Abstract

The study aimed to investigate the association between social capital indicators and depressive symptoms among university students from Brazil. The study drew on a sample of 579 randomly selected university students, from a greater crossnational study conducted in 2018. Students completed a self-administered questionnaire assessing depressive symptoms, indicators of social capital and lifestyle behaviors. Data were analyzed using multivariate logistic regression models. Indicators of social capital included trust, group membership and frequency of meeting friends. Four social capital indicators were significantly associated with clinically relevant depressive symptoms. Students who agreed that people are likely to take advantage of one another were more likely to report depressive clinically relevant symptoms (OR: 1.80, 95%CI: 1.00 - 3.23) as well as students who agreed that people are not willing to help in case needed (OR: 2.11, 95%CI: 1.02 - 4.36). Perceived stress, smoking and hazardous alcohol consumption were not associated with clinically relevant depressive symptoms. Social capital plays an important role in explaining depressive symptoms among Brazilian university students. The study suggests that creating trust and enhancing participation in social networks can be an important strategy for promoting mental health among university students investigated in this study.

Key words:
Depressive symptoms; Students; Social capital; Latin America

Resumo

O estudo investigou a associação entre indicadores de capital social e sintomas depressivos entre estudantes universitários do Brasil. Um estudo transversal foi conduzido com uma amostra de 579 estudantes universitários selecionados randomicamente em 2018. Os estudantes completaram questionários auto-administrados para avaliar sintomas depressivos, indicadores de capital social e comportamentos de estilos de vida. Os dados foram analisados usando modelos de regressão logística multivariada. Indicadores de capital social incluíam confiança, associações em grupos, frequência de encontrar com os amigos, entre outros. Quatro indicadores de capital social se associaram significativamente com relevantes sintomas clínicos de depressão. Estudantes que disseram que as pessoas tendem a tirar mais vantagens umas das outras eram mais propensas a relatar sintomas clínicos relevantes de depressão (OR: 1.80, 95%CI: 1.00 - 3.23), assim como estudantes que relataram que as pessoas não estão dispostas a ajudar caso precise de ajuda (OR: 2.11, 95%CI: 1.02 - 4.36). A autopercepção de estresse, o consumo de álcool e o fumo não se associaram aos sintomas clínicos de depressão. O capital social desempenha um papel importante na explicação dos sintomas depressivos entre os universitários brasileiros. O estudo sugere que promover confiança e aumentar a participação nas redes sociais pode ser uma estratégia importante para a promoção da saúde mental entre os universitários investigados neste estudo.

Palavras-chave:
Sintomas depressivos; Estudantes; Capital social; América Latina

Introduction

Mental health problems among Brazilian university students pose a critical public health concern. A recent study found that 30% of students suffered from depression and nearly 63% had anxiety¹1 Fernandes MA, Vieira FER, Silva JS, Avelino FVSD, Santos JDM. Prevalence of anxious and depressive symptoms in college students of a public institution. Rev Bras Enferm 2018; 71:2169-2175.. For many young people, the years between 18 and 30 are characterized by important life changes. It is a transition from the dependency of an adolescent to the independence of a young adult. It is a phase which is marked by increased autonomy (e.g., leaving the parents’ home), a variety of possible life directions to be chosen, and new social and academic responsibilities and for many students this period coincides with the years dedicated to their education²2 Arnett JJ. Emerging adulthood. A theory of development from the late teens through the twenties. Am Psychol 2000; 55(5):469-480.^,33 Marmot M. Social justice, epidemiology and health inequalities. Eur J Epidemiol 2017; 32(7):537-546.. The uncertainties and the emotional pressure that possibly come as a consequence have been proposed as a risk factor for depression, anxiety, and stress²2 Arnett JJ. Emerging adulthood. A theory of development from the late teens through the twenties. Am Psychol 2000; 55(5):469-480.^,44 Bayram N, Bilgel N. The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Soc Psychiatry Psychiatr Epidemiol 2008 ;43(8):667-672..

Depression often manifests in a wide array of symptoms such as exhaustion, poor concentration, anxiety, disinterest in everyday activities and abandonment of university courses⁵5 Xavier A, Nunes AIBL, Santos MS dos. Subjetividade e sofrimento psíquico na formação do Sujeito na Universidade. Rev Mal Estar Subjetividade 2008; 8(2):427-451.. For many students, it also correlates with poor academic achievements and dropping-out⁶6 Hysenbegasi A, Hass SL, Rowland CR. The impact of depression on the academic productivity of university students. J Ment Health Policy Econ 2005; 8(3):145-151.. Most mental disorders commence and manifest during the university age, with negative consequences on adult life such as poorer career prospects and social relationships. Thus, identifying factors that may contribute to depressiveness in university students is imperative.

