20+ (5.8%) years. Among gamers, the prevalence was 8.6%. Students with IGD were more likely to report lifetime psychological or medical treatment [OR = 1.8 (1.4-2.4)] and any severe role impairment [OR = 2.4 (1.7-3.3)]. Adding any severe role impairment to the diagnostic criteria decreased the 12-month prevalence of IGD to 0.7%. DISCUSSION AND CONCLUSIONS: Prevalence of DSM-5 IGD and the performance of diagnostic criteria in this Mexican sample were within the bounds of what is reported elsewhere. Importantly, about one in every seven students with IGD showed levels of impairment that would qualify them for treatment under DSM-5.
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Conducta Adictiva/epidemiología , Internet , Estudiantes/estadística & datos numéricos , Universidades/estadística & datos numéricos , Juegos de Video , Adolescente , Adulto , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , México/epidemiología , Prevalencia , Adulto JovenRESUMEN
OBJECTIVE: To estimate psychopathology and self-harm behavior of incoming first-year college students, sociodemographic 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. RESULTS: 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. CONCLUSIONS: 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.
OBJETIVO: 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%. RESULTADOS: 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). CONCLUSIONES: 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.
Asunto(s)
Trastornos Mentales/epidemiología , Conducta Autodestructiva/epidemiología , Estudiantes/psicología , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Femenino , Necesidades y Demandas de Servicios de Salud , Encuestas Epidemiológicas , Humanos , Masculino , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Servicios de Salud Mental/provisión & distribución , México/epidemiología , Prevalencia , Conducta Autodestructiva/psicología , Distribución por Sexo , Factores Socioeconómicos , Estudiantes/estadística & datos numéricos , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/terapia , Ideación Suicida , Intento de Suicidio/estadística & datos numéricos , Universidades , Adulto JovenRESUMEN
Abstract: Objective: 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. Results: 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. Conclusions: 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.
Resumen: Objetivo: 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%. Resultados: 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). Conclusiones: 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.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Adulto Joven , Estudiantes/psicología , Conducta Autodestructiva/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Mentales/epidemiología , Factores Socioeconómicos , Intento de Suicidio/estadística & datos numéricos , Universidades , Prevalencia , Encuestas Epidemiológicas , Distribución por Sexo , Ideación Suicida , Necesidades y Demandas de Servicios de Salud , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Servicios de Salud Mental/provisión & distribución , México/epidemiologíaRESUMEN
BACKGROUND: A growing group of emerging adults in many countries around the globe are not incorporated into the education system or the labor market; these have received the label "NEET: not in education, employment nor training". We describe the mental health and socio-demographic characteristics of emerging adults who are NEET from Mexico City (differentiating between NEET who are homemakers and NEET who are not) compared to their peers who are studying, working or both, in a city in which education and employment opportunities for youth are limited. A secondary objective, because of the often inconsistent inclusion criteria or definitions of NEET, was to evaluate the heterogeneity amongst NEET emerging adults in terms of their perceived reasons for being NEET and to evaluate whether different reasons for being NEET are associated with different mental health characteristics. METHODS: The participants were 1071 emerging adults aged 19 to 26; they were interviewed in person by an interviewer in their homes as part of a follow-up study of the Mexican Adolescent Mental Health Survey. The Composite International Diagnostic Interview (WMH-CIDI) assessed psychiatric disorders, substance use and abuse, suicidal behavior and socio-demographic characteristics. RESULTS: Of the total sample, 15.3% were NEET homemakers, 8.6% NEET non-homemakers, 41.6% worked only, 20.9% studied only and 13.5% worked and studied. Of those who were NEET, 12.6% were NEET by choice. NEET non-homemakers had overall greater odds of substance use, substance use disorders and some suicidal behaviors in comparison with all their peers, whereas NEET homemakers had reduced odds. Those who were NEET because they didn't know what to do with their life had greater odds of mood, behavioral, and substance disorders, use of all substances and of suicide behaviors compared to those who were NEET by choice. CONCLUSIONS: Non-homemaker NEET who lack life goals require targeted mental health intervention. The demographic reality of emerging adults not in education or employment and the varying reasons they give for being NEET are not consistent with how NEET is often conceptualized in terms of a societal problem.
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Abandono Escolar/psicología , Abandono Escolar/estadística & datos numéricos , Desempleo/estadística & datos numéricos , Adulto , Composición Familiar , Femenino , Estudios de Seguimiento , Encuestas Epidemiológicas , Humanos , Masculino , Trastornos Mentales/epidemiología , México/epidemiología , Factores de Riesgo , Trastornos Relacionados con Sustancias/epidemiología , Ideación Suicida , Adulto JovenRESUMEN
The purpose is to examine the socio-demographic and mental health outcomes in early adulthood of those who as adolescents were not in education, employment or training, termed NEET, compared to their counterparts who studied, worked, or both. One thousand and seventy-one youth residing in Mexico City participated in a representative, prospective, longitudinal 8-year two-Wave cohort study. At Wave I the participants were aged 12-17 and at Wave II aged 19 and 26. The Composite International Diagnostic Interview assessed psychiatric disorders, substance use and abuse, suicidal behavior, interpersonal relationships, employment and education. The main finding of this study is that being NEET in adolescence was associated with several socio-demographic and mental health outcomes in early adulthood, above and beyond baseline socioeconomic disadvantage and mental health compared to their peers, particularly their peers who studied only or studied and worked. NEET youth were not that different from their peers who worked exclusively highlighting the protective value of keeping youth in school. The strongest differences between NEET youth and all their peer groups were their increased risks of incident suicidal behaviors. Social policies are needed for creating more educational opportunities, greater support for retention of students, and programs to facilitate the transition from school to the labor market considering cultural attitudes towards life trajectory expectations.