Student Precarity and Psychiatry (PEPSY)

Impact of Precarity on the Emergence of Psychiatric Disorders and the Use of Care Among Students

Since the COVID-19 pandemic, mental health disorders have increased significantly, particularly among young people. In France, the proportion of young people aged 18 to 25 suffering from depression almost doubled between 2017 and 2021. This phenomenon particularly affects students, who are already identified as being at greater risk of mental health disorders than the general population. Medical students seem to be particularly vulnerable: in 2021, a national study showed very high rates of depression and suicidal thoughts in this population. The main factor associated with depression was the feeling of financial hardship.

Students often face multiple forms of insecurity. Financially, they have limited resources and struggle to cover their basic needs such as housing, food and healthcare. Socially, many experience significant isolation, particularly when they are away from their families or under pressure from their studies. All of this has a significant impact on their mental health. Unfortunately, many students do not seek help due to lack of time, resources, or awareness of support services. The 2021 study showed that only one-third of medical students suffering from depression received appropriate treatment.

The aim of our study is to assess the impact of precariousness on the onset of psychiatric disorders and on the use or non-use of healthcare services.

Our study will involve nearly 45,000 students from PSL and UPC universities. It is based on a longitudinal cohort (via questionnaires) over three years. The aim is to identify precisely the different aspects of student precariousness (housing, transport, isolation, economic difficulties, etc.) and their link with psychological distress. The study will measure the extent of the phenomenon and identify modifiable factors that could be targeted by preventive measures. The results will enable us to better target preventive measures and propose concrete solutions to improve students' well-being and promote their success.

Study Overview

• Status: Not yet recruiting
• Conditions: Generalized Anxiety Disorder; Suicidal Ideation; Depressive Disorder, Major; Loneliness
• Intervention / Treatment: Other: Questionnaires

Detailed Description

The COVID-19 pandemic has led to an increase in depression, particularly among young people. The French health barometer, conducted every 4-5 years by Santé Publique France (SPF), found that the prevalence of major depressive episodes (MDE) among 18-25 year olds doubled (from 11.7% to 20.8%) between 2017 and 2021. There has also been an increase in suicidal thoughts and suicide attempts. Among students, data from the 2016 Student Life Observatory (OVE) found a higher prevalence of CDE and suicidal thoughts among students than in the general population of the same age. Among the factors associated with the risk of EDC, experiencing significant financial difficulties was the main one[4]. Among medical students, a national study conducted in 2021 found that the prevalence of depression and suicidal thoughts was much higher than in the general population of the same age. Financial difficulties were also the main factor associated with the risk of depression. Indeed, students are a population that is particularly vulnerable to precariousness due to several factors. Economically, they often have limited incomes, depending on parental support, insufficient grants or precarious jobs. This exposes them to difficulties in meeting their basic needs such as housing, food and healthcare. Socially, isolation can exacerbate their situation, especially when they are far from their family network or under pressure from their studies. In addition, high academic demands, combined with unstable living conditions, impact their mental health and can contribute to the development of psychiatric disorders, which often go untreated due to a lack of affordable and accessible resources. International students are even more vulnerable due to language and administrative barriers and limited access to local support services. This multidimensional precariousness highlights the need for comprehensive support for this population, even though students are unlikely to seek professional help. In the 2021 survey, only 32% of medical students suffering from depression received adequate care. If we want to improve the health of medical students, we must not only treat disorders, but also prevent them from occurring by helping students strive for a state of well-being. In terms of prevention, the Haute Autorité de Santé (HAS) distinguishes between three levels: primary prevention, which acts upstream of the disease (on risk factors); secondary prevention, which acts at an early stage of its development (screening); and tertiary prevention, which acts on complications and the risk of recurrence.

The objectives of the study are to identify and quantify the modifiable predictive and moderating factors explaining students' psychological distress that could give rise to (primary) prevention actions by studying the various components of precariousness (housing, transport, study conditions, social isolation, grants, etc.). It also aims to study the impact of the various components of precariousness on the use and non-use of healthcare (screening and treatment, secondary and tertiary prevention).

The data will be entered directly by participants on the SKEZIA platform (https://skezi.eu/) (a solution developed by SKEZI) co-founded by AP-HP and Paris-Cité University, and will be hosted on HDS-approved servers.

