Hostname: page-component-cb9f654ff-w5vf4 Total loading time: 0 Render date: 2025-08-11T00:55:35.751Z Has data issue: false hasContentIssue false
  • English
  • Français

Suicide risk among undergraduate students in Brazil in the periods before and during the COVID-19 pandemic: results of the SABES-Grad national survey

Published online by Cambridge University Press:  14 June 2022

Lauro Miranda Demenech Open the ORCID record for Lauro Miranda Demenech [Opens in a new window] ,
Lucas Neiva-Silva Open the ORCID record for Lucas Neiva-Silva [Opens in a new window] ,
Sandra Mara Silva Brignol Open the ORCID record for Sandra Mara Silva Brignol [Opens in a new window] ,
Samira Reschetti Marcon Open the ORCID record for Samira Reschetti Marcon [Opens in a new window] ,
Sônia Maria Lemos Open the ORCID record for Sônia Maria Lemos [Opens in a new window] ,
Rafael Miranda Tassitano Open the ORCID record for Rafael Miranda Tassitano [Opens in a new window]  and
Samuel C. Dumith Open the ORCID record for Samuel C. Dumith [Opens in a new window]
Lauro Miranda Demenech*
Affiliation:
Center for Studies on Risk and Health (CERIS), Federal University of Rio Grande (FURG), Rio Grande, RS, Brazil Graduate Program in Health Sciences (PPGCS), Federal University of Rio Grande (FURG), Rio Grande, RS, Brazil
Lucas Neiva-Silva
Affiliation:
Center for Studies on Risk and Health (CERIS), Federal University of Rio Grande (FURG), Rio Grande, RS, Brazil Graduate Program in Psychology (PPGPsi), Federal University of Rio Grande (FURG), Rio Grande, RS, Brazil
Sandra Mara Silva Brignol
Affiliation:
Institute of Collective Health (ISC), Fluminense Federal University (UFF), Niterói, RJ, Brazil
Samira Reschetti Marcon
Affiliation:
Graduate Program in Nursing (PPGEnf), Federal University of Mato Grosso (UFMT), Cuiabá, MT, Brazil
Sônia Maria Lemos
Affiliation:
School of Health Sciences (ESA), Amazonas State University (UEA), Manaus, AM, Brazil
Rafael Miranda Tassitano
Affiliation:
Department of Physical Education, Federal Rural University of Pernambuco (UFRPE), Recife, PE, Brazil
Samuel C. Dumith
Affiliation:
Graduate Program in Health Sciences (PPGCS), Federal University of Rio Grande (FURG), Rio Grande, RS, Brazil
*
Author for correspondence: Lauro Miranda Demenech, E-mail: lauro_demenech@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Undergraduate students present high rates of psychological distress, including suicide risk. Due to the coronavirus disease 2019 (COVID-19) pandemic, this scenario may have been aggravated. Thus, the objective of the current study was to evaluate changes in the suicide risk rate from the period before to during the COVID-19 pandemic, as well as the factors associated with this outcome among Brazilian undergraduate students.

Methods

This was a nationwide survey carried out in Brazil with a cross-sectional design, including two data collection periods: a single-center in-person collection in 2019 and another multicenter online collection in 2020/2021. Data were collected using self-administered instruments. The outcome was a high risk of suicide, measured through the Mini International Neuropsychiatric Interview. Analyses were carried out on data from two periods, i.e. before and during the pandemic (bivariate analysis and interaction tests), and a model of associated factors (multivariate analysis using Poisson regression) was developed including all participating universities distributed in the five regions of Brazil.

Results

In total, 6716 Brazilian undergraduate students participated (996 in 2019 and 5720 in 2020/2021). The prevalence of a high suicide risk rose from 11.3% to 17.0%, especially among women and poorer individuals. The prevalence of a high risk of suicide among Brazilian undergraduates was 19.6% and was associated with several socioeconomic, academic, pandemic, and mental health factors.

Conclusions

The prevalence of a high suicide risk increased from prepandemic to during the pandemic, appearing to be largely influenced by social determinants, in conjunction with the implications of the COVID-19 pandemic.