College students stand out as a vulnerable group to develop depressive symptoms because they find themselves in an environment with high social expectations and academic demands⁷7 Cremasco GS, Baptista MN. Depressão, motivos para viver e o significado do suicídio em graduandos do curso de psicologia. Estud Interdiscip Psicol 2017 15; 8(1):22-37.^,88 Padovani RC, Neufeld CB, Maltoni J, Barbosa LNF, Souza WF, Cavalcanti HAF, Lameu JN. Vulnerabilidade e bem-estar psicológicos do estudante universitário. Rev Bras Ter Cogn 2014; 10(1):2-10.. The choice of a profession is accompanied by high positive expectations of how these choices will translate into day to day. This optimism encompasses aspects of education, from activities they hope to develop throughout the course, the institution’s infrastructure, curriculum, faculty, friendships and preparation for previous study. However, in most cases, these are expectations that are not grounded in reality, in which the student faces excessive activities, the professional activity is not what they expected, conflicts with other students and / or teachers, difficulty in adapting to different forms of education, and in some cases to a new home. Thus, when positive expectations are not met, this may lead to demotivation, a pessimistic view of the future and possibly developing depressive symptoms. Consequently, adapting to university life is not an easy process and the repercussions of this process, which can often lead to academic failure, go beyond the area of education and directly affect the health of the individual and the community⁷7 Cremasco GS, Baptista MN. Depressão, motivos para viver e o significado do suicídio em graduandos do curso de psicologia. Estud Interdiscip Psicol 2017 15; 8(1):22-37..

In Brazil, most research investigating college students’ health has focused on lifestyle behaviors such as the longitudinal studies Monisa and Eleseu¹⁰10 Sousa A, Chaves DML, Magalhaes NGG, Fagundes FG, Adel AH. Addiction of neurokinin 1 receptor antagonist aprepitant to double antiemetic prophylaxis improves control of postoperative nausea and vomiting in oncologic patients undergoing laparoscopic procedures: a double-blinded randomized controlled trial. European J Anaesthesiology 2014; 31:155.^,1111 Nogueira PS, Ferreira MG, Rodrigues PRM, Muraro AP, Pereira LP, Pereira RA. Longitudinal Study on the Lifestyle and Health of University Students (ELESEU): design, methodological procedures, and preliminary results. Cad Saude Publica 2018; 34(4):e00145917.. Monisa focuses on characterizing college students’ lifestyle (e.g., physical activity) and Eleseu assess perceived stress, depression, body image, among other factors related to lifestyle among this group¹⁰10 Sousa A, Chaves DML, Magalhaes NGG, Fagundes FG, Adel AH. Addiction of neurokinin 1 receptor antagonist aprepitant to double antiemetic prophylaxis improves control of postoperative nausea and vomiting in oncologic patients undergoing laparoscopic procedures: a double-blinded randomized controlled trial. European J Anaesthesiology 2014; 31:155.^,1111 Nogueira PS, Ferreira MG, Rodrigues PRM, Muraro AP, Pereira LP, Pereira RA. Longitudinal Study on the Lifestyle and Health of University Students (ELESEU): design, methodological procedures, and preliminary results. Cad Saude Publica 2018; 34(4):e00145917.. Other factors related to college students’ lifestyle like smoking and alcohol use, drug use and socio-demographic correlates are also discussed, but relatively little is known about wider social determinants of health such as social capital¹²12 Silva DAS, Petroski EL. The simultaneous presence of health risk behaviors in freshman college students in Brazil. J Community Health 2012; 37(3):591-598.^,1313 Legey S, Aquino F, Lamego MK, Paes F, Nardi AE, Neto GM, Mura G, Sancassiani F, Rocha N, Murillo-Rodriguez E, Machado S. Relationship Among Physical Activity Level, Mood and Anxiety States and Quality of Life in Physical Education Students. Clin Pract Epidemiol Ment Health CP EMH 2017; 13:82-91.. Social capital defined by Putnam (2001) as features of social organization such as networks, norms and social trust that facilitate coordination and cooperation for mutual benefit, has been proposed to be a determinant of health given its association with lower levels of stress, more favorable health-related behaviors and better self-rated and mental health¹⁴14 Putnam RD. Bowling Alone: The Collapse and Revival of American Community. Simon and Schuster; 2001. 550 p.

15 Pattussi MP, Olinto MTA, Canuto R, Silva Garcez A, Paniz VMV, Kawachi I. Workplace social capital, mental health and health behaviors among Brazilian female workers. Soc Psychiatry Psychiatr Epidemiol 2016; 51(9):1321-1330.

16 Ehsan AM, De Silva MJ. Social capital and common mental disorder: a systematic review. J Epidemiol Community Health 2015; 69(10):1021-1028.^-1717 Fujiwara T, Kawachi I. A prospective study of individual-level social capital and major depression in the United States. J Epidemiol Community Health 2008; 62(7):627-633.. Over the years the conceptualization of social capital has developed and the various theoretical definitions of social capital have led to the distinction between different dimensions of social capital. Structural and cognitive social capital are two prominent dimensions in health research. While structural social capital refers to links between people, cognitive social capital refers to the level of trust and reciprocity. The ways in which social capital can influence health are manifold. One possibility through which social capital may mitigate adverse effects on mental is through the provision of mutual psychological support. In the university context the association between levels of social capital on mental health has barely been discussed.