Main objective:

The objective is to explore the impact of precariousness on the risk of characterised depressive episodes and the use of healthcare among PSL students (17,000 students) and UPC health faculty students (28,000 students).

Primary outcome measure:

The study will assess the 12-month prevalence of:

• characterised depressive episodes (using the Composite International Diagnostic Interview Short-Form (CIDI-SF)) and suicidal ideation in the same way as SPF and OVE;
• use of healthcare services, which will be measured in a similar way to the OVE survey and the medical student survey.

Precariousness will be assessed by the question: 'Would you say that you are currently experiencing financial difficulties?'

Secondary objectives and evaluation criteria:

The secondary objectives are to :

• evaluate the prevalence of :
• anxiety, which will be assessed using the GAD7;
• eating disorders, which will be assessed using the SCOFF;
• alcohol addiction, which will be assessed using the AUDIT, and cannabis addiction, which will be assessed using the CAST;
• burnout, using the student version, which will be assessed using the MBI-SS for pre-clinical or healthcare students and the MBI-HSS for externs and residents,
• dropout, which will be assessed by a single question as in the CNA-CORE survey,
• insomnia, which will be measured by the Insomnia Severity Index (ISI),
• loneliness, which will be assessed using the UCLA 3 items,
• harassment,
• discriminatory treatment,
• and quality of life (WHOQOL);
• identify and quantify modifiable predictive and moderating factors explaining students' psychological distress that could lead to (primary) prevention measures = by studying the various components of precariousness (housing, transport, study conditions, social isolation, grants, etc.),
• study the impact of the various components of precariousness on the use and non-use of healthcare (screening and treatment, secondary and tertiary prevention). This will be assessed using questions on the renunciation of healthcare and its causes.

• Study Type: Observational
• Enrollment (Estimated): 45000

Contacts and Locations

• Study Contact: Name: Marie Benhammani-Godard; Phone Number: 0033158411190; Email: marie.godard@aphp.fr
• Study Contact Backup: Name: Cédric LEMOGNE, PR; Phone Number: 00331 42 34 85 76; Email: cedric.lemogne@aphp.fr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

All students enrolled at Paris Sciences et Lettres University or the Faculty of Health Sciences at Paris Cité University.

Description

Inclusion Criteria:

• Student enrolled at Paris Sciences et Lettres University (PSL, 17,000 students) or the Faculty of Health Sciences at Paris Cité University (UPC, 28,000 students),
• Aged 18 or over,
• Fluent in French,
• Affiliated to a health insurance.

Exclusion Criteria:

• Applicants under the age of 18,
• Not enrolled at PSL universities or the UPCS Faculty of Health,
• Insufficient level of French.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Health students; All students enrolled at the Faculty of Health Sciences of Paris Cité University	Other: Questionnaires; Questionnaires
Non-health students; All students enrolled at Paris Sciences and Letters University	Other: Questionnaires; Questionnaires