Keywords

COVID-19pandemicstudentssuicideuniversities

Information

Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 11 , August 2023 , pp. 4977 - 4989
Check for updates
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Amorim, P. (2000). Mini International Neuropsychiatric Interview (MINI): Validation of a short structured diagnostic psychiatric interview. Brazilian Journal of Psychiatry 22(3), 106–115. doi: 10.1590/S1516-44462000000300003CrossRefGoogle Scholar
Arora, A., Jha, A. K., Alat, P., & Das, S. S. (2020). Understanding coronaphobia. Asian Journal of Psychiatry 54, 102384. doi: 10.1016/j.ajp.2020.102384CrossRefGoogle ScholarPubMed
Bachmann, S. (2018). Epidemiology of suicide and the psychiatric perspective. International Journal of Environmental Research and Public Health 15(7), 1425. doi: 10.3390/ijerph15071425CrossRefGoogle ScholarPubMed
Baqui, P., Bica, I., Marra, V., Ercole, A., & van der Schaar, M. (2020). Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: A cross-sectional observational study. The Lancet Global Health 8(8), e1018–e1026. doi: 10.1016/S2214-109X(20)30285-0CrossRefGoogle ScholarPubMed
Barlow, D., Durand, V. M., & Hofmann, S. G. (2017). Abnormal psychology: An integrative approach (8th ed.). Boston, MA: Cengage Learning.Google Scholar
Barros, A. J. D., & Hirakata, V. N. (2003). Alternatives for logistic regression in cross-sectional studies: An empirical comparison of models that directly estimate the prevalence ratio. BMC Medical Research Methodology 3, 21. doi: 10.1186/1471-2288-3-21CrossRefGoogle ScholarPubMed
Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society: Series B (Methodological) 57(1), 289–300. doi: 10.1111/j.2517-6161.1995.tb02031.xGoogle Scholar
Brailovskaia, J., Teismann, T., Friedrich, S., Schneider, S., & Margraf, J. (2021). Suicide ideation during the COVID-19 outbreak in German university students: Comparison with pre-COVID 19 rates. Journal of Affective Disorders Reports 6, 100228. doi: 10.1016/j.jadr.2021.100228CrossRefGoogle ScholarPubMed
Christiansen, T. B., & Lauritsen, J. M. (2010). EpiData – comprehensive data management and basic statistical analysis system. EpiData Association: Odense Denmark.Google Scholar
Connor, J., Madhavan, S., Mokashi, M., Amanuel, H., Johnson, N. R., Pace, L. E., & Bartz, D. (2020). Health risks and outcomes that disproportionately affect women during the Covid-19 pandemic: A review. Social Science & Medicine 266, 113364. doi: 10.1016/j.socscimed.2020.113364CrossRefGoogle ScholarPubMed
Cullen, W., Gulati, G., & Kelly, B. D. (2020). Mental health in the COVID-19 pandemic. QJM: An International Journal of Medicine 113(5), 311–312. doi: 10.1093/qjmed/hcaa110CrossRefGoogle ScholarPubMed
Daly, M., Sutin, A. R., & Robinson, E. (2021). Depression reported by US adults in 2017-2018 and March and April 2020. Journal of Affective Disorders 278, 131–135. doi: 10.1016/j.jad.2020.09.065CrossRefGoogle ScholarPubMed
Davison, K. M., Marshall-Fabien, G. L., & Tecson, A. (2015). Association of moderate and severe food insecurity with suicidal ideation in adults: National survey data from three Canadian provinces. Social Psychiatry and Psychiatric Epidemiology 50(6), 963–972. doi: 10.1007/s00127-015-1018-1CrossRefGoogle ScholarPubMed
Debowska, A., Horeczy, B., Boduszek, D., & Dolinski, D. (2020). A repeated cross-sectional survey assessing university students’ stress, depression, anxiety, and suicidality in the early stages of the COVID-19 pandemic in Poland. Psychological Medicine, 1–4. doi:10.1017/s003329172000392xGoogle ScholarPubMed
