Prediction of major depressive disorder onset in college students

Background: Major depressive disorder (MDD) in college students is associated with substantial burden. Aims: To assess 1-year incidence of MDD among incoming freshmen and predictors of MDD-incidence in a representative sample of students. Method: Prospective cohort study of first-year college students (baseline: n = 2,519, 1-year follow-up: n = 958). Results: The incidence of MDD within the first year of college was 6.9% (SE = 0.8). The most important individual-level predictors of onset were prior suicide plans and/or attempts (OR = 9.5). The strongest population-level baseline predictors were history of childhood–adolescent trauma, stressful experience in the past 12 months, parental psychopathology, and other 12-month mental disorder. Multivariate cross-validated prediction (cross-validated AUC = 0.73) suggest that 36.1% of incident MDD cases in a replication sample would occur among the 10% of students at highest predicted risk (24.5% predicted incidence in this highest-risk subgroup). Conclusions: Screening at college entrance is a promising strategy to identify students at risk of MDD onset, which may improve the development and deployment of targeted preventive interventions.