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Composite International Diagnostic Interview Short-Form (CIDI-SF)	12-months prevalence Major Depressive Disorder and suicidal thoughts Composite International Diagnostic Interview Short-Form (CIDI-SF)	Day 0
Composite International Diagnostic Interview Short-Form (CIDI-SF)	12-months prevalence Major Depressive Disorder and suicidal thoughts Composite International Diagnostic Interview Short-Form (CIDI-SF)	12 months
Use of care	Use of care service of care professional	Day 0
Use of care	Use of care service of care professional	12 months
Precarity	Question "Would you say that you are currently experiencing financial difficulties?"	Day 0
Precarity	Question "Would you say that you are currently experiencing financial difficulties?"	12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
GAD7	Prevalence of anxiety	Day 0
GAD7	Prevalence of anxiety	12 months
GAD7	Prevalence of anxiety	24 months
SCOFF	Prevalence of Eating disorders	Day 0
SCOFF	Prevalence of Eating disorders	12 months
SCOFF	Prevalence of Eating disorders	24 months
AUDIT	Prevalence of Alcohol addiction	Day 0
AUDIT	Prevalence of Alcohol addiction	12 months
AUDIT	Prevalence of Alcohol addiction	24 months
CAST	Prevalence of cannabis addiction	Day 0
CAST	Prevalence of cannabis addiction	12 months
CAST	Prevalence of cannabis addiction	24 months
MBI-SS or MBI-HSS	Prevalence of Burnout using the student version : will be assessed using the MBI-SS for pre-clinical students or caregivers or Prevalence of Burnout using the student version : will be assessed using the MBI-HSS for externs and residents	Day 0
MBI-SS or MBI-HSS	Prevalence of Burnout using the student version : will be assessed using the MBI-SS for pre-clinical students or caregivers or Prevalence of Burnout using the student version : will be assessed using the MBI-HSS for externs and residents Time Frame: D0	12 months
MBI-SS or MBI-HSS	Prevalence of Burnout using the student version : will be assessed using the MBI-SS for pre-clinical students or caregivers or Prevalence of Burnout using the student version : will be assessed using the MBI-HSS for externs and residents Time Frame: D0	24 months
A single question as in the CNA-CORE survey	Prevalence of Dropout: will be assessed using a single question as in the CNA-CORE survey	Day 0
A single question as in the CNA-CORE survey	Prevalence of Dropout: will be assessed using a single question as in the CNA-CORE survey	12 months
A single question as in the CNA-CORE survey	Prevalence of Dropout: will be assessed using a single question as in the CNA-CORE survey	24 months
Insomnia Severity Index (ISI)	Prevalence of Insomnia	Day 0
Insomnia Severity Index (ISI)	Prevalence of Insomnia	12 months
Insomnia Severity Index (ISI)	Prevalence of Insomnia	24 months
UCLA 3 items	Prevalence of Loneliness	Day 0
UCLA 3 items	Prevalence of Loneliness	12 months
UCLA 3 items	Prevalence of Loneliness	24 months
Questions about harrassment	Harrassment	Day 0
Questions about harrassment	Harrassment	12 months
Questions about harrassment	Harrassment	24 months
Questions about discriminatory treatment	Discriminatory treatment	Day 0
Questions about discriminatory treatment	Discriminatory treatment	12 months
Questions about discriminatory treatment	Discriminatory treatment	24 months
WHOQOL	Quality of life	Day 0
WHOQOL	Quality of life	12 months
WHOQOL	Quality of life	24 months
Components of precariousness	Predictive and moderating factors = by studying the different components of precariousness (housing, transport, study conditions, social isolation, grants, etc.).	Day 0
Components of precariousness	Predictive and moderating factors = by studying the different components of precariousness (housing, transport, study conditions, social isolation, grants, etc.).	12 months
Questions on the renunciation of healthcare and its causes.	Impact of the various components of precariousness on the use and non-use of healthcare will be assessed using questions on the renunciation of healthcare and its causes.	12 months
Components of precariousness	Predictive and moderating factors = by studying the different components of precariousness (housing, transport, study conditions, social isolation, grants, etc.).	24 months

Collaborators and Investigators

• Sponsor: Assistance Publique - Hôpitaux de Paris
• Collaborators: Institut de Psychiatrie et Neurosciences de Paris (INSERM)

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2026
• Primary Completion (Estimated): April 1, 2028
• Study Completion (Estimated): June 1, 2028

Study Registration Dates

• First Submitted: March 4, 2026
• First Submitted That Met QC Criteria: May 26, 2026
• First Posted (Actual): June 1, 2026

Study Record Updates

• Last Update Posted (Actual): June 1, 2026
• Last Update Submitted That Met QC Criteria: May 26, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Depression; Students; Precarity; Use of care
• Additional Relevant MeSH Terms: Mental Disorders; Behavioral Symptoms; Self-Injurious Behavior; Mood Disorders; Suicide; Anxiety Disorders; Depressive Disorder; Behavior; Suicidal Ideation; Depression; Depressive Disorder, Major; Generalized Anxiety Disorder; Health Care Quality, Access, and Evaluation; Investigative Techniques; Epidemiologic Methods; Data Collection; Health Care Evaluation Mechanisms; Quality of Health Care; Public Health; Environment and Public Health; Surveys and Questionnaires
• Other Study ID Numbers: APHP251300; N°IDRCB : 2025-A01968-41 (Other Identifier: France : Ministry of Health)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No