Demenech, L. M., Neiva-Silva, L., Brignol, S. M. S., Marcon, S. R., Lemos, S. M., Tassitano, R. M., & Dumith, S. C. (2021a). A Study on the Health and Wellness of Undergraduate Students (SABES-Grad): Methodological aspects of a nationwide multicenter and multilevel study overlapped with the Covid-19 pandemic. Trends in Psychiatry and Psychotherapy. doi: 10.47626/2237-6089-2021-0367Google Scholar
Demenech, L. M., Oliveira, A. T., Neiva-Silva, L., & Dumith, S. C. (2021b). Prevalence of anxiety, depression and suicidal behaviors among Brazilian undergraduate students: A systematic review and meta-analysis. Journal of Affective Disorders 282, 147–159. doi: 10.1016/j.jad.2020.12.108CrossRefGoogle Scholar
Deng, J., Zhou, F., Hou, W., Silver, Z., Wong, C. Y., Chang, O., & Huang, E. (2021). The prevalence of depressive symptoms, anxiety symptoms and sleep disturbance in higher education students during the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatry Research 301, 113863. doi: 10.1016/j.psychres.2021.113863CrossRefGoogle ScholarPubMed
Douglas, M., Katikireddi, S. V., Taulbut, M., McKee, M., & McCartney, G. (2020). Mitigating the wider health effects of covid-19 pandemic response. BMJ 369, m1557. doi: 10.1136/bmj.m1557CrossRefGoogle ScholarPubMed
Dyregrov, A., Fjærestad, A., Gjestad, R., & Thimm, J. (2021). Young people's risk perception and experience in connection with COVID-19. Journal of Loss and Trauma 26(7), 597–610. doi: 10.1080/15325024.2020.1853974CrossRefGoogle Scholar
Faro, A., Silva, L. S., Santos, D. N., & Feitosa, A. L. B. (2020). Adaptation and validation of The Fear of COVID-19 Scale. Scielo Preprints, Preprints. 898. doi: 10.1590/SciELOPreprints.898Google Scholar
Ferigato, S., Fernandez, M., Amorim, M., Ambrogi, I., Fernandes, L. M. M., & Pacheco, R. (2020). The Brazilian Government's mistakes in responding to the COVID-19 pandemic. The Lancet 396(10263), 1636. doi: 10.1016/s0140-6736(20)32164-4CrossRefGoogle ScholarPubMed
Feter, N., Caputo, E. L., Doring, I. R., Leite, J. S., Cassuriaga, J., Reichert, F. F., & Rombaldi, A. J. (2021). Sharp increase in depression and anxiety among Brazilian adults during the COVID-19 pandemic: Findings from the PAMPA cohort. Public Health 190, 101–107. doi: 10.1016/j.puhe.2020.11.013CrossRefGoogle ScholarPubMed
Franz, B., Milner, A., & Braddock, I. (2021). Do black lives matter in the American public's mitigation responses to the COVID-19 pandemic? An analysis of mask wearing and racial/ethnic disparities in deaths from COVID-19. Journal of Racial and Ethnic Health Disparities 16, 1–7. doi: 10.1007/s40615-021-01097-2Google Scholar
Furno, J., Fogo, D., Toneto, L., Cardomingo, M. R., & Paes, T. (2021). Boletim especial de gênero: As mulheres na pandemia [Special gender bulletin: Women in the pandemic]. p. 21. Centro de Estudos de Economia: São Paulo, SP.Google Scholar
Fuse-Nagase, Y., Marutani, T., Tachikawa, H., Iwami, T., Yamamoto, Y., Moriyama, T., & Yasumi, K. (2021). Increase in suicide rates among undergraduate students in Japanese national universities during the COVID-19 pandemic. Psychiatry and Clinical Neurosciences 75(11), 351–352. doi: 10.1111/pcn.13293CrossRefGoogle ScholarPubMed
Goyal, K., Chauhan, P., Chhikara, K., Gupta, P., & Singh, M. P. (2020). Fear of COVID 2019: First suicidal case in India! Asian Journal of Psychiatry 49, 101989. doi: 10.1016/j.ajp.2020.101989CrossRefGoogle ScholarPubMed
Grey, I., Arora, T., Thomas, J., Saneh, A., Tohme, P., & Abi-Habib, R. (2020). The role of perceived social support on depression and sleep during the COVID-19 pandemic. Psychiatry Research 293, 113452. doi: 10.1016/j.psychres.2020.113452CrossRefGoogle ScholarPubMed