In our previously published cross-national study we found that estimates for clinically relevant depressive symptoms were highest among students from Brazil¹⁸18 Backhaus I, Varela AR, Khoo S, Siefken K, Crozier A, Begotaraj E, Fischer F, Wiehn J, Lanning BA, Lin P-H, Jang S, Monteiro LZ, Al-Shamli A, La Torre G, Kawachi I. Associations between social capital and depressive symptoms among college students in 12 countries: results of a cross-national study. Front Psychol 2020; 11.. We also found that overall lower levels of social were associated with poorer mental health¹⁸18 Backhaus I, Varela AR, Khoo S, Siefken K, Crozier A, Begotaraj E, Fischer F, Wiehn J, Lanning BA, Lin P-H, Jang S, Monteiro LZ, Al-Shamli A, La Torre G, Kawachi I. Associations between social capital and depressive symptoms among college students in 12 countries: results of a cross-national study. Front Psychol 2020; 11.. However, it was out of scope of our cross-national study to analyze which specific individual social capital indicators account for depressive symptoms among Brazilian college students. Nevertheless, given that mental health problems among students have increased in number and severity and pose a challenge for higher education institutions and health services, exploring pathways that can mitigate adverse effects on mental health remain of great importance. Therefore, this study aimed to investigate which specific individual social capital indicators account for depressive symptoms among Brazilian college students.

Methods

The data analyzed in this paper are from the SPLASH (Social capital and students’ health) study, an international two-wave panel study¹⁸18 Backhaus I, Varela AR, Khoo S, Siefken K, Crozier A, Begotaraj E, Fischer F, Wiehn J, Lanning BA, Lin P-H, Jang S, Monteiro LZ, Al-Shamli A, La Torre G, Kawachi I. Associations between social capital and depressive symptoms among college students in 12 countries: results of a cross-national study. Front Psychol 2020; 11.. The present study utilized data collected in Brazil from May to October 2018. Participation in the survey was voluntary and anonymous via a self-administered questionnaire distributed during lectures. The questionnaire was compiled of previously published and validated instruments used in various populations. Students that agreed to participate signed a consent form before data collection. Prior to filling out the survey, students were informed that they could terminate their participation at any time and did not have to answer questions they feel uncomfortable with.

Sample size

Based on a 95%CI, a +5% margin of error and an estimated prevalence of depressive symptoms of 30.0% among university students, the minimum sample size required for this study was 317 students. Adjusted for 30% of incomplete responses, missing data, and rejection rate, the final minimum required sample size was 452 students.

Ethical considerations

Permission for conducting the study was granted by the Institutional Review Board from the University Center of the Federal District (approval number: 59713316.0.0000.5650). All proposed and approved ethical procedures were strictly followed by the investigators.

Measures

Depressive symptoms

Depressive symptoms were assessed by using the simplified Beck Depression Inventory (BDI-S)¹⁹19 Schmitt M, Maes J. Vorschlag zur Vereinfachung des Beck-Depressions-Inventars (BDI). Diagnostica 2000; 46(1):38-46.. The simplification of the original BDI included two approaches: (a) the four items per symptom that assessed the specific symptom’s intensity in the original BDI were replaced by a single statement per symptom with a six-point Likert scale (0 = ‘Never’ to 5 = ‘Almost Always’); and (b) the symptom that assessed loss of weight was excluded. Sample items include: “I feel sad,” “I feel I am being punished,” “I have thoughts of killing myself.” Based on respondents’ answers, a single score can be computed, which can range from 0 to 100, with a score higher than 35 suggesting that clinically relevant depressive symptoms are present¹⁹19 Schmitt M, Maes J. Vorschlag zur Vereinfachung des Beck-Depressions-Inventars (BDI). Diagnostica 2000; 46(1):38-46.^,2020 Schmitt M, Altstötter-Gleich C, Hinz A, Maes J, Brähler E. Normwerte für das Vereinfachte Beck-Depressions-Inventar (BDI-V) in der Allgemeinbevölkerung. Diagnostica 2006; 52(2):51-59.. The Cronbach’s alpha in the present study was acceptable with α=0.75.

Social capital

Items of the World Bank Integrated Questionnaire to Measure Social Capital (SC-QI), a psychometrically validated questionnaire, were used to assess social capital²¹21 Grootaert C, van Bastelaer T. Understanding and measuring social capital. DC: World Bank; 2001.. This questionnaire originally has 27 items and is divided into six different dimensions of social capital, a) groups and network, b) trust and solidarity, c) collective action and cooperation, d) information and communication, e) social cohesion and inclusion, f) empowerment and political action. Since the SC-QI has no overall scoring algorithm. Thus, for this study, 13 items out of the 27 items were chosen. This was done with the help of an expert on social capital and health studies. Furthermore, the selection was based on social epidemiological evidence and the peculiarities of the university students. The remaining items of the SC-QI were deemed as irrelevant for the purpose of this study and were therefore excluded. The behavioral dimensions of social capital, for example, were measured by questions inquiring about: Time or money contributed to a community project, participation in community activity and frequency of meeting friends. The cognitive dimensions of social capital were assessed by questions focused on ability to borrow money, perceived helpfulness of others, and trust in other people.

Confounding variables

Potential confounding factors included sociodemographic factors and an individual-level factors associated with depressive symptoms. Specifically, data were obtained on the following variables: age, sex, family socioeconomic status (e.g., parental level of education and employment, perceived level of income), perceived stress and smoking. Perceived stress was measured by Cohen’s Perceived Stress Scale (PSS), which includes ten questions, with answers ranked using a five-point Likert scale (0 = ‘Never’ to 4 = ‘Very often’) and assesses the perception about stressful experiences over the previous four weeks²²22 Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull 1985; 98(2):310-357.. High scores on each scale indicate more stress. Based on the scoring respondents can then be grouped into one of the following three categories: low stress (score: 0-13), moderate stress (14-26), high stress (27-40). The Cronbach’s alpha was high (α=0.71). Smoking status was assessed by asking students whether they were current smokers and if not if they had ever tried a cigarette.

Conceptual model

A considerable amount of research on social capital and health is available. To contribute to the theoretical structure of this research, we have developed a conceptual model of the individual-level social capital process on individual health outcomes to explain the connection between individual factors, social capital, and student’s mental health. The elements of the conceptual framework were drawn from a review of public health literature that addressed social capital (Figure 1).

Individual factors

Individual factors consist of socio-demographic factors including age, sex, and socioeconomic status (SES). Socio-demographic factors are strongly related to health²³23 Marmot M. Commentary: Mental health and public health. Int J Epidemiol 2014; 43(2):293-296.. While good health is more commonly found among those with a higher SES, those of lower SES die younger and suffer a greater burden of disease and disability²⁴24 Bassett E, Moore S. Mental Health and Social Capital: Social Capital as a Promising Initiative to Improving the Mental Health of Communities. In: Rodriguez-Morales AJ, editor. Current Topics in Public Health [Internet]. IntechOpen; 2013. p. 685-707. [cited 2020 ago 3]. Available from: https://doi.org/10.5772/53501
https://doi.org/10.5772/53501... .

Health risk factors

Excessive alcohol consumption, smoking, and physical inactivity are included in the component of health risk factors. Cumulative evidence has shown strong relationships between depression, alcohol consumption, smoking, and physical activity²⁵25 Biddle S. Physical activity and mental health: evidence is growing. World Psychiatry 2016; 15(2):176-177.^,2626 Pedrelli P, Shapero B, Archibald A, Dale C. Alcohol use and depression during adolescence and young adulthood: a summary and interpretation of mixed findings. Curr Addict Rep 2016; 3(1):91-97..

Social capital

The main component in the model, and this study is social capital. Broadly, social capital includes, for instance, the availability of social support and involvement in social networks²⁷27 Kawachi I, Subramanian SV, Kim D. Social Capital and Health. In: Social Capital and Health. Springer, New York, NY; 2008 [cited 2017 set 12]. p. 1-26. Available from: https://link.springer.com/chapter/ 10.1007/978-0-387-71311-3_1. This involvement can, for example, be participation in a religious organization or sports club. Research has shown that social capital can have beneficial effects on mental health²⁷27 Kawachi I, Subramanian SV, Kim D. Social Capital and Health. In: Social Capital and Health. Springer, New York, NY; 2008 [cited 2017 set 12]. p. 1-26. Available from: https://link.springer.com/chapter/ 10.1007/978-0-387-71311-3_1.

Data analysis

As a first step, basic descriptive statistics, including chi-square tests for categorical variables and independent-sample t-tests for continuous variables, were performed. Next multivariate logistic regression analyses, with depressive symptoms as the dependent variable, were performed. Two models were run. The first model adjusted for socio-demographic variables (e.g., age, sex, parental level of employment). The second model was the same as model 1 but added other potential confounders (e.g., smoking habit and perceived stress). All analyses were performed using SPSS statistical software for Windows version 25.0 (SPSS, Inc., Chicago, IL). The significance level was set at p<0.05.