Griep, R. H., Chor, D., Faerstein, E., Werneck, G. L., & Lopes, C. S. (2005). Construct validity of the Medical Outcomes Study's social support scale adapted to Portuguese in the Pró-Saúde Study. Cadernos de Saúde Pública 21(3), 703–714. doi: 10.1590/S0102-311X2005000300004CrossRefGoogle ScholarPubMed
Gritsenko, V., Skugarevsky, O., Konstantinov, V., Khamenka, N., Marinova, T., Reznik, A., & Isralowitz, R. (2020). COVID 19 fear, stress, anxiety, and substance use among Russian and Belarusian university students. International Journal of Mental Health and Addiction, 1–7. doi: 10.1007/s11469-020-00330-zGoogle ScholarPubMed
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics 42(2), 377–381. doi: 10.1016/j.jbi.2008.08.010CrossRefGoogle ScholarPubMed
Henry, L. (2017). Understanding food insecurity among college students: Experience, motivation, and local solutions. Annals of Anthropological Practice 41(1), 6–19. doi: 10.1111/napa.12108CrossRefGoogle Scholar
Hiscott, J., Alexandridi, M., Muscolini, M., Tassone, E., Palermo, E., Soultsioti, M., & Zevini, A. (2020). The global impact of the coronavirus pandemic. Cytokine & Growth Factor Reviews 53, 1–9. doi: 10.1016/j.cytogfr.2020.05.010CrossRefGoogle ScholarPubMed
Ibrahim, A. K., Kelly, S. J., Adams, C. E., & Glazebrook, C. (2013). A systematic review of studies of depression prevalence in university students. Journal of Psychiatry Research 47(3), 391–400. doi: 10.1016/j.jpsychires.2012.11.015CrossRefGoogle ScholarPubMed
Kampmark, B. (2020). Protesting in pandemic times: COVID-19, public health, and Black Lives Matter. Contention 8(2), 1–20. doi: 10.3167/cont.2020.080202CrossRefGoogle Scholar
Kathirvel, N. (2020). Post COVID-19 pandemic mental health challenges. Asian Journal of Psychiatry 53, 102430. doi: 10.1016/j.ajp.2020.102430CrossRefGoogle ScholarPubMed
Kecojevic, A., Basch, C. H., Sullivan, M., & Davi, N. K. (2020). The impact of the COVID-19 epidemic on mental health of undergraduate students in New Jersey, cross-sectional study. PLoS ONE 15(9), e0239696. doi: 10.1371/journal.pone.0239696CrossRefGoogle ScholarPubMed
Kibbey, M. M., Fedorenko, E. J., & Farris, S. G. (2021). Anxiety, depression, and health anxiety in undergraduate students living in initial US outbreak ‘hotspot’ during COVID-19 pandemic. Cognitive Behaviour Therapy 50(5), 1–13. doi: 10.1080/16506073.2020.1853805CrossRefGoogle ScholarPubMed
King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry 8, 70. doi: 10.1186/1471-244x-8-70CrossRefGoogle ScholarPubMed
Lamis, D. A., Ballard, E. D., May, A. M., & Dvorak, R. D. (2016). Depressive symptoms and suicidal ideation in college students: The mediating and moderating roles of hopelessness, alcohol problems, and social support. Journal of Clinical Psychology 72(9), 919–932. doi: 10.1002/jclp.22295CrossRefGoogle ScholarPubMed
Lee, J., Jeong, H. J., & Kim, S. (2021). Stress, anxiety, and depression among undergraduate students during the COVID-19 pandemic and their use of mental health services. Innovative Higher Education, 1–20. doi: 10.1007/s10755-021-09552-yGoogle ScholarPubMed
Lee, S., & Lee, D. K. (2018). What is the proper way to apply the multiple comparison test? Korean Journal of Anesthesiology 71(5), 353–360. doi: 10.4097/kja.d.18.00242CrossRefGoogle ScholarPubMed
Luft, C. D. B., Sanches, S. O., Mazo, G. Z., & Andrade, A. (2007). Brazilian version of the Perceived Stress Scale: Translation and validation for the elderly. Revista de Saúde Pública 41(4), 606–615. doi: 10.1590/S0034-89102007000400015CrossRefGoogle ScholarPubMed