Results

Descriptive statistics for socio-demographic characteristics, depressive symptoms, and social capital are reported in Table 1. The sample consisted of 579 Brazilian university students, with a mean age of 23.11 (SD: 3.46) and the majority being female (66.3%). The respondents were from different fields of study with the majority from the biological sciences field (45.3%). Most students came from a family with a low socioeconomic status, with many parents working part-time only (57%) or unemployed (23%). Students predominantly lived in their parents’ house (58.2%) and most felt like they did not have enough income to cover their monthly costs (59.2%) (Table 1). As outlined in our cross-national study, clinically relevant depressive symptoms (BDI-S >35) were found in 86% of the respondents (Table 1)¹⁸18 Backhaus I, Varela AR, Khoo S, Siefken K, Crozier A, Begotaraj E, Fischer F, Wiehn J, Lanning BA, Lin P-H, Jang S, Monteiro LZ, Al-Shamli A, La Torre G, Kawachi I. Associations between social capital and depressive symptoms among college students in 12 countries: results of a cross-national study. Front Psychol 2020; 11..

Factors associated with depressive symptoms

Significant associations, instead, were found for perceived income (i.e., income is enough to cover costs) (p=0.001) as well as three of the cognitive social capital indicators (Someone is likely to take advantage of you, p=0.029; People are willing to help you, p=0.025; People are eager to collaborate to solve a problem, p=0.003). Perceived stress (p=0.746), hazardous alcohol consumption (p=0.212) and smoking (p=0.962) instead were not associated with clinically relevant depressive symptoms (Table 1).

Results of the binary logistic regression analysis are shown in Table 2. The first step of multivariable-adjusted binary logistic regression (Model I) was controlled for demographic (age, gender) and socioeconomic variables (parental level of education and employment, perceived level of income). Model II controlled for other possible confounding factors (smoking and perceived stress). Three of the five indicators of the cognitive, social capital dimension were significantly associated with clinically relevant depressive symptoms (BDI-S >35). According to the bivariate logistic regression analysis, the odds of having depressive symptoms were significantly higher in students who agreed that someone was likely to take advantage (OR: 1.81, 95%CI: 1.03 - 3.17) and in students who reported that people are not willing to help if needed (OR: 2.11, 95%CI: 1.02 - 4.36). Students who stated that people are not willing to collaborate to solve a problem such as bullying were three times more likely to report depressive symptoms than a student who indicated that people are likely to collaborate (OR: 3.10, 95%CI: 1.05 - 9.17). Concerning the behavioral dimension of social capital, only one out of the seven indicators yielded a statistically significant result. A student who indicated to not to belong to a group such as a sports club had a significantly higher likelihood to report clinically relevant depressive symptoms (OR: 2.21, 95%CI 1.25 - 3.29). Nonetheless, although the other indicators were not statistically significant, they were in the expected direction. As such, that low social capital increased the likelihood of depressive symptoms. For example, meeting friends only rarely increased the risk of clinically depressive symptoms by 15% (OR: 1.15, 95%CI 0.66 - 1.99). Likewise, students who indicated that they were unable to make an important decision that could change their course of life were 28% more likely (OR: 1.28, 95%CI: 0.76 - 2.17) to show signs of clinically relevant depressive symptoms. No statistically significant evidence was found that smoking status and perceived stress were associated with depressive symptoms in university students.

On behalf of all authors, the corresponding author states that there is no conflict of interest

Discussion

The objective of the present study was to test the association between specific social capital indicators and depressive symptoms among Brazilian university students. Approximately 7 out of 10 students reported clinically relevant depressive symptoms. This is significantly higher than the prevalence found among the general population (3% to 14%) and Brazilian undergraduate students (4%)²⁸28 Silva MT, Galvao TF, Martins SS, Pereira MG. Prevalence of depression morbidity among Brazilian adults: a systematic review and meta-analysis. Rev Bras Psiquiatr 2014; 36(3):262-270.. It is also significantly higher than the prevalence of depressive symptoms measured among university students in other countries such as Canada (38.2% to 46%), Bosnia (30.1%) and Turkey (26.2%)²⁹29 Ibrahim AK, Kelly SJ, Adams CE, Glazebrook C. A systematic review of studies of depression prevalence in university students. J Psychiatr Res 2013; 47(3):391-400.. The research conducted by Aragão et al., in universities in Sergipe, Brazil, with 215 students aged 19 to 24 years, identified a prevalence of 29.7% of depressive symptoms³⁰30 Aragão JA, Freire MRM, Farias NLG, Diniz SS, Aragão FMS, Aragão ICS, Lima TB, Reis FP. Prevalence of depressive symptoms among medical students taught using problem-based learning versus traditional methods. Int J Psychiatry Clin Pract 2018; 22(2):123-128.. Contributing to these findings, similar data were found by Jaalouk et al., in a study conducted in Lebanon, with 457 undergraduate students, aged 18 to 33 years, in which 24.1% had depressive symptoms³¹31 Jaalouk D, Matar Boumosleh J, Helou L, Abou Jaoude M. Dietary patterns, their covariates, and associations with severity of depressive symptoms among university students in Lebanon: a cross-sectional study. Eur J Nutr 2019; 58(3):997-1008..

A survey conducted in 100 Brazilian higher education institutions in the 27 state capitals, with 12.711 university students aged between 17 and 31 years showed that 79.9% of participants answered having at least one depressive symptom (i.e., exposed mild depressive symptoms)³¹31 Jaalouk D, Matar Boumosleh J, Helou L, Abou Jaoude M. Dietary patterns, their covariates, and associations with severity of depressive symptoms among university students in Lebanon: a cross-sectional study. Eur J Nutr 2019; 58(3):997-1008.. This high rate corroborates with our findings. University students stand out as a population at risk for high prevalence of depressive symptoms, since they need to adapt to a new reality quickly, as entry to the higher level makes many need to leave their homes and to go to different places, in addition to long commutes, academic failure and overworked periods of work and tests, which creates dissatisfaction and increases in stress levels.

Moreover, our findings showed that low levels of trust (e.g., people are willing to help) and not reporting collective actions (e.g., people collaborate to solve a problem) are associated with depressive symptoms, also after adjustment of all other social capital indicators and other possible confounders. Students who believed that people are likely to take advantage of them and students who believed that people are not willing to help had a higher likelihood of reporting clinically relevant depressive symptoms. Similarly, students who did not belong to a group were more likely to report clinically relevant depressive symptoms. The findings are somewhat similar to those found in a previous study investigating social capital and self-rated health among Brazilian adolescents. Borges and colleagues (2010) examined the association between social capital and self-rated health among youth³²32 Borges CM, Campos ACV, Vargas AD, Ferreira EF, Kawachi I. Social capital and self-rated health among adolescents in Brazil: an exploratory study. BMC Res Notes 2010; 3:338.. Their results suggest that adolescents with low social support and little trust had a greater likelihood to report poor health. Cumulative evidence from public health studies among adults and elderly has also suggested that low levels of social capital were significantly associated with poor mental health status, including depression²⁴24 Bassett E, Moore S. Mental Health and Social Capital: Social Capital as a Promising Initiative to Improving the Mental Health of Communities. In: Rodriguez-Morales AJ, editor. Current Topics in Public Health [Internet]. IntechOpen; 2013. p. 685-707. [cited 2020 ago 3]. Available from: https://doi.org/10.5772/53501
https://doi.org/10.5772/53501... ^,3333 Han KM, Han C, Shin C, Jee HJ, An H, Yoon HK, Ko YH, Kim SH. Social capital, socioeconomic status, and depression in community-living elderly. J Psychiatr Res 2018; 98:133-140..

We cannot exclude that certain contextual factors, such as the country’s political and economic moment of crisis, might have influenced the observed results. In particular, because similar to the findings of Borges and colleagues (2010), the majority of students sampled (75.3%) agreed that someone is likely to take advantage of them. The capacity to trust might be influenced by Brazil’s current political upheaval³²32 Borges CM, Campos ACV, Vargas AD, Ferreira EF, Kawachi I. Social capital and self-rated health among adolescents in Brazil: an exploratory study. BMC Res Notes 2010; 3:338.. Overall, our findings are in line with previous research. Lower levels of trust have been linked to poorer health³²32 Borges CM, Campos ACV, Vargas AD, Ferreira EF, Kawachi I. Social capital and self-rated health among adolescents in Brazil: an exploratory study. BMC Res Notes 2010; 3:338.^,3434 Rose R. How much does social capital add to individual health? A survey study of Russians. Soc Sci Med 2000; 51(9):1421-1435.. Han et al. (2018), for instance, found that older adults with a low level of interpersonal trust were at greater risk for depressive symptoms compared to those with higher levels of trust³²32 Borges CM, Campos ACV, Vargas AD, Ferreira EF, Kawachi I. Social capital and self-rated health among adolescents in Brazil: an exploratory study. BMC Res Notes 2010; 3:338.^,3333 Han KM, Han C, Shin C, Jee HJ, An H, Yoon HK, Ko YH, Kim SH. Social capital, socioeconomic status, and depression in community-living elderly. J Psychiatr Res 2018; 98:133-140.. Research utilizing a sample from Russia established that greater trust was associated with improved emotional as well as physical health³⁴34 Rose R. How much does social capital add to individual health? A survey study of Russians. Soc Sci Med 2000; 51(9):1421-1435.. Already 20 years ago Kawachi and Berkman highlighted the importance of social networks and social bonds for mental health³⁵35 Kawachi I, Berkman LF. Social ties and mental health. J Urban Health 2001; 78(3):458-467.. The researchers proposed that social bonds such as friends or family may offer resources for emotional and informational support, especially during high-stress periods, which can have a positive effect on mental health³⁵35 Kawachi I, Berkman LF. Social ties and mental health. J Urban Health 2001; 78(3):458-467.. The authors also point out that being integrated into a social network may strengthen a sense of purpose, belonging, security, and a recognition of self-worth exerting a salutary influence on mental health³⁵35 Kawachi I, Berkman LF. Social ties and mental health. J Urban Health 2001; 78(3):458-467..