Machado, R. A., Bonan, P. R. F., Perez, D. E. C., & Martelli Júnior, H. (2020). COVID-19 pandemic and the impact on dental education: Discussing current and future perspectives. Brazilian Oral Research 34, e083. doi: 10.1590/1807-3107bor-2020.vol34.0083CrossRefGoogle ScholarPubMed
Marcon, G., Monteiro, G. M. C., Ballester, P., Cassidy, R. M., Zimerman, A., Brunoni, A. R., & Passos, I. C. (2020). Who attempts suicide among medical students? Acta Psychiatrica Scandinavica 141(3), 254–264. doi: 10.1111/acps.13137CrossRefGoogle ScholarPubMed
Moreno, A. L., DeSousa, D. A., Souza, A. M. F. L. P., Manfro, G. G., Salum, G. A., Koller, S. H., & Crippa, J. A. S. (2016). Factor structure, reliability, and item parameters of the Brazilian-Portuguese version of the GAD-7 questionnaire. Trends in Psychology 24(1), 367–376. doi: 10.9788/TP2016.1-25Google Scholar
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/s0033291717002215CrossRefGoogle ScholarPubMed
Munhoz, T. N., Nunes, B. P., Wehrmeister, F. C., Santos, I. S., & Matijasevich, A. (2016). A nationwide population-based study of depression in Brazil. Journal of Affective Disorders 192, 226–233. doi: 10.1016/j.jad.2015.12.038CrossRefGoogle ScholarPubMed
Neves, J. A., Machado, M. L., Oliveira, L. D. A., Moreno, Y. M. F., Medeiros, M. A. T., & Vasconcelos, F. A. G. (2021). Unemployment, poverty, and hunger in Brazil in Covid-19 pandemic times. Revista de Nutrição 34, e200170. doi:10.1590/1678-9865202134e200170CrossRefGoogle Scholar
Noronha, K. V. M. S., Guedes, G. R., Turra, C. M., Andrade, M. V., Botega, L., Nogueira, D., & Ferreira, M. F. (2020). The COVID-19 pandemic in Brazil: Analysis of supply and demand of hospital and ICU beds and mechanical ventilators under different scenarios. Cadernos de Saúde Pública 36(6), e00115320. doi: 10.1590/0102-311X00115320CrossRefGoogle ScholarPubMed
Orellana, J. D. Y., & Souza, M. L. P. (2022). Excess suicides in Brazil: Inequalities according to age groups and regions during the COVID-19 pandemic. The International Journal of Social Psychiatry, 207640221097826. doi: 10.1177/00207640221097826Google ScholarPubMed
Pacheco, J. P., Giacomin, H. T., Tam, W. W., Ribeiro, T. B., Arab, C., Bezerra, I. M., & Pinasco, G. C. (2017). Mental health problems among medical students in Brazil: A systematic review and meta-analysis. Brazilian Journal of Psychiatry 39(4), 369–377. doi: 10.1590/1516-4446-2017-2223CrossRefGoogle Scholar
Pak, A., Adegboye, O. A., Adekunle, A. I., Rahman, K. M., McBryde, E. S., & Eisen, D. P. (2020). Economic consequences of the COVID-19 outbreak: The need for epidemic preparedness. Frontiers in Public Health 8, 241. doi: 10.3389/fpubh.2020.00241CrossRefGoogle ScholarPubMed
Peres, R. S., Frick, L. T., Queliz, F. N. F., Fernandes, S. C. S., Priolo-Filho, S. R., Pereira, A. C. S., & Cortez, P. A. C. (2021). Evidence of the validity of a Brazilian version of the Fear of COVID-19 Scale. Ciência & Saúde Coletiva 26(8), 3255–3264.CrossRefGoogle ScholarPubMed
Pirkis, J., John, A., Shin, S., DelPozo-Banos, M., Arya, V., Analuisa-Aguilar, P., & Spittal, M. J. (2021). Suicide trends in the early months of the COVID-19 pandemic: An interrupted time-series analysis of preliminary data from 21 countries. The Lancet Psychiatry 8(7), 579–588. doi: 10.1016/S2215-0366(21)00091-2CrossRefGoogle ScholarPubMed
Plagg, B., Engl, A., Piccoliori, G., & Eisendle, K. (2020). Prolonged social isolation of the elderly during COVID-19: Between benefit and damage. Archives of Gerontology and Geriatrics 89, 104086. doi: 10.1016/j.archger.2020.104086CrossRefGoogle ScholarPubMed
Planchuelo-Gómez, Á., Odriozola-González, P., Irurtia, M. J., & Luis-García, R. (2020). Longitudinal evaluation of the psychological impact of the COVID-19 crisis in Spain. Journal of Affective Disorders 277, 842–849. doi: 10.1016/j.jad.2020.09.018CrossRefGoogle ScholarPubMed