Generally, it is important to realize that university students represent a particular part of the population. Poor health during academic years can have important implications for their future well-being and occupational success³⁶36 Howard AL, Galambos NL, Krahn HJ. Paths to success in young adulthood from mental health and life transitions in emerging adulthood. Int J Behav Dev 2010; 34(6):538-546.. The college years are stressful and make the late teens and twenties a particularly vulnerable time. It is important to recognize that in the case of Brazil; it may be worse given the uncertain economic and political times. The literature shows that answering to the psychological needs of university students through intervention proposals is still scarce³⁷37 Bardagi MP, Albanaes P. Avaliação de intervenções vocacionais no Brasil: Uma revisão da literatura. [Evaluation of vocational interventions in Brazil: A literature review.]. Rev Bras Orientaç Prof 2015; 16(2):123-135.. However, when such interventions happen (within the scope of school services, extension projects or university management actions) they are important tools for the development of professional and interpersonal skills, in addition to promoting career guidance and health promotion and contributing to reducing academic failure.

A comprehensive national report, published in 2019, addressing the cultural and socio-economic profile of 424,128 undergraduate Brazilian students, enrolled in public higher education Institutions, pointed out that 83% of the students reported having some mental health distress. The fact that this report was an initiative from the National Association of leaders of Brazilian public higher education institutions shows an effort that student’s mental health should be among the priorities for informed decisions at the Universities and Colleges³⁸38 Associação Nacional dos Dirigentes das Instituições Federais de Ensino Superior. V Pesquisa Nacional de Perfil Socioeconômico e Cultural dos (as) Graduandos (as) das IFES - 2018 - Andifes [Internet]. 2019 [acessado 2020 dez 4]. Disponível em: http://www.andifes.org.br/wp-content/uploads/2019/05/V-Pesquisa-Nacional-de-Perfil-Socioecon%C3%B4mico-e-Cultural-dos-as-Graduandos-as-das-IFES-2018.pdf
http://www.andifes.org.br/wp-content/upl... .

This high prevalence of depressive symptoms among university students reveals the importance of implementing services, especially within Higher Education Institutions (HEIs), which aim to facilitate the integration of students into academic life and to optimize their physical and psychological well-being³⁹39 Santos AS, Souto DC, Silveira KSS, Perrone CM, Dias ACG. Psychologist Educational and School performance in higher education: reflections about practice? Psicol Esc Educ 2015; 19(3):515-524.. The activities developed by these services do not necessarily need to be characterized by individual clinical care, it is expected that psychologists working in HEIs are prepared to deal with group demands, but know how to identify the need to develop individual actions, which depends on the situation experienced by each student³⁹39 Santos AS, Souto DC, Silveira KSS, Perrone CM, Dias ACG. Psychologist Educational and School performance in higher education: reflections about practice? Psicol Esc Educ 2015; 19(3):515-524..

The university attendance services were created with the purpose of providing social, economic, physical and psychological assistance to academics³⁷37 Bardagi MP, Albanaes P. Avaliação de intervenções vocacionais no Brasil: Uma revisão da literatura. [Evaluation of vocational interventions in Brazil: A literature review.]. Rev Bras Orientaç Prof 2015; 16(2):123-135.. The National Union of Students (UNE) describes student assistance as the set of policies that aim to guarantee the reduction of socioeconomic and cultural inequalities, the fight against dropout and the promotion of a complete, equal education to all students³⁹39 Santos AS, Souto DC, Silveira KSS, Perrone CM, Dias ACG. Psychologist Educational and School performance in higher education: reflections about practice? Psicol Esc Educ 2015; 19(3):515-524.. Assistance must provide basic conditions for the university student to remain in the institution, ensure the means necessary for full academic development and contribute to the improvement of the university system⁴⁰40 Instituto CEMESP. Mapa do Ensino Superior [Internet]. Semesp. [acessado 2020 dez 4]. Disponível em: https://www.semesp.org.br/sobre-o-mapa-do-ensino-superior/
https://www.semesp.org.br/sobre-o-mapa-d... . Assistance practices in university attendance services are often focused on actions related to housing, food and transportation. Possibilities such as the Student House, the University Restaurant, the receipt of scholarships and the payment of half of the bus ticket or exemption from this fee are essential assistance services for academic permanence and the conclusion of graduation³⁹39 Santos AS, Souto DC, Silveira KSS, Perrone CM, Dias ACG. Psychologist Educational and School performance in higher education: reflections about practice? Psicol Esc Educ 2015; 19(3):515-524.. It is important to highlight that 68.1% and 40.3% of Brazilian university students has a job while attending college; among these working students, 72% received up to R$2,090 Reais [+- U$758.53; reference July 2019)⁴⁰40 Instituto CEMESP. Mapa do Ensino Superior [Internet]. Semesp. [acessado 2020 dez 4]. Disponível em: https://www.semesp.org.br/sobre-o-mapa-do-ensino-superior/
https://www.semesp.org.br/sobre-o-mapa-d... . However, there is still a small number of universities in which actions are taken or planned to meet the mental health needs or to adjust to the academic life of university students³⁷37 Bardagi MP, Albanaes P. Avaliação de intervenções vocacionais no Brasil: Uma revisão da literatura. [Evaluation of vocational interventions in Brazil: A literature review.]. Rev Bras Orientaç Prof 2015; 16(2):123-135.. In fact, most HEIs have little concern with preparing individuals for the changes that occur after high school. The offer of programs that favor the psychosocial adaptation of students is limited and mental health does not receive due attention in higher education despite the increase in the prevalence and severity of psychological problems among university students³⁹39 Santos AS, Souto DC, Silveira KSS, Perrone CM, Dias ACG. Psychologist Educational and School performance in higher education: reflections about practice? Psicol Esc Educ 2015; 19(3):515-524.. Due to this scenario, some universities in Brazil, such as the University of São Paulo (USP), have established a Mental Health Office, while the Federal University of Santa Catarina (UFSC) provides assistance to the community through the Psychological Attention Service (SAPSI).

We also have the Life Valuation Center (CVV) with the objective of providing emotional support and preventing suicide. Provided by the National Mental Health Policy, Psychosocial Care Centers (CAPs) provide services of an open and community nature. In CAPs, the population finds a team formed by professionals from different areas and prepared to deal with more serious and persistent cases⁴¹41 Pereira A. Dor psicológica e ideação suicida em estudantes [Internet]. Universidade de Aveiro; 2013. [acessado 2020 ago 12]. Available from: https://ria.ua.pt/handle/10773/11527
https://ria.ua.pt/handle/10773/11527... . Universities end up giving support to students through extension projects, by offering psychological attention to the university student in different support services⁴²42 Lima R, Fraga S. Intervir para ajudar e ajudar para construir: Um modelo de intervenção psicológica com estudantes do ensino superior. Rev Bras Orientac Prof 2010; 11(2):269-277.. These interventions can assist in facing the countless challenges experienced in the trajectory of higher education, and assist in minimizing psychological illness and promoting the student’s mental health⁴²42 Lima R, Fraga S. Intervir para ajudar e ajudar para construir: Um modelo de intervenção psicológica com estudantes do ensino superior. Rev Bras Orientac Prof 2010; 11(2):269-277.. However, despite the number of students benefited, the actions are still quantitatively insufficient to cover all the needs of the academic population³⁷37 Bardagi MP, Albanaes P. Avaliação de intervenções vocacionais no Brasil: Uma revisão da literatura. [Evaluation of vocational interventions in Brazil: A literature review.]. Rev Bras Orientaç Prof 2015; 16(2):123-135.. Thus, new interdisciplinary projects must be proposed in order to meet the entire academic community that seeks psychological care services.

Strengths and limitations

A series of limitations apply to this study. First, as we used a cross-sectional approach, we cannot establish the direction of the associations studied. Potential bi-directionality of the associations could go either way. Second, since the study was a snapshot and included first-year university students. Therefore, our understanding of when in the academic year, risk for depression is greatest and when interventions may be most needed is limited. Third, data were obtained with self-reported questionnaires; due to that, responses could be exaggerated or downscaled. Although the BDI-S is an immensely utilized instrument for detecting depression and clinically relevant depressive symptoms, it remains a screening and not a diagnostic tool. A clinician report or semi-structured interviews may have led to more accuracy. Students may have answered differently in the presence of another person. Fourth, the study participants were limited to Brasilia, one district of Brazil; therefore, our results might not apply to the general college student population. Despite these limitations, the present study offers important findings as it was the first study to investigate the association between specific social capital indicators and depressive symptoms among Brazilian university students. Until now, the vast majority of the studies on mental health in Brazilian academia were related to factors such as academic workload, stress and lifestyle behaviors³⁶36 Howard AL, Galambos NL, Krahn HJ. Paths to success in young adulthood from mental health and life transitions in emerging adulthood. Int J Behav Dev 2010; 34(6):538-546.. Therefore, the present study presents a new pathway for specific prevention measures and interventions in the university context.

Conclusion

Factors significantly associated with depressive symptoms were low levels of social capital. This implies that enhancing social capital should be a prime target for prevention programs aimed at supporting student mental health. However, it is possible that the further contextual factors lead to elevated levels of depressive symptoms among university students. Future research should have a longitudinal design and should also investigate contextual factors to better understand factors of depressive symptoms and how social capital can affect depressive symptoms.

Acknowledgment

We would like to thank Ichiro Kawachi, Ph.D., Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, for greatly assisting this research.

References

Publication Dates

History