Saltzman, L. Y., Hansel, T. C., & Bordnick, P. S. (2020). Loneliness, isolation, and social support factors in post-COVID-19 mental health. Psychological Trauma 12(S1), S55–S57. doi: 10.1037/tra0000703CrossRefGoogle ScholarPubMed
Santos, H. G. B., Marcon, S. R., Espinosa, M. M., Baptista, M. N., & Paulo, P. M. C. (2017). Factors associated with suicidal ideation among university students. Revista Latino Americana de Enfermagem 25, e2878. doi: 10.1590/1518-8345.1592.2878CrossRefGoogle ScholarPubMed
Santos, I. S., Tavares, B. F., Munhoz, T. N., Almeida, L. S. P., Silva, N. T. B., Tams, B. D., & Matijasevich, A. (2013). Sensitivity and specificity of the Patient Health Questionnaire-9 (PHQ-9) among adults from the general population. Cadernos de Saúde Pública 29(8), 1533–1543. doi: 10.1590/0102-311X00144612CrossRefGoogle ScholarPubMed
Segall-Corrêa, A. M., Marin-León, L., Melgar-Quiñonez, H., & Pérez-Escamilla, R. (2014). Refinement of the Brazilian Household Food Insecurity Measurement Scale: Recommendation for a 14-item EBIA. Revista de Nutrição 27(2), 241–251. doi: 10.1590/1415-52732014000200010CrossRefGoogle Scholar
Shayo, F. K., & Lawala, P. S. (2019). Does food insecurity link to suicidal behaviors among in-school adolescents? Findings from the low-income country of sub-Saharan Africa. BMC Psychiatry 19(1), 227. doi: 10.1186/s12888-019-2212-6CrossRefGoogle ScholarPubMed
Shim, R. S., Compton, M. T., Manseau, M. W., Koplan, C., Langheim, F. J. P., & Powers, R. A. (2015). Overview of the social determinants of mental health. In Compton, M. T. & Shim, R. S. (Eds.), The social determinants of mental health (pp. 1–21). Arlington, VA: American Psychiatric Publishing.Google Scholar
Solar, O., & Irwin, A. (2010). A conceptual framework for action on the social determinants of health. In Social determinants of health discussion paper 2 (Policy and Practice). World Health Organization: Geneva. Retrieved from: https://www.who.int/sdhconference/resources/ConceptualframeworkforactiononSDH_eng.pdf.Google Scholar
StataCorp (2017). Stata statistical software: Release 15. College Station, TX: StataCorp LLC.Google Scholar
Usher, K., Bhullar, N., & Jackson, D. (2020). Life in the pandemic: Social isolation and mental health. Journal of Clinical Nursing 29(15–16), 2756–2757. doi: 10.1111/jocn.15290CrossRefGoogle ScholarPubMed
Victora, C. G., Huttly, S. R., Fuchs, S. C., & Olinto, M. T. (1997). The role of conceptual frameworks in epidemiological analysis: A hierarchical approach. International Journal of Epidemiology 26(1), 224–227. doi: 10.1093/ije/26.1.224CrossRefGoogle ScholarPubMed
World Health Organization (2021). Suicide worldwide in 2019: Global health estimates. p. 35. World Health Organization: Geneva.Google Scholar
Yang, X. Y., Gong, R. N., Sassine, S., Morsa, M., Tchogna, A. S., Drouin, O., & Jantchou, P. (2020). Risk perception of COVID-19 infection and adherence to preventive measures among adolescents and young adults. Children 7(12), 311. doi: 10.3390/children7120311CrossRefGoogle ScholarPubMed
Zanini, D. S., Peixoto, E. M., & Nakano, T. C. (2018). The Social Support Scale (MOS-SSS): Standardizing with item references. Trends in Psychology 26(1), 387–399. doi: 10.9788/TP2018.1-15PtGoogle Scholar
Zolotov, Y., Reznik, A., Bender, S., & Isralowitz, R. (2020). COVID-19 fear, mental health, and substance use among Israeli university students. International Journal of Mental Health and Addiction 20(1), 230–236. doi: 10.1007/s11469-020-00351-8CrossRefGoogle ScholarPubMed